Acupuncture (CPG 024)
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measured by the QLQ-C30 QoL subscale, the Functional Assessment of Cancer Therapy-Endocrine Symptoms
(FACT-ES), the Functional Assessment of Cancer Therapy-General/Breast (FACT-G/B), and the Menopause-
Specific Quality of Life Questionnaire (MENQOL), which depicted a significant improvement. The use of
acupuncture in BC patients lead to a considerable reduction in the scores of all subscales of the Brief Pain
Inventory-Short Form (BPI-SF) and Visual Analog Scale (VAS) measuring pain. Moreover, patients treated with
acupuncture were more likely to experience improvements in hot flashes scores, fatigue, sleep disturbance, and
anxiety compared to those in the control group, while the improvements in depression were comparable across
both groups. Long-term follow-up results were similar to the EOT results. Authors concluded that current
evidence suggests that acupuncture might improve BC treatment-related symptoms measured with PROs
including QoL, pain, fatigue, hot flashes, sleep disturbance and anxiety. However, a number of included studies
report limited amounts of certain subgroup settings, thus more rigorous, well-designed and larger RCTs are
needed to confirm our results.
Ge et al. (2022) developed an evidence-based clinical practice guideline of acupuncture in the treatment of
patients with moderate and severe cancer pain. Recommendations were developed through a Delphi consensus
of an international multidisciplinary panel including 13 western medicine oncologists, Chinese
medicine/acupuncture clinical practitioners, and two patient representatives. The certainty of evidence, patient
preferences and values, resources, and other factors were fully considered in formulating the recommendations.
The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was
employed to rate the certainty of evidence and the strength of recommendations. The guideline proposed three
recommendations: (1) a strong recommendation for the treatment of acupuncture rather than no treatment to
relieve pain in patients with moderate to severe cancer pain; (2) a weak recommendation for the combination
treatments with acupuncture/acupressure to reduce pain intensity, decrease the opioid dose, and alleviate
opioid-related side effects in moderate to severe cancer pain patients who are using analgesics; and (3) a
strong recommendation for acupuncture in breast cancer patients to relieve their aromatase inhibitor-induced
arthralgia. This proposed guideline provides recommendations for the management of patients with cancer pain.
The small sample sizes of evidence limit the strength of the recommendations and highlights the need for
additional research.
Zhang et al. (2022) evaluated and summarized the systematic reviews (SRs) that assess the effects and safety
of acupuncture for cancer-related conditions, and to inform clinical practice and future studies. Fifty-one SRs of
RCTs on acupuncture for cancer-related conditions were included and synthesized. The methodological quality
of SRs included 1 "high", 5 "low" and 45 "very low" by AMSTAR 2. Acupuncture showed effectiveness on
systemic conditions in relation to different cancers, including cancer-related pain (17 SRs, 80 RCTs), fatigue (7
SRs, 18 RCTs), insomnia (4 SRs, 10 RCTs), quality of life (2 SRs, 15 RCTs); conditions in relation to chemo-
radiotherapy, including nausea and vomiting (3 SRs, 36 RCTs) and bone marrow suppression (2 SRs, 21
RCTs); and conditions in relation to specific cancers, including breast cancer-related menopause (3 SRs, 6
RCTs), hot flashes (12 SRs, 13 RCTs), arthralgia (5 SRs, 10 RCTs), and nasopharyngeal cancer-related
dysphagia (1 SRs, 7 RCTs). Acupuncture appeared to have benefit for patients with lymphoedema (3 SRs, 3
RCTs), gastrointestinal function (5 SRs, 27 RCTs), and xerostomia (4 SRs, 7 RCTs). Limited evidence showed
inconsistent results on acupuncture for chemotherapy-induced peripheral neuropathy (3 SRs, 6 RCTs),
depression and anxiety (3 SRs, 9 RCTs). Acupuncture was regarded as a safe therapy for cancer patients as no
severe adverse events related were reported. Authors concluded that evidence from SRs showed that
acupuncture is beneficial to cancer survivors with cancer-related pain, fatigue, insomnia, improved quality of life,
nausea and vomiting, bone marrow suppression, menopausal symptoms, arthralgia, and dysphagia, and may
also be potential for lymphoedema, gastrointestinal function, and xerostomia. For neuropathy, depression and
anxiety, acupuncture should be used as an option based on individual conditions. Acupuncture is relatively safe
without serious adverse events. More well-designed clinical trials of acupuncture are recommended on cancer-
related depression and anxiety, arthralgia, xerostomia, gastrointestinal dysfunction and dysphagia.
Abe et al. (2022) aimed to identify the current treatment options for pain and numbness in cancer survivors and
to evaluate their effects. Cancer survivors were defined as patients diagnosed with cancer who had completed
active cancer treatment, whose conditions were stable, and who had no evidence of recurrent or progressive
disease. A meta-analysis was conducted using the random-effects model to obtain the effect sizes of 7 types of
treatments: opioid therapy, nonopioid pharmacotherapy, interventional therapy, acupuncture,