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Study: Acupuncture may ease breast cancer treatment side effects

Summary

Acupuncture can ease some symptoms of breast cancer treatment. Multiple studies found that acupuncture is a safe and effective strategy to manage certain symptoms but also called for more rigorous research on the topic. (Posted 9/28/22) Este artículo está disponible en español.

Acupuncture may ease breast cancer treatment side effects

Relevance

This article is most relevant for People considering acupuncture for managing breast cancer treatment symptoms.

Relevance Rating Details

Relevance: High

Strength of Science: Medium-High

Research Timeline: Post Approval

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Contents

At a glance Questions for your doctor
Study findings Clinical trials
Strengths and limitations Related resources
What does this mean for me?  
   

STUDY AT A GLANCE

What is this study about?

This study looks at past research on acupuncture to manage symptoms (“side effects”) experienced by breast cancer survivors taking hormone therapy. The researchers looked at findings from 26 separate studies on the effectiveness of acupuncture to ease pain, hot flashes, sleep disturbance, fatigue, depression, and neuropathy.

Why is this study important?

Treatment-related symptoms can affect the quality of life for breast cancer patients. Even when drugs successfully control cancer, they can cause pain, fatigue, hot flashes and other symptoms that interfere with daily life. These side effects can affect both physical and mental health and interfere with work and daily activities. People with hormone receptor-positive breast cancer often stay on hormone therapy for up to 10 years—a long time to live with these symptoms. More information can be found in our XRAY review on how breast cancer patients experience hormone therapy.  

Some people stop taking their medication as prescribed because of their side effects. In some cases, the drugs used to manage side effects can cause other symptoms and may be costly (more information can be found in our XRAY review on the cost of medication for the treatment of side effects). Many breast cancer survivors benefit from non-medicinal approaches, such as acupuncture, for symptom management. Acupuncture is generally thought to be safe but it can cause mild reactions, including pain, bruising, swelling, skin infection, hematoma, headache or menstrual bleeding. It is important to study whether acupuncture approaches are a safe and effective option for breast cancer patients.

Study findings

This study is a that summarizes the findings of research from the past 47 years on the use of acupuncture to manage breast cancer treatment-related symptoms. The research team searched articles published between 1974 and 2021 for information on this topic.

They identified studies that tested acupuncture or electroacupuncture (including various needle techniques) compared to an untreated control group. The untreated group could have included sham acupuncture (performed without established acupuncture points, stimulation and manipulation or using a non-penetrating technique), usual care, a “wait list" group or participants who received acupuncture after the study group or another approach such as meditation or relaxation. Studies that looked at acupressure or laser acupuncture were not included.

The researchers looked at how well acupuncture treated the side effects that are common among people taking hormone therapy for breast cancer:

  • Hot flashes (10 studies)
  • Joint pain (5 studies)
  • Sleep disturbances (5 studies)
  • Fatigue (4 studies)
  • Depression (3 studies)
  • (3 studies)
  • Neuropathy (2 studies)

Researchers identified 26 studies that met the criteria, which together included 2,055 people. The participants had completed chemotherapy and were taking hormonal/endocrine therapy at the time of the study.

Studies differed based on where the acupuncture needles were placed. Seventeen studies used manual acupuncture (acupuncture needles are placed and moved by hand to stimulate a region of the body), while nine studies used electroacupuncture (standard acupuncture in which electricity is relayed by the acupuncture needle to stimulate the body).

  • Standard acupuncture places the needle in traditional points in the body.
  • Semi-standard acupuncture uses standard acupuncture points and additional points based on the patient’s needs.
  • Individualized acupuncture plans all needle point locations based on individual patient needs.

Procedure

Number of studies in which acupuncture eased symptoms more than in the untreated group

Standardized acupuncture

5 of 17 (29%)

Semi-standardized acupuncture

8 of 8(100%)

Individualized acupuncture

1 of 1 (100%)*

*Study of hot flashes

People receiving semi-standard acupuncture treatments were more likely to benefit than those who received only the standard acupuncture treatment. A single study that looked at individualized acupuncture alone showed favorable results in easing hot flashes but more research is needed to confirm this approach.

The authors analyzed the overall effect by looking at information from 20 of the 26 studies combined. In this analysis, acupuncture was more effective than untreated groups in reducing the intensity of pain, the severity of hot flashes and fatigue. They then looked at the subgroups of untreated participants and found that:

  • compared to wait list groups or usual care groups, acupuncture offered more relief for pain intensity, fatigue, depression, hot flash severity and neuropathy.
  • when comparing acupuncture to sham acupuncture, the results were less clear. This may be due in part to how the study was designed.
  • acupuncture was more effective than the diet supplement diosmin in managing .

Acupuncture should always be performed by a licensed healthcare provider using sterile, disposable needles. Side effects of acupuncture are usually mild and may include:

  • soreness
  • minor bleeding or bruising at the site where the needles were inserted
  • swelling
  • hematoma (a bad bruise)
  • headache
  • menstrual bleeding
  • skin infection

Strengths and limitations

Strengths

  • This study attempts to summarize all of the research on a topic of high interest to people with breast cancer.
  • The authors looked at results for several common symptoms experienced by people taking hormone therapy.
  • The research team used a thorough approach to evaluate the studies.
  • Multiple researchers were involved in selecting studies to be included, which may decrease bias.

