Can acupuncture and related therapies manage symptoms in cancer patient receiving palliative care?
Date of publication of the systematic review: March 2016
Design
Systematic review of 13 randomized controlled trials (RCTs).
Participants
A total of 912 participants (age range: 41 to 73 years, overall male % range: 58 to 100%) with any type of cancer.
Intervention
Acupuncture and related therapies with duration ranged from 5 to 60 minutes for each session over 1 week to 24 weeks, at a frequency of 1 session daily or on alternate days.
Comparator
Comparison 1: Manual acupuncture plus acupoint injection or with add-on moxibustion versus control group (analgesics) for pain reduction;
Comparison 2: Manual acupuncture plus Kushen injection or Chinese herbal medicine versus control groups (Kushen injection or Chinese herbal medicine) for improving quality of life.
Major Outcomes
Outcome 1: Pain reduction in Numeric Rating Scale (NRS), measured with a 0 (no pain) to 10 (most intolerable pain);
Outcome 2: Quality of life improvement, measured with Karnofsky Performance Status and Quality of Life Scale.
Settings
The reviewers did not state whether the study was conducted in in-patient or out-patient settings.
Comparison    Manual acupuncture plus acupoint injection or with add-on moxibustion versus control group for pain reduction
Main Results
Manual acupuncture plus acupoint injection or with add-on moxibustion group had resulted in significantly reduced pain score (pooled weighted mean difference: -0.76, 95% CI: -0.39 to -0.14) when compared to control interventions.
Comparison: Manual acupuncture plus acupoint injection or with add-on moxibustion versus control group for pain reduction
Outcomes (unit) No. of studies (Total no. of participants) Mean pain reduction (SD)/ No. of participants Heterogeneity test (I2) Pooled WMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NRS) 2 (120) Not reported/60 Not reported/60 0% -0.76 (-0.39 to -0.14) High
Keys: NRS= numerical rating scale; SD= standard deviation; Pooled WMD: pooled weighted mean difference; CI: confidence interval.
Comparison    Manual acupuncture plus Kushen injection or Chinese herbal medicine versus control group for improving quality of life
Main Results
Manual acupuncture plus Kushen injection or Chinese herbal medicine group had resulted in significantly improved quality of life (pooled standardized mean difference: 0.75, 95% CI: 0.36 to 1.13) compared to control.
Comparison: Manual acupuncture plus Kushen injection or Chinese herbal medicine intervention versus control group for improving quality of life
Outcomes No. of studies (Total no. of participants) Mean quality of life improvement (SD)/ No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) Overall quality of evidence*
Intervention Comparator
2 2 (120) Not reported/60 Not reported/60 0% 0.75 (0.36 to 1.13) High
Keys: SD= standard deviation; Pooled SMD: pooled standardized mean difference; CI: confidence interval.
Comparison    Manual acupuncture plus acupoint injection or with add-on moxibustion versus control group for pain reduction
Main Results
Manual acupuncture plus acupoint injection or with add-on moxibustion group had resulted in significantly reduced pain score (pooled weighted mean difference: -0.76, 95% CI: -0.39 to -0.14) when compared to control interventions.
Comparison: Manual acupuncture plus acupoint injection or with add-on moxibustion versus control group for pain reduction
Outcomes (unit) 1 (NRS)
No. of studies (Total no. of participants) 2 (120)
Mean pain reduction (SD)/ No. of participants Intervention Not reported/60
Comparator Not reported/60
Pooled WMD (95% CI) -0.76 (-0.39 to -0.14)
Overall quality of evidence* High
Keys: NRS= numerical rating scale; SD= standard deviation; Pooled WMD: pooled weighted mean difference; CI: confidence interval.
Comparison    Manual acupuncture plus Kushen injection or Chinese herbal medicine versus control group for improving quality of life
Main Results
Manual acupuncture plus Kushen injection or Chinese herbal medicine group had resulted in significantly improved quality of life (pooled standardized mean difference: 0.75, 95% CI: 0.36 to 1.13) compared to control.
Comparison: Manual acupuncture plus Kushen injection or Chinese herbal medicine intervention versus control group for improving quality of life
Outcomes 2
No. of studies (Total no. of participants) 2 (120)
Mean quality of life improvement (SD)/ No. of participants Intervention Not reported/60
Comparator Not reported/60
Pooled SMD (95% CI) 0.75 (0.36 to 1.13)
Overall quality of evidence* High
Keys: SD= standard deviation; Pooled SMD: pooled standardized mean difference; CI: confidence interval.
Conclusion
Benefits
(i) Manual acupuncture plus acupoint injection or with add-on moxibustion and (ii) manual acupuncture plus Kushen injection or Chinese herbal medicine had both shown significant benefits of reducing pain and improving quality of life respectively, among patients with any type of cancer. For outcomes 1 and 2, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported for the above two comparisons.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26945382
The synopsis is based on the following article:
Lau CH, Wu X, Chung VC, Liu X, Hui EP, Cramer H, Lauche R, Wong SY, Lau AY, Sit RS, Ziea ET. Acupuncture and related therapies for symptom management in palliative cancer care: systematic review and meta-analysis. Medicine. 2016 Mar;95(9).


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.