Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews

Systematic Review of the Effectiveness of Complementary and Alternative Medicine on Nausea and Vomiting in Children With Cancer

BACKGROUND

Nausea and vomiting are distressing symptoms reported by pediatric oncology patients during cancer treatment. More than 40% of them experience these symptoms even after receiving antiemetics.

OBJECTIVE

Given the limitations of pharmacological interventions, this systematic review synthesized the evidence for the effectiveness of complementary and alternative medicine in controlling nausea and vomiting among pediatric oncology patients.

METHODS

Ten databases were searched to identify relevant randomized controlled trials. The risk of bias of selected studies was graded using the Cochrane risk-of-bias tool for randomized trials. The primary outcomes were nausea and vomiting. The secondary outcomes were intervention adherence and number of adverse events.

RESULTS

Nineteen papers met the inclusion criteria and were included in the review. Sixteen studies showed high risk of bias. The tested interventions were acupuncture, acupressure, aromatherapy, hypnosis, massage, active cognitive distraction/relaxation techniques, creative arts therapy, psychoeducation, and combined massage and acupressure. Acupuncture, hypnosis, and massage interventions improved nausea and vomiting. Fifteen trials reported intervention adherence; only 7 monitored adverse events. The most common reason for dropout was refusal from patients and/or their guardians. A total of 34 adverse events were noted.

CONCLUSIONS

There is insufficient evidence that complementary and alternative medicine is effective, feasible, or safe in controlling nausea and vomiting among pediatric oncology patients due to high risk of bias.

IMPLICATIONS FOR PRACTICE

Acupuncture, hypnosis, and massage appear to have therapeutic benefits. However, more robust studies are needed to address the identified methodological issues and determine the real value of these 3 interventions.

Development and Outcomes of a Provider-Driven, Online Continuing Education Program on Integrative Palliative Care: Randomized Controlled Trial

Background

Integrative therapies are increasingly in demand for both symptom management and quality of life in palliative care (PC) populations. Multidisciplinary PC professionals need continuing education/continuing medical education (CE/CME) to keep current on the evidence-informed use of integrative therapies in PC planning.

Objectives

(1) Elicit input from multidisciplinary PC providers on needs for CE/CME content on integrative care, and indicators of implementation for use in impact assessment. (2) Produce an online CE/CME program responsive to provider input. (3) Assess program impact on PC providers in a randomized controlled trial.

Methods

Focus groups with 47 multidisciplinary PC personnel assessed needs for CE/CME content and identified practice-related behaviors indicating implementation of integrative care. Qualitative analysis then informed development a 9-hour CE/CME program, and identified candidate items for an outcome measure (Integrative Practice Assessment) to assess impact. Validation testing followed with 63 new subjects. A randomized, waitlist-controlled trial then assessed program impact on (1) confidence understanding evidence-informed use of integrative therapies in PC, and (2) implementation of practice behaviors that promote integrative care.

Results

213 subjects were randomized and 170 provided follow-up data on program impact. Subjects' confidence (10-point scale) understanding safety considerations increased from 5.4 to 8.7; recommending modalities, from 4.2 to 8.3; and explaining modalities, from 4.8 to 8.5. Direct actions promoting integrative care in the last 10 patient encounters increased (12.2 to 17.9). Indirect actions taken in the work setting increased in the past month to advocate integrative therapies (from 5.7 to 9.1), and to promote organizational change (from 10.9 to 18.2). (All outcomes P < .001).

Conclusion

This provider-driven CE/CME program led to significant positive changes in practitioners' self-efficacy and implementation of integrative care practices in PC settings. The results indicate that CE/CME can have measurable impacts that benefit providers and may potentially impact patients, families and the culture of care.

Developing implementation strategies for promoting integrative oncology outpatient service delivery and utilisation: a qualitative study in Hong Kong

Purpose

Current evidence supports the use of integrative oncology (IO) interventions in cancer supportive care. The demand for outpatient IO services in Hong Kong is expected to soar following the surge in cancer incidence due to population ageing. This study identified the factors influencing the delivery and utilisation of outpatient IO from local stakeholders' perspectives and developed corresponding implementation strategies.

Methods

This study involved two sequential stages. First, with individual semi-structured interviews guided by the Theoretical Domains Framework (TDF), we explored stakeholders' views on the barriers to and facilitators for implementing IO. Second, guided by a TDF-based qualitative data analysis of interview transcripts, we performed intervention mapping to develop Behaviour Change Wheel-based implementation strategies that may overcome the barriers and strengthen the facilitators.

Results

We interviewed 31 stakeholders, including traditional Chinese medicine (TCM) practitioners (n = 8), biomedically-trained doctors (n = 7), nurses (n = 6), administrators (n = 4), caregivers (n = 4), and pharmacists (n = 2). The key local factors influencing outpatient IO are (1) lacking nursing and administrative workforce supporting IO service delivery, (2) lacking awareness of IO services among healthcare professionals, administrators, patients, and caregivers, and (3) lacking knowledge among healthcare professionals of herb-drug interaction and herbal toxicities.

Conclusion

We recommended a multi-faceted implementation strategies package that included arranging funding to train, recruit, and retain nursing and administrative staff, devolving resources into promoting interprofessional collaborations and evidence on IO effectiveness and safety, integrating evidence on herb-drug interactions and herbal toxicities into automated electronic health record systems monitored by pharmacists with dual qualifications in TCM and conventional pharmacy.

Prevalence, trends, and specialized palliative care utilization in Taiwanese children and young adults with life-limiting conditions between 2008 and 2017: a nationwide population-based study

BACKGROUND

Previous studies have shown a growing need for pediatric palliative care, but there is a lack of knowledge in many countries concerning prevalence of service use among children and young adults with life-limiting conditions. This study aimed to estimate (1) the annual prevalence of children and young adults with a life-limiting condition, and (2) their specialized palliative care and other healthcare utilization.

METHODS

Data from the Health and Welfare Data Science Center in Taiwan were used. All children and young adults aged 0-25 years recorded in inpatient or outpatient data, and infants aged < 1 year in death data with a life-limiting condition diagnostic code from 2008 to 2017 were recruited. Poisson regression was used to estimate the crude and adjusted relative risk of prevalence of life-limiting conditions with 95% confidence intervals, adjusted for age and sex, and to evaluate the trend in prevalence of each life-limiting diagnostic groups, in specialized palliative care and other service use.

RESULTS

Data contained 236,250 individuals with a life-limiting condition, of which oncological and congenital abnormalities were the most common. There was an annualized increase over 10 years in the prevalence of life-limiting conditions of 36.4%, from 45,311 cases (59.4 per 10,000 population) to 52,226 cases (81.0 per 10,000 population), with the highest prevalence in individuals aged 21-25 years. All diagnostic groups showed significant increases in prevalence (p < .001) with the exception of oncology, circulatory, and "other" group. Specialized palliative care services, including family consultation, shared care, home visits have increased in use over time (p < .001), while inpatient hospice has slightly decreased. The highest prevalence of healthcare use was for traditional Chinese medicine (237.1 per 1,000 population in 2017), but this decreased over time (p < .001).

CONCLUSIONS

Due to a growing trend towards multidisciplinary care, healthcare professionals and policymakers must engage and take action to expand specialized palliative care and integrate delivery of other healthcare services. Traditional Chinese medicine having a decreasing slope, yet still the highest prevalence of use, needs further attention.

2023 MASCC/ESMO consensus antiemetic guidelines related to integrative and non-pharmacological therapies

PURPOSE

Review the literature to propose suggestions or recommendations for controlling nausea and vomiting through integrative and non-pharmacological treatments for the MASCC/ESMO 2023 update of its antiemetic guidelines.

METHODS

The authors identified available systematic reviews and/or meta-analyses for 12 integrative therapies, including acupressure, acupuncture, auricular therapy, electrical stimulation of point PC6, ginger use (i.e., Zingiber officinale), guided imagery, hypnosis, inhalation aromatherapy, music therapy, food-based interventions, progressive muscle relaxation, and reflexology. Reviews were assessed for quality through the AMSTAR2 tool. A consensus committee reviewed recommendations as per MASCC/ESMO established processes.

RESULTS

Thirty-nine systematic reviews and/or meta-analyses were used. There were major methodological flaws for many of the trials used as the bases for the reviews. No recommendation for ingested ginger could be made because of conflicting evidence. Recommendations were possible for acupuncture/electroacupuncture treatments, food-based interventions, and progressive muscle relaxation training alone or combined with guided imagery. No recommendations could be reached for a number of food-based approaches, inhalation aromatherapy, hypnosis in adults, music therapy, and reflexology.

CONCLUSION

While a limited number of suggestions are provided, there is a need for significantly higher quality trials in many of the therapeutic approaches assessed, before stronger recommendations and a wider range of approaches are made.

Acupuncture for tumor-related depression: a systematic review and meta-analysis

Introduction

Tumor-related depression is a series of symptoms or states triggered by a tumor as the basic disease. It does not belong to psychiatric depression but dramatically affects individuals' quality of life. Acupuncture is extensively used to treat tumor-related depression, but the effect of body acupuncture on tumor-related depression is still unsubstantiated. This work, therefore, set out to assess the effect of acupuncture on tumor-related depression.

Methods

Eight databases were searched from inception to October 2022 for randomized controlled trials (RCTs). Two researchers separately implemented the database search, study selection, data extraction, and quality assessment. All analyses were performed by using Review Manager 5.3.

