Acupuncture
This ancient therapy originating in China involves inserting very thin needles into the body surface at specific points; it is effective in treating many cancer symptoms and side effects.
How can acupuncture help you? What the research says
We summarize the clinical evidence for each medical benefit here. We begin with our assessment of the strength of evidence within each category, followed by a brief summary of individual studies or reviews of several studies. In assessing the strength of evidence, we consider the study design, number of participants, and the size of the treatment effect (how much outcomes changed with treatment).
To see more details, click the plus sign to the right of any section.
Our assessments of evidence for each medical benefit fall into one of these categories:
- Strong evidence: consistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results
- Good evidence: significant effects in one large or several mid-sized and well-designed clinical studies ( randomized controlled trialsa study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects with an appropriate placebo or other strong comparison control or observational studies that control for confounds)
- Modest evidence: significant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies), or several small studies aggregated into a meta-analysis
- Preliminary evidence: significant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect
- Weak evidence: one or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects
- Insufficient evidence: preclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example)
Learn more about how we research and rate therapies and practices in How We Rate Therapies ›
Optimizing your body terrain
Does acupuncture promote an environment within your body that is less supportive of cancer development, growth, or spread? We present the evidence.
See Optimizing Your Body Terrain ›
Find medical professionals who specialize in managing body terrain factors: Finding Integrative Oncologists and Other Practitioners ›
We also recommend that you share with your doctor the information here about how acupuncture might affect these terrain factors if you have any imbalances.
Changes in hormone levels seen in the studies here may not be beneficial in every situation. Your oncology team needs to determine whether any changes would be favorable for your condition.
Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of better hormone balance during chemotherapy among people with gastrointestinal cancer with cachexiaweakness and wasting of the body due to severe chronic illness treated with acupuncture
- Lower levels of blood leptin and ghrelin (hormones affecting appetite) during chemotherapy among people with gastrointestinal cancer with cachexia treated with 8 weekly sessions of targeted acupuncture compared to modified sham (nontargeted) acupuncture in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects;1Grundmann O, Yoon SL, Williams JJ, Gordan L, George TJ Jr. Augmentation of cancer cachexia components with targeted acupuncture in patients with gastrointestinal cancers: a randomized controlled pilot study. Integrative Cancer Therapies. 2019 Jan-Dec;18:1534735418823269. further analysis concluded that some of the responses were gender-specific2Yoon SL, Grundmann O et al. Differential response to targeted acupuncture by gender in patients with gastrointestinal cancer cachexia: secondary analysis of a randomized controlled trial. Acupuncture in Medicine. 2020 Feb;38(1):53-60.
Increased immune system activation is not always beneficial, so your oncology team needs to determine whether immune activation would be favorable in your situation.
Preliminary evidence of higher markers of immune function without regard to treatment phase among people treated with acupuncture and moxibustion
Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of higher markers of immune function during cancer treatment among people with lung cancer treated with acupoint stimulation
No evidence of effectsoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on immune function during hormone therapy among people with breast cancer treated with acupuncture in a combined analysis of studies
Preliminary evidence of higher immune activation after surgery among people treated with warm needle acupuncture and moxibustion
Without regard to treatment phase: preliminary evidence of higher markers of immune function among people treated with acupuncture and moxibustion
- Higher markers of immune function (CD3+T, CD4+T, CD8+T cells and B cells) among people with non-small cell lung cancer with fatigue treated with acupuncture and moxibustion compared to conventional Chinese and Western medicine in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects3Li WT, Liu YH, Pet al. [Effects of “Tiaoyi Sanjiao” acupuncture and moxibustion on cancer-induced fatigue and immune function in patients with advanced non-small cell lung cancer]. Zhen Ci Yan Jiu. 2020 Dec 25;45(12):1000-5.
During cancer treatment: modest evidence of higher markers of immune function during cancer treatment among people with lung cancer treated with acupoint stimulation
- Higher markers of immune function during cancer treatment among people with lung cancer treated with acupoint stimulation compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 31 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial; study authors’ note: “Acupoint stimulation varies from needle insertion, pressure, plaster application, and moxibustion to herbal extraction on the acupoints”4Chen HY, Li SG, Cho WC, Zhang ZJ. The role of acupoint stimulation as an adjunct therapy for lung cancer: a systematic review and meta-analysis. BMC Complementary and Alternative Medicine. 2013 Dec 17;13:362.
During hormone therapy: no evidence of effects on immune function during hormone therapy among people with breast cancer treated with acupuncture in a combined analysis of studies
- No change in a marker of immune function during hormone therapy among people with breast cancer treated with acupuncture compared to control or placebo in a meta-analysis of 20 RCTs of moderate quality; all studies used full-body or ear (auricular) needles, some studies included electroacupuncture5Yuanqing P, Yong T et al. Acupuncture for hormone therapy-related side effects in breast cancer patients: a grade-assessed systematic review and updated meta-analysis. Integrative Cancer Therapies. 2020 Jan-Dec;19:1534735420940394.
