Molassiotis, A., Bardy, J., Finnegan-John, J., Mackereth, P., Ryder, D. W., Filshie, J., . . . Richardson, A. (2012). Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized controlled trial. Journal of Clinical Oncology, 30, 4470–4476.

To assess the effectiveness of acupuncture for cancer-related fatigue (CRF) in women with breast cancer.

Women were randomly assigned to acupuncture or enhanced usual care groups. Usual care enhancement consisted of providing a booklet about CRF, diet, exercise, and sleep. The intervention group was offered six acupuncture treatments over six weeks. Sessions lasted 20 minutes each and involved unilateral or bilateral needles at three points. No rotation or flicking of needles was performed. Patients were followed for 18 weeks. Outcome measures were recorded at six weeks.

• The sample was comprised of 246 participants.
• Mean age was 52.5 years (range 25–80).
• All participants were female.
• All participants had breast cancer with no distant metastases. 
• All participants had completed antitumor treatment within one month to five years prior to enrollment. 
• All participants had a baseline fatigue of at least 5 on an 11-point screening scale. 
• Average time since diagnosis was 20.5 months.
• Mean duration of fatigue was 16.5 months.
• Participants were predominantly white, married, and had at least a college education.

• Multisite
• Outpatient
• United Kingdom

The study has clinical applicability for late effects and survivorship.

The study was a randomized, controlled trial.

• Multidimensional Fatigue Inventory (MFI)
• Hospital Anxiety and Depression Scale (HADS)
• Functional Assessment of Cancer Therapy-Breast (FACT-B)
   

The difference score between the control and acupuncture groups for fatigue was –3.11 (95% confidence interval [CI] [–3.97, –2.25]; p < 0.001). Intention-to-treat (ITT) analysis, using an assumption of no improvement for patients whose week six outcome data were missing, continued to show a significant difference (–2.49; p < 0.001). Week six outcomes, as reflected in HADS and FACT-B scores, were significantly improved from baseline in patients who received acupuncture (p < 0.001).

Findings showed that acupuncture as provided was effective in reducing fatigue over a six-week period among survivors of breast cancer.

• The study had a risk of bias due to no blinding.
• Data were missing for 20.3% of the acupuncture group and 13.3% of the control group. The authors performed conservative ITT analysis to account for the missing data. For the intervention group, the authors reported complete data only.
• The authors did not discuss data relative to anxiety or depression.

Findings showed that acupuncture was helpful in reducing fatigue in patients with breast cancer who had completed antitumor treatment. The study supports the effectiveness of acupuncture for the treatment of fatigue.