Methodological Review: Summary of Findings for Acupuncture as Treatment for Cancer Therapy-induced Xerostomia

Abstract

Background/Aim: With a rapidly growing number of studies, systematic reviews (SRs) and meta-analyses (MAs) on acupuncture, the level of evidence seems to be high. Yet, traditional Chinese acupuncture is built on concepts which are not in accordance with science-based medicine. Accordingly, our aim was to critically assess the evidence presented in SRs and MAs on xerostomia induced by treatment of head and neck cancer with radiotherapy. Materials and Methods: In February 2022, a systematic search of five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) was conducted to find SRs/MAs on acupuncture use against cancer-treatment induced xerostomia. We evaluated all SRs/MAs using the AMSTAR instrument, comparing the assessment of the individual studies included and the conclusions drawn by the authors. In case of heterogeneity between the SRs, we evaluated the controversial items of the assessments directly from the studies. Results: Finally, eight SRs/MAs were included. Most of them show methodological drawbacks in several domains of the AMSTAR instrument, which influences the credibility of the results. Conclusion: The evidence on the use of acupuncture as treatment for radiotherapy-induced xerostomia is low. Present SRs/MAs mainly summarize results of a few and mostly small studies. Even though the included studies greatly overlap, the quality of the presentation and interpretation of the authors differs greatly. Therefore, a high quality and conclusive summary of the present evidence on the use of acupuncture to treat radiotherapy induced xerostomia is still missing.

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“…A new alternative for patients with no saliva is acupuncture, it stimulates the sympathetic and parasympathetic nervous system through neuronal activation, which causes the release of neuropeptides having anti-inflammatory properties and nutritional effects on the salivary glands and increases blood flow in the acini [1] . There is little relevant and high-quality information on the relationship between acupuncture and xerostomia [38] . Mechanical stimulation of saliva is achieved by chewing sugar-free gum containing xylitol and sorbitol with an antimicrobial effect [39] .…”