Effectiveness Not Established
Moxibustion
for Fatigue
Moxibustion is an east Asian traditional therapy involving the application of the heat from burning herbs to stimulate specific spots on the skin or acupoints. Moxibustion may be used in combination with acupuncture. This intervention has been examined in people with cancer for its effect on fatigue.
Systematic Review/Meta-Analysis
Lee, S., Jerng, U.M., Liu, Y., Kang, J.W., Nam, D., & Lee, J. (2014). The effectiveness and safety of moxibustion for treating cancer-related fatigue: A systematic review and meta-analyses. Supportive Care in Cancer, 22, 1429–1440.
Purpose
Search Strategy
Literature Evaluated
Sample Characteristics
Phase of Care and Clinical Applications
PHASE OF CARE: Multiple phases of care
Results
Insufficient data to make recommendations regarding safety or efficacy of moxibustion on fatigue among Chinese patients with cancer
Conclusions
Insufficient data to make recommendations regarding safety or efficacy of moxibustion on fatigue among Chinese patients with cancer
Limitations
- High risk of bias among studies (CONCERT and STRICTA)
- Low quality of reporting among studies
- Findings not generalizable (all subjects from inpatient Chinese population)
- Use of daily treatment schedules
- Lack of placebo or sham controls
- Methodological flaws
- Lack of blinding procedures
- Single measure of fatigue (Piper Fatigue Scale)
- Mention of adverse effects omitted with exception of one case of blistering.
Nursing Implications
Techniques of moxibustion requires specialized training not usually available in United States. Access to qualified practitioners, lack of an appropriate placebo or sham control, and frequency of treatment administration to outpatients would make additional studies of safety and efficacy difficult for nurse researchers to conduct.
Research Evidence Summaries
Mao, H., Mao, J.J., Guo, M., Cheng, K., Wei, J., Shen, X., & Shen, X. (2016). Effects of infrared laser moxibustion on cancer-related fatigue: A randomized, double-blind, placebo-controlled trial. Cancer, 122, 3667–3672.
Study Purpose
To evaluate the safety and efficacy of laser moxibustion for cancer-related fatigue
Intervention Characteristics/Basic Study Process
Moxibustion is a modality of acupuncture that involves burning the herb Artemisia vulgaris on or above the skin at acupoints. This provides heat stimulation instead of stimulation by needles. Infrared laser moxibustion is an approach using laser devices to irradiate acupoints at about 2 cm away from the skin's surface. Patients were randomly assigned to receive real or sham laser moxibustion for 20 minutes three times per week for four weeks. The laser operator was blinded; because the infrared laser is colorless, neither the operator nor the patient could see it. For the sham group, the laser source was turned off. Fatigue was measured at baseline and at weeks 2, 4, and 8.
Sample Characteristics
- N = 61
- MEAN AGE = 59.3 years
- MALES: 46.1%, FEMALES: 53.9%
- CURRENT TREATMENT: Chemotherapy, radiation, combination radiation and chemotherapy
- KEY DISEASE CHARACTERISTICS: Multiple tumor types—breast, lung, and gastrointestinal were more prevalent.
- OTHER KEY SAMPLE CHARACTERISTICS: The majority were undergoing current treatment; 35.9% were in the survivorship phase after curative treatment. Baseline fatigue was 4.5; 5.03 was the average across groups.
Setting
- SITE: Single site
- SETTING TYPE: Not specified
- LOCATION: China
Phase of Care and Clinical Applications
PHASE OF CARE: Multiple phases of care
Study Design
Double-blind, sham-controlled, randomized, controlled trial
Measurement Instruments/Methods
Brief Fatigue Inventory (BFI), Chinese version
Results
At week 2, the fatigue score in the moxibustion group was lower (3.8 versus 4.7, Cohen’s d = 0.685, p = 0.044). At week 4, fatigue was also lower in the moxibustion group (3.01 versus 4.40, Cohen's d = 1.14, p = 0.002), and at week 8, the moxibustion group had lower fatigue as well (3.03 versus 4.26, Cohen's d = 0.886, p = 0.006). No serious adverse events were reported.
Conclusions
The findings suggest that laser moxibustion may be helpful in relieving cancer-related fatigue.
Limitations
- Small sample (< 100)
- Subject withdrawals ≥ 10%
- The dropout rate was over 20% but mostly because of disease progression.
- The follow-up period was relatively short.
Nursing Implications
Laser moxibustion may be another option to combat cancer-related fatigue. This is a painless, noninvasive intervention that warrants further investigation.