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Acupuncture (PDQ®)

Health Professional Version
Last Modified: 10/07/2014

Human/Clinical Studies

Effect of Acupuncture on Immune Function
Effect of Acupuncture on Cancer Pain
Effect of Acupuncture on Cancer Treatment–related Side Effects
        Pain
        Nausea and vomiting
        Vasomotor symptoms
        Fatigue
        Xerostomia
Other Treatment-related Side Effects
Current Clinical Trials



Effect of Acupuncture on Immune Function

At least seven human studies have evaluated the effect of acupuncture on immune system function in patients with cancer.[1-7] These studies were all conducted in China. Five were reported in English,[1-3,6,7] and two were reported in Chinese with English abstracts.[4,5]

Four randomized controlled trials,[1,2,4,5] a nonrandomized clinical study,[3] and two case series [6,7] found that acupuncture enhanced or regulated immune function.

The first randomized controlled trial found that acupuncture treatment enhanced platelet count and prevented leukocyte decrease after radiation therapy or chemotherapy, in comparison with the control group.[1]

A second study involved a group of 40 postoperative cancer patients, 20 of whom received daily acupuncture treatment and 20 of whom served as a control group. After 3 days, leukocyte phagocytosis was enhanced in the treated group, compared with the baseline measurement (P < .01); no such enhancement was observed in the control group.[2]

A third study observed the effect of acupuncture on interleukin-2 (IL-2) and natural killer (NK) cell activity in the peripheral blood of patients with malignant tumors. The patients were divided into an acupuncture treatment group (n = 25), which received 30 minutes of acupuncture daily for 10 days, and a nonacupuncture control group (n = 20). The data showed that IL-2 level and NK cell activity were significantly increased in the acupuncture group, compared with the control group (P < .01).[4]

A fourth study observed the effect of acupuncture on T-lymphocyte subsets (CD3+, CD4+, and CD8+), soluble IL-2 receptor (SIL-2R), and beta-endorphin (beta-EP) in the peripheral blood of patients with malignant tumors. The data showed that acupuncture treatment increased the proportion of the CD3+ and CD4+ T-lymphocyte subsets, the CD4+/CD8+ ratio (P < .01), and the level of beta-EP. It decreased the level of SIL-2R (P < .01). The investigators suggested that the anticancer effect of acupuncture may be mediated via the mechanism of immunomodulation. [5]

The nonrandomized clinical study showed that microwave acupuncture (MAT), a newly developed technique in which a specially designed device attached to a normally inserted acupuncture needle is used to deliver microwave radiation to a given point, enhanced the immunologic function of cancer patients. Although there was an increase in white blood cell count in the MAT group, the change was not significantly different from that seen in the control group under drug treatment.[3]

In a clinical case series, 28 cancer patients who were treated with electroacupuncture (EA) while undergoing chemotherapy experienced no declines in T cells (CD3+, CD4+, CD8+) or in NK cell activity, both of which are usually suppressed by chemotherapy.[7] Similar findings were reported in a study comparing EA to the control in patients receiving chemotherapy for breast, colorectal cancer, and non-Hodgkin lymphoma.[8]

In another clinical case series, 48 patients with leukopenia —including two cancer patients—who were treated with manual acupuncture experienced improvements in leukocyte count, intracutaneous phytohemagglutinin (PHA), and immunoglobulin (IgG, IgA, and IgM) levels after 14 daily acupuncture treatments, compared with their pretreatment levels.[6]

Effect of Acupuncture on Cancer Pain

Seven clinical studies of acupuncture as a treatment for cancer-related pain have been reported in the English language (refer to Table 1 at the end of this section).[9-15] Three studies were randomized controlled clinical trials, with two studies conducted in China and one in France.[10,14,15] Four studies were case series, with one each from England, France, Hong Kong, and the United States.[9,11-13]

One randomized trial compared classical Chinese acupuncture, acupuncture point injection with freeze-dried human transfer factor, and conventional analgesic treatment in patients with gastric cancer pain.[10] The investigators reported an equivalent analgesic effect among the three groups observed after 2 months of treatment; however, the conventionally treated group experienced significantly superior analgesia compared with both acupuncture treatment groups during the first 10 days of treatment. The researchers reported that the patients in both acupuncture treatment groups also experienced improved quality of life and a decrease in the side effects of chemotherapy, in addition to analgesia.