Results

A total of 10 studies, including 725 participants, were included. A majority of studies recruited patients diagnosed with various tumor types and statuses. Meta-analysis revealed that acupuncture had a beneficial effect compared with usual care on the Hamilton depression scale (HAMD) (mean difference (MD) = -2.23, 95% CI [-4.43, -0.03], p = 0.05), self-rating depression scale (SDS) (MD= -6.22, 95% CI [-10.67, -1.78], p = 0.006), effective rate (RR = 1.23, 95% CI [1.06, 1.43], p = 0.006), and quality-of-life questionnaire (QLQ-C30) (MD = 6.08, 95% CI [3.72, 8.43], p<0.0001). In the dimension of the HAMD (MD = -4.41, 95% CI [-6.77, -2.05], p = 0.0002) and SDS (MD = -9.19, 95% CI [-13.14, -5.24], p <0.00001), subgroup analysis also highlighted that acupuncture combined with usual care had an advantage over usual care. However, there was no superiority in acupuncture itself compared to usual care on the HAMD (MD = -1.25, 95% CI [-4.34, -1.84], p = 0.43) and SDS (MD = -3.08, 95% CI [-11.14, 4.98], p = 0.45). Acupuncture also reduced the incidence of adverse effects (RR=0.43, 95% CI [0.23, 0.80], p = 0.008).

Conclusion

Acupuncture is a safe and effective complementary therapy for tumor-related depression. This technique can provide clinical references for the medical field.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO, identifier CRD42022372513.

Integrative Oncology and the Clinical Care Network: Challenges and Opportunities

Integrative oncology is a new and growing field of cancer care. Integrative oncology is a patient-centered, evidence-based field of comprehensive cancer care that utilizes integrative therapies such as mind-body practices, acupuncture, massage, music therapy, nutrition, and exercise in collaboration with conventional cancer treatments. Patient interest and utilization has been growing over the past two decades. Clinical research has shown the benefits of these approaches to improving symptom management and quality of life, and is now being incorporated into national guidelines from the National Comprehensive Cancer Network (NCCN) and American Society for Clinical Oncology (ASCO). The availability of these services at cancer centers is growing, although the structure and implementation of integrative oncology remains highly variable. This article discusses the benefits of integrative oncology and provides an overview of the current state of integrative oncology programs nationwide. Current challenges and opportunities for cancer centers to provide integrative services is reviewed in the areas of programmatic structure, clinical service, education, and research.

Efficacy and safety of acupuncture-point stimulation combined with opioids for the treatment of moderate to severe cancer pain: a network meta-analysis of randomized controlled trials

Background

Pain is one of the most common and troublesome symptoms of cancer. Although potential positive effects of acupuncture-point stimulation (APS) on cancer pain have been observed, knowledge regarding the selection of the optimal APS remains unclear because of a lack of evidence from head-to-head randomized controlled trials (RCTs).

Objective

This study aimed to carry out a network meta-analysis to compare the efficacy and safety of different APS combined with opioids in treating moderate to severe cancer pain and rank these methods for practical consideration.

Methods

A comprehensive search of eight electronic databases was conducted to obtain RCTs involving different APS combined with opioids for moderate to severe cancer pain. Data were screened and extracted independently using predesigned forms. The quality of RCTs was appraised with the Cochrane Collaboration risk-of-bias tool. The primary outcome was the total pain relief rate. Secondary outcomes were the total incidence of adverse reactions, the incidence of nausea and vomiting, and the incidence of constipation. We applied a frequentist, fixed-effect network meta-analysis model to pool effect sizes across trials using rate ratios (RR) with their 95% confidence intervals (CI). Network meta-analysis was performed using Stata/SE 16.0.

Results

We included 48 RCTs, which consisted of 4,026 patients, and investigated nine interventions. A network meta-analysis showed that a combination of APS and opioids was superior in relieving moderate to severe cancer pain and reducing the incidence of adverse reactions such as nausea, vomiting, and constipation compared to opioids alone. The ranking of total pain relief rates was as follows: fire needle (surface under the cumulative ranking curve (SUCRA) = 91.1%), body acupuncture (SUCRA = 85.0%), point embedding (SUCRA = 67.7%), auricular acupuncture (SUCRA = 53.8%), moxibustion (SUCRA = 41.9%), transcutaneous electrical acupoint stimulation (TEAS) (SUCRA = 39.0%), electroacupuncture (SUCRA = 37.4%), and wrist-ankle acupuncture (SUCRA = 34.1%). The ranking of total incidence of adverse reactions was as follows: auricular acupuncture (SUCRA = 23.3%), electroacupuncture (SUCRA = 25.1%), fire needle (SUCRA = 27.2%), point embedding (SUCRA = 42.6%), moxibustion (SUCRA = 48.2%), body acupuncture (SUCRA = 49.8%), wrist-ankle acupuncture (SUCRA = 57.8%), TEAS (SUCRA = 76.3%), and opioids alone (SUCRA = 99.7%).

Conclusions

APS seemed to be effective in relieving cancer pain and reducing opioid-related adverse reactions. Fire needle combined with opioids may be a promising intervention to reduce moderate to severe cancer pain as well as reduce opioid-related adverse reactions. However, the evidence was not conclusive. More high-quality trials investigating the stability of evidence levels of different interventions on cancer pain must be conducted.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/#searchadvanced, identifier CRD42022362054.

Acupuncture for cancer pain: a scoping review of systematic reviews and meta-analyses

Background

Due to the effectiveness and safety, acupuncture, one of the traditional therapies of Chinese medicine, has been widely used in clinical practice globally. A few systematic review or meta-analyses have proved its effectiveness and safety towards patients with cancer pain, while there are no syntheses among those evidence. The aim of this scoping review is to summarize the evidence from systematic reviews of acupuncture for the treatment of cancer pain and evaluate the breadth and methodological quality of these evidence as well.

Methods

The scoping review process was guided by the methodology framework of Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA ScR) and "Arkseyand O'Malley six-stage framework". Electronic searches were carried out in several online databases from inception to Jan 2022. Systematic reviews and meta-analyses that involve any type of acupuncture for patients with cancer pain will be included. A pair of reviewers independently screened full texts. Moreover, review characteristics were extracted, and methodological quality was assessed using the AMSTAR 2 tool.

Results

Twenty-five systematic reviews and meta-analyses were included. Manual acupuncture is the most frequently included types of test group intervention (48%), followed by acupuncture + medicine (28%), and auricular acupuncture (12%). All the reviews have declared that acupuncture is an effective method for cancer pain treatment. Eleven reviews (44%) aiming at evaluating the safety also have confirmed that acupuncture is safe for treating cancer pain. However, most included studies were conducted in China. With certain geographical limitations, the findings were not representative within the region. The results of our review may owe to the synthesis of all kinds of cancer pain, and only 2 reviews described the type of cancer pain in detail.

Conclusions

This scoping review synthesizes and evaluates existing evidence of acupuncture for cancer pain. From this scoping review of systematic reviews and meta-analyses, there are clear recommendations for future studies: expanding the region of research in the world and trying to conduct the study of different types of cancer pain in details as much as possible. Evidences of acupuncture for cancer pain can inform clinical decision-making.

Systematic review registration

https://inplasy.com/inplasy-2022-1-0073/, identifier INPLASY202210073.

Effects of Ginseng on Cancer-Related Fatigue: A Systematic Review and Meta-analysis of Randomized Controlled Trials

BACKGROUND

Cancer-related fatigue (CRF) is a common yet troublesome adverse effect that compromises patient quality of life (QoL). Ginseng is often used to boost energy.

OBJECTIVES

The aim of this study was to systematically appraise evidence whether ginseng could alleviate CRF and improve QoL.

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials on the effectiveness of ginseng for relieving CRF. The primary outcome was fatigue. The secondary outcomes included QoL, anxiety, adverse events, depression, and laboratory markers.

RESULTS

The final sample comprised seven trials. The pooled results showed that ginseng consumption led to significant reductions in CRF levels (standard mean difference [SMD], -0.21; 95% confidence interval [CI], -0.42 to 0.00). Furthermore, improvements in physical well-being (SMD, 0.25; 95% CI, 0.09-0.41) and emotional well-being (SMD, 0.20; 95% CI, 0.01-0.40) were observed, as were nonsignificant trends toward improvement in vigor (SMD, 0.18; 95% CI, -0.02 to 0.38), mitigated nausea (SMD, 0.38; 95% CI, -0.09 to 0.85), dyspnea (SMD, 0.27; 95% CI, -0.04 to 0.59), and anxiety (mean difference, -0.97; 95% CI, -2.12 to 0.18).

CONCLUSIONS

Ginseng consumption alleviates CRF and may have certain benefits in improving QoL especially physical well-being.

IMPLICATIONS FOR PRACTICE

Ginseng may be used as an energy or nutrient supplement to alleviate CRF. However, the concentration of ginseng's functional components is affected by the production methods and thus probably its effects. Oncology nurses are encouraged to have a better understanding of the benefits and functional limitations of ginseng as an energy or nutrient supplement for CRF.

Effect of acupuncture in myelosuppression and quality of life in women with breast cancer undergoing chemotherapy: a randomized clinical study

OBJECTIVE

This study aimed to evaluate the effect of acupuncture on myelosuppression and quality of life in women with breast cancer during treatment with anthracyclines (ANT).

