Category: Cancer Care

Acupuncture can make a useful contribution in cancer care. There is no evidence that it can treat or cure cancer, but used alongside conventional oncology, it can help relieve some cancer symptoms and the side effects of treatment.

The respected journal Supportive Care in Cancer has in 2024 published the first international, multidisciplinary, peer-reviewed recommendations for safe acupuncture practice in integrative oncology. These recommendations conclude by saying “It (acupuncture) should be routinely considered, and ideally offered, as part of the multi-disciplinary approach to cancer care, as it can be administered safely within and outside of oncology settings, at any stage of the cancer survivorship pathway.”

Cancer Research UK has a summary of acupuncture and how it may be useful to patients. They point out that acupuncture is generally safe, gives very few side effects, and that most studies show that acupuncture is better than no treatment at all. Furthermore, it is as good as or better than, standard treatment for chemotherapy-related sickness, tiredness, pain, anxiety and stress, depression, mood changes, quality of life, and hot flushes.

The American Society of Clinical Oncology says in its 2022 Guideline that among adult patients, acupuncture should be recommended for aromatase inhibitor–related joint pain, and it may be recommended for general cancer pain or musculoskeletal pain. These recommendations are based on an intermediate level of evidence, with the benefit outweighing the risk, and with moderate strength of recommendation.

You can read below the results of some of the research which has been undertaken into acupuncture in cancer care. The trials vary in quality, but systematic reviews and randomised controlled trials are generally considered to provide the highest quality evidence. If you would like to read more about evidence quality, I would refer you to the British Acupuncture Council’s description of the evidence pyramid.

Acupuncture helps hot flushes in breast cancer therapy, concludes an international research team from America, South Korea and China. The trial enrolled 158 women receiving treatment for stage 0 to 3 breast cancer, and who were experiencing hot flushes. They joined three parallel trials in each of the three participating countries, and were randomised to receive either immediate acupuncture or delayed acupuncture as a control.

Immediate acupuncture patients were given 20 sessions over 10 weeks. Delayed acupuncture patients received usual care, then crossed over to receive acupuncture at a reduced intensity.

At week 10, immediate acupuncture patients reported statistically and clinically significant improvements in endocrine symptom scores, hot flushes and cancer therapy-related quality of life scores, compared with delayed acupuncture patients.

(Acupuncture for hot flashes in hormone receptor-positive breast cancer: A pooled analysis of individual patient data from parallel randomized trials. Cancer – Journal of the American Cancer Society, 24 June 2024.)

Acupuncture helps radiotherapy-induced xerostomia concludes an American research team. They found it more effective than standard oral hygiene, for patients who had been undergoing treatment for head and neck cancer.

The team identified 258 patients, mean age 65, experiencing xerostomia after their therapy, and divided them into three groups: true acupuncture, sham control acupuncture and standard oral hygiene (mouth rinses, lip balms, hydration etc). Acupuncture was given twice a week for four weeks, plus an additional four weeks for patients showing a minor response. Treatments were administered at 33 centres across 12 states.

At week four, the true acupuncture group showed significantly lower xerostomia and higher quality of life scores than either of the other two groups. At the week 4 point, 31% of patients receiving true acupuncture had received a partial treatment response. This compared with 17% and 14% for sham acupuncture and standard care respectively. Differences between true acupuncture and standard care remained at week 12 follow-up.

The sham acupuncture group improved over time but took until week 26 to show a significant difference from standard care. By this time, there were no longer any significant differences between the true and sham acupuncture groups.

The authors conclude that acupuncture is minimally invasive and inexpensive, has a low incidence of adverse effects, and was found to be superior to standard care. They go on to say that although acupuncture mechanisms are not well understood, findings from multiple studies suggest possible central nervous system effects through manipulation of the fascia. Studies have revealed significantly increased blood flow in the skin of the cheek of patients with xerostomia. Other plausible hypotheses suggest that increased production of certain neuropeptides after acupuncture stimulation may cause vasodilation and increased microcirculation. Research has explored neuronal substrates during acupuncture, using functional magnetic resonance imaging. True acupuncture was associated with activation of areas of the brain where sensory stimuli and expectation/suggestion signals are integrated, an effect not seen with sham treatment.

