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Acupuncture for chemotherapy or radiotherapy-induced nausea and vomiting

Evidence-Based Clinical Practice Guidelines
American College of Chest Physicians

In cancer patients experiencing nausea and vomiting from chemotherapy or radiotherapy, does acupuncture as an adjunct treatment option reduce the symptoms?
        After initial review of potential articles, 16 unique studies were deemed eligible, 15 of which were original articles, with one systemic review. A high-quality Cochrane systematic review of 11 trials (total N=1,247) concluded that electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies combining electroacupuncture with state-of-the-art antiemetics and in patients with refractory symptoms are needed to determine clinical relevance. Self-administered acupressure appears to have a protective effect for acute nausea and can readily be taught to patients though studies did not involve placebo control. Noninvasive electrostimulation appears unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.
        Another systematic review of more than 40 randomized controlled trials (RCTs) in nonchemotherapy settings supports the role of acupuncture in preventing or attenuating nausea and vomiting. Studies published since the Cochrane review are, in general, consistent with these findings.

Acupuncture for CIPN and cancer-related pain
In cancer patients whose lung cancer whose cancer-related pain and peripheral neuropathy is not controlled adequately, does acupuncture as an adjunct treatment help reduce the symptoms?
        After initial review for CIPN articles, five were selected: one RCT, three prospective case series or reports, and one retrospective review. The RCT compared acupuncture with vitamin B12, but only the abstract was evaluated. The prospective trials may lend themselves to potentially larger trials that may evaluate efficacy; however, the data given were inconclusive.
        After our initial search for articles on cancer-related pain and acupuncture, 19 were selected, 12 of which were RCTs, one a prospective trial, and six case series trials. The RCTs involving head and neck cancer- and breast cancer-related pain showed improvement in pain scores (Brief Pain Inventory). No difference was seen for postthoracotomy pain vs sham acupuncture. The case series trials suggested improvement in pain scale scores (Brief Pain Inventory and numerical rating measurements) and symptoms related to pain.
        Overall, there is a paucity of data on whether acupuncture could be useful in the treatment of CIPN. Small case series show some improvement in visual analog pain scale and neuropathy symptoms. Although data for cancer-related pain are more abundant, the data only support potential benefit in breast and head and neck cancer. There does not seem to be an improvement in pain control for postsurgical patients.

Recommendations

1. In patients having nausea and vomiting from either chemotherapy or radiation therapy, acupuncture or related techniques is suggested as an adjunct treatment option.

2. In patients with cancer related pain and peripheral neuropathy, acupuncture is suggested as an adjunct treatment in patients with inadequate control of symptoms.

Safety
After initial review of safety-related articles for acupuncture treatments, nine articles, none of which were specific to patients with cancer, were included for discussion, and all were review articles. Two articles reviewed acupuncture treatments in the pediatric population. Two reviews are presented that are meta-analyses of review articles, and two reviews evaluated prospective trials and case reports in the literature. The remaining three reviews evaluated responses from practitioners with regard to adverse events. The rate of pneumothorax was reported as one in 150,000. In the prospective responder studies, no severe events were noted; however, the retrospective review showed numerous pneumothorax, hepatitis, and spinal cord injury. Mild adverse event rates are reported as 1% to 10% in the pediatric population.
        Therefore, acupuncture is generally safe when performed by qualified professional practitioners. Serious adverse events from acupuncture have been reported in the literature but appear to be rare. Precautions, including follow-up and infectious precautions, should be taken to reduce the rates of serious events.

Acupuncture supports cancer care

An increasing body of evidence supports the use of acupuncture for the control of cancer-related symptoms.

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