A nonrandomized, single-arm, observational clinical study evaluated the effect of auricular acupuncture in 20 cancer patients who were still experiencing pain after treatment with analgesics.[11] While patients continued their analgesic medication, auricular acupuncture needles were embedded in ear acupuncture points, chosen according to clinical symptoms and electrodermal response, and were left in place until they fell out. In some cases, the needles remained in place for 35 days, while in others they fell out after 5 days. Pain intensity was measured by a nurse on the Visual Analog Scale (VAS) on day 0 and day 60, and the data were analyzed using a t test. The results showed that pain intensity decreased or remained stable after auricular acupuncture in all patients, with a significant average pain intensity decrease of 33 mm (P < .001). The same investigators later reported a larger (n = 90) randomized, blinded, controlled trial in which cancer pain intensity was significantly decreased (by 36%) in an auricular acupuncture treatment group, in comparison with control groups (acupuncture at placebo points or auricular seeds placed at placebo points) after 2 months of treatment (P < .001).[14]

In a case series involving 183 cancer patients who were treated with acupuncture for cancer-related pain, 52% were significantly helped (P value not stated).[12] Multiple treatments at intervals of 1 to 4 weeks were nearly always necessary for significant and long-term pain control.

In another case series, 29 patients with malignant tumors who developed pain received EA treatment.[13]. All experienced various degrees of pain relief, and 25 out of 29 were able to either reduce or eliminate their analgesic requirements following multiple EA treatments.

A third case series produced similar results.[9] After auricular EA treatment, five patients with cancer pain reported improvements.

Although most of these studies were positive and demonstrated the effectiveness of acupuncture in cancer pain control, the findings have limited significance because of methodologic weaknesses such as small sample sizes, an absence of patient blinding to treatment in most cases, varying acupuncture treatment regimens, a lack of standard outcome measurements, and an absence of adequate randomization. Further investigations into the effects of acupuncture on cancer pain using rigorous scientific methodology are warranted.

Table 1. Clinical Studies of Acupuncture: Cancer-related Paina
Reference Citation(s) Type of Study Condition Treated No. of Patients: Enrolled; Treated; Controlb Strongest Benefit Reportedc Concurrent Therapy Used (Yes/No/ Unknown)d Level of Evidence Scoree 
[10]RCTGastric cancer pain48; 16 acupuncture and 16 acupuncture point injection of freeze-dried human transfer factor; 16 conventional analgesicsIn long-term treatment, equal or better analgesia than conventional drugsfNo1iiC
[15]RCTCancer pain41 patients treated with NUR combined with opioid analgesics. 43 patients in the control group treated with opioids alone. All the patients enrolled were differentiated as of yin deficiency and meridian blocked syndrome type of TCM.NUR combined with opioid analgesics in cancer pain management was more effective than opioid analgesics alonegYes (combined with opioid analgesics in managing cancer pain)1iiC
[14]RCTCancer pain90; 28 auricular acupuncture; 51 acupuncture at placebo points in ear or auricular seeds fixed at placebo points with adhesivePain intensity decreased by 36% at 2 monthshYes (analgesics and co-analgesics, including tricyclic antidepressants and antiepileptics)1iiC
[11]Nonconsecutive case seriesCancer pain20; 20 auricular acupuncture; noneAverage pain intensity decreased by 43%, using VAS (0–100 mm)iYes (analgesics)3iiiC
[12]Nonconsecutive case seriesCancer-related pain183; 183 acupuncture; none95 (52%) “significantly helped”Yes (analgesics)3iC
[13]Nonconsecutive case seriesCancer pain29; 29 EA; nonePain reduced; injection of analgesics reduced or no longer requiredYes (analgesics)3iC
[9]Best case seriesCancer pain5; 5 auricular EA; noneSymptoms improvedUnknown4

EA = electroacupuncture; No. = number; NUR = Nourishing yin and Unblocking meridians Recipe; RCT = randomized controlled trial; TCM = traditional Chinese medicine; VAS = Visual Analog Scale.
aRefer to text and the NCI Dictionary of Cancer Terms for additional information and definition of terms.
bNumber of patients treated plus number of patient controls may not equal number of patients enrolled; number of patients enrolled equals number of patients initially recruited/considered by the researchers who conducted a study; number of patients treated equals number of enrolled patients who were given the treatment being studied AND for whom results were reported.
cStrongest evidence reported that the treatment under study has activity or otherwise improves the well-being of cancer patients.
dConcurrent therapy for symptoms treated (not cancer).
eFor information about levels of evidence analysis and an explanation of the level of evidence scores, refer to Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine.
f P < .05, acupuncture treatment versus conventional analgesics.
g P < .05, combination of traditional Chinese medicine (acupuncture and Chinese herbs) and epidural morphine versus placebo.
h P < .0001, acupuncture versus placebo.
i P < .00001, day 60 after start of acupuncture treatment versus day 0.

