Lu, W., Matulonis, U.A., Doherty-Gilman, A., Lee, H., Dean-Clower, E., Rosulek, A., . . . Penson, R.T. (2009). Acupuncture for chemotherapy-induced neutropenia in patients with gynecologic malignancies: A pilot randomized, sham-controlled clinical trial. Journal of Alternative and Complementary Medicine, 15, 745–753.

The purpose of the study is to investigate the use of acupuncture during chemotherapy on white blood cell count, absolute neutrophil count, and endogenous G-CSF level.

Patients were randomly assigned to receive acupuncture or sham acupuncture sessions 2–3 times weekly beginning one week prior to chemotherapy cycle 2 and ending at the beginning of cycle 3 of chemotherapy.  A standard acupuncture protocol was administered by five different experienced providers. An electroacupuncture machine was connected to needles and a heat lamp was placed above the feet of the patient. Lab work was obtained at baseline, the nadir of cycle 1 and then every seven days during the study period.

• The sample consisted of 20 participants with a mean age of 50.4 years.
• All participants were female.
• All had newly diagnosed ovarian cancer and were receiving myelosuppressive therapy.

Multiple sites in New England

Active antitumor treatment

 Double-blind, randomized, placebo-controlled trial

• Complete blood counts
• NCI Common Terminology Criteria for Adverse Events (version 3)
   

Five patients withdrew from the trial due to disease progression, side effects of chemotherapy, or time commitment. After patients received six acupuncture sessions, there was a significant different in white blood cell counts between groups in favor of acupuncture (p = 0.04). These differences remained at nadir and the second recovery day. Average absolute neutrophil counts (ANCs) were higher in the acupuncture group at several time points, but this difference was not statistically significant. G-CSF levels in the acupuncture group were about four times higher; however, this difference between groups was not statistically significant.

Acupuncture may be helpful in  in patients receiving myelosuppressive chemotherapy in reducing neutropenia and associated problems. More definitive study in this area is needed to better evaluate the clinical efficacy of acupuncture in this area

• Small sample size (less than 30 participants)
• Intervention was expensive, impractical, or training was needed
• Recruitment was done over 24 months; however, few patients out of a large pool were successfully enrolled. The dropout rate in the study was high. These factors raise the question of practicality to provide this type of intervention. 
• The authors noted that patient travel to receive the acupuncture treatments was a barrier encountered.

Study findings suggest some promise for use of acupuncture among strategies for the prevention of infection; however, due to the very small sample size, no firm conclusions can be drawn. Issues seen in this study point to the problem of time and frequent travel for patients involved in cancer treatment to participate in this type of intervention. Further research in the use of acupuncture with larger trials is needed for further evaluation of efficacy.