Acupuncture from the perspective of evidence-based medicine – options of clinical use based on National Comprehensive Cancer Network (NCCN) guidelines


Authors: J. Halámková 1;  R. Dymáčková 2;  D. Adámková Krákorová 1
Authors‘ workplace: Klinika komplexní onkologické péče LF MU a MOÚ Brno 1;  Klinika radiační onkologie LF MU a MOÚ Brno 2
Published in: Klin Onkol 2022; 35(2): 94-99
Category: Review
doi: 10.48095/ccko202294

Overview

Background: Acupuncture is one of the oldest therapeutic methods. The traditional view of acupuncture is represented by influencing energy pathways through stimulation of specific points. The original meridian theory, which works with the assumption of normalization of the flowing energy Qi in the organism is, with increasing evidence, supplemented with information about the bio­logical impact of the use of acupuncture from the perspective of Western medicine. Specific stimulation of particular points on the body leads to the activation of hypothalamus and pituitary gland through neurotransmitters, resulting in a wide range of systemic effects. Stimulation of nerves in the muscle, which then trans­mits a signal to the spinal cord, midbrain, and hypothalamic-pituitary system, releases neurotransmitters, endogenous opioid peptides, or hormones. Stimulation of acupuncture points changes the levels of proinflammatory cytokines, including IL-1-beta, IL-6, IL-17, and TNF-alpha. Currently, according to the National Comprehensive Cancer Network (NCCN) guidelines, the following symptoms are indicated for acupuncture treatment: pain including neuropathic pain, arthralgia, and myalgia, especially in the aromatase inhibitors therapy, nausea, and vomiting, fatigue, vasomotor symptoms in women and vasomotor symptoms in men caused by androgen deprivation therapy. Acupuncture seems to be an effective and safe treatment method for many of the cancer symptoms or the side effects of cancer treatment, but, like any other treatment method, it has its indications and contraindications. Purpose: This work aims to provide a comprehensive overview of the use of acupuncture in defined indications, according to current international guidelines. Thus, the therapeutic possibilities of symptomatic treatment of cancer and therapy of adverse events of oncological treatment can be extended.

Keywords:

Pain – Fatigue – Myalgia – Arthralgia – Acupuncture – Vomiting – guidelines – vasomotor symptoms


Sources

1. Dorfer L, Moser M, Bahr F et al. A medical report from the stone age? Lancet 1999; 354 (9183): 1023–1025. doi: 10.1016/S0140-6736 (98) 12242-0.

2. Fiala P. Akupunktura ve 21. století. Mladá fronta 2018.

3. NIH Consensus Conference. Acupuncture. JAMA 1998; 280 (17): 1518–1524.

4. Wong R, Sagar CM, Sagar SM. Integration of Chinese medicine into supportive cancer care: a modern role for an ancient tradition. Cancer Treat Rev 2001; 27 (4): 235–246. doi: 10.1053/ctrv.2001.0227.

5. He CJ, Gong KH, Xu QZ et al. Effects of microwave acupuncture on the immunological function of cancer patients. J Tradit Chin Med 1987; 7 (1): 9–11.

6. Mayer DJ. Biological mechanisms of acupuncture. Prog Brain Res 2000; 122: 457–477. doi: 10.1016/s0079-6123 (08) 62157-3.

7. Lao L, Zhang G, Wei F et al. Electro-acupuncture attenuates behavioral hyperalgesia and selectively reduces spinal Fos protein expression in rats with persistent inflammation. J Pain 2001; 2 (2): 111–117. doi: 10.1054/jpai.2001.19575.

8. Han Ji-Sheng. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 2003; 26 (1): 17–22. doi: 10.1016/s0166-2236 (02) 00006-1.

9. Joos S, Schott C, Zou H et al. Immunomodulatory effects of acupuncture in the treatment of allergic asthma: a randomized controlled study. J Altern Complement Med 2000; 6 (6): 519–525. doi: 10.1089/acm.2000.6.519.