Effect of Acupuncture on Cancer Treatment–related Side Effects

Pain

Five studies published in English have addressed the use of acupuncture for pain related to cancer treatment, mostly postsurgical pain (refer to Table 2 at the end of this section). A randomized clinical trial evaluated the effect of various combinations of auricular acupuncture, Chinese herbs, and epidural morphine to relieve postoperative pain in 16 patients with liver cancer.[16] The study design was complicated and had a very small sample size (n = 2 per group). On the basis of the VAS (0–100 mm), all of the combination treatment groups experienced better analgesia than did the placebo -treated control group.

A nonrandomized study investigated the effect of acupuncture in postoperative pain management and arm movement in breast cancer patients after surgical excision of the cancer and axillary lymph node dissection.[17] Forty-eight patients were treated with acupuncture on the third, fifth, and seventh days after surgery and on the day of patient discharge. Compared with a control group of 32 patients who had the same surgery but did not receive acupuncture treatment, the acupuncture group had significant pain relief during arm movement on the fifth and seventh days following surgery and at the time of discharge. The range of arm motion also increased significantly in the treatment group, compared with the control group, during the postoperative period (P < .001). The authors concluded that acupuncture point selection based on the state of the patient and obtaining a needling "de qi" sensation were important in achieving an effective acupuncture treatment. A small retrospective case review of acupuncture for chemotherapy-induced peripheral neuropathy in 18 patients showed benefit with reduced symptoms in 82%.[18]

Arthralgias and myalgias from aromatase inhibitors

A randomized, blinded study comparing true acupuncture with sham acupuncture for aromatase-related joint symptoms enrolled 51 patients, 38 of whom were evaluable. True acupuncture was significantly more effective than sham acupuncture, as measured by Brief Pain Inventory-Short Form scores in relieving joint symptoms.[19]

Table 2. Clinical Studies of Acupuncture: For Cancer Treatment–related Side Effect: Paina
Reference Citation(s)  Type of Study  Condition Treated  No. of Patients: Enrolled; Treated; Controlb Strongest Benefit Reportedc Concurrent Therapy (Yes/No/ Unknown)d Level of Evidence Scoree 
[20]RCTPain/depression138; 93 acupuncture and massage; 45 usual careIncreased pain relief/decreased depressionYes (usual care)1iiC
[16]RCTPain/depression16; 12 Chinese herbs, auricular EA, or epidural morphine given alone or in combination; 4 placebo controlsCombination treatment better than placebo and EA alone, Chinese herbs alone, or epidural morphine alonefYes (Chinese herbs; epidural morphine)1iC
[19]RCTMusculoskeletal pain51; 23; 20Improved joint pain and stiffnessYes (aromatase inhibitors)1iiC
[17]Nonrandomized controlled trialLocal pain and limitation of arm movement after breast cancer surgery and axillary lymph node dissection80; 48 acupuncture; 32 no acupunctureImproved postoperative pain; improved range of arm motiongUnknown2C
[21]Pilot studyMusculoskeletal pain related to adjuvant aromatase inhibitor therapy21; 19 acupuncture; noneReduced severity and increased functional abilityYes (analgesics: acetaminophen, NSAIDs, or COX-2 inhibitors and various CAM approaches)3iiiC
[18]Retrospective case reviewChemotherapy-induced peripheral neuropathy18; 17; noneImprovement in symptomsUnknown3iiiC

COX-2 = cyclooxygenase 2; EA = electroacupuncture; No. = number; NSAID = nonsteroidal anti-inflammatory drug; RCT = randomized controlled trial.
aRefer to text and the NCI Dictionary of Cancer Terms for additional information and definition of terms.
bNumber of patients treated plus number of patient controls may not equal number of patients enrolled; number of patients enrolled equals number of patients initially considered by the researcher who conducted a study; number of patients treated equals number of enrolled patients who were given the treatment being studied AND for whom results were reported.
cStrongest evidence reported that the treatment under study has anticancer activity or otherwise improves the well-being of cancer patients.
dConcurrent therapy for symptoms treated (not cancer).
eFor information about levels of evidence analysis and an explanation of the level of evidence scores, refer to Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine.
f P < .05, combination of traditional Chinese medicine (acupuncture and Chinese herbs) and epidural morphine versus placebo.
g P < .01, acupuncture treatment versus no acupuncture treatment.

Nausea and vomiting

Chemotherapy-induced nausea and vomiting

Of all the investigated effects of acupuncture on cancer-related or chemotherapy-related symptoms and disorders, the positive effect of acupuncture on chemotherapy-induced nausea and vomiting (N/V) is the most convincing, as demonstrated by the consistency of the results of a variety of clinical study types, including randomized clinical trials (RCTs), nonrandomized trials, prospective consecutive case series, and retrospective studies (refer to Table 3 at the end of this section). Consistent with the findings from clinical studies of acupuncture on N/V due to other causes such as postoperative N/V and morning sickness, these studies showed acupuncture to be effective in the treatment of chemotherapy-induced N/V. A well-documented example is discussed below.