Limitations

  • Little information is provided on the safety of acupuncture, although findings from prior research indicate that acupuncture is safe. Ten studies in this review did not report adverse events.
  • Only 5 of 17 studies that used a standardized acupuncture approach showed improvement with acupuncture, weakening the article’s conclusion.
  • Some of the studies included in the review had small sample sizes.
  • The authors encourage more research on the topic due to biases in 14 studies.
  • The studies of acupuncture versus sham acupuncture cannot be conducted as double-blind research.
  • This study only focused on the side effects of hormone therapy, not other treatment side effects, and does not offer any specific insight into treatment for cancers linked to genetic mutations.

Context

Acupuncture is a technique used in Traditional Chinese Medicine, an Eastern approach to medicine that considers the whole body. Acupuncture is increasingly used in the United States for many purposes and is considered safe and effective for the relief of certain symptoms. More than 60 percent of National Cancer Institute-designated cancer centers offer acupuncture. A 2019 study published in Integrative Medicine Research found that acupuncture improves overall health.

People with breast cancer often stay in treatment for many years. This is especially common among people with hormone receptor-positive breast cancer who may receive endocrine therapy for five to 10 years. Side effects can interfere with daily life, affecting mood and physical wellness.

Conclusions

This study adds to the research on acupuncture of managing side effects from breast cancer treatment. Overall, acupuncture was found to be beneficial compared to usual care or wait list control, especially for severe hot flashes and joint pain. A benefit was also seen for fatigue, depression and neuropathy. Based on these results, the authors recommend incorporating acupuncture into clinical practice. Double-blind control trials are needed to fully assess the impact of acupuncture.
 

What does this mean for me?

If you are experiencing side effects from hormone therapy, acupuncture may provide some relief, especially for hot flashes, joint pain, fatigue, depression or neuropathy. The studies showed that acupuncture may ease the intensity of the pain and hot flashes, although it does not eliminate them. Acupuncture is more effective for than diosmin, a diet supplement derived from citrus fruits. (Diosmin is sometimes used for vein inflammation however there is limited evidence of effectiveness.) Overall, semi-standard acupuncture treatments are more likely to be effective than standard acupuncture treatments. A semi-standard approach incorporates acupuncture points based on the needs of the individual in addition to a standard set of acupuncture points. Acupuncture is generally safe but it can cause mild reactions, including pain, bruising, swelling, skin infection, hematoma, headache or menstrual bleeding.

 

Reference

Li H, Schlaeger JM, Jang MK, et al. Acupuncture Improves Multiple Treatment-Related Symptoms in Breast Cancer Survivors: A Systematic Review and . Journal of Alternative and Complementary Medicine 2021 Dec;27(12):1084-1097. Published online August 27, 2021.

 

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

 

Share your thoughts on this XRAY review by taking our brief survey.  

posted 9/28/22

This article is relevant for:

People considering acupuncture for managing breast cancer treatment symptoms.

This article is also relevant for:

people with breast cancer

men with breast cancer

people newly diagnosed with cancer

people with metastatic or advanced cancer

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Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • Could acupuncture help ease the symptoms I am experiencing from hormone therapy, such as pain, fatigue, hot flashes, depression or neuropathy?
  • Do you offer acupuncture at this clinic, cancer center or hospital? If not, where do you reccommend I go to receive treatment?
  • Will my insurance cover the cost of acupuncture?

Open Clinical Trials
Open Clinical Trials

The following studies are looking at management of side effects: 

Multiple cancers

Breast cancer

Colorectal cancer

Endometrial cancer

Ovarian cancer

  • NCT04533763: Living WELL: A Web-Based Program for Ovarian Cancer Survivors. This studies a group-based and web-delivered tool for ovarian cancer survivors in increasing quality of life and decreasing stress, depressive mood, anxiety, and fatigue across a 12-month period.
  • NCT05047926: Prehabilitation for Advanced Ovarian Cancer Patients. Prehabilitation may improve peri-operative outcomes in patients undergoing cancer surgery. This study will look at structured activity for women undergoing chemotherapy to improve their physical state prior to surgical intervention and thus improve outcomes.

cancer

Updated: 02/15/2023

Open Clinical Trials
Open Clinical Trials

The following are studies on menopause and menopause management for survivors and previvors:

Updated: 03/09/2023

Related Resources
Related Resources

The following organizations have resources related to treatment side effects. 

Updated: 08/06/2022

Related Resources
Related Resources

The following organizations have resources related to menopause for survivors and previvors. 

Updated: 12/25/2022

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Article Rating Details

Study Rating Details

Relevance: High

  • This is a topic of high interest to breast cancer patients who are looking for effective strategies to manage cancer-related side effects, particularly those related to hormone therapy.
  • A meta-analysis, which looks at data from multiple independent studies on the same subject, is a useful way to understand overall trends on a topic.
  • This study only included people receiving hormone therapy after chemotherapy for breast cancer.

Scientific Strength: Medium-High

  • The evidence supports the use of acupuncture over usual care or wait list control.
  • The conclusions don’t entirely address the limitations described in the study.
  • More rigorous randomized control trials of acupuncture versus sham acupuncture are needed.

Research Timeline:  Post approval

  • Acupuncture is widely available to the general public, including people with cancer. While the needles used require FDA approval, the treatment itself is not FDA-approved.