The efficacy of acupoint stimulation for the management of therapy-related adverse events in ...

13 Pages·2009·0.27 MB·English

BreastCancerResTreat(2009)118:255–267
DOI10.1007/s10549-009-0533-8
REVIEW
The efficacy of acupoint stimulation for the management
of therapy-related adverse events in patients with breast cancer:
a systematic review
Li-Fen Chao Æ Anthony Lin Zhang Æ Hsueh-Erh Liu Æ
Ming-Huei Cheng Æ Hung-Bun Lam Æ Sing Kai Lo
Received:16May2009/Accepted:26August2009/Publishedonline:17September2009
(cid:1)SpringerScience+BusinessMedia,LLC.2009
Abstract The aim of the present study was to scrutinize The 26 articles were published between 1999 and 2008.
the evidence on the use of acupoint stimulation for They assessed the application of acupoint stimulation on
managing therapy-related adverse events in breast cancer. six disparate conditions related to anticancer therapies
A comprehensive search was conducted on eight English including vasomotor syndrome, chemotherapy-induced
and Chinese databases to identify clinical trials designed nausea and vomiting, lymphedema, post-operation pain,
to examine the efficacy of acupressure, acupuncture, or aromatase inhibitors-related joint pain and leukopenia.
acupoint stimulation (APS) for the management of Modalities of acupoint stimulation used included tradi-
adverse events due to treatments of breast cancer. Meth- tional acupuncture, acupressure, electroacupuncture, and
odological quality of the trials was assessed using a the use of magnetic device on acupuncture points. Over-
modified Jadad scale. Using pre-determined keywords, all, 23 trials (88%) reported positive outcomes on at least
843 possibly relevant titles were identified. Eventually 26 one of the conditions examined. However, only nine trials
papers, 18 in English and eight in Chinese, satisfied the (35%) were of high quality; they had a modified Jadad
inclusion criteria and entered the quality assessment stage. score of 3 or above. Three high quality trials revealed that
acupoint stimulation on P6 (NeiGuang) was beneficial to
chemotherapy-induced nausea and vomiting. For other
L.-F.Chao(cid:1)H.-E.Liu adverse events, the quality of many of the trials identified
SchoolofNursing,ChangGungUniversity,Gueishan,
was poor; no conclusive remarks can be made. Very few
Taoyuan,Taiwan,ROC
minor adverse events were observed, and only in five
L.-F.Chao trials. APS, in particular acupressure on the P6 acupoint,
DepartmentofNursing,ChangGungInstituteofTechnology, appears beneficial in the management of chemotherapy-
Taoyuan,Taiwan,ROC
induced nausea and vomiting, especially in the acute
phase. More well-designed trials using rigorous method-
A.L.Zhang
DisciplineofChineseMedicine,RMITUniversity, ology are required to evaluate the effectiveness of acu-
Melbourne,VIC,Australia point stimulation interventions on managing other distress
symptoms.
M.-H.Cheng
DepartmentofPlasticandReconstructiveSurgery,ChangGung
MemorialHospital,ChangGungCollegeofMedicine,Chang Keywords Acupuncture (cid:1) Evidence-based
GungUniversity,Gueishan,Taoyuan,Taiwan,ROC Chinese medicine (cid:1) Breast cancer (cid:1) Adverse event (cid:1)
Critical appraisal
H.-B.Lam
DepartmentofGeneralSurgery,MackayMemorialHospital,
Taipei,Taiwan,ROC
Introduction
S.K.Lo(&)
FacultyofArtsandSciences,HongKongInstituteofEducation,
The prevalence of breast cancer is increasing [1–3].
10LoPingRoad,TaiPo,NewTerritories,HongKong
e-mail:[email protected] More than 50% of breast cancer patients experience a
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256 BreastCancerResTreat(2009)118:255–267
number of adverse events (AEs) such as vasomotor Methods
syndrome (with prevalence up to 80%) [4–6], chemo-
therapy-induced emesis (75%) [7], post-mastectomy The conduct and presentation of this systematic review
oedema (approximately 30–60%) [8, 9], and arthralgia adhered to the guidelines of the Quality of Reporting of
(over 40%) [10]. Apart from general discomfort reducing Meta-analyses (QUOROM).
