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Cancer Treatment Side Effects & Supportive and Palliative Care

Acupuncture for fatigue

Currently, there is only one RCT reporting on the effect of acupuncture in fatigue in cancer survivors. This study involved 40 patients with moderate to severe fatigue who were randomized either to an acupuncture group (n = 15), an acupressure group (n = 16) or a sham acupressure group (n = 16). The acupuncture group received six 20-min sessions over 2 weeks, while the patients in the two acupressure groups were taught to massage/press the points and did so daily thereafter for 2 weeks on their own. Significant improvements were found with regards to general and physical fatigue. At the end of the intervention, there was a 36% improvement in fatigue levels in the acupuncture group, while the acupressure group improved by 19% and the sham acupressure by 0.6%. Improvements were observed even 2 weeks after treatments, although they were lower (22%, 15%, 7%, respectively). Acupuncture was a more effective method than acupressure or sham acupressure. Subjects needed a longer treatment period to have more sustained results.

An uncontrolled pilot trial of acupuncture in post-chemotherapy fatigue in cancer patients has also shown promising results (Vickers et al, 2004). A couple of RCTs are currently underway at major academic centers: one at Sloan-Kettering (Deng et al - randomized controlled trial of acupuncture for post primary treatment fatigue in cancer patient) and another at UCLA (Hui et al- a Phase IIB randomized controlled trial in which acupuncture plus patient education will be compared to standard care for disease-free breast cancer survivors with fatigue).

The positive effect of acupuncture for fatigue has been reported in other patient populations, such as patients with end-stage renal-disease (ESRD) and patients with fibromyalgia. For example, an RCT of 106 patients with end-stage renal-disease (ESRD) randomly assigned patients into acupressure group, sham group or control group. Data of fatigue measures were collected at pretreatment and a week following treatment. Patients in the acupressure group had significantly lower scores of fatigue than patients in the control group.

Safety

Acupuncture is considered a highly safe intervention in the hands of well-trained and licensed providers. Serious side effects from acupuncture are extremely rare. Minor side effects may include bruising in the needling area that usually disappears within 24 hours.

Recommendations

There is one small RCT indicating that acupuncture may be useful to treat fatigue in cancer survivors. Other RCTs are currently underway.

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References - Hide References

  • Molassiotis A, Sylt P, Diggins H. The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial. Complement Ther Med. 2007 Dec;15(4):228-37. Epub 2006 Nov 13.
  • Tsay SL. Acupressure and fatigue in patients with end-stage renal disease-a randomized controlled trial. Int J Nurs Stud. 2004 Jan;41(1):99-1
  • Vickers AJ, Straus DJ, Fearon B, Cassileth BR. Acupuncture for postchemotherapy fatigue: a phase II study. J Clin Oncol. 2004;22(9):1731Ð5.
  • Harris RE, Tian X, Williams DA, Tian TX, Cupps TR, Petzke F, et al. Treatment of fibromyalgia with formula acupuncture: investigation of needle placement, needle stimulation, and treatment frequency. J Altern Complement Med. 2005;11(4):663Ð71.
  • Assefi NP, Sherman KJ, Jacobsen C, Goldberg J, Smith WR, Buchwald D. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Ann Intern Med. 2005;143(1):10Ð9.
  • Hays RD, Brodsky M, Johnston MF, Spritzer KL, Hui KK. Evaluating the statistical significance of health-related quality-of-life change in individual patients. Eval Health Prof. 2005;28(2):160Ð71.
  • Deng G. Principal investigator, memorial sloan-kettering cancer center. Acupuncture for the treatment of chronic post-chemotherapy fatigue: a randomized, phase III trial. ClinicalTrials.gov identifier NCT00200096. http://clinicaltrials.gov.offcampus.lib.washington.edu/ct/show/NCT00200096?order=2.
  • Hui K-K. Principal investigator, UCLA Center for East-West Medicine. Improving fatigue: a pilot study of acupuncture and patient education for breast cancer survivors. Susan G. Komen Breast Cancer Foundation.