METHODS

Women with indication for ANT chemotherapy were randomized into two groups: acupuncture group (AG) and control group (CG). A quality of life questionnaire (FACT-G) and peripheral blood levels of the participants were evaluated before and at the end of treatment. The AG was submitted to an acupuncture intervention, starting before the first chemotherapy infusion, and continuing throughout the treatment.

RESULTS

A total of 26 women were randomized into 2 groups: AG (10) and CG (16). Of these, 26.9% had a dense dose indication according to the service's protocol for the administration of granulocyte-stimulating factor (G-CSF) from the first cycle, not participating in the analysis. The need for secondary prophylaxis with G-CSF occurred in 72.7% in the control group versus 12% in the acupuncture group. Regarding quality of life (QoL), it was observed that the groups did not initially differ from each other. At the end of the treatment, there was a significant difference in the AG for the physical (GP) (p-value=0.011), social/family (GS) (p-value=0.018), and functional (GF) (p-value=0.010) domains, regarding the initial and final FACT-G showed a difference between the groups, where the GA average at the end rose from 80.68 to 90.12 (p-value = 0.004) and in the CG the average dropped from 81.95 to 70.59 (p-value=0.003).

CONCLUSION

Acupuncture was efficient in the secondary prophylaxis of myelosuppression during chemotherapy and the quality of life of women during treatment has increased.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials - Rebec on 06/28/2018, registration number U1111-1216-3921, Rebec Trial RBR-7BWJ6R.

Implementation science in traditional, complementary and integrative medicine: An overview of experiences from China and the United States

BACKGROUND

The introduction of traditional, complementary and integrative medicine (TCIM) services into health systems has been advocated by the World Health Organization, but there is a paucity of reviews synthesising the experiences of (i) implementing TCIM services in conventional healthcare settings and (ii) introducing evidence-based practice in TCIM. Knowledge of the first issue will assist policymakers to innovate implementation interventions in their own health system contexts. Addressing the second issue will facilitate the closure of the evidence-practice gap in TCIM and improve the translation of research evidence into health outcome benefits.

PURPOSE

The aim of this study was to identify, describe and analyse publications on these two key TCIM policy issues via an overview from an implementation science perspective.

METHODS

Publications describing international experiences of implementing TCIM services or evidence for TCIM practices were identified by searching MEDLINE, EMBASE and Global Health databases in November 2021. The findings were summarised using a narrative synthesis approach.

RESULTS

Sixty-three relevant publications were included in the analysis. Current experiences in China and the United Sates (US) reflect varying policy priorities at different stages of implementing TCIM services. In the US, where TCIM have yet to be introduced into mainstream healthcare settings, implementation interventions were designed to facilitate the provision of specific, evidence-based TCIM modalities via referrals from conventional clinicians. The application of these strategies at the health system, regulatory, financial, community, provider and patient levels provided a comprehensive picture of how TCIM implementation may be facilitated via multi-level interventions. In China, the major form of TCIM is traditional Chinese medicine (TCM), for which service provision has already been adopted at all levels of healthcare. With the high volume of clinical research that has been generated in the past several decades, a key policy question at this stage is how to translate TCM-related clinical evidence into practice. The development of clinical practice guidelines (CPGs) is the main implementation intervention, but adherence by TCM clinicians has been poor, due to the conflict between classical individualised practice and CPG standardisation. While tailoring interventions to facilitate CPG uptake is indicated, concurrent innovations in TCM clinical research methods would improve the compatibility between classical and CPG-based practice.

CONCLUSION

Policymakers managing different stages of TCIM implementation will benefit from the experiences of practitioners in the US and China. Multi-level implementation interventions launched in the US provide ideas for the initial introduction of TCIM into a conventional medicine-dominated health system. As TCIM service provision and related clinical research become more common, China's experience will inform how clinical evidence related to TCIM may be disseminated and implemented to improve service quality.

Integrative Oncology's 30-Year Anniversary: What Have We Achieved? A North American Naturopathic Oncology Perspective

In 1991 the U.S. Congress mandated that the National Institutes of Health (NIH) form the Office of Alternative Medicine to study alternative medical therapies, especially in oncology care. Shortly after, the National Cancer Institute (NCI) created its own division of complementary and alternative medicine (Office of Complementary and Alternative Medicine). At the genesis of the field 30 years ago, what were we hoping to see accomplished by now? In this article we take a look back at milestones, shortfalls and future directions. Exciting opportunities exist to direct our established subspeciality's future directions and we have made valuable advances the field of integrative oncology over the last 30 years: 1, IV high dose ascorbate has clinical research-based applications when used concurrently with some chemotherapeutic agents. 2. Whole body, extracorporeal and locoregional hyperthermia are being applied in treating solid tumors, including brain tumors. 3. PDL-1 tumor microenvironment testing and PDL-1 inhibitor immunotherapies have surprisingly excellent outcomes in a subgroup of cancer patients. 4. Tumor DNA sequencing (resected tumor and circulating tumor DNA in blood) has led to personalized precision targeted treatments. 5. Glucose metabolism's role in cancer progression is better understood and better therapies are available (e.g., intermittent fasting, metformin). 6. Medical cannabis has a larger role in treating chemotherapy-related side effects and shows promise for anti-proliferative effects. 8. Greater understanding has been gained of the interdependence and mutual regulation of processes in psychoneuroendocrinoimmunology (PNEI). The burgeoning field of PNEI has exponentially expanded the discussion of tumorigenesis, apoptosis, and introduced to the field the investigation of more holistic approaches to immune regulation and cancer care. 8. Psychedelic-assisted psychotherapy is gaining traction especially for cancer patients facing demoralization, existential and spiritual distress, anxiety, depression and trauma related to the diagnosis and treatment of their cancer. 9. Spiritual health of cancer patients is more commonly addressed and measurable with an NIH validated scale. 10. Mind-Body therapies are efficacious for reducing cancer-related distress and are included in many cancer care programs.

MASCC/ISOO expert opinion on the management of oral problems in patients with advanced cancer

PURPOSE

The Palliative Care Study Group in conjunction with the Oral Care Study Group of the Multinational Association for Supportive Care in Cancer (MASCC) formed a sub-group to develop evidence-based guidance on the management of common oral problems in patients with advanced cancer.

METHODS

This guidance was developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews and trials, respectively. Guidance was categorised by the level of evidence, and "category of guideline" (i.e., "recommendation", "suggestion" or "no guideline possible").

RESULTS

Twelve generic suggestions (level of evidence - 5), three problem-specific recommendations and 14 problem-specific suggestions were generated. The generic suggestions relate to oral hygiene measures, assessment of problems, principles of management, re-assessment of problems and the role of dental/oral medicine professionals.

CONCLUSIONS

This guidance provides a framework for the management of common oral problems in patients with advanced cancer, although every patient requires individualised management.

Acupuncture for cancer-related conditions: An overview of systematic reviews

BACKGROUND

Acupuncture is commonly used for cancer-related conditions worldwide, and evidence is increasing year on year. There is a need to summarize the evidence of acupuncture for cancer-related conditions comprehensively and critically.

OBJECTIVE

To evaluate and summarize the systematic reviews (SRs) that assess the effects and safety of acupuncture for cancer-related conditions, and to inform clinical practice and future studies.

METHODS

A comprehensive search was conducted on Pubmed, Embase, the Cochrane Library, Web of Science, CNKI, VIP, Sinomed, and Wanfang from their inception to October 16, 2021. SRs of randomized controlled trials (RCTs) on acupuncture for cancer-related conditions were to be included. Two reviewers screened the eligible articles, and four reviewers in pair extracted data and assessed the methodological quality/risk of bias of all included reviews by AMSTAR 2 and ROBIS tools. The overlap of primary studies was measured by calculating corrected covered areas. Data from the included reviews were synthesized with a summary of meta-analysis or narrative description.

RESULTS

Fifty-one SRs of RCTs on acupuncture for cancer-related conditions were included and synthesized. The methodological quality of SRs included 1 "high", 5 "low" and 45 "very low" by AMSTAR 2. Sixteen SRs assessed as low risk of bias (31.37%), and 35 SRs had high risk of bias (68.63%) by ROBIS. Acupuncture showed effective on systemic conditions in relation to different cancers, including cancer-related pain (17 SRs, 80 RCTs), fatigue (7 SRs, 18 RCTs), insomnia (4 SRs, 10 RCTs), quality of life (2 SRs, 15 RCTs); conditions in relation to chemo-radiotherapy, including nausea and vomiting (3 SRs, 36 RCTs) and bone marrow suppression (2 SRs, 21 RCTs); and conditions in relation to specific cancers, including breast cancer-related menopause (3 SRs, 6 RCTs), hot flashes (12 SRs, 13 RCTs), arthralgia (5 SRs, 10 RCTs), and nasopharyngeal cancer-related dysphagia (1 SRs, 7 RCTs). Acupuncture appeared to have benefit for patients with lymphoedema (3 SRs, 3 RCTs), gastrointestinal function (5 SRs, 27 RCTs), and xerostomia (4 SRs, 7 RCTs). Limited evidence showed inconsistent results on acupuncture for chemotherapy-induced peripheral neuropathy (3 SRs, 6 RCTs), depression and anxiety (3 SRs, 9 RCTs). Acupuncture was regarded as a safe therapy for cancer patients as no severe adverse events related were reported.