the patients’ quality of life [11], these unpleasant
symptoms often lead to an increased use of health care Search and screening strategy
resources. AEs are also the main reason for non-adher-
ence to oncologic treatment [12]. Both pharmacologic Relevantarticleswereacquiredbysearchingthefollowing
and non-pharmacologic interventions have been used to five English databases: PubMed, Cochrane library, EM-
alleviate the AEs [13–17]. However, pharmacotherapy BASE,theCumulativeIndextoNursingandAlliedHealth,
agents for resolving distress may produce adverse effects andPsycINFO;andthreeChinesedatabases:CNKI,CEPS,
such as dry mouth, somnolence, drowsiness, skin rash, and WanFang. All databases were retrieved from their
heart palpitations, peripheral oedema, and gastrointestinal inceptions until October 2008. Manual searching was also
symptoms and hence have low patient acceptance [18]. carried out to find trials from the references cited in the
Two systematic reviews have investigated the manage- articles identified. Key terms used in the search included
ment of AEs using Chinese medicinal herbs (CMHs) medical terms of ‘‘breast cancer’’ (e.g., breast neoplasm,
[16] and exercise interventions [15]. The conclusion was breastcarcinoma,breasttumour),combinedseparatelywith
that it is difficult to make definitive therapeutic at least one of the following words related to acupuncture
recommendations. modalities:‘‘acupuncture’’,‘‘acupressure’’,‘‘auricular acu-
Acupuncture is a popular non-pharmacological ther- puncture’’, ‘‘ear acupuncture’’, ‘‘acupuncture points’’,
apy used for treating a variety of conditions such as low ‘‘electroacupuncture’’, ‘‘acupoints’’, ‘‘transcutaneous elec-
back pain [19] and allergic rhinitis [20]. It was sug- tricnervestimulation’’,and‘‘Moxibustion’’.
gested that neurochemicals released after needling or Two independent reviewers undertook the selection of
pressuring acupoints may contribute to the therapeutic publications from the databases: in the initial stage, they
effect of acupuncture [21]. Methods to stimulate acu- screened the titles and abstracts of all the publications
points include manual needling, needling combined with retrieved to determine eligibility. Then, the full text of
electric stimulation (electroacupuncture), wrist band, seemingly relevant articles was read by the same two
stimulation, magnet stimulation, lasers or heat with reviewers, again independently, for final inclusion in the
burning herbs (moxibustion), applying pressure to the methodological assessment. Disagreements over selection
acupoint (acupressure), as well as treating the whole andinclusion were resolvedbydiscussionwithathirdand
body by using acupoints in the ears only (auricular more experienced reviewer.
acupuncture) [22]. In this review, we used the term
‘‘acupoint stimulation’’ (APS) to represent all these Inclusion criteria
modalities.
The effectiveness of APS on the relief of symptom A study was considered eligible if it satisfied all the fol-
distress during and after cancer treatments is well lowing criteria: (1) Study design: clinical trials including
documented [23, 24]. The growing interest in the use randomized controlled trials (RCTs), controlled clinical
of APS modalities has also led to several studies trials (CCTs), or single-group studies; (2) Participants:
investigating its efficacy on therapy-related AEs adults who were diagnosed with breast cancer at any stage
among oncologic patients, including hot flashes, fati- and undergoing treatments such as surgery, radiotherapy,
gue, xerostomia [25], leucopenia [26], and emesis [23, chemotherapy, hormonal therapy, or palliative treatment
24, 27, 28]. However, the efficacy of acupuncture for metastatic breast cancer, and experiencing treatment-
modalities on the management of breast cancer thera- induced adverse events; (3) Intervention: stimulation of
pies-related AEs remains uncertain [28, 29]; no sys- acupuncture points by any modality; (4) Outcome mea-
tematic review has been conducted to summarize the sures: at least one clinically related outcome variable such
results. Previous reviews have only examined a single assymptomscores;aswell ascondition-specific outcomes
AE and on nonspecific groups [30, 31]. We therefore or generic health status outcomes.
initiated this comprehensive review to scrutinize the
evidence of using APS—the stimulation of acupunc- Exclusion criteria
ture points by any modality—on managing adverse
events related to anticancer therapies in patients with Animal studies, case reports and anecdotal evidence,
breast cancer. qualitative studies or descriptive surveys, and reports that
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BreastCancerResTreat(2009)118:255–267 257
were available only in abstract form were excluded. The Results
trialsthatincludeddiagnosisotherthanbreastcancerwere
also excluded unless separate data were available for the Overall results (all treatment modalities)
breast cancer subgroup.
