Acupuncture for Breast Cancer: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes

Zhang, Yuzhu; Sun, Yang; Li, Dongmei; Liu, Xiaoyuan; Chen, Fang; Yang, Chunfang; Luo, Tianyu; Lü, Hai; Li, Huachao; Zhang, Hongyan; Liang, Qiao‐Mei; Wu, Jiahua; Huang, Limei; Xu, Rui; Ren, Liping; Chen, Qianjun

doi:10.3389/fonc.2021.646315

Cited by 24 publications

(37 citation statements)

References 47 publications

(193 reference statements)

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“…Recently, there has been an increase in systematic reviews (SRs) evaluating the effects of AT on CRF [ 24 , 25 , 26 , 27 ]. However, all SRs evaluated the effect of AT not only on fatigue but also on various side effect symptoms.…”

Section: Introductionmentioning

confidence: 99%

Acupuncture for Managing Cancer-Related Fatigue in Breast Cancer Patients: A Systematic Review and Meta-Analysis

Choi

Ang

Jun

et al. 2022

Cancers

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Breast cancer (BC) is the most common cancer in women and is a serious threat to women’s health. Cancer-related fatigue (CRF) is a distressing symptom in BC patients during and after chemotherapy or radiation therapy that severely affects quality of life (QoL). AT is widely used for fatigue management. However, the effect of AT on CRF is still uncertain. This study aimed to evaluate the efficacy and safety of AT in the management of CRF in patients with BC. Eleven databases were searched through June 2022. Two researchers independently performed the database search, study selection, data extraction, and risk of bias assessment. Study selection was performed based on predefined Participants, Intervention, Comparators, Outcomes, Study design (PICOS) criteria, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed when reporting the results. A meta-analysis was performed according to the Cochrane systematic review method using RevMan 5.3. A total of 12 studies including a total of 1084 participants were included. The results showed that AT had a beneficial effect compared with sham AT (n = 256, SMD = −0.26, 95% CI [−0.51, −0.01], p = 0.04, I2 = 0%) and a long-term effect on fatigue score (n = 209, MD = −0.32, 95% CI [–0.59, −0.04], p = 0.02, I2 = 0%). Meta-analysis showed that AT had a beneficial effect compared with usual care (UC) on fatigue scores (n = 238, SMD = −0.39, 95% CI [−0.66 to −0.12], p = 0.005, I2 = 0%). Of the 12 articles, 3 articles were judged as having a low risk of bias in all domains and hence were of high quality. No serious adverse effects were identified. AT is an effective and safe treatment for CRF, and AT is more effective than sham AT or UC or wait-list control (WLC). Nevertheless, the methodological quality of most of these studies was low, and the included studies/sample sizes were small, so the ability to derive decisive implications was limited. Further research is needed to confirm these findings.

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Section: Introductionmentioning

confidence: 99%

Acupuncture for Managing Cancer-Related Fatigue in Breast Cancer Patients: A Systematic Review and Meta-Analysis

Choi

Ang

Jun

et al. 2022

Cancers

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“…Thus, it is urgent to find a widely used, relatively safe, and well-accepted intervention. Both acupuncture and auricular acupressure (AA), as complementary and alternative treatment, might be promising treatment options, which appear to be effective in improving cancer-related insomnia ( 13 , 14 ). Acupuncture has been defined as the insertion of fine needles into specific acupuncture points (acupoints) in the human body to relieve certain symptoms, and AA is a non-invasive therapy of treating physical and psychosomatic diseases by stimulating specific points of ears with something ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

Association of Acupuncture and Auricular Acupressure With the Improvement of Sleep Disturbances in Cancer Survivors: A Systematic Review and Meta-Analysis