10. Petti FB, Liguori A, Ippoliti F. Study on cytokines IL-2, IL-6, IL-10 in patients of chronic allergic rhinitis treated with acupuncture. J Tradit Chin Med 2002; 22 (2): 104–111.

11. Wu HG, Zhou LB, Pan YY et al. Study of the mechanisms of acupuncture and moxibustion treatment for ulcerative colitis rats in view of the gene expression of cytokines. World J Gastroenterol 1999; 5 (6): 515–517. doi: 10.3748/wjg.v5.i6.515.

12. Jeong HJ, Hong SH, Nam YC et al. The effect of acupuncture on proinflammatory cytokine production in patients with chronic headache: a preliminary report. Am J Chin Med 2003; 31 (6): 945–954. doi: 10.1142/S0192415X03001661.

13. Langevin HM, Bouffard NA, Badger GJ et al. Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: evidence for a mechanotransduction-based mechanism. J Cell Physiol 2006; 207 (3): 767–774. doi: 10.1002/jcp.20623.

14. Goldman N, Chen M, Fujita T et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nat Neurosci 2010; 13 (7): 883–888. doi: 10.1038/nn.2562.

15. Sato T, Yu Y, Guo SY et al. Acupuncture stimulation enhances splenic natural killer cell cytotoxicity in rats. Jpn J Physiol 1996; 46 (2): 131–136. doi: 10.2170/jjphysiol.46.131.

16. Saraswati W, Gumilar Dahlan E, Saputra K et al. Effect of electroacupuncture on natural-killer cells and tumor size in patients with cervical squamous-cell carcinoma: a randomized controlled trial. Med Acupunct 2019; 31 (1): 29–36. doi: 10.1089/acu.2018.1316.

17. Johnston MF, Sánchez EO, Vujanovic NL et al. Acupuncture may stimulate anticancer immunity via activation of natural killer cells. Evid Based Complement Alternat Med 2011; 2011: 481625. doi: 10.1093/ecam/nep236.

18. Hershman DL, Unger JM, Greenlee H et al. Effect of acupuncture vs sham acupuncture or waitlist control on joint pain related to aromatase inhibitors among women with early-stage breast cancer: a randomized clinical trial. JAMA 2018; 320 (2): 167–176. doi: 10.1001/jama.2018.8907.

19. Mao JJ, Liou KT, Baser RE et al. Effectiveness of electroacupuncture or auricular acupuncture vs usual care for chronic musculoskeletal pain among cancer survivors: the PEACE randomized clinical trial. JAMA Oncol 2021; 7 (5): 720–727. doi: 10.1001/jamaoncol.2021.0310.

20. National Comprehensive Cancer Network. Guidelines detail. [online]. Available from: https: //www.nccn.org/guidelines/guidelines-detail.

21. Ezzo JM, Richardson MA, Vickers A et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database Syst Rev 2006; (2): CD002285. doi: 10.1002/14651858.CD002285.pub2.

22. Widgren YA, Enblom A. Emesis in patients receiving acupuncture, sham acupuncture or standard care during chemo-radiation: a randomized controlled study. Complement Ther Med 2017; 34: 16–25. doi: 10.1016/j.ctim.2017.07.003.

23. Enblom A, Johnsson A, Hammar M et al. Acupuncture compared with placebo acupuncture in radiotherapy-induced nauzea – a randomized controlled study. Ann Oncol 2012; 23 (5): 1353–1361. doi: 10.1093/annonc/mdr402.

24. Enblom A, Steineck G, Hamma M et al. Reduced need for rescue antiemetics and improved capacity to eat in patients receiving acupuncture compared to patients receiving sham acupuncture or standard care during radiotherapy. Evid Based Complement Alternat Med 2017; 2017: 5806351. doi: 10.1155/2017/5806351.

25. Rithirangsriroj K, Manchana T, Akkayagorn L. Efficacy of acupuncture in prevention of delayed chemotherapy induced nausea and vomiting in gynecologic cancer patients. Gynecol Oncol 2015; 136 (1): 82–86. doi: 10.1016/j.ygyno.2014.10.025.