A total of 843 titles were found from the databases and
Methodological quality assessment reference lists. After deleting repetitious and irrelevant
studies by examining the titles and abstracts, 51 possible
All eligible trials identified were evaluated by two inde- relevant studies remained. After reading the full text of
pendent reviewers using a modified Jadad scale. The scale these 51 studies and applying the selection criteria, 26
assesses three major aspects of RCT: (1) randomization articles[29,34–58]werefoundeligibleformethodological
procedure (1 point is given if patients were randomized qualityassessment.Figure 1presentstheselectionprocess.
into the group allocation; 1 bonus point if the randomi- Ofthe26studies,18[29,34–38,41–48,51,52,54,58]
zation procedure is appropriate), (2) dropout and with- were RCTs and 8 [39, 40, 49, 50, 53, 55–57] were CCTs
drawal (1 point is given for a clear description of but not RCTs; 18 [29, 34–44, 49–51, 53–55] were written
dropouts and withdrawals) and blinding (2 points) [32]. in English and 8 [45–48, 52, 56–58] in Chinese. All of
Blinding acupuncturist is not practical in RCT design. them were published in referred journals; none of them
Nevertheless, blinding patients and outcome assessors were theses, dissertations, or conference proceedings.
were considered critical in manual therapy trials [33]. Basic characteristics of the studies are summarized in
Thus, we have adapted a modified version of the Jadad Table 1.
scale [30]. That is, 1 point was given for blinding of Thestudieswerepublishedbetween1999and2008and
patient, and an additional 1 point was given if the out- were conducted in several counties, but mainly in the
come assessor was blinded. Therefore, each article could United States and China. The age of patients ranged from
score 0 (lowest quality) to 5 (highest quality). Studies 28 to 76 years. Five studies reported the body mass index
were classified as high quality if they attained a score of 3 (BMI) of the participants, ranging from 23.1 to 28.8; but
or more [32]. BMI was not used as an outcome variable.
DespitetherelativeeaseofuseoftheJadadscale,inter- The26trialsuseddifferenttypesofAPS,includingnine
raterreliabilityofthisscalehasbeenshowntobepoor.To trials(34.6%)ofconventionalacupuncturetherapy[34,35,
assess inter-rater reliability, we calculated the percentage 39, 40, 49, 51, 53–55], six trials (27.1%) of electroacu-
agreement between the two independent reviewers on puncture [36, 37, 44, 50, 52, 58], five by drug injection in
quality assessment. The percentage of agreement was acupoints [45, 47, 48, 56, 57], three by self-acupressure
93.2%, and all disparities were resolved after, again, dis- [41, 43, 46], and three studies in acupoints stimulation by
cussion with a third and more experienced reviewer. specific devices including wristband [29, 42] and acu-
magnet [38]. More than 40% of the trials (11/26; 42.3%)
Data extraction
843 potential titles of
The information of each trial was extracted and entered
papers searched from
into a worksheet specially designed for this purpose. Data
various databases
recorded included the following: (1) Descriptive informa- Deleted irrelevancies and
tion including first author, study location, year, language, repetitions from abstracts
and name of the journal; (2) Population parameters 51 papers retrieved
including samples size and demographic characteristics;
2 excluded for being only poster
(3) Methodologies including study design, assignment and
blinding procedures, attritions, and follow-up duration; (4) 49 papers included
3 excluded for being Russian and
Intervention parameters including type and pattern of
hence unrecognizable
acupuncture therapy, treatment duration, and acupoint(s)
46 potential papers
used; (5) Outcomes including measuring instrument(s)
which included full text
used, and main results.
18 excluded for lacking separated
outcome for breast cancer patients.
