Wang, T., Deng, R., Tan, J.Y., & Guan, F.G. (2016). Acupoints stimulation for anxiety and depression in cancer patients: A quantitative synthesis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2016, 5645632. 

DOI Link

Purpose

STUDY PURPOSE: To review randomized, controlled trials on the current evidence on the therapeutic effects of acupoints stimulation for patients with cancer with anxiety and depression

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: PubMed, CENTRAL, CINAHL, AMED, PsycINFO, ISI Web of Science, Science Direct, WanFang Data, China National Knowledge Infrastructure, Chinese Scientific Journal DataBase
 
INCLUSION CRITERIA: Randomized, controlled trials comparing acupoints stimulation to one or more of the following: sham acupoints stimulation, standard treatment/care, or waitlist control. Participants had to be patients with cancer and anxiety or depression regardless of age. Included trials published in English or Chinese
 
EXCLUSION CRITERIA: None specifically identified

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,135
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Two different reviewers. Literature search of 10 databases. Articles reviewed for primary outcome data measures of anxiety and depression. Methodological quality assessment was conducted on each trial with the 2015 risk of bias criteria provided by the Cochrane Back and Neck Group. Synthesis of data was conducted by Review Manager, version 5.3. The studies included nine English and two Chinese articles published between 2006 and 2014.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 11
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,073
  • SAMPLE RANGE ACROSS STUDIES: 30–302
  • KEY SAMPLE CHARACTERISTICS: Six studies were of breast cancer; one, lung; one, gynecologic; and three involved more than two types of cancer. Eight had a two-arm design, and three had a three-arm design. All assessed anxiety and/or depression.

Phase of Care and Clinical Applications

APPLICATIONS: Palliative care

Results

Acupoints may be a useful approach for managing anxiety and depression with limited risks, but should be interpreted with caution because of the limitations identified. Definite evidence still cannot be concluded from this review. The studies included had a number of methodological flaws, which alters the reliability.
 
Depression: acupoints stimulation could improve depression in patients with cancer, but trials were inconsistent in the types of acupoints used. Both manual and electroacupuncture showed positive effects on depression, but identified methodological approaches were flawed.
 
Anxiety: encouraging results on acupoints were reported; but again, the authors identified methodological flaws in the studies.
 
No conclusive evidence existed to report on the effects to sleep quality.

Conclusions

Overall, the findings really did not support acupoints as a useful approach for managing anxiety and depression. Although it has limited risks, it may be useful in patients who do not tolerate oral medications. Results should be interpreted with caution because of the limitations identified. Still, much needs to be researched in this area. Study heterogeneity and lack of standardization of care and design are some of the major limitations to this meta-analysis. Further studies including controls for environmental as well as study site differences are needed before these results can be interpreted. Generalizability is not possible outside of the current study demographics, which should also be taken into account for future studies.

Limitations

  • Limited number of studies included
  • Mostly low quality/high risk of bias studies
  • High heterogeneity

Nursing Implications

Acupoints could be a safe intervention used in clinical practice for patients with cancer who experience anxiety and depression. No serious harm was reported, so it could be used as an alternative to medications when patients do not tolerate. Still, much research needs to be conducted in this area.

Legacy ID

6270