Study: Acupuncture may ease breast cancer treatment side effects

Relevance: High

Strength of Science: Medium-High

Research Timeline: Post Approval

Relevance Rating Details

What is this study about?

This study looks at past research on acupuncture to manage symptoms (“side effects”) experienced by breast cancer survivors taking hormone therapy. The researchers looked at findings from 26 separate studies on the effectiveness of acupuncture to ease pain, hot flashes, sleep disturbance, fatigue, depression, lymphedema and neuropathy. This type of research that combines results from multiple studies is called a meta-analysis. 

Why is this study important?

Treatment-related symptoms can affect the quality of life for breast cancer patients. Even when drugs successfully control cancer, they can cause pain, fatigue, hot flashes and other symptoms that interfere with daily life. These side effects can affect both physical and mental health and interfere with work and daily activities. People with hormone receptor-positive breast cancer often stay on hormone therapy for up to 10 years—a long time to live with these symptoms. More information can be found in our XRAY review on how breast cancer patients experience hormone therapy.  

Some people stop taking their medication as prescribed because of their side effects. In some cases, the drugs used to manage side effects can cause other symptoms and may be costly (more information can be found in our XRAY review on the cost of medication for the treatment of side effects). Many breast cancer survivors benefit from non-medicinal approaches, such as acupuncture, for symptom management. Acupuncture is generally thought to be safe but it can cause mild reactions, including pain, bruising, swelling, skin infection, hematoma, headache or menstrual bleeding. It is important to study whether acupuncture approaches are a safe and effective option for breast cancer patients.

Study findings

This study summarizes the findings of research from the past 47 years on the use of acupuncture to manage breast cancer treatment-related symptoms. The research team searched articles published between 1974 and 2021 for information on this topic.

They identified studies that tested acupuncture or electroacupuncture (including various needle techniques) compared to an untreated control group. The untreated group could have included sham acupuncture (performed without established acupuncture points, stimulation and manipulation or using a non-penetrating technique), usual care, a “wait list" group or participants who received acupuncture after the study group or another approach such as meditation or relaxation. Studies that looked at acupressure or laser acupuncture were not included.

The researchers looked at how well acupuncture treated the side effects that are common among people taking hormone therapy for breast cancer:

• Hot flashes (10 studies)
• Joint pain (5 studies)
• Sleep disturbances (5 studies)
• Fatigue (4 studies)
• Depression (3 studies)
• Lymphedema (3 studies)
• Neuropathy (2 studies)

Researchers looked at 26 studies which included 2,055 people. The participants had completed chemotherapy and were taking hormonal/endocrine therapy at the time of the study.

Studies differed based on where the acupuncture needles were placed. Seventeen studies used manual acupuncture (acupuncture needles are placed and moved by hand to stimulate a region of the body), while nine studies used electroacupuncture (standard acupuncture in which electricity is relayed by the acupuncture needle to stimulate the body).

• Standard acupuncture places the needle in traditional points in the body.
• Semi-standard acupuncture uses standard acupuncture points and additional points based on the patient’s needs.
• Individualized acupuncture plans all needle point locations based on individual patient needs.

*Study of hot flashes

People receiving semi-standard acupuncture treatments were more likely to benefit than those who received only the standard acupuncture treatment. A single study that looked at individualized acupuncture alone showed favorable results in easing hot flashes but more research is needed to confirm this approach.

The authors analyzed the overall effect by looking at information from 20 of the 26 studies combined. In this analysis, acupuncture was more effective than untreated groups in reducing the intensity of pain, the severity of hot flashes and fatigue. They then looked at the subgroups of untreated participants and found that:

• compared to wait list groups or usual care groups, acupuncture offered more relief for pain intensity, fatigue, depression, hot flash severity and neuropathy.
• when comparing acupuncture to sham acupuncture, the results were less clear. This may be due in part to how the study was designed.
• acupuncture was more effective than the diet supplement diosmin in managing lymphedema.

Acupuncture should always be performed by a licensed healthcare provider using sterile, disposable needles. Side effects of acupuncture are usually mild and may include:

• soreness
• minor bleeding or bruising at the site where the needles were inserted
• swelling
• hematoma (a bad bruise)
• headache
• menstrual bleeding
• skin infection

Context

Acupuncture is a technique used in Traditional Chinese Medicine, an Eastern approach to medicine that considers the whole body. Acupuncture is increasingly used in the United States for many purposes and is considered safe and effective for the relief of certain symptoms. More than 60 percent of National Cancer Institute-designated cancer centers offer acupuncture. A 2019 study published in Integrative Medicine Research found that acupuncture improves overall health.

People with breast cancer often stay in treatment for many years. This is especially common among people with hormone receptor-positive breast cancer who may receive endocrine therapy for five to 10 years. Side effects can interfere with daily life, affecting mood and physical wellness.

Conclusions

This study adds to the research on acupuncture of managing side effects from breast cancer treatment. Overall, acupuncture was found to be beneficial compared to usual care or wait list control, especially for severe hot flashes and joint pain. A benefit was also seen for fatigue, depression and neuropathy. Based on these results, the authors recommend incorporating acupuncture into clinical practice. Double-blind randomized control trials are needed to fully assess the impact of acupuncture.

What does this mean for me?

If you are experiencing side effects from hormone therapy, acupuncture may provide some relief, especially for hot flashes, joint pain, fatigue, depression or neuropathy. The studies showed that acupuncture may ease the intensity of the pain and hot flashes, although it does not eliminate them. Acupuncture is more effective for lymphedema than diosmin, a diet supplement derived from citrus fruits. (Diosmin is sometimes used for vein inflammation however there is limited evidence of effectiveness.) Overall, semi-standard acupuncture treatments are more likely to be effective than standard acupuncture treatments. A semi-standard approach incorporates acupuncture points based on the needs of the individual in addition to a standard set of acupuncture points. Acupuncture is generally safe but it can cause mild reactions, including pain, bruising, swelling, skin infection, hematoma, headache or menstrual bleeding.

Reference

Li H, Schlaeger JM, Jang MK, et al. Acupuncture Improves Multiple Treatment-Related Symptoms in Breast Cancer Survivors: A Systematic Review and Meta-Analysis. Journal of Alternative and Complementary Medicine 2021 Dec;27(12):1084-1097. Published online August 27, 2021.

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

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posted 9/28/22