Statistical analysis
2 excluded for duplication
The software program Number Cruncher Statistical Sys- 26 data extraction
tems (NCSS 2004) was employed to calculate the effect
size and the corresponding 95% confidence interval (CI). Fig.1 Aschemaforillustratingtheprocessofstudyselection
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258 BreastCancerResTreat(2009)118:255–267
Table1 Summaryofdemographicinformationoftheincludedstudies(n=26)
Conditions
Characteristics Vasomotor Chemotherapy-inducednauseaand Post-operation Leukopenia Other Total
symptom vomiting pain conditions
Numberoftrials(%) 7(26.9) 11(42.3) 3(11.5) 2(7.7) 3(11.6) 26
Studydesign
RCT 5 9 2 0 2 18
CCT 0 0 1 1 0 2
Singlegroup 2 2 0 1 1 6
ModifiedJadadscore
C3 4 4 1 0 0 9
\3 3 7 2 2 3 17
Totalnumberoftrial 281 776 165 211 115 1548
participants
APSmodality
Conventionalacupuncture 4 1 2 0 2 9
Electroacupuncture 2 2 1 0 1 6
Self-acupressure 0 3 0 0 0 3
Acupointinjection 0 3 0 2 0 5
Acuband 0 2 0 0 0 2
Magnet 1 0 0 0 0 1
Country(studyconductedin)
US 2 4 1 0 2 9
China 0 4 1 2 1 8
UK 2 1 0 0 0 3
Sweden 1 1 0 0 0 2
Other 2 1 1 0 0 4
APSacupointstimulation;RCTrandomizedcontrolledtrial;CCTcontrolledclinicaltrial
examinedchemotherapy-inducednauseavomiting(CINV). Effect on vasomotor syndrome (VMS)
The remaining trials examined vasomotor syndrome
(VMS, 7/26; 26.9%), post-operational pain (3/26; 11.5%), As shown in Table 2, seven trials (N = 281) explored the
radiotherapy or chemotherapy-induced leukopenia (2/26; effect of acupuncture on vasomotor syndrome [34–40],
7.7%), AI-induced arthralgia (1/26; 3.8%), and breast including five RCTs and two single-group pre-post com-
cancer-related lymphoedema (1/26; 3.8%). However, parisons. Daily flush frequency was the main outcome
informationonparticipants’educationlevel,backgroundof measure. All the studies used self-administrated question-
the acupuncturists, period of symptom distress before naires to measure this effect. Three trials also used the
management, and reliability of measurement tools were KuppermanIndex(KI)toscoreclimactericsymptoms[35–
revealed in too few studies to allow any meaningful 37].Allstudiesexceptone[36]usedsixormoreacupoints.
summary. SP6 was the most commonly used acupoint, which was
usedinfourstudies[34,38–40].FourRCTs,includedthree
Quality assessment high quality trials [34, 36, 37], did not find any significant
difference in the primary outcome measure between the
The range of the modified Jadad methodological quality intervention and the control group [34, 36–38]. Using data
score ranged from 0 to 5. Two studies scored 5 [34, 44], from three of the four studies [34, 37, 38], the effect size
one scored 4 [35], and six scored 3 points [29, 36, 37, 41, (expressedasstandardizeddifference)wascalculatedtobe
42,51].Moststudies(65.4%)scored2orlessthan2points, 0.39 (95% CI -1.26 to 2.02; P = 0.428). For the other
including three 0-point trials [53, 56, 57], nine 1-point three trials [35, 39, 40] demonstrating an association
trials [39, 40, 45, 46, 48–50, 52, 55] and five 2-point trials betweenAPSinterventionandlowerfrequencyofdailyhot
[38, 43, 47, 54, 58]. flush, two of them were single-group studies.