A systematic review of the effect of acupuncture on N/V describes five clinical trials of chemotherapy-induced N/V, conducted by different investigators on different groups of patients and using different forms of acupuncture point stimulation.[22] All five trials yielded positive results. These consistent results support the claim that acupuncture is useful for treating chemotherapy-induced N/V. More recently, the efficacy of acupuncture point stimulation for chemotherapy-induced N/V has been reviewed, suggesting that acupuncture is more effective for acute vomiting than for acute or chronic nausea.[23]

A number of clinical studies of the effect of acupuncture on chemotherapy-induced N/V have been reported.[24-36]

A randomized placebo-controlled clinical trial investigated the effect of EA on chemotherapy-induced emesis in 104 patients with breast cancer who were undergoing a highly emetogenic chemotherapy regimen. [26] The patients were randomly assigned to receive low-frequency EA at classic antiemetic acupuncture points once daily for 5 days (n = 37), minimal needling at control points with mock EA on the same schedule (n = 33), or no adjunct needling (n = 34). All patients received concurrent antiemetic drugs (prochlorperazine, lorazepam, and diphenhydramine) and high-dose chemotherapy (cyclophosphamide, cisplatin, and carmustine). The main outcome measures were the total number of emesis episodes and the proportion of emesis-free days occurring during the 5-day study period. The data revealed fewer emesis episodes in the EA treatment group than in the minimal needling and drug-only control groups (P < .001), although differences among the groups were not significant during the 9-day follow-up period (P = .18). These findings are consistent with results reported by other investigators.[24,25,27,28,30,31,34] However, another published study showed that acupuncture had no additional effect on the prevention of acute N/V in patients receiving high-dose chemotherapy combined with ondansetron.[36] One RCT of acupuncture and vitamin B6 versus acupuncture or vitamin B6 intramuscular injection alone for N/V in women with ovarian cancer undergoing highly emetogenic chemotherapy, found a statistically significant benefit of both vitamin B6 and acupuncture. Results also showed that acupuncture alone, compared with vitamin B6, had a greater benefit in reducing the frequency of emesis.[37] One study suggested decreased delayed nausea from acupressure at point p6 compared with sham acupressure.[38] One study involving 34 patients with gynecologic cancer suggested that the acupressure applied to P6 acupuncture point with wristbands may be effective in reducing chemotherapy-related nausea and may decrease the antiemetic use after chemotherapy.[39]

Radiation-induced nausea and vomiting

Acupuncture has also been used to relieve radiation-induced nausea and vomiting. In one randomized study, patients who were randomly assigned to receive either verum or sham acupuncture experienced fewer episodes of nausea and vomiting than did those who received standard care.[40]