CONCLUSION

Evidence from SRs showed that acupuncture is beneficial to cancer survivors with cancer-related pain, fatigue, insomnia, improved quality of life, nausea and vomiting, bone marrow suppression, menopausal symptoms, arthralgia, and dysphagia, and may also be potential for lymphoedema, gastrointestinal function, and xerostomia. For neuropathy, depression and anxiety, acupuncture should be used as an option based on individual conditions. Acupuncture is relatively safe without serious adverse events. More well-designed clinical trials of acupuncture are recommended on cancer-related depression and anxiety, arthralgia, xerostomia, gastrointestinal dysfunction and dysphagia.

Acupuncture and Moxibustion for Cancer-Related Fatigue: An Overview of Systematic Reviews and Meta-Analysis

Simple Summary

Acupuncture, per se, is not used for treating cancer. However, acupuncture is used for treating several cancer-related symptoms, such as, for example, pain, antiestrogen-induced hot flashes, as well as cancer-related fatigue (CRF). There are several studies that assess the evidence of acupuncture for palliative cancer treatment; but there are none for CRF. The aim of this overview, therefore, was to comprehensively summarize and critically evaluate the current evidence of the efficacy of AT in the management of CRF.

Abstract

Although acupuncture (AT) is used in the treatment of CRF, the evidence from different systematic reviews (SRs) of AT has not yet been comprehensively evaluated. Moxibustion, which is a treatment method that is well established within Traditional East Asian Medicine, applies the heat of burning herbs towards or onto special points on the skin. Commonly, the herb Artemisia vulgaris, is used. It has been used for palliative cancer care, as well as for CRF. The aim of this overview was to evaluate the efficacy of AT and moxibustion in the management of CRF. Eleven databases were searched through for studies that were published from their dates of inception to February 2022. The study selection, the data extraction, and the assessment were performed independently by two researchers. The methodological and report quality were assessed by using the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) tool. The evidence quality was evaluated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Fifteen SRs on AT (n = 10) and moxibustion (n = 5) treatments for CRF were included, and they include 169 randomized controlled trials and 14,392 participants. All of the SRs that were evaluated by the AMASTAR-2 had more than one deficiency, and so all of the SRs were rated as either low or critically low. For the GRADE, 18 outcomes were rated as very-low-quality evidence, 13 as low-quality evidence, 3 as moderate-quality evidence, and 0 as high-quality evidence. Most of the SRs reached the potential benefits of AT for CRF. No serious adverse effects were identified. In conclusion, the evidence suggests that, despite the advantages of AT in terms of the improvement in and the safety of the treatment of CRF, the methodological quality of most of these studies is low, which limits our ability to draw definitive meanings. Further research of high quality is needed in order to confirm these findings.

Understanding the experiences and perception of people living with HIV on integrative traditional East Asian medicine management in Korea: an interview protocol for qualitative research

INTRODUCTION

Patients with HIV/AIDS have been able to experience the average life expectancy of the general population due to medical advancements. However, they face physical, emotional and social difficulties that worsen their quality of life. The pharmacological approach is often the first choice to address these issues, but it involves some limitations. Integrative traditional East Asian medicine (ITEAM) can compensate for the limitations of drugs and can be applied to treat physiological and psychiatric problems. In Korea, ITEAM interventions are easily accessible under the government insurance. However, the experiences, perceptions and barriers to the use of ITEAM in patients with HIV/AIDS are less studied. Therefore, we will interview them to explore their experiences and examine the strengths, limitations, barriers and improvements in the use of ITEAM.

METHODS AND ANALYSIS

This is a qualitative study using a phenomenological framework. We will conduct one-to-one interviews with 3-10 patients with HIV/AIDS who have been treated with ITEAM from March 2021 to January 2022. We will present semistructured open-ended questions and analyse them using experiential phenomenological research methods. The results will be reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies.

ETHICS AND DISSEMINATION

This research was approved by the Institutional Review Board of the National Medical Center (IRB number, NMC-2101-008). The results of this study will be disseminated through journal articles, newspapers and conference proceedings.

TRIAL REGISTRATION NUMBER

Clinical Research Information Service: KCT0005855; Pre-results.

Comparison of physical electrical conductivity and acupuncture de-qi sensation between stainless steel needling and supercritical fluid-treated needling

BACKGROUND

While acupuncture has been used for thousands of years, modern technology to develop new needle materials has rarely been discussed. We aim to explore a new acupuncture needle material and compare the differences in the needling sensations between the acupuncture needle surface treated with nitrogen applied supercritical fluid (SCF-N) and conventional stainless steel needles.

METHODS

This was a double-blind cohort study. The acupuncture needles were randomly used in this experiment, including the SCF-N-treated needles and the control stainless steel needles. LI 4 (Hegu) and LI 11 (Quchi) acupuncture points in the Yangming Large Intestine Meridian of Hand were treated. Physical electrical resistance, scanning electron microscopy, energy dispersive spectrometry, and visual analog scale (VAS) score including the sensations of soreness, numbness, distention, and heaviness were assessed.

RESULTS

The proportion of nitrogen (N) was significantly higher in the SCF-N-treated needles than in the stainless steel needles group (2.3 ± 0.2% vs 0.0 ± 0.0%, P < 0.01). The cumulative de-qi sensation score at the LI 4 Hegu acupoint (1.87 ± 1.88 vs 1.54 ± 1.62, P = 0.014), especially the sensation of soreness score (2.76 ± 2.06 vs 2.13 ± 1.85, P = 0.045), revealed statistically significant differences between both groups. SCF-N surface treatment of acupuncture needles may lower the electrical resistance more than the control stainless steel needles (24.67 ± 0.88 kW vs 26.45 ± 0.75 kW, p < 0.01).

CONCLUSION

Acupuncture needles modified with SCF-N surface treatment can enhance de-qi sensations to improve electrical conductivity of the meridian and therapeutic effects on the Yangming Large Intestine Meridian of Hand. SCF-N surface treated needles can be as a new acupuncture needle material in the future.

Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses

Background and Objectives: Uncertainty about the clinical efficacy of transcutaneous electric nerve stimulation (TENS) to alleviate pain spans half a century. There has been no attempt to synthesise the entire body of systematic review evidence. The aim of this comprehensive review was to critically appraise the characteristics and outcomes of systematic reviews evaluating the clinical efficacy of TENS for any type of acute and chronic pain in adults. Materials and Methods: We searched electronic databases for full reports of systematic reviews of studies, overviews of systematic reviews, and hybrid reviews that evaluated the efficacy of TENS for any type of clinical pain in adults. We screened reports against eligibility criteria and extracted data related to the characteristics and outcomes of the review, including effect size estimates. We conducted a descriptive analysis of extracted data. Results: We included 169 reviews consisting of eight overviews, seven hybrid reviews and 154 systematic reviews with 49 meta-analyses. A tally of authors' conclusions found a tendency toward benefits from TENS in 69/169 reviews, no benefits in 13/169 reviews, and inconclusive evidence in 87/169 reviews. Only three meta-analyses pooled sufficient data to have confidence in the effect size estimate (i.e., pooled analysis of >500 events). Lower pain intensity was found during TENS compared with control for chronic musculoskeletal pain and labour pain, and lower analgesic consumption was found post-surgery during TENS. The appraisal revealed repeated shortcomings in RCTs that have hindered confident judgements about efficacy, resulting in stagnation of evidence. Conclusions: Our appraisal reveals examples of meta-analyses with 'sufficient data' demonstrating benefit. There were no examples of meta-analyses with 'sufficient data' demonstrating no benefit. Therefore, we recommend that TENS should be considered as a treatment option. The considerable quantity of reviews with 'insufficient data' and meaningless findings have clouded the issue of efficacy. We offer solutions to these issues going forward.

Pharmacologic and Non-Pharmacologic Dyspnea Management in Advanced Cancer Patients

As there is a high propensity for patients with advanced malignancy to experience refractory dyspnea, it is necessary for physicians to be well-versed in the management of these patients' dyspneic symptoms. For symptomatic treatment of cancer patients with dyspnea, both pharmacologic and non-pharmacologic methods should be considered. The main source of pharmacologic symptom management for dyspnea is oral and parenteral opioids; benzodiazepines and corticosteroids may serve as helpful adjuncts alongside opioid treatments. However, oxygen administration and nebulized loop diuretics have not been shown to clinically benefit dyspneic cancer patients. Applying non-pharmacologic dyspnea management methods may be valuable palliative therapies for advanced cancer patients, as they provide benefit with negligible harm to the patient. Advantageous and minimally harmful non-pharmacologic dyspnea therapies include facial airflow, acupuncture and/or acupressure, breathing exercises, cognitive behavioral therapy, music therapy, and spiritual interventions. Thus, it is vital that physicians are prepared to provide symptomatic care for dyspnea in advanced cancer patients as to minimize suffering in this patient population during definitive cancer treatments or hospice care.

Acupuncture for palliative cancer pain management: systematic review

BACKGROUND

Pain is one of the most common and problematic symptoms encountered by patients with cancer. Due to the multifactorial aetiology, pain management of these patients frequently requires multidisciplinary interventions including conventional support and specialty palliative care. Acupuncture has been identified as a possible adjunctive therapy for symptom management in cancer pain, and there is currently no systematic review focused solely on the evidence of acupuncture on cancer pain in palliative care.

OBJECTIVE

To critically analyse currently available publications regarding the use of acupuncture for pain management among patients with cancer in palliative care settings.

METHODS

Multiple academic databases were searched from inception to 29 October 2020. Randomised controlled trials involving acupuncture in palliative care for treatment of cancer-related pain were synthesised. Data were extracted by two independent reviewers, and methodological quality of each included study was assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) 2011 Levels of Evidence.

