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What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews

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Abstract

Purpose

This study aims to systematically appraise the evidence for the use of acupuncture for symptom management in cancer and supportive care and to identify recommendations for clinical practice and future research.

Methods

A systematic search was carried out to identify reviews of the use of acupuncture in cancer supportive and palliative care, using MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Library, British Nursing Index, Index to Theses, Dissertations and Theses (via Proquest) and NHS evidence. Search terms included: acupuncture, cancer and symptoms. Data were extracted for analysis. Reviews were assessed for quality using a five-item checklist but were not excluded from the review on grounds of quality, in order to include a comprehensive scope of the subject.

Results

Seventeen reviews were included in the review. Evidence was found for the use of acupuncture for treatment-related nausea and vomiting. Benefit was reported for other cancer-related symptoms, including pain, fatigue, hot flushes, xerostomia, dyspnoea and anxiety. Reviewers found a paucity of rigorous trials and heterogeneity of populations, interventions, controls and outcome measures, which challenge the process of systematic review and meta-analysis.

Conclusion

Acupuncture should be considered for symptom management where there are limited treatment options, using current peer-reviewed guidelines and clinical reasoning. Much of the primary research reported in reviews is innovative and indicates potential benefit for people with cancer-related symptoms. The complexity of acupuncture as an intervention needs to be acknowledged in future research designs and when reviewing research findings. An iterative approach using adequate interventions, appropriate outcome measures and adherence to reporting standards is required to evaluate the efficacy of acupuncture in cancer supportive and palliative care.

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References

  1. Deng G, Cassileth B (2010) Complementary therapies in palliative medicine. In: Hanks G, Cherny NI, Christakis NA, Fallon M, Kassa S, Portenoy RK (eds) Oxford textbook of palliative medicine, 4th edn. Oxford University Press, Oxford

    Google Scholar 

  2. Pomeranz B (2001) Acupuncture analgesia—basic research. In: Stux G, Hammerschlag R (eds) Clinical research, scientific basis. Springer, Berlin, pp 1–28

    Google Scholar 

  3. Leng G (1999) A year of acupuncture in palliative care. Palliat Med 13:163–164

    Article  CAS  PubMed  Google Scholar 

  4. Johnstone PAS, Polston GR, Niemtzow RC, Martin PJ (2002) Integration of acupuncture into the oncology clinic. Palliat Med 16:235–239

    Article  PubMed  Google Scholar 

  5. Macmillan Cancer Relief (2002) Directory of complementary therapies in UK cancer care: public and voluntary sectors. Macmillan Cancer Relief, London

  6. Barsevick AM, Whitmer K, Nail LM, Beck SL, Dudley WN (2006) Symptom cluster research: conceptual, design, measurement, and analysis issues. J Pain Symptom Manag 31(1):85–95

    Article  Google Scholar 

  7. Dean-Clower E, Doherty-Gilman AM, Keshaviah A, Kaw C, Lu W, Manola J, Penson RT, Matulonis UA, Rosenthal DS (2010) Acupuncture as palliative therapy for physical symptoms and quality of life for advanced cancer patients. Integr Cancer Ther 9(2):158–167

    Article  PubMed  Google Scholar 

  8. Beer TM, Benavides M, Emmons SL, Hayes M, Liu G, Garzotto M, Donovan D, Katovic N, Reeder C, Eilers K (2010) Acupuncture for hot flashes in patients with prostate cancer. Urology 76(5):1182–1188

    Article  PubMed  Google Scholar 

  9. Frisk J, Spetz A-C, Hjertberg H, Petersson B, Hammar M (2009) Two modes of acupuncture as a treatment for hot flushes in men with prostate cancer. Eur Urol 55(1):156–163

    Article  PubMed  Google Scholar 

  10. Hammar M, Frisk J, Grimas O, Hook M, Spetz AC, Wyon Y (1999) Acupuncture treatment of vasomotor symptoms in men with prostatic carcinoma: a pilot study. J Urol 161:853–856

    Article  CAS  PubMed  Google Scholar 

  11. Blom M, Dawidson I, Angmar-Mansson B (1992) The effect of acupuncture on salivary flow rates in patients with xerostomia. Oral Surg Oral Med Pathol 73:293–298

