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• W2033367097 abstract "Many cancer patients currently use acupuncture to alleviate symptoms and improve their overall well-being,1Ernst E. Cassileth B.R. The prevalence of complementary/alternative medicine in cancer: a systematic review.Cancer. 1998; 83: 777-782Crossref PubMed Scopus (809) Google Scholar and many report experiencing benefit from it.2Vyas T. Hart R.D. Trites J.R. et al.Complementary and alternative medicine use in patients presenting to a head and neck oncology clinic.Head Neck. 2010; 32: 793-799PubMed Google Scholar Its therapeutic value has been tested in numerous clinical trials, and several systematic reviews (SRs) of these data have become available. In addition, theories about the plausible mechanisms of acupuncture's actions have been developed.3Zhao Z.-Q. Neural mechanism underlying acupuncture analgesia.Prog Neurobiol. 2008; 84: 355-375Crossref Scopus (680) Google Scholar Yet despite this evidence, many experts remain skeptical about the true value of acupuncture in oncology.4Ernst E. Acupuncture—a critical analysis.J Intern Med. 2006; 259: 125-137Crossref PubMed Scopus (210) Google Scholar With this review, we try to provide a critical evaluation of the clinical evidence that has emerged. In particular, we wanted to assess all recent SRs of acupuncture as a treatment for cancer palliation and supportive care. We conducted literature searches in the following databases: Medline, Embase, Amed, CINHAL, Health Technology Assessments, DARE, the Cochrane Library, five Korean medical databases (Korean Studies Information, DBPIA, Korea Institute of Science and Technology Information, KoreaMed, and Research Information Service System), and the China National Knowledge Infrastructure (CNKI) database, without language restrictions. Our aim was to locate all SRs and meta-analyses of any type of acupuncture published since 2005 (older articles were deemed to be now out of date and were, therefore, not considered). The search terms were acupuncture, acupressure, electro-acupuncture, moxibustion, SR, and meta-analysis. We also searched our own departmental files and the bibliographies of the articles thus found. Reviews were defined as systematic if they included an explicit and repeatable method for searching the scientific literature and if there were explicit and repeatable inclusion and exclusion criteria for studies. We excluded transcutaneous electrical nerve stimulation, which does not use the meridian theories. SRs of complex packages of interventions that happened to include acupuncture were excluded. The initial searches were independent of clinical condition. The hits were studied, and those SRs that related to cancer were identified. Data were extracted independently by two authors (E. E. and M. S. L.) using predefined criteria (Table 1). Disagreements were resolved by discussion between the authors.Table 1Systematic Reviews of Acupuncture for Supportive Cancer CareFirst Author, Year (Ref.)ConditionNo. of Primary StudiesQuality of Primary StudiesMeta-analysisConclusion (Quote)Quality of SROverall Result +/−Chao 20095Chao L.-F. Zhang A.L. Liu H.-E. et al.The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: a systematic review.Breast Cancer Res Treat. 2009; 118: 255-267Crossref PubMed Scopus (51) Google ScholarTherapy-related adverse effects in breast cancer patients26Mostly poorNo…no conclusive remarks can be madeGood+/−Lee 20096Lee M.S. Kim K.H. Shin B.C. Choi S.M. Ernst E. Acupuncture for treating hot flushes in men with prostate cancer: a systematic review.Support Care Cancer. 2009; 17: 763-770Crossref PubMed Scopus (30) Google ScholarHot flashes in prostate cancer patients6Mostly poorYesThe evidence is not convincing…Good−Lee 20097Lee M.S. Kim K.H. Choi S.-M. Ernst E. Acupuncture for hot flashes in breast cancer patients: a systematic review.Breast Cancer Res Treat. 2009; 115: 497-503Crossref PubMed Scopus (50) Google ScholarHot flashes in breast cancer6Mostly goodYesThe evidence is not convincing…Good−Lu 20078Lu W. Hu D. Dean-Clower E. et al.Acupuncture for chemotherapy-induced leukopenia: exploratory meta-analysis of randomized controlled trials.J Soc Integr Oncol. 2007; 5: 1-10Crossref PubMed Scopus (43) Google ScholarChemotherapy-induced leucopenia11PoorYes…studies may lead to false-positive estimationPoor+/−Ezzo 20069Ezzo J.M. Richardson M.A. Vickers A. et al.Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting.Cochrane Database Syst Rev. 2006; (CD002285)Google ScholarChemotherapy-induced nausea and vomiting11VariableYes…suggests a biologic effect of acupoint stimulation…Excellent+Jedel 200510Jedel E. Acupuncture in xerostomia—a systematic review.J Oral Rehabil. 2005; 32: 392-396Crossref PubMed Scopus (34) Google ScholarXerostomia3Mostly poorNo…there is no evidence for the efficacy of acupuncture…Good−Lee 200511Lee H. Schmidt K. Ernst E. Acupuncture for the relief of cancer-related pain—a systematic review.Eur J Pain. 2005; 9: 437-444Crossref PubMed Scopus (108) Google ScholarCancer pain7Mostly poorNoThe notion that acupuncture is effective… is not supported by… rigorous clinical trialsGood−+=positive; −=fails to show effectiveness; +/−=unclear. Open table in a new tab +=positive; −=fails to show effectiveness; +/−=unclear. Seven SRs met our inclusion criteria.5Chao L.-F. Zhang A.L. Liu H.-E. et al.The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: a systematic review.Breast Cancer Res Treat. 