(Acupuncture for Chronic Radiation-Induced Xerostomia in Head & Neck Cancer: A Multicenter Randomized Clinical Trial. Journal of the American Medical Association Network Open, 13 May 2024.)

A new survey has been undertaken in the US, to try to learn more about the extent to which acupuncture and Chinese herbal medicine are being used in cancer care. Collaborating authors were drawn from: Dana-Farber Cancer Institute, Harvard Medical School, Boston; Memorial Sloan Kettering Cancer Center, New York; Fred Hutchinson Cancer Center, Seattle; Indiana University School of Medicine, Bloomington; Refuot Integrative Medical Center, Tel Aviv.

Demographic and usage data was gathered from five clinics, each giving between 1100 and 4500 acupuncture treatments per year. In addition, to better understand the barriers faced by acupuncture and herbal medicine clinics in implementing their treatment modalities, over 2000 members of the Society for Integrative Oncology were approached worldwide for a survey. The authors knew that as of 2016, 73% of National Cancer Institute-designated cancer centres offered acupuncture, and that numerous clinical guidelines now include acupuncture for the management of symptoms in cancer care.

Key reasons for referral to acupuncture in the oncology centres surveyed here included pain/neuropathy, fatigue, low blood counts, insomnia, hot flushes and nausea/digestive dysfunction. A significant barrier to accessing acupuncture is cost: a review of covered nonpharmacologic pain options among 15 US insurance plans found only 1 in 5 offered acupuncture cover. Geographic accessibility is another barrier, with more than 50% of licensed acupuncturists concentrated in California, Florida and New York alone.

The authors say it was not surprising that pain and neuropathy were the primary reasons for a medical oncologist to refer a patient for acupuncture. There was a lack of referrals for immune support, despite some evidence in the literature on effects of acupuncture on neutropenia in patients receiving myelosuppressive chemotherapy.

In 1997 a 12-member panel at a National Institutes of Health Consensus Conference concluded there is clear evidence that acupuncture treatment is effective for postoperative and chemotherapy nausea and vomiting. Numerous clinical trials have since demonstrated the effectiveness of acupuncture for other cancer-related symptoms including cancer related pain, chemotherapy-induced peripheral neuropathy, fatigue, hot flushes, xerostomia, lymphedema, dyspnoea, cachexia, dysphagia, post-operative pain, anxiety, depression, insomnia, constipation, diarrhoea and the joint pains associated with aromatase inhibitors. The growth in data on the safety and efficacy of acupuncture in the treatment of cancer-related symptoms and treatment side effects, has been a driving factor behind the inclusion of evidence-based recommendations of acupuncture in public health statements by national and state governments, health departments and clinical practice guidelines for patients with lung and breast cancers. The inclusion of acupuncture in these clinical practice guidelines indicates broad support for acupuncture and an increasing acceptance of including acupuncture in standard cancer care by oncologists, conventional medical providers, and health systems including cancer centres.

In addition to the recommendations in clinical practice guidelines, acupuncture is recommended by the American Cancer Society (ACS) for the treatment of side effects associated with conventional cancer therapy and cancer-related ailments.

The authors conclude that among other things, an organised strategy for implementation of acupuncture and Chinese herbal medicine in oncology settings, involving a diverse group of federal and private payers and policymakers, is needed.

(Characteristics and Challenges of Providing Acupuncture and Chinese Herbal Medicine in Oncology Treatment: Report of Survey Data and Experience of Five Unique Clinical Settings. Integrative Cancer Therapies, 30 January 2024.)

Acupuncture and massage for cancer pain have been studied in a large American multi-centre pragmatic trial. Both were found to be associated with pain reduction, and improved fatigue, insomnia and quality of life.

Nearly 300 patients, mean age 59, with advanced cancer, moderate to severe pain and life expectancy of six months or more, were selected. Patients were randomised to receive either acupuncture or massage, which was given weekly for ten weeks, then monthly up to the 26 week point.

Over the 26 weeks of treatment, acupuncture was found to reduce the worst pain scores by a mean of 2.5 whilst massage reduced the same scores by a mean 3.0. The difference between the two groups was not significant. Both treatments also improved fatigue, insomnia and quality of life.

(Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer: The IMPACT Randomised Clinical Trial. Journal of the American Medical Association Network Open, 14 November 2023.)