    Article  CAS  Google Scholar 

  12. Meidell L, Rasmussen BH (2009) Acupuncture as an optional treatment for hospice patients with xerostomia: an intervention study. Int J Palliat Nurs 15(1):12–20

    PubMed  Google Scholar 

  13. Molassiotis A, Sylt P, Diggins H (2006) The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial. Complement Thers In Med 15(4):228–237

    Article  Google Scholar 

  14. Filshie J, Penn K, Ashley S, Davies CL (1996) Acupuncture for the relief of cancer-related breathlessness. Palliat Med 10:145–150

    Article  CAS  PubMed  Google Scholar 

  15. Ernst E, Lee MS (2010) Acupuncture for palliative and supportive cancer care: a systematic review of systematic reviews. J Pain Symptom Manag 40(1):e3–e5

    Article  Google Scholar 

  16. Lundeberg T, Lund I (2009) Treatment recommendations should take account of individual patient variation not just group responses. Acupunct Med 27(1):31–32

    Article  PubMed  Google Scholar 

  17. Linde K, Hammerschlag R, Lao L (2007) Evidence overviews: the role of systematic reviews and met-analyses. In: MacPherson H, Hammerschlag R, Lewith G, Schneyer R (eds) Acupuncture research. Churchill Livingston, London, pp 199–217

    Google Scholar 

  18. Filshie J, Hester J (2006) Guidelines for providing acupuncture treatment for patients. Acupunct Med 24(4):172–182

    Article  PubMed  Google Scholar 

  19. Department of Health (2010) Equity and excellence. www.dh.gov.uk. 10/08/2011

  20. Campbell M, Fitzpatrick R, Haines A, Kinmouth AL, Sandercock P, Spiegelhalter D, Tyrer P (2000) Framework for design and evaluation of complex interventions to improve health. BMJ 321:694–696

    Article  CAS  PubMed  Google Scholar 

  21. Craig P, Dieppe P, Macintrye S, Mitchie S, Nazareth I, Petticrew M (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 337:a1655. doi:10.1136/bmj.a1655

    Article  PubMed  Google Scholar 

  22. Collins JA, Fauser BCJM (2005) Balancing the strengths of systematic and narrative reviews. Hum Reprod Updat 11(2):103–104

    Article  Google Scholar 

  23. Dijkers MPJ (2009) The value of “traditional” reviews in the era of systematic and narrative reviews. Am J Phys Med Rehabil 88(5):423–430

    Article  PubMed  Google Scholar 

  24. Jesson JK, Matheson L, Lacey FM (2011) Doing your literature review. Sage, London

    Google Scholar 

  25. Critical Appraisal Skills Programme. 10 Questions to help you make sense of reviews. Available at www.sph.nhs/sph-files/casp

  26. Lee MS, Kim K-H, Choi S-M, Ernst E (2009) Acupuncture for treating hot flashes in breast cancer patients: a systematic review. Breast Cancer Res Treat 115:497–503

    Article  PubMed  Google Scholar 

  27. Chao L-F, Zhang AL, Liu H-E, Cheng M-H, Lam H-B, Lo SK (2009) 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 118:255–267

    Article  PubMed  Google Scholar 

  28. Dos Santos S, Hill N, Morgan A, Smith J, Thai C, Cheifetz O (2010) Acupuncture for treating common side effects associated with breast cancer treatment: a systematic review. Medicial Acupunct 22(2):81–97

    Article  Google Scholar 

  29. Lee MS, Kim K-H, Shin B-C, Choi S-M, Ernst E (2009) Acupuncture for treating hot flushes in men with prostate cancer: a systematic review. Support Care Cancer 17:763–770

    Article  PubMed  Google Scholar 

  30. O’Sullivan EM, Higginson I (2010) Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review. Acupunct Med 28(4):191–199

    Article  PubMed  Google Scholar 

  31. Lee H, Schmidt K, Ernst E (2005) Acupuncture for the relief of cancer-related pain—a systematic review. Eur J Pain 9:437–444

    Article  PubMed  Google Scholar 

  32. Paley CA, Johnson MI, Tashani OA, Bagnall AM (2011) Acupuncture for cancer pain in adults. Cochrane Database Syst Rev CD007753