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BreastCancerResTreat(2009)118:255–267 259
Within-groupdifference (1)N/R (2)ATgroup,P\0.001;Shamgroup:NS P\0.01inbothgroups N/R P\0.01onallparameterinbothgroup N/R Anxiety,somaticandvasomotorsymptomwereimprovedP\(0.001)lasting6months
ng ng S)
uri uri (N
Between-groupdifference P(1)=0.009dtreatment;P\0.001infollowing P(2)=0.004dtreatment;P=0.001infollowing N/R NotsignificantP(=0.3) NS P(1)=0.48 P(2)=0.2 P(3)=0.55 NS P(1)=0.21 P(2)=0.02 P(3)=0.13 N/A
Adverseevent N/R N/R Veryminorbleeding N/R Itching,redness None
Keyoutcomemeasurement 1)Dailyflashfrequency, 2)KIscore Dailyflashfrequency,KIscore Dailyflashfrequency, 1)Dailyflashintensity, 2)KIscore 3)MoodScale 1)Dailyflashseverity 2)Botherrating 3)Qualityoflife Greenemenopauseindex: 1)Anxiety, 2)Depression 3)Somaticsymptom 4)Vasomotorsymptom
er ( ( ( ( ( ( ( ( ( ( ( (
nc w-
(VMS)inpatientswithbreastca AcupointsLengthoftreatment(wks)/folloup LIV3,GB20,LU7,10/12KI3,SP6,REN4,P7,LIV8 N/R12/24mos DU14,GB20,BL13,4/6mosPC7,H6,K7,ST36,SP6,Earshenmen,Earsympatheticpoint 12/6mosBL23,BL32,HT7,SP6,SP9,LR3,PC6,GV20 6points/N/R3days/N/A KI6,SP6,BL23,12/6mosCV4,GB35,H5
m
gvasomotorsympto Controlgroupregimen(samplesize/dropout) Placebo:ShamATonnon-acupoints(29/NR) Hormonetherapy(18/7) Placebo:ShamATonnon-acupoints(30/2) Relaxationprogramme(19/5) Placebo:Shamdevice,(15/4) NA
n
diesincludedfortreati Experimentalregimen(samplesize/dropout) AT30min,twiceweeklyforfirst5weeks,thenonceaweekfor5weeks(30/NR) EA30min,twiceweeklyforthefirst2weeks,thenonceaweekfor10weeks(27/8) ATtwiceweeklyfor4weeks(42/9) EA2Hz,30min,twiceweeklyforthefirst2weeks,thenonceaweekfor10weeks(19/2) Magneticdevice(15/4) ATweeklyfor3monthsthenmonthly(15/NR)
mmaryofstu Studydesign/modifiedJadadscore RCT(subjectblinding)/4 RCT/3 RCT(doubleblinding,cross-over)/5 RCT/3 RCT(cross-over)/2 Singlegroup/1
u
S
e
2 nc
Table Refere [35] [36] [34] [37] [38] [39]
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260 BreastCancerResTreat(2009)118:255–267
Within-groupdifference 88%experiencedeffectiveimproveP\(0.001) CTrandomizedRINVRptoms), acEEnhfletefievmecemtonteohtnseictrucaedhpfieyfemes(coTt[taoh2bfe9lr,eAapP34y)1S.-–ioTn5nhd0eu]dcia(secntdrue=pnsoasiu7nss6ytes1ma)Ppv6tioonammvneidstsitiSninggTda3ute6cdewdetbhryee
Rm
a,sy used in these studies. Participants received intervention
AdverseBetween-groupeventdifference NoneN/A PRadiotherapy-inducedleukopeniKIKupperman’sIndex(climactericpost-operationday eETs[os4ttmvfhuu1ferddee,eriisc4eeeiats2ss,ot,tcrsrn4itateaea4uaplnt]ssteo,med(srud9tees-0tpnmbeh.otdy9earp%tsbfAeetor)edreP,licloatStoihsdonwtamcttoo-cluyufAadpnm5PpicnaSapedignernacaryottighhosueerdletrdopae[pso43ihy4sgti.,wn-gmi4hefi9eacq]ksa.utsnea;Octllttifywotymtiohmsyeotpsuferpdoati1vhein1ees
RILon,OD [51–53](Table 4).Theresultswereinconsistent.Acupoint
a,otiP L14 was used in all the three trials. Two studies demon-