Table 3. Clinical Studies of Acupuncture: Nausea and Vomitinga
Reference Citation(s) Type of Study Condition Treated No. of Patients: Enrolled; Treated; Controlb Strongest Benefit Reportedc Concurrent Therapyd Level of Evidence Scoree 
[26]RCTN/V related to high-dose chemotherapy for breast cancer104; 37; 67 (sham EA or no EA)Less N/V in EA groupfYes (prochlorperazine, lorazepam, and diphenhydramine)1iiC
[24,30,31]RCTN/V from chemotherapy10; 10 EA; 10 sham EA (crossover study)Significantly less N/V than controlgYes (metoclopramide)1iiC
[27]RCTN/V from chemotherapy100 (these patients were used more than once because of nature of crossover study); 27 surface electrodes; 11 rubber electrodes; 14 crossover study; 24 transcutaneous electrical stimulation75% achieved considerable benefithYes (metoclopramide, thiethylperazine, prochlorperazine, cyclizine, lorazepam, and steroid)1iiC
[34]RCTN/V from chemotherapy16 (the same 16 patients treated twice in a crossover study); 16 ondansetron plus transcutaneous electrical stimulation; 16 cross-over treatment ondansetron onlySymptom-free patient days: 58.8%iYes (ondansetron)1iiC
[32]RCTN/V from chemotherapy53 enrolled; 38 completed; 38 acupressure; 38 crossover to acupressure at a sham point55% reduction in N/VjYes (antiemetics)1iiC
[36]RCTN/V from high-dose chemotherapy80; 41 acupuncture; 39 noninvasive placebo acupunctureNonekYes (ondansetron)1iiC
[35]RCTN/V from chemotherapy739; 233 bilateral acupressure bands and 234 transcutaneous electrical stimulation bands; 233 no bands; 39 not evaluableLess N/V in treatment groups than in controllYes (5-HT3 receptor antagonist, prochlorperazine, and/or others)1iiC
[37]RCTN/V from chemotherapy142; 48 acupuncture + vitamin B6 PC6 point injection; 46 vitamin B6; 48 acupunctureFewer emesis episodesYes (diazepam, diphenhydramine, cimetidine, and granisetron)1iiC
[41]RCTN/V from chemotherapy36; 17 acupressure; 19 controlSignificantly lower N/VYes (antiemetics)1iiC
[40]RCTN/V from radiation277; 215; 62Less nauseaYes (antiemetics)1iiC
[38]RCTN/V from moderate to highly emetogenic chemotherapy160; 96; 54Decreased delayed N/V for acupressureYes (anthracycline, cyclophosphamide, and an antiemetic)1iiC
[25]Nonrandomized controlled trialN/V from chemotherapy105; EA at P663%, complete relief, at least 8 hYes (metoclopramide; prednisolone)2C
[25]CTN/V from chemotherapy43; 38 10 Hz EA; 5 sham (crossover subset)8–10 h relief; 32 patients had complete reliefYes (antiemetics)2C
[33]CTN/V from chemotherapy18; 18 acupressure bands; 18 (crossover study—incorrect placement of acupressure bands)Effective for N/VYes (antiemetics: prochlorperazine, metoclopramide, and domperidone suppository)2C
[29]Nonconsecutive case seriesN/V from chemotherapy26; 26 acupuncture; 51 historical controls—no acupunctureMean no. of episodes and duration of N/V reducedYes (metoclopramide, dexamethasone, and diphenhydramine)3iiiC
[24]Nonconsecutive case series (pilot study)N/V from chemotherapy15; 15 EA; none12 patients—no symptoms for 8 hYes (antiemetic: metoclopramide)3iiiC
[28,30]Consecutive case studyN/V from chemotherapy40; 40 acupressure8–24 h reliefYes (not specified)3iiC
[42]Consecutive, uncontrolled case seriesN/V from chemotherapy mean no. of emesis 7–327; no controls10 patients had complete response to EA and had no vomitingYes (antiemetics: either ondansetron 8 mg or granisetron 3 mg)3iiiC

CT = controlled trial; EA = electroacupuncture; No. = number; N/V = nausea and vomiting; RCT = randomized controlled trial.
aRefer to text and the NCI Dictionary of Cancer Terms for additional information and definition of terms.
bNumber of patients treated plus number of patient controls may not equal number of patients enrolled; number of patients enrolled equals number of patients initially considered by the researcher who conducted a study; number of patients treated equals number of enrolled patients who were given the treatment being studied AND for whom results were reported; historical control subjects are not included in number of patients enrolled.
cStrongest evidence reported that the treatment under study has activity or improves the well-being of cancer patients.
dConcurrent therapy for symptoms treated (not cancer).
eFor information about levels of evidence analysis and an explanation of the level of evidence scores, refer to Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine.
f P < .001, low-frequency EA at classical antiemetic acupuncture points daily versus minimal needling at control points with sham EA versus no adjunct needling.
g P < .001, EA versus sham EA.
h P < .001, surface electrodes versus rubber electrodes.
i P < .00059.
j P < .02, acupressure versus acupressure at a sham point.
k P < .05, acupuncture versus noninvasive placebo acupuncture.
l P < .05, acupressure and acustimulation wrist bands versus no treatment.

Vasomotor symptoms

Some studies have reported that acupuncture may be effective in reducing vasomotor symptoms among postmenopausal women with breast cancer and prostate cancer patients on androgen-deprivation therapy.[43-49] One study randomly assigned 55 patients to acupuncture versus venlafaxine for management of vasomotor symptoms in women with hormone receptor–positive breast cancer. Acupuncture was just as effective as venlafaxine and caused fewer adverse effects.[45]

A phase I pilot study evaluated the effect of acupuncture on tamoxifen -induced menopause symptoms.[44] Fifteen patients with breast cancer who were taking tamoxifen were treated with acupuncture weekly for 3 months. The Greene Menopause Index was used for outcome assessments at baseline before treatment and at 1, 3, and 6 months. The results showed that anxiety, depression, and somatic and vasomotor symptoms, but not libido, were significantly improved in comparison with the baseline (P < .001).