RESULTS

Five studies (n=189) were included in this systematic review. Results indicated a favourable effect of acupuncture on pain relief in palliative care for patients with cancer. According to OCEBM 2011 Levels of Evidence, they were level 2 in one case (20%), level 3 in two cases (40%) and level 4 in the remaining (40%). Low-level evidence adversely affects the reliability of findings.

CONCLUSIONS

Acupuncture may be an effective and safe treatment associated with pain reduction in the palliative care of patients with cancer. Further high-quality, adequately powered studies are needed in the future.

Cutting edge: Metabolic immune reprogramming, reactive oxygen species, and cancer

A recently proposed term "immunometabolism" points to the functional intracellular metabolic changes that occur within different immune cells. Recent findings suggest that immune responses can be determined by the metabolic status of immune cells and metabolic reprogramming is an important feature of immune cell activation. Metabolic reprogramming is also well known for cancer cells and has been suggested as a major sign of cancer progression. Metabolic reprogramming of immune cells is also seen in the tumor microenvironment. In the past decade, immunometabolism has progressively become an extraordinarily vibrant and productive area of study in immunology because of its importance for immunotherapy. Understanding the immunometabolic situation of T cells and other immune cells along with the metabolic behavior of cancer cells can help us design new therapeutic approaches against cancers. Here, we have the aim to review the cutting-edge findings on the immunometabolic situation in immune and tumor cells. We discuss new findings on signaling pathways during metabolic reprogramming, its regulation, and the participation of reactive oxygen species in these processes.

Research Trends of Acupuncture Therapy on Cancer Over the Past Two Decades: A Bibliometric Analysis

Purpose:

Acupuncture has been used for managing cancer-related symptoms. However, there are still few studies concerning the overall trends in acupuncture therapy on cancer based on bibliometric analysis. This study aims to demonstrate the current status and trends in this field over the past 2 decades.

Methods:

Articles were retrieved from the Web of Science from 2000 to 2019. CiteSpace was used for co-authorship network of countries/institutions, dual-map analysis, and detecting the keywords with citation bursts. VOSviewer was used to construct networks based on co-authorship and co-citation analysis of authors, and co-occurrence of keywords.

Results:

A total of 927 articles and reviews were included in the final analysis. The number of publications has steadily increased with some fluctuations among years. The country and institution contributing most to this field are the USA and Memorial Sloan Kettering Cancer Center. Mao JJ was the most productive author and Molassiotis A ranked first in the cited authors. The co-occurrence analysis revealed 5 clusters (including “clinical trials,” “clinical studies on chemotherapy/radiation-induced symptoms,” “CAM therapy for cancer,” “clinical studies on vasomotor symptoms,” and “systematic reviews”). Most recent keyword bursts were “neuropathic pain,” “arthralgia,” “prevention,” “supportive care,” and “integrative medicine”.

Conclusions:

The annual publication output would increase rapidly in the next decade, which shows a promising future in this research field. Future research hotspots would focus on the role of acupuncture in neuropathic pain, arthralgia, prevention, supportive care, and integrative medicine.

Prioritizing Chinese medicine clinical research questions in cancer palliative care from patient and caregiver perspectives

BACKGROUND

Chinese medicine (CM) modalities, including acupuncture and Chinese herbal medicine (CHM), are popular palliative interventions among patients with cancer, but further clinical research is required to assess their effectiveness and safety.

OBJECTIVE

To prioritize top ten important CM clinical research questions from patients with cancer, cancer survivors and caregivers' perspectives via a face-to-face prioritization workshop in Hong Kong.

METHODS

A list of 25 CM clinical research questions for cancer palliative care, which were identified from existing systematic reviews (SRs) and overview of SRs, was presented to 17 participants (patients with cancer [n = 5], cancer survivors [n = 6] and caregivers [n = 6]). The participants were then invited to establish consensus on prioritizing top ten research questions.

RESULTS

Among the top ten priorities, five (50%) focused on acupuncture and related therapies, while five (50%) were on CHM. The three most important research priorities were (i) manual acupuncture plus opioids for relieving pain; (ii) CHM for improving quality of life among patients receiving chemotherapy; and (iii) concurrent use of CHM plus loperamide for reducing stomatitis.

CONCLUSION

The top ten participant-endorsed CM clinical research priorities for cancer palliative care can guide local researchers on future direction. They can also inform local research funders on patient-centred allocation of limited funding. Under limited research funding, the most important co-prioritized research question from professional and patient perspectives may be addressed first.

PATIENT OR PUBLIC CONTRIBUTION

Patients with cancer, cancer survivors and caregivers participated in conduct of the study to prioritize CM clinical research questions.

Acupuncture and Derived Therapies for Pain in Palliative Cancer Management: Systematic Review and Meta-Analysis Based on Single-Arm and Controlled Trials

Background: Acupuncture is a classical complementary therapy, but benefits in palliative cancer pain are still unclear due to lack of consistent evidence. Objectives: To comprehensively evaluate the effectiveness of acupuncture and derived therapies (such as electroacupuncture, laser acupuncture, and transcutaneous electrical nerve stimulation) for analgesia in palliative cancer care based on both single-arm and controlled trials. Design: Eight databases were searched from inception to August 31, 2020. Both single-arm trials and controlled trials were included. The primary outcome was the change in pain intensity, as evaluated by the numeric rating scale (NRS) and the visual analog scale. Subjects: Adults with cancer. Results: Forty-one controlled studies with 2685 participants and 18 single-arm studies with 1084 participants were included. For controlled trials, meta-analysis indicated that acupuncture and derived therapies in addition led to greater reductions in the NRS score than conventional analgesics alone (weighted mean difference [WMD]: 1.33 [0.85-1.82], p < 0.001). For single-arm trials, meta-analysis showed that both the immediate effect (WMD: 1.57 [1.43-1.71], p < 0.001) and long-term longitudinal effect (WMD: 1.81 [1.25-2.37], p < 0.001) of acupuncture on analgesia were positive, as evaluated by the NRS, respectively. The benefits of acupuncture and derived therapies were also seen in quality of life and the global improvement rate. LI4 (Hegu) was the most frequently used acupoint. Conclusions: This systematic review supported the application of acupuncture and derived therapies for managing pain during palliative cancer care from two dimensions. Further studies could explore the effect of acupuncture on other predominant symptoms in palliative cancer patients.

Digestion-Specific Acupuncture Effect on Feeding Intolerance in Critically Ill Post-Operative Oral and Hypopharyngeal Cancer Patients: A Single-Blind Randomized Control Trial

Malnourishment is prevalent in patients suffering from head and neck cancer. The postoperative period is crucial in terms of nutritional support, especially after composite resection and reconstruction surgery. These patients present with a number of risk factors that aggravate feeding intolerance, including postoperative status, prolonged immobility, decreased head elevation, mechanical ventilation, and applied sedative agents. Routine management protocols for feeding intolerance include prokinetic drug use and post-pyloric tube insertion, which could be both limited and accompanied by detrimental adverse events. This single-blind clinical trial aimed to investigate the effects of acupuncture in postoperative feeding intolerance in critically ill oral and hypopharyngeal cancer patients. Twenty-eight patients were randomized into two groups: Intervention group and Control group. Interventions were administered daily over three consecutive postoperative days. The primary outcome revealed that the intervention group reached 70% and 80% of target energy expenditure (EE) significantly earlier than the control group (4.00 ± 1.22 versus 6.69 ± 3.50 days, p = 0.012), accompanied by higher total calorie intake within the first postoperative week (10263.62 ± 1086.11 kcals versus 8384.69 ± 2120.05 kcals, p = 0.004). Furthermore, the intervention group also needed less of the prokinetic drug (Metoclopramide, 20.77 ± 48.73 mg versus 68.46 ± 66.56 mg, p = 0.010). In conclusion, digestion-specific acupuncture facilitated reduced postoperative feeding intolerance in oral and hypopharyngeal cancer patients.

Perceptions That Influence Acupuncture Use in Hospice Settings: Results of a State-Wide Survey Study

Background: Acupuncture is an effective and low-risk therapy for a wide spectrum of medical conditions. In the hospice setting, where comfort is the top priority, acupuncture could play a vital role in reducing symptom burden at the end of life. Objective: This state-wide survey study explored perceived barriers to acupuncture use in the hospice setting from acupuncturist and hospice staff perspectives. Specific barriers addressed included insurance coverage/funding for acupuncture, lack of knowledge of acupuncture as a therapeutic modality, and perceived insufficient evidence base for acupuncture. Materials and Methods: Acupuncturists and hospice staff in Oregon were recruited by e-mail and/or telephone to complete their survey. Results: Among acupuncturists, a response rate of 50% was obtained. The response rate of hospice staff could not be obtained. There were a total of 270 providers and hospice staff (102 acupuncturists, 16 hospice doctors, 14 hospice directors, 93 hospice nurses, 30 hospice social workers, and 15 hospice chaplains). The majority of acupuncturists (76% and 89%, respectively) and hospice staff (59% and 82%, respectively) strongly agreed or somewhat agreed that insurance coverage/funding for acupuncture and lack of knowledge of acupuncture as a therapeutic modality are important barriers. With respect to the perceived evidence base for acupuncture, the majority of acupuncturists (91%) and hospice staff (69%) strongly agreed or somewhat agreed that acupuncture can help provide a higher quality of life for hospice patients, although knowledge of specific conditions amenable to acupuncture among acupuncturists and hospice staff varied. Conclusions: From the acupuncturist and hospice staff perspectives, insurance coverage/funding for acupuncture, lack of knowledge of acupuncture as a therapeutic modality, and perceived insufficient evidence base for acupuncture are primary barriers to the use of acupuncture in hospice care. Increased awareness/education about acupuncture in the hospice setting, as well as improved funding structures, is critical.

