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
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 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 Pain^a

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]	RCT	Gastric cancer pain	48; 16 acupuncture and 16 acupuncture point injection of freeze-dried human transfer factor; 16 conventional analgesics	In long-term treatment, equal or better analgesia than conventional drugsf	No	1iiC
[15]	RCT	Cancer pain	41 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 aloneg	Yes (combined with opioid analgesics in managing cancer pain)	1iiC
[14]	RCT	Cancer pain	90; 28 auricular acupuncture; 51 acupuncture at placebo points in ear or auricular seeds fixed at placebo points with adhesive	Pain intensity decreased by 36% at 2 monthsh	Yes (analgesics and co-analgesics, including tricyclic antidepressants and antiepileptics)	1iiC
[11]	Nonconsecutive case series	Cancer pain	20; 20 auricular acupuncture; none	Average pain intensity decreased by 43%, using VAS (0–100 mm)i	Yes (analgesics)	3iiiC
[12]	Nonconsecutive case series	Cancer-related pain	183; 183 acupuncture; none	95 (52%) “significantly helped”	Yes (analgesics)	3iC
[13]	Nonconsecutive case series	Cancer pain	29; 29 EA; none	Pain reduced; injection of analgesics reduced or no longer required	Yes (analgesics)	3iC
[9]	Best case series	Cancer pain	5; 5 auricular EA; none	Symptoms improved	Unknown	4

EA = electroacupuncture; No. = number; NUR = Nourishing yin and Unblocking meridians Recipe; RCT = randomized controlled trial; TCM = traditional Chinese medicine; VAS = Visual Analog Scale.

aSee text and the NCI Dictionary of Cancer Terms 3 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, see Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine 4.

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 ⁵ 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: Pain^a

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]	RCT	Pain/depression	138; 93 acupuncture and massage; 45 usual care	Increased pain relief/decreased depression	Yes (usual care)	1iiC
[16]	RCT	Pain/depression	16; 12 Chinese herbs, auricular EA, or epidural morphine given alone or in combination; 4 placebo controls	Combination treatment better than placebo and EA alone, Chinese herbs alone, or epidural morphine alonef	Yes (Chinese herbs; epidural morphine)	1iC
[19]	RCT	Musculoskeletal pain	51; 23; 20	Improved joint pain and stiffness	Yes (aromatase inhibitors)	1iiC
[17]	Nonrandomized controlled trial	Local pain and limitation of arm movement after breast cancer surgery and axillary lymph node dissection	80; 48 acupuncture; 32 no acupuncture	Improved postoperative pain; improved range of arm motiong	Unknown	2C
[21]	Pilot study	Musculoskeletal pain related to adjuvant aromatase inhibitor therapy	21; 19 acupuncture; none	Reduced severity and increased functional ability	Yes (analgesics: acetaminophen, NSAIDs, or COX-2 inhibitors and various CAM approaches)	3iiiC
[18]	Retrospective case review	Chemotherapy-induced peripheral neuropathy	18; 17; none	Improvement in symptoms	Unknown	3iiiC

COX-2 = cyclooxygenase 2; EA = electroacupuncture; No. = number; NSAID = nonsteroidal anti-inflammatory drug; RCT = randomized controlled trial.

aSee text and the NCI Dictionary of Cancer Terms 3 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, see Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine 4.

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 ⁷ 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 Vomiting^a

