Shen, J., Wenger, N., Glaspy, J., Hays, R.D., Albert, P.S., Choi, C., & Shekelle, P.G. (2000). Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA, 284, 2755-2761.

To compare the effectiveness of electroacupuncture, minimal needling and mock electrical stimulation, or antiemetic medications alone in controlling emesis among patients undergoing highly emetogenic chemotherapy

Participants were randomly assigned to one of three groups.

• Low-frequency electroacupuncture at classic antiemetic acupuncture points once daily for five days
• Minimal needling at control points with mock electrostimulation once daily for five days
• No adjunct needling

• The study consisted of 104 patients.
• The mean age was 46 years with a range of 18–62 years.
• All participants were women with histologically proven resected breast cancer undergoing myeloablative chemotherapy, Karnofsky scores of 80 or more (on a 0–100 scale), and life expectancy of at least six months. All participants were appropriate candidates for bone marrow transplantation.
• Patients were excluded from the study if they had brain metastases, cardiac pacemakers, life-threatening concurrent nonmalignant conditions, or active skin infections over the proposed treatment area.

Participants were from an inpatient unit at a tertiary hospital with a comprehensive cancer center. Patients were recruited from oncology clinics.

The study design was random, without stratification.

Investigators recorded the total number of emetic episodes during the five-day study period and the proportion of emesis-free days across the treatment groups.

• The electroacupuncture group had significantly fewer emesis episodes than the minimal needling group or the pharmacotherapy group alone (p < 0.001).
• The minimal needling group had significantly fewer episodes of emesis than the pharmacotherapy group alone (p = 0.01).
• The electroacupuncture group had a greater proportion of emesis-free days than the other groups (p < 0.001).
• No significant difference existed between the groups over days 6–14.

• Homogeneity of sample (standard chemotherapy and supportive care) helped to increase the precision in measurement; however, generalizability is limited.
• The study did not include 5-HT₃ antagonists or corticosteroids.
• Training is required for electroacupuncture and minimal needling. The two investigators administered the procedure (training completed with 3–20 years of experience).
• Time commitment was 30 minutes a day for five days.
• This was a grant-funded project. 

• The beneficial effect of electroacupuncture may be related to attention and clinician-patient interaction.
• Minimal needling led to a reduction in emesis, which could have been a placebo effect.
• Electroacupuncture has been thought to modulate serotonin, substance P, and endogenous opioids (similar to drugs that are available now).