An uncontrolled prospective case series of 50 women on tamoxifen for early breast cancer evaluated women receiving eight treatments of traditional acupuncture weekly. Mean frequency of vasomotor symptoms dropped by 49.8% (P < .0001) at the end of treatment. Seven domains of the Women's Health Questionnaire showed statistically significant improvement.[50]

A retrospective evaluation of 194 patients with predominantly breast or prostate cancer and experiencing vasomotor symptoms found long-term relief of vasomotor symptoms associated with acupuncture and self-acupuncture. The authors suggested that overall treatment dose may be more important than point location, but favored SP6.[51] A small RCT of EA compared with hormone therapy in women with breast cancer suggested a prolonged effect of EA on hot flushes after 24 months. Seven of 19 women initially randomly assigned to EA had 2.1 flushes in 24 hours compared with a baseline of 9.6 flushes in 24 hours.[52] In a prospective randomized study of 84 breast cancer patients on tamoxifen treated with acupuncture versus placebo, acupuncture showed a reduction of hot flashes in both the treatment and the control arms, but there was no difference between true acupuncture and sham acupuncture.[53] The findings from these studies are summarized in Table 4 below.

Table 4. Clinical Studies of Acupuncture: Vasomotor Symptomsa
Reference Citation(s)  Type of Study  Condition Treated  No. of Patients: Enrolled; Treated; Controlb Strongest Benefit Reportedc Concurrent Therapy (Yes/No/ Unknown)d Level of Evidence Scoree 
[43]RCTHot flashes in breast cancer patients treated with tamoxifen and aromatase inhibitors72; 42; 30Reduction of hot flashes but no statistical difference between acupuncture and sham treatmentYes (SSRIs)1iiC
[52]RCTHot flushes45; 27 EA; 18 hormone therapyVasomotor symptoms improvedUnknown1iiC
[45]RCTHot flashes50; 25; 25Vasomotor symptoms improvedYes (tamoxifen or arimidex)1iiC
[53]RCTHot flashes in breast cancer patients treated with tamoxifen84; 74; noneDecrease in severity and frequency in hot flushes and sweatingYes (tamoxifen)1iiC
[44]Phase I pilot studyMenopausal symptoms in breast cancer patients treated with tamoxifen15; 15 acupuncture; noneAnxiety, depression, and somatic and vasomotor symptoms improvedfNo3iiiC
[46]Pilot study/case seriesHot flashes in patients with prostate cancer25; 22; none55% treatment for hot flashesNo3iiiC
[9]Nonconsecutive case seriesNight sweats, hot flashes in patients with cancer6; 6 acupuncture; noneSymptoms improvedYes (not specified)3iiiC
[51]Nonconsecutive case seriesVasomotor symptoms for breast and prostate cancer194; 194; none79% showed 50% or greater reduction in hot flashesNo3iiiC
[49]Nonconsecutive case seriesVasomotor symptoms for prostate cancer17; 14; noneDecreased hot flashesYes (androgen ablation therapy)3iiiC
[50]Prospective case seriesHot flashes and night sweats54; 50; noneDecreased hot flashes and night sweats and improved physical and emotional well-beingYes (tamoxifen)3iiiC

EA = electroacupuncture; No. = number; RCT = randomized controlled trial; SSRIs = selective serotonin reuptake inhibitors.
aRefer to text and the NCI Dictionary of Cancer Terms for additional information and definition of terms.
bNumber of patients treated plus number of patient controls may not equal number of patients enrolled; number of patients enrolled equals number of patients initially considered by the researcher who conducted a study; number of patients treated equals number of enrolled patients who were given the treatment being studied AND for whom results were reported.
cStrongest evidence reported that the treatment under study has anticancer activity or otherwise improves the well-being of cancer patients.
dConcurrent therapy for symptoms treated (not cancer).
eFor information about levels of evidence analysis and an explanation of the level of evidence scores, refer to Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine.
f P < .001, versus baseline.

Fatigue

In a randomized controlled trial, 47 cancer patients with moderate to severe fatigue were randomly assigned to one of three groups. One group received six 20-minute sessions of acupuncture (n = 15); one group was instructed to use acupressure (n = 16); and the third group, the sham acupressure group (n = 16), was taught to apply pressure in three points unrelated to true acupressure. All three groups continued with the same techniques for 2 weeks. The study concluded that acupuncture was a more effective method than acupressure or sham acupressure.[54]

In a follow-up study, 302 breast cancer patients were randomly assigned to a 6-week course of either daily acupuncture or usual care enhanced by educational booklets on managing fatigue. Acupuncture significantly reduced fatigue and improved quality of life over that of the "enhanced usual care" group.[55]

Xerostomia

A number of clinical studies have investigated the effect of acupuncture for the treatment and prevention of xerostomia in nasopharyngeal carcinoma and head and neck cancer patients.