26. Vickers AJ, Straus DJ, Fearon B et al. Acupuncture for postchemotherapy fatigue: a phase II study. J Clin Oncol 2004; 22 (9): 1731–1735. doi: 10.1200/JCO.2004.04.102.

27. Molassiotis A, Bardy J, Finnegan-John J et al. Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized controlled trial. J Clin Oncol 2012; 30 (36): 4470–4476. doi: 10.1200/JCO.2012.41.6222.

28. Zhang Y, Lin L, Huiling L et al. Effects of acupuncture on cancer-related fatigue: a meta-analysis. Support Care Cancer 2018; 26 (2): 415–425. doi: 10.1007/s00520-017-3955-6.

29. Cheng CS, Chen LY, Ning ZY et al. Acupuncture for cancer-related fatigue in lung cancer patients: a randomized, double blind, placebo-controlled pilot trial. Support Care Cancer 2017; 25 (12): 3807–3814. doi: 10.1007/s00520-017-3812-7.

30. Jang A, Brown C, Lamoury G et al. The effects of acupuncture on cancer-related fatigue: updated systematic review and meta-analysis. Integr Cancer Ther 2020; 19: 1534735420949679. doi: 10.1177/1534735420949679.

31. Fabi A, Bhargava R, Fatigoni S et al. Cancer-related fatigue: ESMO Clinical Practice Guidelines for dia­gnosis and treatment. Ann Oncol 2020; 31 (6): 713–723. doi: 10.1016/j.annonc.2020.02.016.

32. Greenlee H, Dupont-Reyes MJ, Balneaves LG et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 2017; 67 (3): 194–232. doi: 10.3322/caac.21397.

33. Lu W, Giobbie-Hurder A, Freedman RA et al. Acupuncture for chemotherapy-induced peripheral neuropathy in breast cancer survivors: a randomized controlled pilot trial. Oncologist 2020; 25 (4): 310–318. doi: 10.1634/theoncologist.2019-0489.

34. Bao T, Patil S, Chen C et al. Effect of acupuncture vs sham procedure on chemotherapy-induced peripheral neuropathy symptoms: a randomized clinical trial. JAMA Netw Open 2020; 3 (3): e200681. doi: 10.1001/jamanetworkopen.2020.0681.

35. Jin Y, Wang Y, Zhang J et al. Efficacy and safety of acupuncture against chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2020; 2020: 8875433. doi: 10.1155/2020/8875433.

36. Ju ZY, Wang K, Cui HS et al. Acupuncture for neuropathic pain in adults. Cochrane Database Syst Rev 2017; 12 (12): CD012057. doi: 10.1002/14651858.CD012057.pub2.

37. Jordan B, Margulies A, Cardoso F et al. Systemic anticancer therapy-induced peripheral and central neurotoxicity: ESMO-EONS-EANO Clinical Practice Guidelines for dia­gnosis, prevention, treatment and follow-up. Ann Oncol 2020; 31 (10): 1306–1319. doi: 10.1016/j.annonc.2020.07.003.

38. Vickers AJ, Vertosick EA, Lewith G et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain 2018; 19 (5): 455–474. doi: 10.1016/j.jpain.2017.11.005.

39. He Y, Guo X, May BH et al. Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta-analysis. JAMA Oncol 2020; 6 (2): 271–278. doi: 10.1001/jamaoncol.2019.5233.

40. Dodin S, Blanchet C, Marc I et al. Acupuncture for menopausal hot flushes. Cochrane Database Syst Rev 2013; 2013 (7): CD007410. doi: 10.1002/14651858.CD007410.pub2.

41. Lesi G, Razzini G, Musti MA et al. Acupuncture as an integrative approach for the treatment of hot flashes in women with breast cancer: a prospective multicenter randomized controlled trial (AcCliMaT). J Clin Oncol 2016; 34 (15): 1795–1802. doi: 10.1200/JCO.2015.63.2893.