Reference Citation(s)	Type of Study	Condition Treated	No. of Patients: Enrolled; Treated; Controlb	Strongest Benefit Reportedc	Concurrent Therapyd	Level of Evidence Scoree
[26]	RCT	N/V related to high-dose chemotherapy for breast cancer	104; 37; 67 (sham EA or no EA)	Less N/V in EA groupf	Yes (prochlorperazine, lorazepam, and diphenhydramine)	1iiC
[24,30,31]	RCT	N/V from chemotherapy	10; 10 EA; 10 sham EA (crossover study)	Significantly less N/V than controlg	Yes (metoclopramide)	1iiC
[27]	RCT	N/V from chemotherapy	100 (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 stimulation	75% achieved considerable benefith	Yes (metoclopramide, thiethylperazine, prochlorperazine, cyclizine, lorazepam, and steroid)	1iiC
[34]	RCT	N/V from chemotherapy	16 (the same 16 patients treated twice in a crossover study); 16 ondansetron plus transcutaneous electrical stimulation; 16 cross-over treatment ondansetron only	Symptom-free patient days: 58.8%i	Yes (ondansetron)	1iiC
[32]	RCT	N/V from chemotherapy	53 enrolled; 38 completed; 38 acupressure; 38 crossover to acupressure at a sham point	55% reduction in N/Vj	Yes (antiemetics)	1iiC
[36]	RCT	N/V from high-dose chemotherapy	80; 41 acupuncture; 39 noninvasive placebo acupuncture	Nonek	Yes (ondansetron)	1iiC
[35]	RCT	N/V from chemotherapy	739; 233 bilateral acupressure bands and 234 transcutaneous electrical stimulation bands; 233 no bands; 39 not evaluable	Less N/V in treatment groups than in controll	Yes (5-HT3 receptor antagonist, prochlorperazine, and/or others)	1iiC
[37]	RCT	N/V from chemotherapy	142; 48 acupuncture + vitamin B6 PC6 point injection; 46 vitamin B6; 48 acupuncture	Fewer emesis episodes	Yes (diazepam, diphenhydramine, cimetidine, and granisetron)	1iiC
[41]	RCT	N/V from chemotherapy	36; 17 acupressure; 19 control	Significantly lower N/V	Yes (antiemetics)	1iiC
[40]	RCT	N/V from radiation	277; 215; 62	Less nausea	Yes (antiemetics)	1iiC
[38]	RCT	N/V from moderate to highly emetogenic chemotherapy	160; 96; 54	Decreased delayed N/V for acupressure	Yes (anthracycline, cyclophosphamide, and an antiemetic)	1iiC
[25]	Nonrandomized controlled trial	N/V from chemotherapy	105; EA at P6	63%, complete relief, at least 8 h	Yes (metoclopramide; prednisolone)	2C
[28,30]	Consecutive case study	N/V from chemotherapy	40; 40 acupressure	8–24 h relief	Yes (not specified)	3iiC
[25]	CT	N/V from chemotherapy	43; 38 10 Hz EA; 5 sham (crossover subset)	8–10 h relief; 32 patients had complete relief	Yes (antiemetics)	2C
[33]	CT	N/V from chemotherapy	18; 18 acupressure bands; 18 (crossover study—incorrect placement of acupressure bands)	Effective for N/V	Yes (antiemetics: prochlorperazine, maxalon, and domperidone suppository)	2C
[29]	Nonconsecutive case series	N/V from chemotherapy	26; 26 acupuncture; 51 historical controls—no acupuncture	Mean no. of episodes and duration of N/V reduced	Yes (metoclopramide,dexamethasone, and diphenhydramine)	3iiiC
[24]	Nonconsecutive case series (pilot study)	N/V from chemotherapy	15; 15 EA; none	12 patients—no symptoms for 8 h	Yes (antiemetic: metoclopramide)	3iiiC
[42]	Consecutive, uncontrolled case series	N/V from chemotherapy mean no. of emesis 7–3	27; no controls	10 patients had complete response to EA and had no vomiting	Yes (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.

aSee text and the NCI Dictionary of Cancer Terms 3 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, see Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine 4.

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 ⁹ below.

Table 4. Clinical Studies of Acupuncture: Vasomotor Symptoms^a

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]	RCT	Hot flashes in breast cancer patients treated with tamoxifen and aromatase inhibitors	72; 42; 30	Reduction of hot flashes but no statistical difference between acupuncture and sham treatment	Yes (SSRIs)	1iiC
[52]	RCT	Hot flushes	45; 27 EA; 18 hormone therapy	Vasomotor symptoms improved	Unknown	1iiC
[45]	RCT	Hot flashes	50; 25; 25	Vasomotor symptoms improved	Yes (tamoxifen or arimidex)	1iiC
[53]	RCT	Hot flashes in breast cancer patients treated with tamoxifen	84; 74; none	Decrease in severity and frequency in hot flushes and sweating	Yes (tamoxifen)	1iiC
[44]	Phase I pilot study	Menopausal symptoms in breast cancer patients treated with tamoxifen	15; 15 acupuncture; none	Anxiety, depression, and somatic and vasomotor symptoms improvedf	No	3iiiC
[46]	Pilot study/case series	Hot flashes in patients with prostate cancer	25; 22; none	55% treatment for hot flashes	No	3iiiC
[9]	Nonconsecutive case series	Night sweats, hot flashes in patients with cancer	6; 6 acupuncture; none	Symptoms improved	Yes (not specified)	3iiiC
[51]	Nonconsecutive case series	Vasomotor symptoms for breast and prostate cancer	194; 194; none	79% showed 50% or greater reduction in hot flashes	No	3iiiC
[49]	Nonconsecutive case series	Vasomotor symptoms for prostate cancer	17; 14; none	Decreased hot flashes	Yes (androgen ablation therapy)	3iiiC
[50]	Prospective case series	Hot flashes and night sweats	54; 50; none	Decreased hot flashes and night sweats and improved physical and emotional well-being	Yes (Tamoxifen)	3iiiC