Acupuncture was associated with a decrease in the onset of symptoms and an increased saliva flow in two randomized studies that compared acupuncture with standard care for preventing xerostomia in patients undergoing radiation therapy.[56,57]

Compared with standard care, acupuncture significantly improved xerostomia symptoms in patients who experienced the condition following radiation therapy.[58,59]

Two phase III randomized controlled studies, one for prevention, and one for treatment of radiation-induced xerostomia revealed increases in salivary flow rates following real and sham (superficial needling 1 or 2 cm away from acupuncture points) acupuncture, although differences between groups were not significant.[60,61] It also reported improvements in quality of life after acupuncture treatment, but there were no significant differences between the groups.[61]

One study examined long-term effects of acupuncture on xerostomia.[62] Patients who received real acupuncture were followed for 6 months and up to 3 years. Compared with baseline, significant differences in salivary flow rates were seen in patients 6 months after acupuncture treatment. At 3 years, patients who received additional acupuncture exhibited greater saliva flow rates than patients who did not continue acupuncture treatment.

There is one ongoing phase III clinical trial evaluating the effect of acupuncture for treatment (NCT01141231) of xerostomia in head and neck cancer patients. Information about ongoing clinical trials is available from the NCI Web site.

The findings from these studies are summarized in Table 5 below.

Table 5. Clinical Studies of Acupuncture: Radiation-induced Xerostomiaa
Reference Citation(s) Type of Study Condition Treated No. of Patients: Enrolled; Treated; Controlb Strongest Benefit Reportedc Concurrent Therapy (Yes/No/ Unknown)d Level of Evidence Scoree 
[61]RCTRadiation-induced xerostomia12; 12; sham: non-active acupuncture points located 2 cm away from real pointsImproved symptomsUnknown1iiC
[60]RCTRadiation-induced xerostomia38; 20; 18Increased salivary flow ratesUnknown1iiC
[63]RCTXerostomia21; 11; 10Increased salivary flow ratesUnknown1iiC
[56]RCTRadiation-induced xerostomia23; 11; 12Increased salivary flow ratesUnknown1iiC
[56]RCTRadiation-induced xerostomia86; 40; 46Symptoms improvedUnknown1iiC
[58]RCT with crossoverRadiation-induced xerostomia145; 75; 70Symptoms improvedNo1iiC
[64]Pilot studyRadiation-induced xerostomia20; 19; noneImproved symptomsUnknown2C
[65]CTRadiation-induced xerostomia12; 12; noneSymptoms improvedUnknown2C
[66]CTRadiation-induced xerostomia12; 12; noneSymptoms improvedUnknown2C
[67]CTRadiation-induced xerostomia18; 18; noneReduced xerostomiaYes (pilocarpine)2C
[62]CTXerostomia70; 21; noneReduced xerostomiaUnknown2C
[68]CTXerostomia17; 14; noneIncreased salivary flow ratesUnknown2C
[69]CTXerostomia20; 20; noneSymptoms improvedUnknown2C
[70]CTXerostomia17; 10; noneIncreased salivary flow ratesUnknown2C
[71]Nonconsecutive case seriesXerostomia14; 8 acupuncture; noneSymptoms improvedNo3iiiC
[9]Nonconsecutive case seriesXerostomia after radiation therapy in patients with cancer13; 13 acupuncture; noneSymptoms improvedYes (not specified)3iiiC

CT = controlled trial; No. = number; RCT = randomized controlled trial.
aRefer to text and the NCI Dictionary of Cancer Terms for additional information and definition of terms.
bNumber of patients treated plus number of patient controls may not equal number of patients enrolled; number of patients enrolled equals number of patients initially considered by the researcher who conducted a study; number of patients treated equals number of enrolled patients who were given the treatment being studied AND for whom results were reported.
cStrongest evidence reported that the treatment under study has anticancer activity or otherwise improves the well-being of cancer patients.
dConcurrent therapy for symptoms treated (not cancer).
eFor information about levels of evidence analysis and an explanation of the level of evidence scores, refer to Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine.

Other Treatment-related Side Effects

Many studies have reported on the effects of acupuncture on cancer or other cancer treatment–related symptoms, including weight loss, cough, hemoptysis, fever, anxiety, depression, xerostomia, proctitis, dysphonia, esophageal obstruction, hiccups, and postoperative lymphedema.[1,9,44,72-78] These studies were from China,[1,56,73-75] Japan,[76] England,[78] Italy,[44] Sweden,[71] and the United States.[9,19,54,72,77] The findings from these studies are summarized in Table 6 below.