The efficacy of acupuncture and moxibustion for early and middle-stage osteonecrosis of the femeral head: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Osteonecrosis of the femeral head (ONFH) occurs predominantly in young- and middle-aged people, and the disability rate is high in the late stage of the disease and most patients have to undergo total hip replacement. Clinically, increasing attention is paid to intervening early and middle-stage ONFH so as to delay its progress. Acupuncture and moxibustion (AM) is a unique method for treating ONFH in China. This study aims to summarize the advantages of AM for the treatment of ONFH.

METHODS

A comprehensive literature search was conducted on the database with languages of English and Chinese. The medical subject titles used are "Osteonecrosis of the femoral head" and "acupuncture and moxibustion." Related words in the title or abstract including but were not limited to "necrosis of the femoral head," "avascular necrosis of the femoral head," "ischemic necrosis of the femoral head," "caput femoris necrosis," "bone paralysis," "bone erosion," and "bone atrophy."

RESULTS

Nine randomized controlled trials were identified in this meta-analysis that included 630 subjects. Meta-analysis showed that the trial group that treated with conventional therapy combined with AM had a higher effective rate (Z = 2.27 P = 0.02) and excellent and good rate (Z = 4.85 P < 0.00001) and Harris hip function score (HHS) (Z = 2.31 P = 0.02) and lower incidence of related adverse reactions during treatment (Z = 2.82 P = 0.005) compared with the control group that treated with conventional therapy alone.

CONCLUSIONS

AM for early and middle-stage ONFH is an effective and relatively safe intervention, which can improve the effective rate and excellent and good rate and HHS, and reduce the adverse reaction rate. Clinically, early and middle-stage ONFH can be intervened by combining with AM while taking conventional therapy to improve the efficacy.

The Risk of QTc Prolongation with Antiemetics in the Palliative Care Setting: A Narrative Review

Nausea and vomiting are common within the palliative care population. Antiemetic agents may help control symptoms, but may also place patients at risk for QTc prolongation. This article reviews pharmacotherapy agents including anticholinergics, antihistamines, antidopaminergics, 5-HT3 receptor antagonists, dronabinol, and medical marijuana and their associated risk of QTc prolongation. A clinical treatment pathway is provided to help guide clinicians in choosing the most appropriate antiemetic based upon patient specific factors for QTc prolongation.

Acupuncture in oncological pain relief: A systematic review of randomized clinical trials

Abstract Introduction: Cancer pain has a considerable impact on patients’ health and quality of life, and its treatment is essentially based on opioid use. Objective: To report the effectiveness of acupuncture in relieving cancer pain (secondary to the disease or to the corresponding therapy) or in decreasing opioid use compared to other interventions. Methods: A systematic review of randomized clinical trials was conducted following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. The trials were selected from the PubMed, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Results: The search strategy resulted in the inclusion of eight trials, of which five compared acupuncture and drug therapy and three compared acupuncture and placebo. Seven trials reported decreased pain and analgesic use. The trials showed clinical heterogeneity, making a meta-analysis unfeasible. Conclusion: The findings herein provided no robust evidence to support the routine use of acupuncture as an adjuvant therapy in the treatment of cancer pain. However, its use is promising since the results showed a trend toward decreased pain and analgesic use, thus justifying further studies in the future.

The Adjunctive Effect of Acupuncture for Advanced Cancer Patients in a Collaborative Model of Palliative Care: Study Protocol for a 3-Arm Randomized Trial

BACKGROUND

Cancer is the second leading cause of death before the age of 70. Improved cancer survival has put increasing demands on cancer care. Palliative care is the specialized multi-disciplinary care providing relief from the pain, symptoms, and stress of serious illness. The study aims to evaluate the adjunctive effect of acupuncture for advanced cancer patients in a collaborative model of palliative care.

METHODS/DESIGN

This is a single-blinded, randomized, sham-controlled trial. One hundred twenty advanced cancer patients undergoing palliative care will be randomized in a ratio of 2:1:1 to manual acupuncture plus standard care group (ASC), sham acupuncture plus standard care group (SSC), and standard care group (SC). Patients in ASC and SSC will receive 9 sessions of acupuncture or sham acupuncture for 3 weeks, and will be followed up for 2 months. The primary measure is the change from baseline score of the Edmonton Symptom Assessment System at 3 weeks. The secondary measures include the Brief Fatigue Inventory, Hospital Anxiety and Depression Scale, Insomnia Severity Index, Numeric Rating Scale, and European Organization for Research and Treatment of Cancer Quality of Life 15 items Questionnaire for Palliative Care.

DISCUSSION

The finding of this trial will provide high-quality evidence on the adjunctive effect of acupuncture to standard care on advanced cancer patients undergoing palliative care.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT04398875 (https://www.clinicaltrials.gov/ct2/show/NCT04398875), Registered on 21 May 2020.

[What happened in the acupoint area of mouse after blood injection?]

OBJECTIVE

Autologous blood acupoint injection has practiced for treatment of various diseases, but its therapeutic mechanism remains unknown. This study aimed to explore the histological changes in the acupoint area after blood injection.

METHODS

Blood samples (0.1 mL) collected from donator mice was injected in the recipient mice at the acupoint of left Zusanli (ST- 36). At 0, 6, 12, 24, 48, 72 and 96 h after the injection (3 mice at each time point), peripheral blood and muscular tissue were collected from the injection site for blood cell classification and histological study with HE staining.

RESULTS

White blood cells and lymphocytes tended to increase but platelets tended to decrease at the acupoint after blood injection, but these changes were not statistically significant. Within 24 h after blood injection, acute inflammation occurred at the acupoint, and the injected blood components were infiltrated by neutrophils; a small number of monocytes were observed at the injection site, where red blood cells gradually disappeared. From 24 to 96 h, the injected area showed chronic inflammation with infiltration by mononuclear cells, macrophages, and lymphocytes, and the number of fibroblasts increased and neutrophils decreased gradually over time; the local muscle fibers were destroyed, and proliferation of fibrous tissue could be seen.

CONCLUSIONS

Blood injection at the acupoints can mimic the process of hematoma absorption in the muscular tissue, and local inflammation is initiated to engulf and clear the blood components, which may be the basis for the therapeutic effects induced by acupoint stimulation.

Referrals of Plastic Surgery Patients to Integrative Medicine Centers: A Review of Resource Utility

BACKGROUND

Integrative medicine (IM) centers are becoming more established nationwide and provide an expansive range of therapeutic services. Given the high prevalence of IM usage among plastic surgery patients, we sought to define referrals rates to IM centers by plastic surgeons to investigate (1) the role of IM in the continuous care process of plastic surgery patients and (2) whether IM centers are being effectively utilized.

METHODS

Institutions with plastic surgery residency programs were identified using the American Medical Association's Fellowship and Residency Electronic Interactive Database Access System in January 2017. Data on the presence of a named IM center, director/administrator contact information, and types of therapeutic services offered were extracted. The total number of IM services at these centers was summed and tabulated for preliminary analyses. A survey questionnaire was sent to the center to ascertain referral patterns in February 2017.

RESULTS

Of 96 institutions with plastic and reconstructive surgery residency programs in North America, 49 (51%) provide IM services, and 24 (25%) have affiliated named IM centers of which we attained a survey response from 13 (54.5%). Of these centers, 10 (76.9%) evaluate more than 50 patients per week. Patient referrals to these centers were primarily from the department of medicine (73.8%) as opposed to surgery (13.1%) (P < 0.0001). An average of 0.77% of surgical referrals, or 0.077% of all referrals, arose from plastic and reconstructive surgery.

CONCLUSIONS

Plastic surgeons appear to infrequently refer patients to IM centers. Given the high prevalence of IM usage among our patient population, IM centers are an underutilized adjunct in the care of our patients. Further study into specific IM services that may benefit our patients would be helpful in increasing IM utilization in our field.

Acupuncture as a Treatment Within Integrative Health for Palliative Care: A Brief Narrative Review of Evidence and Recommendations

Background: Acupuncture is one of the fastest developing evidence bases in Complementary Medicine and is one of the leading therapies included within integrative health care. This narrative review includes two separate parts: the first is about evaluation of the current evidence status in reviews on acupuncture and the second examines and gives examples of available recommendations on acupuncture in treatment guidelines from health care experts and public health organizations recommending acupuncture as a viable treatment in patients in palliative care. Methods: Electronic searches were performed in PubMed using the terms "acupuncture" + "palliative" and adding the term "safety" to find review articles documenting safety and evidence of effectiveness of acupuncture for treatment of symptoms in palliative care patients. Treatment guidelines that recommend use of acupuncture for symptom control in palliative care were found by searching through a database currently under construction by the lead author. Results: Acupuncture shows emerging evidence for 17 indications in palliative care. Examples were found and presented of publications recommending acupuncture for treatment of symptoms for patients in palliative care from Government, public health, oncology, and medical expert sources. The most publications are in oncology, but other conditions were found and a number were found in pediatric care. Conclusions: While the evidence for use of acupuncture to treat symptoms in palliative care patients is relatively weak, the evidence base is growing. Experts worldwide are also increasingly recommending acupuncture as a treatment for symptoms in palliative care. Since acupuncture is a safe, nonpharmacological treatment but with small, clinically significant effects, these recommended uses appear as pragmatic efforts to bridge the gap of treatment options available to this patient group.

