Garcia, M. K., McQuade, J., Haddad, R., Patel, S., Lee, R., Yang, P., . . . Cohen, L. (2013). Systematic review of acupuncture in cancer care: a synthesis of the evidence. Journal of Clinical Oncology, 31, 952–960.

To evaluate the effectiveness of acupuncture for symptom control in patients with cancer.

Databases searched were MEDLINE, EMBASE, CINAHL, Cochrane Collaboration, Scopus, and PubMed through December 2011.

Search keywords were acupuncture, electroacupuncture, moxibustion, Chinese medicine, Asian medicine, and keywords that included cancer and cancer symptoms.

Studies were included in the review if they

• Were randomized, clinical trials (RCTs)
• Involved acupuncture with needle insertion
• Compared acupuncture to control, placebo, or sham acupuncture.

Studies were excluded from the review if they

• Compared two active acupuncture forms, acupressure, or other interventions similar to acupuncture that did not involve needle insertion
• Did not measure the effect of acupuncture on symptoms
• Were considered gray literature (i.e., not generally accessible).

In total, 3,494 references were retrieved and evaluated according to the Cochrane Handbook for Systematic Reviews of Interventions.

• The final number of studies included was 41.
• The authors did not provide the sample range across studies, total number of patients, disease types, or characteristics.

Studies addressed potential management of the following symptoms:

• Pain:  Eleven RCTs met the criteria for analysis. No large trials reported positive results or were of good quality.
• Chemotherapy-Induced Nausea and Vomiting (CINV):  Eleven RCTs met the criteria for analysis. One large study with a low risk of bias showed between-group effect sizes for acupuncture versus sham (0.80) and for acupuncture versus usual care (1.10).
• Fatigue:  Three RCTs met the criteria for analysis. All had high risks of bias, and two had negative outcomes.
• Hot Flashes:  Seven RCTs met the criteria for analysis. None had a low risk of bias.
• Anxiety or Depression:  Five of the six RCTs analyzed showed positive results. All five had high risks of bias.
• Sleep:  Three RCTs met the criteria for analysis, and all three reported positive outcomes and had high risks of bias.

The strongest evidence that the study produced showed that acupuncture may be effective for the management of CINV. The study did not show acupuncture to be efficacious in the treatment of other symptoms.

The studies included were of low quality.

Available evidence, which was limited, did not support the claim that acupuncture is effective in alleviating various adverse symptoms in adults with cancer. Additional research is needed to determine the efficacy. The findings of this analysis suggested that patients with uncontrolled CINV may be appropriate candidates for acupuncture referral. For the treatment of other symptoms, the efficacy is undetermined.