2009; 118: 255-267Crossref PubMed Scopus (51) Google Scholar, 6Lee M.S. Kim K.H. Shin B.C. Choi S.M. Ernst E. Acupuncture for treating hot flushes in men with prostate cancer: a systematic review.Support Care Cancer. 2009; 17: 763-770Crossref PubMed Scopus (30) Google Scholar, 7Lee M.S. Kim K.H. Choi S.-M. Ernst E. Acupuncture for hot flashes in breast cancer patients: a systematic review.Breast Cancer Res Treat. 2009; 115: 497-503Crossref PubMed Scopus (50) Google Scholar, 8Lu W. Hu D. Dean-Clower E. et al.Acupuncture for chemotherapy-induced leukopenia: exploratory meta-analysis of randomized controlled trials.J Soc Integr Oncol. 2007; 5: 1-10Crossref PubMed Scopus (43) Google Scholar, 9Ezzo J.M. Richardson M.A. Vickers A. et al.Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting.Cochrane Database Syst Rev. 2006; (CD002285)Google Scholar, 10Jedel E. Acupuncture in xerostomia—a systematic review.J Oral Rehabil. 2005; 32: 392-396Crossref PubMed Scopus (34) Google Scholar, 11Lee H. Schmidt K. Ernst E. Acupuncture for the relief of cancer-related pain—a systematic review.Eur J Pain. 2005; 9: 437-444Crossref PubMed Scopus (108) Google ScholarTable 1 summarizes key data from these reviews. They cover a range of different symptoms experienced by patients with different types of cancers: therapy-related adverse effects, hot flashes, chemotherapy-induced nausea and vomiting or leucopenia, xerostomia, and pain. Most reviews were based on only a few primary studies that often were of poor quality. The reviews themselves were mostly of good quality. The overall conclusions were negative in four cases and unclear in two. The only cancer-related indication that is supported by good evidence from at least one SR is chemo-therapy-induced nausea and vomiting.9Ezzo J.M. Richardson M.A. Vickers A. et al.Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting.Cochrane Database Syst Rev. 2006; (CD002285)Google Scholar This review9Ezzo J.M. Richardson M.A. Vickers A. et al.Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting.Cochrane Database Syst Rev. 2006; (CD002285)Google Scholar also is the only one that is rigorous and based on a sizable amount of studies of which at least some are of high quality. Our overview suggests that acupuncture as a treatment of chemotherapy-induced nausea and vomiting is backed by good evidence from a rigorous SR.9Ezzo J.M. Richardson M.A. Vickers A. et al.Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting.Cochrane Database Syst Rev. 2006; (CD002285)Google Scholar Other indications for which acupuncture is frequently used in palliative or supportive cancer care are not supported by such evidence. In 2001, Linde et al.12Linde K. Vickers A. Hondras M. et al.Systematic reviews of complementary therapies—an annotated bibliography. Part 1: acupuncture.BMC Complement Altern Med. 2001; 1: 3Crossref PubMed Scopus (107) Google Scholar published an overview of SRs of acupuncture, which included four articles focused on nausea and vomiting resulting from various causes. Their general conclusion was that the evidence is promising but not convincing. This suggests that, since 2001, the evidence has become stronger, which also is the impression we had when updating the evidence in this area.13Ernst E. Pittler M.H. Wider B. Boddy K. The desktop guide to complementary and alternative medicine.2nd ed. Elsevier Mosby, Edinburgh, UK2006Google Scholar Linde et al.12Linde K. Vickers A. Hondras M. et al.Systematic reviews of complementary therapies—an annotated bibliography. Part 1: acupuncture.BMC Complement Altern Med. 2001; 1: 3Crossref PubMed Scopus (107) Google Scholar also noticed that SRs of acupuncture tended to be based on poor-quality primary studies. Our analysis confirms this notion (Table 1). Others have shown that nearly 100% of all Chinese acupuncture trials report positive results.14Vickers A. Goyal N. Harland R. Rees R. Do certain countries produce only positive results—a systematic review of controlled trials.Control Clin Trials. 1998; 19: 159-166Abstract Full Text Full Text PDF PubMed Scopus (536) Google Scholar As most reviews heavily rely on primary studies from China, they might have generated conclusions that were too positive. This means that the evidence has to be interpreted with caution. As poor-quality trials tend to generate false-positive results, it is unlikely that the reviews discussed here generate a false-negative picture. What does all this mean for palliative and supportive cancer care? The concepts of evidence-based medicine imply that acupuncture should be used only for indications that are backed by sound data. This means that, according to the evidence summarized above, acupuncture should be considered as a treatment for nausea and vomiting. The question then arises whether acupuncture is superior to other interventions available for this purpose. In the absence of a sufficient amount of rigorous studies investigating it, no conclusive answer can be offered. In turn, this means that future research should address this issue with some urgency. In conclusion, chemotherapy-induced nausea and vomiting is the only indication for acupuncture that is currently supported by good evidence from SRs. The authors thank Tae-Young Choi, MD, PhD, of the Korea Institute of Oriental Medicine for searching and checking the Chinese literature. Dr. Lee was funded by the Korea Institute of Oriental Medicine." @default.
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