Acupuncture for the treatment of post-chemotherapy chronic fatigue: a randomized, blinded, sham-controlled trial

Abstract

Purpose Many cancer patients experience persistent fatigue after the completion of chemotherapy. A previous single-arm study provided evidence for an effect of acupuncture in this population. We conducted a randomized controlled trial to determine whether acupuncture reduces post-chemotherapy chronic fatigue more effectively than sham acupuncture. Methods Cancer patients reporting significant fatigue persisting for at least 2 months following the completion of chemotherapy were randomized to receive once weekly true or sham acupuncture for 6 weeks. Fatigue was evaluated before and after treatment using the Brief Fatigue Inventory (BFI, the primary endpoint). Secondary endpoints included the Hospital Anxiety and Depression Scale (HADS) and Functional Assessment of Cancer Treatment-General (FACT-G) scores. Results One hundred one patients were randomized with 74 (34 true acupuncture; 40 sham control) evaluated for the primary endpoint. BFI scores fell by about one point between baseline and follow-up in both groups with no statistically significant difference between groups. HADS and FACT-G scores also improved in both groups, but there was no significant difference between groups. Patients in the sham acupuncture group crossed over to receive true acupuncture in week 7. No long-term reduction of fatigue scores was observed at the 6-month evaluation. Conclusions True acupuncture as provided in this study did not reduce post-chemotherapy chronic fatigue more than did sham acupuncture. The study is limited by the number of patients lost to follow-up. We also cannot exclude the possibility that a more intensive treatment regimen may be more effective.

Defining the Quality of Acupuncture

“…All studies were RCTs of parallel design. Five trials had 2 study groups, [22][23][24][25][26] and 2 trials had 3 study groups. 27,28 Risk of bias assessment has been completed elsewhere for these trials.…”

“…To recruit patients with persistent CRF, studies sought patients who had chemotherapy at least 1 month [24][25][26][27][28] or at least 60 days prior to the trial commencement date. 22 One study did not include length of time since chemotherapy or radiotherapy. 23 The type of chemotherapy was documented in all 3 Molassiotis studies and length of chemotherapy regime or radiotherapy in one study.…”

“…23 Molassiotis and colleagues included patients who reported high fatigue levels >5 on a visual analogue scale (VAS) of 0 to 10. [25][26][27] The primary outcome measures used were FACIT-F, 23 BFI, 22,24,28 and the Multidimensional Fatigue Inventory (MFI). [25][26][27] Interventions were acupuncture alone, or acupuncture combined with education.…”

“…Actual acupuncture point location was adequately provided in 4 studies by providing a figure in one study 22 and described in anatomical terms in 3 studies. 23,26,27 Three studies did not provide details of actual acupuncture point location in anatomical terms or by reference to a standard acupuncture text.…”

Acupuncture Research at Memorial Sloan Kettering Cancer Center

“…Both true and sham acupuncture were found to alleviate fatigue slightly, but there were no significant differences between the two groups [12]. However, a 2007 randomized trial demonstrated that true acupuncture showed substantial improvement (36%) in fatigue levels compared with sham acupuncture and acupressure [13].…”