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 RCTs, nonrandomized trials, prospective consecutive case series, and retrospective studies. Consistent with the findings from clinical studies of acupuncture on N/V due to other causes (i.e., postoperative N/V and morning sickness), these studies showed acupuncture to be effective in the treatment of chemotherapy-induced N/V (CINV).
A 2013 systematic review of literature on acupuncture in cancer care screened 2,151 publications and identified 41 RCTs studying the effect of using acupuncture to treat eight cancer treatment–related symptoms (pain, nausea, hot flashes, fatigue, radiation-induced xerostomia, prolonged postoperative ileus, anxiety/mood disorders, and sleep disturbance). The review concluded that acupuncture is an appropriate adjunctive treatment for CINV, but additional studies are needed because most RCTs had unclear bias or a high risk of bias.
In 2005, a comprehensive meta-analysis of 11 RCTs (N = 1,247) evaluating the effect of acupuncture-point stimulation in controlling CINV showed that acupuncture-point stimulation significantly reduced the proportion of acute vomiting (relative risk, 0.82; 95% CI, 0.69–0.99, P = .04), although the meta-analysis did not show that acupuncture reduced the mean number of acute emetic episodes or acute or delayed nausea severity compared with control.
The trials in the meta-analysis were published between 1987 and 2003, and the sample sizes ranged from ten patients in the smallest trial to 747 patients in the largest trial. Among the ten trials that reported a chemotherapy regimen, all patients received moderate to high emetogenic chemotherapy. Eight of the trials used ondansetron, a 5-HT3-receptor antagonist, as the antiemetic regimen. The other three trials used methotrexate alone, methotrexate with prednisone, or methotrexate with dopaminergic antagonists as the antiemetic regimen. None of the antiemetic regimens contained aprepitant because the trials all predated this drug.
A meta-analysis of acupuncture in N/V is the most comprehensive summary of clinical research on the role of acupuncture-point stimulation in controlling CINV. It found that acupuncture-point stimulation decreases the proportion of patients who experience acute chemotherapy-induced vomiting and concurred with the previous systemic review and meta-analysis. It suggested that acupressure may relieve chemotherapy-induced nausea, even though the studies were limited by lack of an effective control arm to rule out the placebo effect. It also suggested differences among acupuncture-point stimulation modalities, with invasive-point stimulation to be more effective than noninvasive-point stimulation in reducing acute CINV. It has since been cited multiple times by review articles and oncology practice guidelines.
The National Institutes of Health Consensus Development Conference held in 1997 reviewed studies that evaluated the safety and efficacy of acupuncture in treating postoperative- and CINV. Studies discussed at the conference reported significantly less N/V compared with the control group.The panel stated that “there is clear evidence that needle acupuncture treatment is effective for postoperative and chemotherapy N/V.”
The acupuncture point specificity is worth mentioning because most of the earlier acupuncture CINV trials used the PC6 acupuncture point and showed positive results. A well-designed, randomized, placebo-controlled trial published in 2014 showed that K1 acupoint acustimulation combined with antiemetics did not prevent cisplatin-induced or oxaliplatin-induced nausea in 103 liver cancer patients who underwent a transarterial chemoembolization (TACE) procedure. A single-blind, randomized, controlled trial in 2017 showed that transcutaneous electrical stimulation at P6, LI4, and ST36 acupoints did not significantly alleviate CINV associated with TACE, when compared with placebo in patients with liver cancer. EA at P6, LI4, and ST36 points did, however, reduce anorexia scores more than SA.
My comments:
This is cited from the website of National Cancer Institutes, an expert consensus.
Reference
Acupuncture (PDQ®)–Health Professional Version. https://www.cancer.gov/about-cancer/treatment/cam/hp/acupuncture-pdq#section_5.56
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