Is acupuncture-point stimulation effective in reducing acute and delayed chemotherapy-induced nausea and vomiting among cancer patients?
Date of publication of the systematic review: April 2006
Design
Systematic review of 11 randomized controlled trials (RCTs).
Participants
1247 patients with various types of cancer. The reviewers did not report mean age and gender proportion of the participants.
Intervention
Acupuncture-point stimulation of all types of methods including electroacupuncture, acupressure, manual acupuncture, and needle stimulation. For electroacupuncture, 2 to 10 Hz was used to apply on acupuncture points P6 or ST36 for 3-30 min before chemotherapy for 1 to 5 days. For acupressure, an acupressure band was worn at P6 continuously for 1 to 7 days. For manual acupuncture, P6 was stimulated for 30 minutes prior to first application of chemotherapy. For needle stimulation, it was applied on P6 with manipulation at the first instance, then the needles was kept inserted for 20 min without additional stimulation.
Comparator
Comparison: Acupuncture-point stimulation plus antiemetics versus antiemetics only or antiemetics with sham acupuncture.
Major Outcomes
Outcome 1: Incidence of acute vomiting within first 24 hours after treatment;
Outcome 2: Acute nausea defined as mean nausea severity in first 24 hours after treatment;
Outcome 3: Delayed nausea defined as mean nausea severity during day 2 to day 5-7 post treatment.
Settings
3 studies were conducted in inpatient settings, while others were in carried out in outpatient settings.
Comparison    Acupuncture-point stimulation plus antiemetics versus antiemetics with or without sham acupuncture
Main Results
Compared to antiemetics with or without sham acupuncture, acupuncture-point stimulation on top of antiemetics showed significant reduction in incidence of acute vomiting (pooled relative risk reduction (RRR): 18%, 95% CI: 1% to 31%). However, it did not show significant reduction in acute mean nausea severity (pooled standardized mean difference (pooled SMD): -0.11, 95% CI: -0.25 to 0.02) or delayed mean nausea severity (pooled SMD: -0.02, 95% CI: -0.17 to 0.12).
Comparison: Acupuncture-point stimulation plus antiemetics versus antiemetics with or without sham acupuncture among subjects with cancer
Outcomes No. of studies (Total number of participants) No of events / No. of participants Heterogeneity test (I2) Pooled RRR (95% CI) Overall quality of evidence*
Intervention Comparator
1 9 (1214) 155/ 714 154/ 500 0.0% 18% (1% to 31%) Moderate
Outcomes No. of studies (Total number of participants) Standardized mean/ No. of participants Heterogeneity test (I2) Pooled SMD (95% CI) Overall quality of evidence*
Intervention Comparator
2 7 (896) 1.28 / 555 1.39 / 341 14% -0.11 (-0.25 to 0.02) Moderate
3 5 (821) 1.71 / 520 1.74 / 301 56% -0.02 (-0.17 to 0.12) Low
Keys: RRR = relative risk reduction; SMD = standardized mean difference; CI = confidence interval.
Comparison    Acupuncture-point stimulation plus antiemetics versus antiemetics with or without sham acupuncture
Main Results
Compared to antiemetics with or without sham acupuncture, acupuncture-point stimulation on top of antiemetics showed significant reduction in incidence of acute vomiting (pooled relative risk reduction (RRR): 18%, 95% CI: 1% to 31%). However, it did not show significant reduction in acute mean nausea severity (pooled standardized mean difference (pooled SMD): -0.11, 95% CI: -0.25 to 0.02) or delayed mean nausea severity (pooled SMD: -0.02, 95% CI: -0.17 to 0.12).
Comparison: Acupuncture-point stimulation plus antiemetics versus antiemetics with or without sham acupuncture among subjects with cancer
Outcomes 1
No. of studies (Total number of participants) 9 (1214)
No of events / No. of participants Intervention 155/ 714
Comparator 154/ 500
Pooled RRR (95% CI) 18% (1% to 31%)
Overall quality of evidence* Moderate
Outcomes 2 3
No. of studies (Total number of participants) 7 (896) 5 (821)
Standardized mean/ No. of participants Intervention 1.28 / 555 1.71 / 520
Comparator 1.39 / 341 1.74 / 301
Pooled SMD (95% CI) -0.11 (-0.25 to 0.02) -0.02 (-0.17 to 0.12)
Overall quality of evidence* Moderate Low
Keys: RRR = relative risk reduction; SMD = standardized mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to antiemetics with or without sham acupuncture, acupuncture-point stimulation on top of antiemetics was effective in reducing the incidence of acute vomiting. However, it did not reduce acute or delayed mean nausea severity among cancer patients significantly. For outcomes 1 and 2, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. For outcome 3, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
Adverse events were minimal and transient, which included skin irritation and transient rash at site where treatment was applied, and aggravation of tingling.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/16625560
The synopsis is based on the following article:
Ezzo JM, Richardson MA, Vickers A, Allen C, Dibble SL, Issell BF, et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database of Systematic Reviews. 2006 Apr 19;(2):CD002285.


* 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.