martes, 18 de junio de 2019

Acupuncture (PDQ®) 5/6 —Health Professional Version - National Cancer Institute

Acupuncture (PDQ®)—Health Professional Version - National Cancer Institute

National Cancer Institute



Acupuncture (PDQ®)–Health Professional Version



Lymphedema

Treatment-induced lymphedema may be a lifelong concern for some breast cancer survivors. There have been a number of case reports, retrospective chart reviews, and pilot studies demonstrating that acupuncture was safe and potentially effective in reducing swelling and improving symptoms in patients with upper- and lower-extremity edema.[105-108] A 2016 qualitative study of 23 breast and head and neck cancer patients with lymphedema who completed acupuncture and moxibustion treatments showed that patients viewed acupuncture and moxibustion as a valuable whole-person approach that helped them improve their energy and decrease pain.[109]
A 2013 single-arm clinical trial (N = 37) evaluated the safety and potential efficacy of acupuncture in treating patients with breast cancer–related lymphedema (BCRL).[108] In this trial, the investigators enrolled 37 breast cancer survivors with moderate to severe unilateral chronic BCRL; the survivors received eight sessions of standard acupuncture treatment given twice per week for 4 weeks. Four patients were not able to be evaluated because of early withdrawal. Acupuncture was deemed to be safe; no serious adverse events were reported after 255 acupuncture treatment sessions. Twelve of the 33 evaluable patients reported at least one incidence of mild bruising or minor pain/tingling in the arm, shoulder, or acupuncture site; no infections were reported, although the standard acupuncture treatment protocol involved inserting four acupuncture needles in the limb with lymphedema. This pilot study, although not an RCT, suggested a trend toward efficacy with a mean reduction in arm circumference of 0.90 cm in patients who received acupuncture treatment; eleven patients (33%) experienced at least a 30% reduction in arm circumference. Two patients did not use any additional lymphedema treatment during the trial. Most patients (28 of the remaining 31 patients) reported making no changes in their standard regimens to treat lymphedema during treatment. The authors concluded that acupuncture for BCRL is safe and may be effective. The same research group is conducting an RCT to further determine the efficacy of acupuncture in reducing BCRL symptoms (NCT01706081). However, in 2014, a pilot RCT of 17 women that compared acupuncture with usual care showed that 12 acupuncture treatments on the nonlymphedematous limb during 8 weeks did not change extracellular fluid or any patient-reported lymphedema outcomes.[110] The authors concluded that acupuncture may stabilize symptoms; however, further study is needed.
A 2016 RCT of 30 patients showed that warm acupuncture (acupuncture and moxibustion) improved BCRL in 51% of patients compared with 26% of patients treated with oral diosmin in the control group.[111] No adverse reaction was reported in the acupuncture and moxibustion group. The acupuncture and moxibustion group also had significant improvement in shoulder joint range of movement and QOL compared with the control group.
A RCT of acupuncture versus usual care WLC studying 82 BCRL patients did not show a significant difference in arm circumference or bioimpedance.[112]

Ileus

Three RCTs have studied the effect of acupuncture in reducing the duration of postoperative ileus and have generated conflicting results. In 2010, one study reported the results of an RCT studying the effect of EA compared with usual care and found that EA did not significantly prevent prolonged postoperative ileus.[113]
In 2012, another study reported the results of a phase II RCT that compared RA with SA (N = 90) for reducing postcolectomy ileus. No significant differences were reported between RA and SA in reducing postcolectomy ileus as measured by the time that the patient first tolerated solid food and the time that the patient first passed flatus or a bowel movement.[114]
In 2013, a third study reported the results of a three-arm RCT (N = 165) that compared EA with SA and no acupuncture in reducing duration of postoperative ileus after laparoscopic surgery for colorectal cancer. EA significantly shortened the time to defecation and the hospital stay compared with SA and no acupuncture.[115]
A 2017 systematic review and meta-analysis of 10 RCTs involving 776 cancer patients showed that acupuncture was associated with earlier recovery of bowel function (shorter time to first flatus and defecation) compared with the control (no acupuncture, or SA or other types of active treatments).[116] However, the data quality was deemed low because of the high risk of bias stemming from small sample sizes and methodological limitations.

Sleep

A number of RCTs have studied the effect of acupuncture in improving depression and sleep quality in cancer patients. In 2011, one study (N = 80) reported that acupuncture significantly improved depression and sleep quality when compared with fluoxetine. Patients receiving acupuncture reported significantly greater reductions in Self-rating Depression Scale, Hamilton Depression Rating Scale, and Pittsburgh Sleep Quality Index scores.[117]
The effect of acupuncture on sleep was also studied as one of the secondary end points in acupuncture for an AIMSS study published in 2014.[81] When compared with WLCs, EA resulted in a nonsignificant improvement in sleep disturbance (P = .058).[81] Further studies are warranted.

