Is manual acupuncture effective in symptom management among breast cancer patients?
Date of publication of the randomized controlled trial: February 2014
Design
Randomized controlled trial (RCT).
Participants
51 postmenopausal women with stage 0-III hormone-receptor-positive breast cancer receiving aromatase inhibitors (AIs) therapy for at least 1 month who reported AI-associated musculoskeletal symptoms (AIMSS) (median age: 61 years).
Intervention
Manual acupuncture was provided for 8 weeks. The researcher did not report the length and frequency of each session of manual acupuncture. Patients received acupuncture in CV4, CV6, CV12, bilateral LI4, MH6, GB34, ST36, KI3, BL65 points.
Comparator
Comparison: Manual acupuncture versus sham acupuncture. For sham acupuncture, non-penetrating retractable needles were placed in 14 acupoints.
Major Outcomes
Outcome 1: Depression or depressive symptoms as assessed by the Center for Epidemiologic Studies Depression Scale (CESD) at week 8;
Outcome 2: Severity of hot flashes as assessed by Hot Flash Daily Diary at week 8;
Outcome 3: Severity of hot flashes as assessed by Hot Flash Related Daily Interference Scale (HFRDI) at week 8;
Outcome 4: Menopausal symptoms as assessed by the revised National Surgical Adjuvant Breast and Bowel Project (NSABP) at week 8.
Settings
The researcher did not state whether the trial was conducted in inpatient or outpatient settings.
Comparison    Manual acupuncture versus sham acupuncture
Main Results
Compared to baseline, patients in manual acupuncture group improved significantly at week 8 on the CESD depressive symptoms, hot flashes severity as assessed by Hot Flash Daily Diary and HFRDI and NSABP menopausal symptoms. However, compared to sham acupuncture, manual acupuncture did not provide significant impacts on patient reported outcomes among breast cancer patients.
Comparison: Manual acupuncture versus sham acupuncture in patients with breast cancer at week 8
Outcomes (units) No. of studies (Total no. of participants) Median score(IQR) / No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 1 (47) 10(10.5)/ 23 6(11.25)/ 24 Not applicable as there is only 1 study Not reported 0.442 Low
2 (NA) 1 (47) 14(32.5)/ 23 10(47.25)/ 24 Not applicable as there is only 1 study Not reported 0.467 Low
3 (NA) 1 (47) 4(13.5)/ 23 6(18.5)/ 24 Not applicable as there is only 1 study Not reported 0.633 Low
4 (NA) 1 (47) 18(18.5)/ 23 19(17)/ 24 Not applicable as there is only 1 study Not reported 0.463 Low
Keys: IQR= interquartile range, MD = mean difference, CI = confidence interval.
Comparison    Manual acupuncture versus sham acupuncture
Main Results
Compared to baseline, patients in manual acupuncture group improved significantly at week 8 on the CESD depressive symptoms, hot flashes severity as assessed by Hot Flash Daily Diary and HFRDI and NSABP menopausal symptoms. However, compared to sham acupuncture, manual acupuncture did not provide significant impacts on patient reported outcomes among breast cancer patients.
Comparison: Manual acupuncture versus sham acupuncture in patients with breast cancer at week 8
Outcomes (units) 1 (NA) 2 (NA) 3 (NA) 4 (NA)
No. of studies (Total no. of participants) 1 (47) 1 (47) 1 (47) 1 (47)
Median score(IQR) / No. of participants Intervention 10(10.5)/ 23 14(32.5)/ 23 4(13.5)/ 23 18(18.5)/ 23
Comparator 6(11.25)/ 24 10(47.25)/ 24 6(18.5)/ 24 19(17)/ 24
MD (95% CI) Not reported Not reported Not reported Not reported
p value 0.442 0.467 0.633 0.463
Overall quality of evidence* Low Low Low Low
Keys: IQR= interquartile range, MD = mean difference, CI = confidence interval.
Conclusion
Benefits
Manual acupuncture was associated with improvement in the CESD depressive symptoms, hot flashes severity as assessed by Hot Flash Daily Diary and HFRDI and NSABP menopausal symptoms at week 8. However, compared to sham acupuncture, acupuncture did not provide significant improvements on patient reported outcomes among breast cancer patients. For all outcomes, 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
No adverse events were reported in this trial.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/24375332
The synopsis is based on the following article:
Bao T, Cai L, Snyder C, Betts K, Tarpinian K, Gould J, et al. Patient‐reported outcomes in women with breast cancer enrolled in a dual‐center, double‐blind, randomized controlled trial assessing the effect of acupuncture in reducing aromatase inhibitor‐induced musculoskeletal symptoms. Cancer. 2014 Feb 1;120(3):381-9.


* 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.