LengthofKeyoutcometreatmentmeasurement(wks)/follow-up Upto7/3–5Flashfrequency Pchemotherapy-inducedleukopeniN/RROMnotreported,rangeofmN/AancerInstitutenon-applicable, bfgEOerseetfurfrfrflofataeeeutttnchoceeptcetdnd.eeoo2sjnif6bohgeiinjtangtoriwcithfiiauneclpptsqeauaunsniinynatncmlcteihtltfuapueyfnrtdeeodceRimntdCtt,ffsheuaToervnvnrocae[ltu5ypni1ryotoii]nnonaognfelontsughatnreaubodrdiAoulyimpnPty[oSa5at4n(sagTi]sdrgeoaenubxtihpilfipneelc[hoa55icrnb)2eo;ti,dnt5odattr3rnihosf]de--l,
Le,C
Acupoints BL62,LR14,KI3,HT7,TE6,SP6,LI11,ST36,GV20,LI4 CIatedlymphedema,ACdigitalacupressurNCIecklist,National pEOwofnafsseeitceistvftfueoedncryetbisv[rue5ela5tiss]ntwdmceeaamrnencoaeongrbsi-nttraregailntapeetodedsd.tt-hlmyatmastprteahcdotieotdimoenmyaaoleadceumpuanucstuinrge
Controlgroupregimen(samplesize/dropout) NA RLbreastcancer-relacupuncturetherapy,SCLg,:symptomch maETfwsefiteonhcgattlsreooia-nnglesrloe[iuun5pkj6eo,cdpt5eees7ndi]giaanct.onthdeucStTed36ininCtrhai-naacufpoouinndt wthaastedfefxeac--
Experimentalregimen(samplesize/dropout) AT20–30mintwiceaweeklyfor7weeks(22/NR) BCednauseavomit,ATpuncture,manualVomitingandRetchin tltAiehvdueevkraeoprpisyneen[ei5apv6re]einnvotesrbnrrtaeidnaigsotthcbeaornancpeeyr[mp5a7atr]ireo(nTwtsabulsenudp5ep)r.rgeosisniogn-crheelamteod-
cu
Table2continued ReferenceStudydesign/modifiedJadadscore [40]Singlegroup/1 CINVchemotherapy-induEAcontroltrial,electroacRhodesIndexofNausea, asaOe[s3iaddvdf9thveie,notee-hsrtne4sesifv.e0f[2ee,4Fe6c4ovt4o]stue2.rrnri,iAanteslt5cllsretl4i,[huac3]1oldt;4sr7uio,ngacr(g3nhe6u8dp5rs,por.ke4arfi4int%in4vent,de)isro4drtntr9iiriomtd,iamatu5lnaisil0odnoa]nvott.riereoc[Arpno3sbocm8elrue]gtm-eeeemaddvnenieanendngrstgaotnsostmeherntedooeslaccaddkcatmeeuvdvsriefnreireecsontwdoeer-
123
BreastCancerResTreat(2009)118:255–267 261
up n nw-
Within-grodifference N/R N/R N/R N/R N/A N/R N/R N/R N/R P\0.05ilast P\0.01i1stfolloup
Between-groupdifference (1)NS P(2)=0.002vs.Placebo;P\0.0001vs.control P\0.05 NS P\(1)0.01 P\(2)0.04 P\5days:0.001 9days:NS 1stday:NS, P2ndday:=0.017 P3rdday:=0.01 P\0.05 P\(1)0.05 P\(2)0.05 P\0.05 N/A
Adverseevent N/R None N/R N/R Shocksensation&tingling N/R N/R N/R N/R Pain
withbreastcancer Keyoutcomemeasurement (1)Acuteintensityofnauseavomitingrating(RINVR) (2)Delayedemesis Experienceandintensityofemesis(RIN) Dailyemesisepisodesnumber,severitylevel (1)Nauseaexperience(RINVRscore0–12) (2)Nauseaintensity(0–10) Totalemesisepisodesnumber Antiemeticrating(0–3) Antiemeticrating(0–4) (1)Nausearating(0–4) (2)Vomitingrating(0–4) Antiemeticrating(0–3) 11pointsnauseascore
s
nginpatient Lengthoftreatment(wks)/follow-up Around2/N/A 5days/N/A 5days/N/A Around3/N/A 5days/9days Once/3days 10days/N/A N/R N/R 3/2
vomiti points ST36 ST36 6 ST36 6 6,P6,4
and Acu P6 P6 P6 P6, P6, ST3 P6, ST3 ST3LI P6
a
herapy-inducednause Controlgroupregimen(samplesize/dropout) Placebo:acupressureatacupointS13(53/4) Control:usualcare(54/3) Usualcare(17/2groupstotaldrop18) Placebo:Shamacupoint(31/NR) Control:usualcare(33/NR) Usualcare(8/totaldrop:1) Placebo:Shamacupointandnoelectroniccurrent(33/NR) Control:usualcare(34/NR) Intravenousinjecteddexa(60/NR) Mentalsupport(30/NR) UsualcareIntramuscularinjected(50/NR) ATinjectedinLI4,P6(48) N/A