Meridian study on the response current affected by electrical pulse and acupuncture

Acupuncture and its meridians are important components of traditional Chinese medicine, and numerous opinions have been previously expressed regarding these meridians. This study aims to explore the phenomenon of meridians from the perspective of electronic physics by studying these meridians for the response current affected by electrical pulse and acupuncture. In this study, acupuncture which applies an electrical pulse was used to research the physical properties of the meridians. Different kinds of pulses were applied to the human body to realize abnormal electrical signals. Comparing these electrical measurement results with the isothermal transient ionic current (ITIC) theory, we found that the transmission of meridian messages may be related to ion conduction. The movement of ions induced by acupuncture and electrical stimulation can lead to drift and diffusion currents through the meridians. The ionic conduction of meridian hypothesis is proved in that the substances delivered by meridians are in fact ions.

Integrating Traditional and Complementary Medicine Recommendations into Clinical Practice Guidelines for People with Diabetes in Need of Palliative and End-of-Life Care: A Scoping Review

Objectives: This study was conducted before an evidence review on Traditional and Complementary Medicine (TCM) to update the clinical practice guidelines (CPGs): "Deciding palliative and end-of-life (P/EoL) care for people with diabetes." The aim was to frame the PICO (population/problems, interventions/comparisons, and outcomes), ascertain their importance, and identify other modifying factors for grading recommendations. Design: A systematic scoping review mapped information about diabetes P/EoL problems and outcomes, TCM use, provision, benefits and risks, and stakeholder preferences and values. Thirteen electronic databases were searched in 2017/18 until no new information was identified. Relevant data were extracted, rated for quality, directness, and relevance, and synthesized using triangulation methods. Excluded was diabetes prevention or treatment, as this is not an important P/EoL problem. Results: Of the 228 included articles, except for diabetes P/EoL problems, insufficient direct evidence led to data being extrapolated from either adults with diabetes or any P/EoL diagnosis. The findings affirmed that caring for people with diabetes in need of P/EoL care is complex due to multiple fluctuating needs that are influenced by the P/EoL trajectories (stable, unstable, deteriorating, terminal, or bereaved), multimorbidity, and difficult-to-manage chronic and acute problems. The only problem specific to diabetes P/EoL care, was unstable glycemia. Over 50 TCM interventions commonly used by patients and/or provided by services were identified, of which, many might simultaneously address multiple problems and 18 had been appraised in systematic reviews. Physical and psychologic symptom reliefs were most often evaluated; however, these were only one aspect of a "good death." Other important outcomes were the quality and location of care, personal agency, relationships, preparations for the dying process, spirituality, and affirmation of the whole person. Other important modifying factors included opportunity costs, affordability, availability, preferences, cultural appropriateness, and alignment with beliefs about the meaning of illness and death. Conclusions: There is a role for TCM in the multidisciplinary holistic P/EoL care of people with diabetes. Due to the paucity of evidence specific to this population, the generalizability of some of these results is broader and the updated CPG will also need to consider indirect evidence from other patient groups. Along with recommendations about indications for TCM use, the CGP should provide guidance on ceasing unnecessary interventions, reducing polypharmacy and managing unstable glycemia is required. Before ceasing a TCM, a broader risk-benefit analysis is recommended, as unlike many conventional therapies, there may be multiple benefits warranting its continuation.

Acupuncture treatment for chemotherapy-induced nausea and vomiting: A protocol for systematic review and meta-analysis

BACKGROUND

Chemotherapy-induced nausea and vomiting (CINV) make many patients have negative adherence of treatment. Acupuncture has been widely applied in treatment of CINV, but its efficacy has not been evaluated scientifically and systematically in recent years. Hence, evaluating the safety and effectiveness of acupuncture treatment in patients with CINV is the main purpose of this review.

METHODS AND ANALYSIS

We will search the following electronic databases from inception to Mar 2020: the Cochrane Central Register of Controlled Trials, EMBASE, PubMed, the Web of Science, China National Knowledge Infrastructure (CNKI), Traditional Chinese Medicine, Chinese Biomedical Literature Database (CBM), Wan-Fang Database and Chinese Scientific Journal Database (VIP database). All published academic data about clinical randomized controlled trials in English or Chinese related to acupuncture for treating CINV will be obtained. The primary outcomes are defined as frequency and severity of CINV during chemotherapy. The secondary outcomes are defined as any adverse events and quality of life of CINV during chemotherapy. The study selection, data extraction, and assessment of study quality will be conducted by 2 researchers independently. Review Manager Software (RevMan) V.5.3 will be performed for meta-analysis.

RESULTS

The results of this review will provide a high-quality synthesis of current available evidence to evaluate acupuncture is an effective and safe treatment for CINV.

CONCLUSION

The conclusion of this review will provide the highest level of evidence to judge whether acupuncture is an effective and safe treatment for patients suffered from CINV.

PROSPERO REGISTRATION NUMBER

CRD42020153993.

Triterpenoids from Liquidambar Fructus induced cell apoptosis via a PI3K-AKT related signal pathway in SMMC7721 cancer cells

A previously undescribed taraxerene-type triterpenoid possessing a class of rare natural taraxerene triterpenoid possessing skeleton with 14, 28-lactone, two undescribed oleane-type triterpenoids, and twenty-five known triterpenoids were isolated from Liquidambar formosana (Hamamelidaceae). The structures of undescribed compounds were determined on the basis of 1D and 2D NMR spectroscopic, HR-ESI-MS, and X-ray crystallographic data analysis. Among the isolates, ursolic acid, 3,6-dion-20(29)-lupen-28-oic acid, and 3-oxo-12α-hydroxyoleanan-28,13β-olide induced a significant apoptosis in SMMC7721 cells in the flow cytometer experiment with apoptosis rates of 94.5%, 57.3% and 89.9% at 8.0 μM, respectively, exhibiting near equivalent apoptosis-inducing abilities to that positive drug taxol (apoptotic rate of 71.2% at 1.4 μM). Mechanism studies suggested that these three compounds could regulate the mitochondrial pathway by up-regulating the expressions of pro-apoptotic factors (Bad and Bax) and activating caspase-3 and caspase-9 to induce apoptosis. Further studies indicated that the pro-apoptotic effects of these three compounds were associated with PI3K-AKT pathway inhibition. Taken together, these studies provide evidence that triterpenoids from L. Fructus are promising candidates for the hepatocellular carcinoma therapy.

Acupuncture for Breathlessness in Advanced Diseases: A Systematic Review and Meta-analysis

CONTEXT

Nonpharmacological approaches are effective strategies for difficult to palliate breathlessness. Although acupuncture is effective for dyspnea in early-stage chronic obstructive pulmonary disease (COPD), little is known about its effects in patients with advanced (non)malignant diseases.

OBJECTIVES

The objective of this study was to identify and examine the evidence of acupuncture on breathlessness in advanced malignant and nonmalignant diseases.

METHODS

Systematic literature review of randomized controlled trials of acupuncture and acupressure searched in five databases. Included were adult participants with at least 25% having advanced diseases such as cancer or COPD with severe breathlessness. Primary outcome was severity of dyspnea on Visual Analogue Scale or Borg Scale. Secondary outcomes included quality of life, function, and acceptability. Data were pooled using a random effects model of standardized mean differences.

RESULTS

Twelve studies with 597 patients (347 COPD, 190 advanced cancer) were included. For breathlessness severity, significant differences were obtained in a meta-analysis (10 studies with 480 patients; standardized mean difference (SMD) = -1.77 [95% CI -3.05, -0.49; P = 0.007; I2 = 90%]) and in a subgroup analysis of using sham acupuncture control groups and a treatment duration of at least three weeks (6 studies with 302 patients; SMD = -2.53 [95% CI -4.07, -0.99; P = 0.001; I2 = 91%]). Exercise tolerance (6-minute walk test) improved significantly in the acupuncture group (6 studies with 287 patients; SMD = 0.93 [95% CI 0.27, 1.59; P = 0.006; I2 = 85%]). In four of six studies, quality of life improved in the acupuncture group.

CONCLUSION

Acupuncture improved breathlessness severity in patients with advanced diseases. The methodological heterogeneity, low power, and potential morphine-sparing effects of acupuncture as add-on should be further addressed in future trials.

Development of Evidence-Based Chinese Medicine Clinical Service Recommendations for Cancer Palliative Care Using Delphi Approach Based on the Evidence to Decision Framework

Objectives: Existing evidence supports the use of certain Chinese medicine (CM) interventions for symptom management among palliative cancer patients. However, evidence-based service recommendations tailored to the local context are needed for CM planning and implementation. In response, we aimed to establish consensus on CM clinical service recommendations for cancer palliative care among Hong Kong experts. Methods: Seven CM interventions showing statistically significant favorable results in existing systematic reviews (SRs) and overviews of SRs were subjected to a GRADE-ADOLOPMENT-based 2-round Delphi survey. Twelve Hong Kong experts in cancer palliative care, including conventionally trained physicians, CM practitioners, and nurses (n = 4 from each category), were invited to participate. Use of the Evidence to Decision framework within the GRADE-ADOLOPMENT approach enabled experts to consider aspects of problem priority, benefits, harms, equity, acceptability, and feasibility when making CM recommendations in cancer palliative care. Results: Three evidence-based CM interventions reached positive consensus as service recommendations, namely: (1) acupuncture for reducing fatigue among palliative cancer patients; (2) acupressure for reducing fatigue among palliative cancer patients; and (3) moxibustion for reducing nausea and vomiting among patients receiving chemotherapy. Median rating of recommendation ranged from 2.5 to 3.0 (interquartile range = 0.00-1.00) on a 4-point Likert-type scale, and the percentage agreement ranged from 83.4% to 91.7%. Conclusions: The GRADE-ADOLOPMENT approach facilitates a consensus-based process of reaching 3 evidence-based CM recommendations for cancer palliative care. Future studies may develop tailored strategies to implement these recommendations in the Hong Kong health system.