  33. Hopkins Hollis AS (2010) Acupuncture as a treatment modality for the management of cancer pain: the state of the science. Oncol Nurs Forum 37(5):E344–E348

    Article  PubMed  Google Scholar 

  34. Lu W, Hu D, Dean-Clower E, Doherty-Gilman A, Legedza ATR, Lee H, Matulonis U, Rosenthal DS (2007) Acupuncture for chemotherapy-induced leukopenia: exploratory meta-analysis of randomized controlled trials. J Soc Integr Oncol 5(1):1–10

    Article  PubMed  Google Scholar 

  35. Ezzo J, Richardson MA, Vicker A, Allen C, Dibble S, Issell BF, Lao L, Pearl M, Ramirez G, Roscoe JA, Shen J, Shivnan JC, Streitberger K, Treish I, Zhang G (2006) Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting (Review). Cochrane Database Syst Rev CD00285 pub 2

  36. Cohen AJ, Menter A, Hale L (2005) Acupuncture: role in comprehensive cancer care-a primer for the oncologist and review of the literature. Integr Cancer Ther 4(2):131–143

    Article  PubMed  Google Scholar 

  37. Lu W, Dean-Clower E, Doherty-Gilman A, Rosenthal DS (2008) The value of acupuncture in cancer care. Haematol Oncol Clin North Am 22(4):631–648

    Article  Google Scholar 

  38. Standish LJ, Kozak L, Congdon S (2008) Acupuncture is underutilized in hospice and palliative medicine. Am J Hosp Palliat Med 25(4):298–308

    Article  Google Scholar 

  39. Lu W, Rosenthal DS (2010) Recent advances in oncology acupuncture and safety considerations in practice. Curr Treat Options in Oncol 11:141–146

    Article  Google Scholar 

  40. O’Regan D, Filshie J (2010) Acupuncture and cancer. Auton Neurosci Basic Clin 157:96–100

    Article  Google Scholar 

  41. Sagar SM (2008) Acupuncture as an evidence-based option for symptom control in cancer patients. Curr Treat Options Oncol 9:117–126

    Article  PubMed  Google Scholar 

  42. Paterson C (2010) Evaluating the effect of treatment from the patient’s perspective. Eur J Orient Med 6(4):36–39

    Google Scholar 

  43. White A (2009) Editorial. Acupunct Med 27(1):p1–p2

    Google Scholar 

  44. Simmons B (2010) Clinical reasoning: concept analysis. J Adv Nurs 66(5):1151–1158

    Article  PubMed  Google Scholar 

  45. MacPherson H, Altman DG, Hammerschlag R, Li Y, Wu T, White A, Moher D (2010) Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. Acupunct Med 28(2):83–96

    Article  PubMed  Google Scholar 

  46. Simmock R, Fallowfield L, Monson K, Solis-Trapala I, Parlour L, Langridge C, Jenkins V, IX Steering Committee (2013) ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol 24(3):776–783

    Article  Google Scholar 

  47. Molassiotis A, Bardy J, Finnegan-John J, Mackereth P, Ryder WD, Filshie J, Ream E, Richardson A (2012) Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized trial. J Clin Oncol 30(36):4470–4476

    Article  PubMed  Google Scholar 

  48. Finnegan-John J, Molassiotis A, Richardson A, Ream E (2013) A systematic review of complementary and alternative medicine interventions for the management of cancer-related fatigue. Integr Cancer Ther 12:276–290

    Article  PubMed  Google Scholar 

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Acknowledgments

P. Towler was supported in undertaking this review by a scholarship from the Cancer Experiences Collaborative, which was funded by the National Cancer Research Institute. We appreciate and acknowledge the contribution of Dr J. Brine, subject librarian for Health and Medicine, Lancaster University, in undertaking the electronic searches.

Conflict of interest

No relevant financial conflict of interest reported for all authors.

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Correspondence to S. G. Brearley.

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Towler, P., Molassiotis, A. & Brearley, S.G. What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews. Support Care Cancer 21, 2913–2923 (2013). https://doi.org/10.1007/s00520-013-1882-8

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  • DOI: https://doi.org/10.1007/s00520-013-1882-8

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