includedfortreatingchemot Experimentalregimen(samplesize/dropout) 0Self-acupressureatP6,6in0eachthemorningand3duringtherestofthedayintherapyperiod(53/6) Wearwristbandacupressuredevice(19/NR) WearEAbandfor5days(32/NR) Self-acupressure3minoneachacupointfrequentlyfor21days(9/NR) EA2–10Hz,20mindailyfor5days(37/totaldrop7) ATinjecteddexa(60/NR) Self-AC?mentalsupport(30/NR) ATinjecteddrug(50/NR) ATinjecteddruginST36(42/NR) AT10minbilateral,10timesduring3weeksn(breastca=5/NR)
s
e
ummaryofstudi Studydesign/modifiedJadadscore RCT3arms(evaluatorblinding)/3 RCT/3 RCT3arms/3, RCT/2 RCT3arms(doubleblinding)/5, RCT(cross-over)/1 RCT/1 RCT/2 RCT/1 Singlegroup/1
S
e
3 nc
Table Refere [41] [42] [29] [43] [44] [45] [46] [47] [48] [49]
123
262 BreastCancerResTreat(2009)118:255–267
Within-groupdifference 96.3%ofcases CTrandomizedRINVRmptoms) AwmPearnSeagweamnsoenret.psoerritoeudsinesfofemcetsstutdhiaets [r3e8q,ui4r9e,d50m],etdhiecrael
difference Rukopenia,mactericsy DBrisecaustsscioanncer victims suffer a variety of therapy-related
up lecli adverse events [4–11]; there is an urgent need to address
o d(
AdverseBetween-grevent Shiver,N/Aheadache,pain RILPRadiotherapy-induceKIon,Kupperman’sIndexODpost-operationday aAppubmthtausePtoeeteneiiSddnmceratnulpAutpitrtstoshPeeieedySdwsasrnieiimtfctdnosohaocorlelldsulvbaueadderlclmelieitstarmitAtaoserrcteaesaEuscarscspiotuzmearbpeesnesuexscenncsce[ructe1ovr-tp.r5imeuentd,rCdp(el1ur2eoienw1cu0nhe.k–ve5etdor2eh%nepn6isset)]iativ,.hndoreewievnaOlveayme.irulaesOorrwteimshtnth;ergaeceetnvorvhaeuimecefepafnuywleomtbcsphaoatuanhnclovdaoualynessrf-
AcupointsLengthofKeyoutcometreatmentmeasurement(wks)/follow-up P6,ST36C/TGratingintensity(NCIperiod/scale)N/A CILPdema,chemotherapy-inducedleukopenia,N/RROMcupressure,notreported,rangeofmotiN/APNationalCancerIinstitute,non-applicable, AaB(misacoAAn7tntrueulmPiiac.dttot7sTdglShciioun%cinohdopendaaemeeurs)elgelots,)gfidep,,cfchmtaseaaehtv,pchcdidoePacnptureusoish6erpvvtnrona(eeeuiei3milmwcnsscynheeaosoacoiiultnmgtst(t9,uhsouh3hedimrrte.agrdehis8qrelehostea%tudusywhnpw)audqno)a.yelci.iuducir-etaOitareuhigsndynolfphgvidmdtot(ietyurin3hiesr2iancj5asess3eceteli%(tcusmd27uctt()6di[eeih8osl3ivoan8etnsw4uerestsa%,undee,mui(drnt3i)ns1tseeei,h6e9essrra,t)t.sitheeo3h,sr3peefei%e7ansova[n]sech)rto4ited,tnliudm1eutgdthdi,daedphdiritnreoeeib4vddnnpsseqy2etogoun-,ifttsuonaortAiisipl4fituoa(iiiteP4tn1nnvhlnyrs]Sd1gdees-...
ea any benefit of APS on VMS. These studies carried out
phalCI
ExperimentalregimenControlgroup(samplesize/dropout)regimen(samplesize/dropout) EA10Hz,10minbeforeN/AC/Tthen20minwithinC/Tdaily(27/NR) BCRLnauseavomit,breastcancer-relatedlymATACncture,manualacupuncturetherapy,digitSCLNmitingandRetching,symptomchecklist, rmwssHpeptwpreeifoaoaghoisfacitwsdeATuniwsnohtccitli-ehntleethfimtaitrrsedicvohcevratwecnosalueoedsahronausamta,twionletegesnyudtcyhdeteasrhatlmfrocodfetefotaulmhemaoocebptcegnslhaudyeutlaarasojrpeeonmogdeiwvmupwuncriejipnanutptidahulenitlcgv.ienreerrgmtaipne[nu.oan5rcsirtslTctteo5hesieuazotrh]erteaue,amgrieadrseopenodiaplnwpnorcedmniay.esgancadr,taautlsermrAyrtterdoaeliessaePosadhwpmssueucSiosktsiusgaaotryitlophhltgnoylmepuseh.uderuqn(ipTesnbgnucotutsihiotghaonaatu=emleaollirsvtrtee[mttyse25hsAvut5ta6eis[hoRPdcn),h5a;hSeaCfio4ct5ngr]lorTa7Ahcaet,sms-]eatcmPtp,[djkep5owSoearat1imnnsnhoanrit]tdoeess-ft,,.
