Acupuncture for Hormone Therapy–Related Side Effects in Breast Cancer Patients: A GRADE-Assessed Systematic Review and Updated Meta-Analysis

Abstract

Purpose: To determine the efficacy of acupuncture on the management of hormone therapy–related side effects in breast cancer patients. Methods: Randomized controlled trials of acupuncture versus a control or placebo in breast cancer patients that examined reductions in therapy-related side effects were retrieved from PubMed, EMBASE, Web of Science, and the Cochrane Library through April 2020. Data on patient symptoms (hot flashes, fatigue, pain, stiffness, and gastrointestinal symptoms), physical capacity, cytokines, and general psychosomatic well-being were analyzed. We evaluated and analyzed the quality of all included studies with the 5.2 Cochrane Handbook standards using Stata software (version 10.0) and Revman software (version 5.2), respectively. We assessed the risk of bias using the Cochrane Risk of Bias tool and evaluated the quality of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. Results: The pooled results suggested that acupuncture led to moderate improvements in hot flashes, fatigue, and stiffness. No significant differences were observed in pain, gastrointestinal symptoms, Kupperman index scores, Overall quality of life, tumor necrosis factor levels, and interleukin levels. Conclusions: Evidence for outcome indicators of symptom management were downgraded by the GRADE system for inconsistency, indirectness, and imprecision in the included RCTs. Nonetheless, acupuncture is a moderately appropriate alternative therapy for hormone therapy–related side effects in breast cancer patients. However, it still lacks large-sample, multicenter, prospective RCTs. Future research should focus on standardizing comparison groups and treatment methods, be at least single-blinded, assess biologic mechanisms, have adequate statistical power, and involve multiple acupuncturists.

Use of Acupuncture for Adult Health Conditions, 2013 to 2021

“… 13 We included 82 publications in this map. 8 , 9 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , …”

“…The number of studies included for acupuncture in the reviews ranged from 1 to 73 studies. Thirty-seven reviews included fewer than 10 studies, 8 , 9 , 15 , 17 , 18 , 19 , 22 , 23 , 28 , 29 , 30 , 32 , 36 , 41 , 42 , 43 , 45 , 47 , 50 , 52 , 54 , 56 , 61 , 63 , 66 , 68 , 69 , 73 , 79 , 80 , 81 , 82 , 83 , 85 , 90 , 91 , 92 34 reviews included 10 to 25 studies, 14 , 20 , 21 , 25 , 26 , 27 , 29 , 30 , 31 , 33 , 34 , 35 , 37 , 38 , 39 , 40 , 44 , 48 , 51 , 53 , 55 , 58 ,…”

“…The country of origin for reviews varied, with the highest number of reviews originating from China (34 studies). 27 , 30 , 31 , 33 , 35 , 38 , 42 , 44 , 46 , 49 , 51 , 54 , 55 , 60 , 63 , 65 , 67 , 70 , 72 , 73 , 74 , 75 , 76 , 77 , 83 , 84 , 85 , 86 , 87 , 89 , 90 , 91 , 92 , 93 Other countries included Australia (4 studies), 56 , 68 , 69 , 79 Brazil (1 study), 43 Italy (1 study), 36 Korea (7 studies), 32 , 34 , 37 , 59 , 66 , 80 , 88 Taiwan (1 study), 53 the United Kingdom (1 study), 8 and the United States (7 studies). 9 , 28 , 29 , 45 , 50 , 58 , 61 Twenty-six publications involved teams from multiple countries,…”

“…Fifty-nine reviews included more than 1 type of acupuncture, 9 , 15 , 16 , 18 , 20 , 21 , 22 , 23 , 25 , 29 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 48 , 49 , 51 , 52 , 54 , 55 , 57 , 59 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 70 , 71 , 72 , 75 , 77 , 78 , 79 , 80 , 84 , 85 , 86 , 87 , 88 , 89 , 91 , 92 , 93 while 23 reviews included only 1 type of acupuncture as the intervention. 8 ,...…”

The Effects of Press Needle on Immune Function and Quality of Life Among Female Breast Cancer Patients After Radical Mastectomy: Study Protocol for a Randomised Controlled Trial

“…Due to the limited e cacy and many side effects of drug therapy, various non-pharmacological techniques have been used in clinical practice [15] . A large number of clinical studies have shown that acupuncture has a de nite effect on enhancing immunode ciency and improving the side effects of adjuvant therapy after radical mastectomy of breast cancer [16][17][18] , and it also shows signi cant advantages in the treatment of chronic urticarial, in ammatory bowel disease and other types of immunode ciency diseases [19][20][21] . The intradermal thumbtack needle, an improved subcutaneous needle, is a type of shallow needling method that reduces pain and prolongs the acupuncture effect via longer needle retention [22] .…”