Prioritizing Chinese Medicine Clinical Research Questions in Cancer Palliative Care: International Delphi Survey

CONTEXT

Chinese medicine modalities, including acupuncture and Chinese herbal medicine (CHM), have been used as palliative interventions among cancer patients. More research should be conducted to confirm their effectiveness.

OBJECTIVES

The objective of this study was to prioritize Chinese medicine clinical research questions for cancer palliative care.

METHODS

Twelve international experts, including physicians, Chinese medicine practitioners, nurses, and clinical research methodologists (n = 3 from each category), from Asia, North America, Australia, and Europe participated in a two-round Delphi survey for prioritizing 29 research questions identified from existing systematic reviews. The experts were asked to 1) rate clinical importance of answering the questions on a nine-point Likert scale; 2) provide qualitative comments on their ratings; and 3) suggest outcome measurement approaches.

RESULTS

Eight research priorities reached positive consensus after the two-round Delphi survey. Six of the priorities focused on acupuncture and related therapies, of which median ratings on importance ranged from 7.0 to 8.0 (interquartile range: 1.00 to 2.50), and the percentage agreement ranged from 75.0% to 91.7%. The remaining two priorities related to CHM, with median ratings ranged from 7.0 to 8.0 (interquartile range: 1.00 to 1.50) and percentage agreement ranged from 75.0% to 83.3%. Neither positive nor negative consensus was established among the remaining 21 questions.

CONCLUSION

The findings will inform rational allocation of scarce research funding for evaluating the effectiveness of Chinese medicine for cancer palliative care, especially on acupuncture and related therapies. Further research on herb safety and herb-drug interaction should be performed before conducting international trials on CHM.

The prognostic value of long noncoding RNA SNHG16 on clinical outcomes in human cancers: a systematic review and meta-analysis

BACKGROUND

Cancer has been a worldwide health problem with a high risk of morbidity and mortality, however ideal biomarkers for effective screening and diagnosis of cancer patients are still lacking. Small nucleolar RNA host gene 16 (SNHG16) is newly identified lncRNA with abnormal expression in several human malignancies. However, its prognostic value remains controversial. This meta-analysis aimed to synthesize available data to clarify the association between SNHG16 expression levels and clinical prognosis value in multiple cancers.

METHODS

Extensive literature retrieval was conducted to identify eligible studies, and data regarding SNHG16 expression levels on survival outcomes and clinicopathological features were extracted and pooled for calculation of the hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs). Forest plots were applied to show the association between SNHG16 expression and survival prognosis. Additionally, The Cancer Genome Atlas (TCGA) dataset was screened and extracted for validation of the results in this meta-analysis.

RESULTS

A total of eight studies comprising 568 patients were included in the final meta-analysis according to the inclusion and exclusion criteria. In the pooled analysis, high SNHG16 expression significantly predicted worse overall survival (OS) in various cancers (HR = 1.87, 95% CI 1.54-2.26, P < 0.001), and recurrence-free survival (RFS) in bladder cancer (HR = 1.68, 95% CI 1.01-2.79, P = 0.045). Meanwhile, stratified analyses revealed that the survival analysis method, tumor type, sample size, and cut-off value did not alter the predictive value of SNHG16 for OS in cancer patients. In addition, compared to the low SNHG16 expression group, patients with high SNHG16 expression were more prone to worse clinicopathological features, such as larger tumor size, advanced clinical stage, lymph node metastasis (LNM) and distant metastasis (DM). Exploration of TCGA dataset further validated that the upregulated SNHG16 expression predicted unfavorable OS and disease-free survival (DFS) in cancer patients.

CONCLUSIONS

The present study implicated that aberrant expression of lncRNA SNHG16 was strongly associated with clinical survival outcomes in various cancers, and therefore might serve as a promising biomarker for predicting prognosis of human cancers.

Effect of acupoint therapies on chemotherapy-induced nausea and vomiting: A systematic review protocol

BACKGROUND

Patients suffering from chemotherapy-induced nausea and vomiting (CINV) might have negative adherence of treatment. Acupoint therapies, including acupuncture, acupressure, acupoints injection, massage, and moxibustion, are safe medical procedures with minimal side effects for CINV, but studies about overall safety and effectiveness of acupoint therapies have not been scientifically and methodically evaluated in recent years. Evaluating the overall safety and effectiveness of acupoint therapies in patients with CINV is the purpose of this review.

METHODS AND ANALYSIS

Relevant randomized controlled trials (RCTSs) are being searched in the following electronic databases: PubMed, Cochrane Library, Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP database), Wanfang Data Knowledge Service Platform, and Chinese Biomedical Literature Database (CBM). We will also attempt to obtain the unpublished academic data by contacting the colleague, professor, or Institute of Traditional Chinese Medicine. The RCTs of the acupoint therapies for CINV patients will be searched in the databases from inception to July 2019. The primary outcomes are defined as severity, duration and frequency of nausea or vomiting, or both. The secondary outcomes are defined as any adverse events and quality of life. Performing the meta-analysis by using RevMan version 5 software. Mean difference (MD) or standardized mean difference (SMD) will express the continuous variables, while relative risk (RR) will express the categorical variables.

RESULTS

The results of this review will provide a high-quality synthesis to evaluate the effectiveness and safety of acupoint therapies for CINV.

CONCLUSION

This review will provide evidence to estimate whether acupoint therapies are effective interventions for CINV.

DISSEMINATION

Evidence whether acupoint therapies are effective interventions for CINV will be provided by this systematic review. This knowledge will recommend better acupoint therapies and selections of acupoints which might be helpful in treating CINV. The findings of this systematic review will be disseminated via various forms of presentation and publication of the data in a journal or electronic databases.

PROSPERO REGISTRATION NUMBER

CRD42019125538.

Evidence, safety and recommendations for when to use acupuncture for treating cancer related symptoms: a narrative review

Background

Recently research on acupuncture for cancer related symptoms has significantly increased. To what extent have medical professionals recommended to use acupuncture in light of that evidence?

Methods

Evidence of effectiveness and safety was found by searching Pubmed for reviews to identify for what conditions and general results. Publications that recommend acupuncture in oncology were searched in the database of an ongoing general search for publications that recommend acupuncture. This database was developed by searching google for publications that recommend the use of acupuncture with the terms ‘name of symptom’ and ‘clinical practice guideline’ or ‘treatment guideline’.

Results

Acupuncture is moderately or weakly effective for 19 symptoms in patients with cancer and cancer survivors. Acupuncture is a safe therapy in cancer care if administered by trained acupuncturists. Acupuncture is targeted to improve symptoms associated with the cancer and different cancer treatments, not to treat the cancer itself. More than 350 publications by clinical practice guideline groups and expert groups, including public health statements made by national and government agencies recommended the use of acupuncture for 61 cancer related symptoms many with positive evidence of effectiveness.

Conclusion

The strength of evidence is weak for many indications, however the evidence for many standard therapies is either not very strong or if stronger, the incidence of adverse events is more, which makes acupuncture a treatment option despite the weak evidence. We have found evidence that many oncologists around the world have started to incorporate acupuncture into the treatment of various cancer related symptoms.

Hypoglossal acupuncture for acute chemotherapy-induced dysgeusia in patients with breast cancer: study protocol of a randomized, sham-controlled trial

Background

Distortion of taste sensations is a common chemotherapy-induced side effect; however, treatment evidence is limited. Pilot data indicated that acupuncture might be able to improve symptoms of dysgeusia. Thus, the aim of this study is to investigate the effects and side effects of hypoglossal acupuncture in the treatment of dysgeusia in patients with breast cancer undergoing chemotherapy.

Methods/design

The study is a randomized controlled trial comparing a single verum acupuncture treatment with two active comparators: sham acupuncture and dietary recommendations. Sample size calculation revealed a total of 75 patients pending an alpha of 0.05, a power of 0.8, and an estimated effect size of 0.80. Patients with breast cancer undergoing platinum- or taxane-based chemotherapy will be included if they present with phantogeusia (abnormal taste sensations without an external oral stimulus) with an intensity of 4 points or above on an 11-point numeric rating scale (NRS). The primary outcome is phantogeusia; secondary outcomes include parageusia (abnormal taste of food), hypogeusia (reduced taste sensations), hypergeusia (increased taste sensations), xerostomia (dry mouth), stomatitis, appetite, and functional impairment. All outcomes will be assessed at baseline and prior to the next chemotherapy administration using an 11-point NRS for each. All adverse events will be recorded.

Discussion

The results of this study will demonstrate the extent to which hypoglossal acupuncture may influence the intensity of and functional impairment due to chemotherapy-induced dysgeusia.

Trial registration

Clinical Trials.gov, NCT02304913. Registered on 19 November 2014.