Table3continued ReferenceStudydesign/modifiedJadadscore [50]Singlegroup/1 significantlyreducedCINVgradeafterEAP\(0.001) CINVchemotherapy-inducedEAcontroltrial,electroacupuRhodesIndexofNausea,Vo eisscswtnrhytxhiiahomapalslilwnebptrgn[iaetit5eooekdos4mtner]csntsswihteniraenaxog(trtAnpneodlgaIjocsocor)ioueibemnnnpdstspoeucirrutnhdpvhogeceaeevmthridueaneortweiffftofhuohreneenrcecslrocnta.attuthpFioetloeyhodfdn.eraatrewltcmeoxAuodaaeplubmttauhscihdlnepeooijcctluduyeotgAovu,,nhlaroIdonen-nagroteerftiyhcolscaaaerirtrlgooeopnudsmqaristuefict-aijsaoocetoulavamniilsnnetttyeessrtt
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BreastCancerResTreat(2009)118:255–267 263
1 dR
Between-groupdifference P=0.14(NS) P\(1)0.05 P[(2)0.05 P\(3)0.05 P\(1)0.01 P\(2)0.00 CTrandomizeRINVmptoms)
se Ry
KeyoutcomeAdvermeasurementevent PainnumericratingN/Rscale (1)Overallpost-N/RoperationpainVAS (2)Sedationscore (3)Numberofanalgesiaapplied (1)PainduringarmN/Rmovement (2)Abductionanglerangeintolerablepain herapy-inducedleukopenia,erman’sIndex(climactericsationday
withbreastcancer AcupointsLengthoftreat(wks)/follow-up 5,LI4,SP6,auricularpointsPOD1,POD2/N/A RLI4,P630minonce/6,12,24,48and72hpost-operation GB6,SJ6,PC2,PC3,LE14,3days/N/AMP19,DI14,BL17,LU2,RE6,RE17 CILPRILPema,chemotherapy-inducedleukopenia,RadiotN/RROMKIupressure,notreported,rangeofmotion,KuppN/APODationalCancerInstitute,non-applicable,post-oper
diesincludedfortreatingpost-operationpaininpatients ExperimentalregimenControlgroup(samplesize/dropout)regimen(sampledsize/dropout) nAT&massage20mindailyforUsualcare(=4nn2days(=93,breastcabreastca=7,n=18,20%)16%) HANS?usual(30/NR)Usualcare(30)/N ATunclear(48/NR)Observation(32/NR) BCRLcednauseavomit,breastcancer-relatedlymphedATACupuncture,manualacupuncturetherapy,digitalacSCLNCIVomitingandRetching,symptomchecklist,N
Table4Summaryofstu ReferenceStudydesign/modifiedJadascore [51]RCT/3 [52]RCT/1 [53]Non-RCT/0 CINVchemotherapy-induEAcontroltrial,electroacRhodesIndexofNausea,
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264 BreastCancerResTreat(2009)118:255–267
Between-Within-groupgroupdifferencedifference N/ASignificantimprovementinjointpainP(=0.008),nononQOLandinflammationcontrolbyAT N/ASignificantdifferenceonROMofshoulder,sensationandLEP\degree(0.05) N/RLeukopeniawasimprovedintwo-group,interventiongroupischeaper N/RWBCincreasedinmathematics GI,immuneN/AreactionP\(0.05) RCTucedleukopenia,randomizedRINVRdex(climactericsymptoms)
dn
e nIy
Adversevent None N/R N/R N/R N/R herapy-ierman’sationda
Table5Summaryofstudiesincludedfortreatingtheotherproblemsinpatientswithbreastcancer KeyoutcomeAcupointsLengthofReferenceClinicalStudydesign/ExperimentalregimenControlgroupmeasurementtreatproblemmodified(samplesize/dropout)regimen(weeks)/Jadadscore(samplesize/follow-updropout) [54]ArthralgiasRCT(cross-AT30mintwiceaweeklyObservationTB5,GB41,GB34,LI4,6/6weeks(1)Pain(BPI-over)/2for6weeks(21/2)(21/2)ST41,KD3.LI15,SJ14,SF)SI10,SJ4,LI5,SI5,SI3,(2)QOLLI3,Du3,Du8,UB23,(FACT-G)GB30,GB39,SP9,SP10,(3)Inflam.ST34biomarkerb(IL-1,aTNF-) [55]BCRLSinglegroup/AT30min,onceaweekforN/ACV2,CV3,CV12,LI15,24/N/A(1)Rangeof124weeks(29/NR)TE14,LU5,TE5,LI4,motionST36,ST6,SP9,SJ5,(2)SensationSJ14,REN2,REN3,(VAS),REN12(3)Cirtometrydifference (4)Degree(0–3score) [56]CILPNon-RCT/0ATinjecteddrug(Dexa)UsualcareST367days/N/ASerumWBC(102/NR)withGCS-Faccount(102/NR) SerumWBC[57]RILPSinglegroup/ATinjecteddrug(Dexa)(7/N/AST363-5days/N/Aaccount0NR) [58]AdverseRCT/2EA30mindailyforUsualcareST36,BL23,BL18,BL1762daysMultipleeventof62days(24/NR)(24/NR)dimensionstreatment CINVBCRLCILPRILPchemotherapy-inducednauseavomit,breastcancer-relatedlymphedema,chemotherapy-inducedleukopenia,RadiotEAATACN/RROMKIcontroltrial,electroacupuncture,manualacupuncturetherapy,digitalacupressure,notreported,rangeofmotion,KuppSCLNCIN/APODRhodesIndexofNausea,VomitingandRetching,symptomchecklist,NationalCancerInstitute,non-applicable,post-oper
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