et al. 2022

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BackgroundStudies on the efficacy of acupuncture and auricular acupressure on sleep disturbances in cancer patients have been growing, but there is no specific and comprehensive systematic review and meta-analysis. This review aims to evaluate the efficacy and safety of acupuncture and auricular acupressure on sleep disturbances in cancer survivors based on existing randomized clinical trials (RCTs).MethodsFour English-language and four Chinese-language biomedical databases were searched for RCTs published from database inception to July 30, 2021. RCTs comparing acupuncture and auricular acupressure with sham control, drug therapy, behavior therapy, or usual care for managing cancer were included. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias (ROB) tool. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated for the effect sizes.ResultsThirteen RCTs with 961 patients were included. The risk of performance bias or reporting bias for most of the included trials was high or unclear. Evidence was not found for short-term effects on sleep scales compared to sham control (MD, 1.98; 95% CI, 0.33–3.64; p = 0.02; I2 = 36%), wait list control (MD, 0.40; 95% CI, −0.87–1.68; p = 0.54; I2 = 49%), drug therapy (MD, 1.18; 95% CI, −3.09–5.46; p = 0.59; I2 = 98%). For long-term effect, two sham-controlled RCTs showed no significance of acupuncture on insomnia scale scores (MD, 1.71; 95% CI, −2.38–5.81; p = 0.41; I2 = 89%). Subgroup analyses suggested no evidence that auricular acupressure (MD, 3.14; 95% CI=1.52, 4.76; p = 0.0001; I2 = 0%) or acupuncture (MD, 0.54; 95% CI=−1.27, 2.34; p = 0.56; I2 = 0%) was associated with the reduction in insomnia scale scores.ConclusionsThis systematic review and meta-analysis found no evidence about acupuncture or auricular acupressure in the improvement of sleep disturbances in cancer survivors in terms of short- or long-term effect. Adverse events were minor. The finding was inconsistent with previous research and suggested that more well-designed and large-scale randomized controlled trials are needed to identify the efficacy of acupuncture and auricular acupressure for sleep disturbances in cancer survivors.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, CRD42020171612.

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“…Multiple clinical studies have confirmed the potential of acupuncture to treat anemia and leukopenia during chemotherapy ( 17 , 20 ), but the use and efficacy of EA are still moot because of the weak response in many patients. The mechanism of EA is still unknown and thus why it is effective in many patients but not in others with similar symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…The World Health Organization recommends acupuncture to prevent toxicity and leukopenia during radio- and chemotherapy ( 16 ). Acupuncture is safe and its effects have been confirmed in multiple clinical trials with different types of tumors including breast ( 17 ) and lung cancer ( 18 ). Systematic analysis of 31 clinical trials showed that acupuncture alleviated chemotherapy-induced myelosuppression (leukopenia, hemoglobin, and platelet reduction) and preserved immune responses including IL-2 production and lymphocyte counts in lung cancer patients during chemotherapy ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

PAC1 Receptor Mediates Electroacupuncture-Induced Neuro and Immune Protection During Cisplatin Chemotherapy

Huang

Guo

et al. 2021

Front. Immunol.

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Platinum-based chemotherapy is an effective treatment used in multiple tumor treatments, but produces severe side effects including neurotoxicity, anemia, and immunosuppression, which limits its anti-tumor efficacy and increases the risk of infections. Electroacupuncture (EA) is often used to ameliorate these side effects, but its mechanism is unknown. Here, we report that EA on ST36 and SP6 prevents cisplatin-induced neurotoxicity and immunosuppression. EA induces neuroprotection, prevents pain-related neurotoxicity, preserves bone marrow (BM) hematopoiesis, and peripheral levels of leukocytes. EA activates sympathetic BM terminals to release pituitary adenylate cyclase activating polypeptide (PACAP). PACAP-receptor PAC1-antagonists abrogate the effects of EA, whereas PAC1-agonists mimic EA, prevent neurotoxicity, immunosuppression, and preserve BM hematopoiesis during cisplatin chemotherapy. Our results indicate that PAC1-agonists may provide therapeutic advantages during chemotherapy to treat patients with advanced neurotoxicity or neuropathies limiting EA efficacy.

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Acupuncture for Breast Cancer: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes

Cited by 24 publications

References 47 publications

Acupuncture for Managing Cancer-Related Fatigue in Breast Cancer Patients: A Systematic Review and Meta-Analysis

Acupuncture for Managing Cancer-Related Fatigue in Breast Cancer Patients: A Systematic Review and Meta-Analysis

Association of Acupuncture and Auricular Acupressure With the Improvement of Sleep Disturbances in Cancer Survivors: A Systematic Review and Meta-Analysis

PAC1 Receptor Mediates Electroacupuncture-Induced Neuro and Immune Protection During Cisplatin Chemotherapy

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