Other treatment-related side effects

A 2017 RCT comparing acupuncture with SA in 60 multiple myeloma patients undergoing bone marrow transplantation (BMT) showed that even though acupuncture did not significantly improve overall symptoms during and 15 days after BMT compared with SA, it was significantly more efficacious in reducing nausea, lack of appetite, and drowsiness at 15 days after BMT.[118] Patients who received SA were more likely to increase pain medication usage post-BMT.
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, proctitis, dysphonia, esophageal obstruction, and hiccups.[1,8,60,119-123] These studies were from China,[1,120-122] Japan,[60] and Sweden.[8,29,119,123] The findings from these studies are summarized in Table 8 below.
Table 8. Clinical Studies of Acupuncture for Other Cancer-Related Symptoms or Cancer Treatment–Related Side Effectsa
ENLARGE
Reference/Sample SizeType of StudyCondition TreatedTreatment GroupsbTreatment DurationConcurrent Therapy (Yes/No/ Unknown)cLevel of Evidence Score and Resultsd
ANC = absolute neutrophil count; AVLT = auditory-verbal learning test; BMT = bone marrow transplantation; CDT = clock-drawing test; FACT-COG = functional assessment of cancer treatment cognition test; N = number; RA = real acupuncture; RCT = randomized controlled trial; SA = sham acupuncture; WLC = wait-list control.
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.
cConcurrent therapy for symptoms treated (not cancer).
dStrongest evidence reported that the treatment under study has anticancer activity or otherwise improves the well-being of cancer patients. For information about levels of evidence analysis and an explanation of the level of evidence scores, refer to Levels of Evidence for Human Studies of Integrative, Alternative, and Complementary Therapies.
e P < .001, versus baseline.
[1] (N = 76)RCTSymptoms of weight loss, cough, thoracodynia, hemoptysis, fever, and side effects of chemotherapy and radiation therapyGroup 1, acupuncture (N = 38); Group 2, no acupuncture (N = 38)UnknownNo1iiC; weight gain, symptom relief, fewer side effectse
[75] (N = 47)RCTCancer-related fatigueGroup 1, acupuncture (N = 15); Group 2, acupressure (N = 16); Group 3, SA (N = 16)4 wkNo1sC; improved fatigue levels
[111] (N = 30)RCTBreast cancer–related lymphedemaGroup 1, warm acupuncture at 6 acupoints (N = 15); Group 2, control group received 900 mg diosmin tablets (N = 15)Acupuncture, 30 min on alternate days for 30 d; diosmin 3 times a day for 30 dUnknown1iiC, significant reduction in upper arm lymphedema compared with diosmin
[112] (N = 82)RCTBreast cancer–related lymphedemaGroup 1, RA (N = 40); Group 2, WLC (N = 42)Twice weekly for 6 wkYes, massage, compression garments, exercise, or wraps1iiC; no significant difference between groups for arm circumference difference or bioimpedance difference
[124] (N = 80)RCTChemotherapy-related cognitive impairmentGroup 1, RA (N = 40); Group 2, control (N = 40)5x/wk for two 4-wk coursesUnknown1iiC; treatment group had significantly higher scores on FACT-COG, AVLT3, and CDT compared with baseline
[118] (N = 60)RCTNausea, decreased appetite, and drowsiness in multiple myeloma patients after BMTGroup 1, RA (N = 29); Group 2, SA (N = 31)5 d for 20 min each treatment or until ANC dropped below 200/μl or plateletcount dropped below 20,000/μlYes1sC; acupuncture group had less severe symptoms of nausea, appetite loss, and drowsiness than sham acupuncture
[60] (N = 79)Nonconsecutive case series, surveyed retrospectivelyUnspecified symptoms (including pain, xerostomia, hot flashes, nausea/loss of appetite) from cancer or cancer treatment79 traditional Chinese acupuncture, auricular acupuncture, percutaneousnerve stimulation, Korean hand acupuncture, or Japanese scalp acupuncture; noneUnknownYes, standard medical therapies3iiiC; 60% showed at least 30% improvement
[120] (N = 44)Nonconsecutive case seriesRadiation proctitis in women treated for cervical cancerAcupuncture (N = 44); noneUnknownNo3iiiC; radiation proctitis resolved in 73% of patients: no blood or mucus for 15 days
[105] (N = 24)Nonconsecutive case seriesPostoperative lower-extremity lymphedema in women treated for gynecologictumorsGroup 1, acupuncture and moxibustion(N = 24); Group 2, control group, none5x/wk during hospitalization and two times/wk at outpatientclinicUnknown3iiiC; edema prevented or markedly reduced
[125] (N = 35)Nonconsecutive case seriesSymptoms related to lymphedema (including pain, discomfort, anxiety, and insomnia)Group 1, acupuncture and moxibustion (N = 30); Control group, none2 wk with 4- and 12-wk follow-upUnknown3iiiC; symptoms improved
[123] (N = 16)Retrospective case seriesHiccupsGroup 1, acupuncture (N = 16); Control group, none1–7 dUnknown3iiiC; symptom relief
In an RCT,[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). In patients with lung cancer, the acupuncture group also showed greater improvement than the controls in the symptoms of cough, thoracodynia, hemoptysis, and fever; in patients with esophageal cancer, the acupuncture group showed greater improvement in the symptoms of chest pain, mucus vomiting, and difficulty in swallowing. In addition, the acupuncture group suffered fewer side effects (e.g., 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 postoperative cancer patients treated with acupuncture plus massage showed decreased pain (P = .05) and a decrease in depressive mood (P = .003) compared with usual care.[20]
A retrospective study involved patients at an oncology clinic who were offered acupuncture treatment for potential palliation of symptoms.[119] 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 about acupuncture-treatment expectations.

Current Clinical Trials

Use our advanced clinical trial search to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. General information about clinical trials is also available.
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  77. Molassiotis A, Bardy J, Finnegan-John J, et al.: Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized controlled trial. J Clin Oncol 30 (36): 4470-6, 2012. [PUBMED Abstract]
  78. Molassiotis A, Bardy J, Finnegan-John J, et al.: A randomized, controlled trial of acupuncture self-needling as maintenance therapy for cancer-related fatigue after therapist-delivered acupuncture. Ann Oncol 24 (6): 1645-52, 2013. [PUBMED Abstract]
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