EA = electroacupuncture; No. = number; RCT = randomized controlled trial; SSRIs = selective serotonin reuptake inhibitors.

aSee text and the NCI Dictionary of Cancer Terms 3 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, see Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine 4.

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]

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.[1,9,44,55-61] Four studies were from China,[1,56-58] one from Japan,[59] one from England,[61] and three from the United States.[9,19,55] Most were case studies or case series,[9,56-58,60] one was a retrospective survey study,[55] one was a phase I pilot study,[44] and one was a RCT.[1] The findings from these studies are summarized in Table 5 ¹¹ below.

Table 5. Clinical Studies of Acupuncture: For Other Cancer-related Symptoms or Cancer Treatment–related Side Effects^a

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]	RCT	Symptoms of weight loss, cough, thoracodynia, hemoptysis, fever, and side effects of chemotherapy and radiation therapy	76; 38 acupuncture; 38 no acupuncture	Weight gain, symptom relief, fewer side effectsf	No	1iiC
[54]	RCT	Cancer-related fatigue	47; 31; 16	Improved fatigue levels	No	1iiC
[44]	Nonconsecutive case series, surveyed retrospectively	Unspecified symptoms (including pain, xerostomia, hot flashes, nausea/loss of appetite) from cancer or cancer treatment	79; 79 traditional Chinese acupuncture, auricular acupuncture, percutaneous nerve stimulation, Korean hand acupuncture, or Japanese scalp acupuncture; none	60% showed at least 30% improvement	Yes (standard medical therapies)	3iiiC
[56]	Nonconsecutive case series	Radiation proctitis in women treated for cervical cancer	44; 44 acupuncture; none	73% radiation proctitis cured: no blood or mucus for 15 days	No	3iiiC
[59]	Nonconsecutive case series	Postoperative lower extremity lymphedema in women treated for gynecologic tumors	24; 24 acupuncture and moxibustion; none	Edema prevented or markedly reduced	Unknown	3iiiC
[61]	Nonconsecutive case series	Symptoms related to lymphedema (including pain, discomfort, anxiety and insomnia)	35; 30 acupuncture and moxibustion; none	Symptoms improved	Unknown	3iiiC
[9]	Nonconsecutive case series	Xerostomia after radiation therapy in patients with cancer	13; 13 acupuncture; none	Symptoms improved	Yes (not specified)	3iiiC
[62]	Nonconsecutive case series	Xerostomia	14; 8 acupuncture; none	Symptoms improved	No	3iiiC
[57]	Case report	Dysphonia after radiation therapy	1; 1 acupuncture; none	Voice recovered	Unknown	Not applicable
[58]	Case report	Esophageal obstruction in patients with esophageal cancer	2; 2 acupuncture; none	Obstruction relieved and normal bowel movements restored	Yes (not specified)	Not applicable
[60]	Retrospective case series	Hiccups	16; 16 acupuncture; none	Symptom relief	Unknown	3iiiC

No. = number; RCT = randomized controlled trial.

aSee text and the NCI Dictionary of Cancer Terms 3 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, see Levels of Evidence for Human Studies of Cancer Complementary and Alternative Medicine 4.

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. A 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.[55] 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 ¹³, acupuncture-like transcutaneous electrical nerve stimulation ¹⁴, electroacupuncture therapy ¹⁵ and acupressure therapy ¹⁶ that are actively enrolling patients.

General information about clinical trials is also available from the NCI Web site ¹⁷.

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