Effects of Acupuncture and Moxibustion on Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Objective: The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the effects of acupuncture and moxibustion (AM) in women with breast cancer-related lymphedema (BCRL). Methods: We retrieved RCTs published before January 24, 2021, from the MEDLINE, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (VIP), and Wanfang databases. RCTs that compared acupuncture and/or moxibustion intervention with other treatments were included. A random effects or fixed effects model was used based on the heterogeneity findings. Study quality was evaluated using the Cochrane risk of bias tool. Results: We included 14 RCTs in the analyses, of which 4 RCTs adopted acupuncture, 4 RCTs used moxibustion, and the rest used both. AM significantly reduced arm circumference at the elbow crease compared to routine care (Mean deviation (MD) = −7.26, 95% confidence interval (CI) = −8.30 to −6.21, P < .00001). There was a significant difference between AM and diosmin tablets in the effective index for upper limb lymphedema (MD = 24.68, 95% CI = 24.82-30.53, P < .00001), the range of motion of the shoulder during protraction (MD = 6.77, 95% CI = 2.81-10.73, P = .0008), and adduction (MD = 4.17, 95% CI = 1.02-7.32, P = .01). There was a significant difference between moxibustion and pneumatic circulation (MD = −0.51, 95% CI = −0.85 to −0.17, P = .003) in the visual analog score (VAS) for swelling. Finally, compared to the blank control, acupuncture reduced the VAS for pain (MD = −1.33, 95% CI = −1.52 to −1.15, P < .00001; heterogeneity ( I2) = 0%, P = .57). Conclusion: Our results suggest that AM is effective in the treatment of BCRL. AM may reduce arm circumference at the elbow crease (compared to routine care), increase effective index for upper limb lymphedema (compared to oral diosmin tablets), improve the range of motion of the shoulder during protraction and adduction (compared to oral diosmin tablets), and decrease the VAS for both swelling (compared to pneumatic circulation) and pain (compared to blank control).

The Effects of Complementary Therapies on Patient-Reported Outcomes: An Overview of Recent Systematic Reviews in Oncology

“…Acupuncture seems to have the capacity to alleviate several physical symptoms in patients with cancer (see Table 2 ). Significant reductions in cancer pain, including aromatase inhibitor-induced arthralgia (AIA) [ 22 , 23 ] and lymphedema pain [ 24 ], post-mastectomy pain [ 25 ] and neuropathy pain [ 19 , 26 ] were reported in the included meta-analyses.…”

“…Except for inappetence and abdominal pain , significant effects on the amelioration of gastrointestinal symptoms, such as nausea and vomiting, constipation, diarrhea and abdominal distension , were reported for patients using moxibustion [ 52 , 53 ]. Compared to pneumatic circulation, moxibustion was found to be significantly effective for reducing lymphedema swelling in breast cancer patients [ 24 ].…”

Effects of Tuina Combined With Moxibustion on Breast Cancer-Related Lymphedema: A Randomized Cross-Over Controlled Trial

“…Furthermore, we found that whether TCM treatment or CDT is being selected, the effect on arm circumference reduction is more apparent from the elbow to the shoulder joint, which is consistent with the findings of a systematic review of acupuncture and moxibustion for BCRL. 25 Anatomically, the elbow and shoulder joints are in a state of frequent and large arc movement, and the local edema may be more severe. Therefore, once treated, it will easily reflect the curative effect.…”

Comparison efficacy and safety of acupuncture and moxibustion therapies in breast cancer-related lymphedema: A systematic review and network meta-analysis

“…As complementary or alternative therapies for BCRL, acupuncture and/or moxibustion therapies, using metal fine needles or moxa sticks to stimulate acupoints for therapeutic purposes, have been recommended to relieve the symptoms of BCRL [ 9 ]. According to several meta-analyses, acupuncture and moxibustion therapies show strong potential advantages for the management of BCRL [ 10 , 11 ]. According to a study, local acupuncture might accelerate metabolism, increase blood circulation, and cause accumulation of inflammatory cells in the upper limb edema areas to attempt to mitigate the edema [ 12 ].…”

“…Appropriate acupuncture and moxibustion modality selection can enhance therapeutic outcomes and lower treatment costs, which in turn lowers the strain on clinicians and patients. However, due to insufficient evidence of direct comparisons between acupuncture and moxibustion therapies, clinicians find it difficult to determine which are the most effective for clinical applications [ 17 ]. Network meta-analysis (NMA), in comparison to conventional meta-analysis, may compare different treatments for one health condition and perform quantitative analysis to evaluate and order the efficacy of these therapies [ 18 ].…”