42. Soares JM, Branco-De-Luca AC, da Fonseca AM et al. Acupuncture ameliorated vasomotor symptoms during menopausal transition: single-blind, placebo-controlled, randomized trial to test treatment efficacy. Menopause 2020; 28 (1): 80–85. doi: 10.1097/GME.0000000000001 651.

43. Walker EM, Rodriguez AI, Kohn B et al. Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. J Clin Oncol 2010; 28 (4): 634–640. doi: 10.1200/JCO.2009.23.5150.

44. Mao JJ, Bowman MA, Xie SX et al. Electroacupuncture versus gabapentin for hot flashes among breast cancer survivors: a randomized placebo-controlled trial. J Clin Oncol 2015; 33 (31): 3615–3620. doi: 10.1200/JCO.2015.60.9412.

45. Johns C, Seav SM, Dominick SA et al. Informing hot flash treatment decisions for breast cancer survivors: a systematic review of randomized trials comparing active interventions. Breast Cancer Res Treat 2016; 156 (3): 415–426. doi: 10.1007/s10549-016-3765-4.

46. Li S, Wang Z, Wu H et al. Electroacupuncture versus sham acupuncture for perimenopausal insomnia: a randomized controlled clinical trial. Nat Sci Sleep 2020; 12: 1201–1213. doi: 10.2147/NSS.S282315.

47. Palma F, Fontanesi F, Facchinetti F et al. Acupuncture or phy (F) itoestrogens vs. (E) strogen plus progestin on menopausal symptoms. A randomized study. Gynecol Endocrinol 2019; 35 (11): 995–998. doi: 10.1080/09513590.2019.1621835.

48. Ashamalla H, Jiang ML, Guirguis A et al. Acupuncture for the alleviation of hot flashes in men treated with androgen ablation therapy. Int J Radiat Oncol Biol Phys 2011; 79 (5): 1358–1363. doi: 10.1016/j.ijrobp.2010.01.025.

49. Beer TM, Benavides M, Emmons SL et al. Acupuncture for hot flashes in patients with prostate cancer. Urology 2010; 76 (5): 1182–1188. doi: 10.1016/j.urology.2010.03.033.

50. Filshie J, Bolton T, Browne D et al. Acupuncture and self acupuncture for long-term treatment of vasomotor symptoms in cancer patients – audit and treatment algorithm. Acupunct Med 2005; 23 (4): 171–180. doi: 10.1136/aim.23.4.171.

51. Frisk J, Spetz AC, Hjertberg H et al. Two modes of acupuncture as a treatment for hot flushes in men with prostate cancer – a prospective multicenter study with long-term follow-up. Eur Urol 2009; 55 (1): 156–163. doi: 10.1016/j.eururo.2008.02.002.

52. Qan’ir Y, DeDeaux D, Godley PA et al. Management of androgen deprivation therapy-associated hot flashes in men with prostate cancer. Oncol Nurs Forum 2019; 46 (4): E107–E118. doi: 10.1188/19.ONF.E107-E118.

53. Lopez G, Garcia MK, Liu W et al. Outpatient acupuncture effects on patient self-reported symptoms in oncology care: a retrospective analysis. J Cancer 2018; 9 (19): 3613–3619. doi: 10.7150/jca.26527.

54. Kasymjanova G, Grossman M, Tran T et al. The potential role for acupuncture in treating symptoms in patients with lung cancer: an observational longitudinal study. Curr Oncol 2013; 20 (3): 152–157. doi: 10.3747/co.20.1312.

55. Miller KR, Patel JN, Symanowski JT et al. Acupuncture for cancer pain and symptom management in a palliative medicine clinic. Am J Hosp Palliat Care 2019; 36 (4): 326–332. doi: 10.1177/1049909118804464.

Labels
Paediatric clinical oncology Surgery Clinical oncology

Article was published in

Clinical Oncology

Issue 2

2022 Issue 2

Most read in this issue
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account