Table 6. Clinical Studies of Acupuncture: For Other Cancer-related Symptoms or Cancer Treatment–related Side Effectsa
Reference Citation(s)  Type of Study  Condition Treated  No. of Patients: Enrolled; Treated; Controlb  Strongest Benefit Reportedc  Concurrent Therapy (Yes/No/ Unknown)d Level of Evidence Scoree 
[1]RCTSymptoms of weight loss, cough, thoracodynia, hemoptysis, fever, and side effects of chemotherapy and radiation therapy76; 38 acupuncture; 38 no acupunctureWeight gain, symptom relief, fewer side effectsf No1iiC
[54]RCTCancer-related fatigue47; 31; 16Improved fatigue levelsNo1iiC
[44]Nonconsecutive case series, surveyed retrospectivelyUnspecified symptoms (including pain, xerostomia, hot flashes, nausea/loss of appetite) from cancer or cancer treatment79; 79 traditional Chinese acupuncture, auricular acupuncture, percutaneous nerve stimulation, Korean hand acupuncture, or Japanese scalp acupuncture; none60% showed at least 30% improvementYes (standard medical therapies)3iiiC
[73]Nonconsecutive case seriesRadiation proctitis in women treated for cervical cancer44; 44 acupuncture; none73% radiation proctitis cured: no blood or mucus for 15 daysNo3iiiC
[76]Nonconsecutive case seriesPostoperative lower extremity lymphedema in women treated for gynecologic tumors24; 24 acupuncture and moxibustion; noneEdema prevented or markedly reducedUnknown3iiiC
[78]Nonconsecutive case seriesSymptoms related to lymphedema (including pain, discomfort, anxiety and insomnia)35; 30 acupuncture and moxibustion; noneSymptoms improvedUnknown3iiiC
[74]Case reportDysphonia after radiation therapy1; 1 acupuncture; noneVoice recoveredUnknownNot applicable
[75]Case reportEsophageal obstruction in patients with esophageal cancer2; 2 acupuncture; noneObstruction relieved and normal bowel movements restoredYes (not specified)Not applicable
[77]Retrospective case seriesHiccups16; 16 acupuncture; noneSymptom reliefUnknown3iiiC

No. = number; RCT = randomized controlled trial.
aRefer to text and the NCI Dictionary of Cancer Terms for additional information and definition of terms.
bNumber of patients treated plus number of patient controls may not equal number of patients enrolled; number of patients enrolled equals number of patients initially considered by the researcher who conducted a study; number of patients treated equals number of enrolled patients who were given the treatment being studied AND for whom results were reported.
cStrongest evidence reported that the treatment under study has anticancer activity or otherwise improves the well-being of cancer patients.
dConcurrent therapy for symptoms treated (not cancer).
eFor information about levels of evidence analysis and an explanation of the level of evidence scores, refer to Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine.
f P < .001, versus baseline.

In a randomized clinical trial,[1] 76 patients with various types of cancer, including 38 with esophageal cancer, 24 with gastric cancer, and 14 with lung cancer, were randomly assigned to two groups (n = 38 per group). The treatment group received acupuncture in combination with radiation therapy or chemotherapy, and the control group was treated with radiation therapy or chemotherapy alone. The data showed that the patients in the acupuncture group gained significantly more body weight than patients in the control group (P < .001). The acupuncture group also showed greater improvement than the controls in the symptoms of cough, thoracodynia, hemoptysis, and fever for patients with lung cancer and the symptoms of chest pain, mucus vomiting, and difficulty in swallowing for patients with esophageal cancer. In addition, the acupuncture group suffered fewer side effects (poor appetite, N/V, dizziness, or fatigue) from radiation therapy or chemotherapy than the control group. However, no statistical analysis was performed on these data. An RCT of 138 patients treated with acupuncture plus massage versus usual care showed decreased pain (P = .05) and a decrease in depressive mood (P = .003) in postoperative cancer patients.[20]

A retrospective survey study involved patients of an oncology clinic who were offered acupuncture treatment for potential palliation of symptoms.[72] Among 89 patients treated with acupuncture, 79 responded to a telephone questionnaire survey. The data indicated that the major reasons for referral included pain (53%), xerostomia (32%), hot flashes (6%), and nausea/loss of appetite (6%). Sixty percent of the patients showed at least 30% improvement in their symptoms, and about one-third had no change in the severity of symptoms. Patients were not questioned regarding acupuncture treatment expectations.

Current Clinical Trials

Check NCI’s list of cancer clinical trials for cancer CAM clinical trials on acupuncture therapy, acupuncture-like transcutaneous electrical nerve stimulation, electroacupuncture therapy and acupressure therapy that are actively enrolling patients.

General information about clinical trials is also available from the NCI Web site.

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