After surgery: preliminary evidence of higher immune activation after surgery among people treated with warm needle acupuncture and moxibustion
- Higher markers of immune activation after radical resection of colorectal cancer among people treated with conventional medication plus warm-needle acupuncture and moxibustion stimulation compared to conventional medication alone in a small RCT6Sun H, Zhang B, Qian HH, Chen ZC. [Effect of warm-needle moxibustion intervention on immune function and intestinal flora in patients after colorectal cancer radical operation]. Zhen Ci Yan Jiu. 2021 Jul 25;46(7):592-7. Chinese.
Insufficient evidencepreclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example) (this is the CancerChoices definition; other researchers and studies may define this differently) of effects on inflammation among people with cancer-related depression taking sertraline hydrochloride after 6 weeks of acupuncture without regard to treatment phase
Preliminary evidence of a higher marker of inflammatory response during chemotherapy among people with cachexia treated with acupuncture
No evidence of an effect on inflammation during hormone therapy among people treated with acupuncture in a combined analysis of studies
Preliminary evidence of lower inflammation after radical resection of colorectal cancer among people treated with warm needle acupuncture and moxibustion
Without regard to treatment phase: insufficient evidence of effects on inflammation among people with cancer-related depression taking sertraline hydrochloride after 6 weeks of acupuncture
- Some lower and some increased markers of inflammation among people with cancer-related depression taking sertraline hydrochloride after 6 weeks of Tiadu Jieyu acupuncture compared to sertraline hydrochloride alone in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects7Lian JL, Wu XM, Sun X, Wang YJ, Li YH. [Effect of Tiaodu Jieyu acupuncture on cancer-related depression: a randomized controlled trial]. Zhongguo Zhen Jiu. 2021 Apr 12;41(4):381-5. Chinese.
During chemotherapy: preliminary evidence of a higher marker of inflammatory response during chemotherapy among people with cachexia treated with acupuncture
- A higher marker of a proinflammatory signaling cytokine (TNF-α) among people with gastrointestinal cancer with cachexia undergoing chemotherapy treated with 8 weekly sessions of targeted acupuncture compared to modified sham (nontargeted) acupuncture in a small RCT;8Grundmann O, Yoon SL, Williams JJ, Gordan L, George TJ Jr. Augmentation of cancer cachexia components with targeted acupuncture in patients with gastrointestinal cancers: a randomized controlled pilot study. Integrative Cancer Therapies. 2019 Jan-Dec;18:1534735418823269. elevated levels of circulating TNF-α are linked to cachexia associated with terminal cancer, but it may also contribute to killing cancer cells
During hormone therapy: no evidence of an effect on inflammation during hormone therapy among people treated with acupuncture in a combined analysis of studies
- No change in a marker of inflammation during hormone therapy among people with breast cancer treated with acupuncture compared to control or placebo in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 20 RCTs of moderate quality9Yuanqing P, Yong T et al. Acupuncture for hormone therapy-related side effects in breast cancer patients: a grade-assessed systematic review and updated meta-analysis. Integrative Cancer Therapies. 2020 Jan-Dec;19:1534735420940394.
- Comparable improvements in a marker of inflammation among postmenopausal women with early stage breast cancer experiencing aromatase inhibitor-associated musculoskeletal symptoms treated with either acupuncture or sham in a small RCT10Bao T, Cai L et al. A dual-center randomized controlled double blind trial assessing the effect of acupuncture in reducing musculoskeletal symptoms in breast cancer patients taking aromatase inhibitors. Breast Cancer Research and Treatment. 2013 Feb;138(1):167-74.
After surgery: preliminary evidence of lower inflammation after radical resection of colorectal cancer among people treated with warm needle acupuncture and moxibustion
- Lower markers of inflammation and less vein inflammation (phlebitis) among people who underwent radical resection of colorectal cancer with subsequent use of conventional medication plus warm-needle acupuncture moxibustion stimulation compared to conventional medication alone in a small RCT11Sun H, Zhang B, Qian HH, Chen ZC. [Effect of warm-needle moxibustion intervention on immune function and intestinal flora in patients after colorectal cancer radical operation]. Zhen Ci Yan Jiu. 2021 Jul 25;46(7):592-7. Chinese.
Preliminary evidence of less disruption to antioxidanta molecule that can cause a free radical molecule to stabilize and become less reactive; an antioxidant can reduce harmful oxidation from free radicals levels during general anesthesia for radical surgery among people with intestinal cancer treated with acupuncture
- Maintained levels of an antioxidant enzyme (SOD) after radical surgery for intestinal cancer among people treated with scalp acupuncture plus general anesthesia compared to drops in SOD with general anesthesia alone in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects12He BM, Li WY, Li WS, Zhao WX. [Effects of scalp acupuncture on regulative ability of oxidative stress reaction at operation stage]. Zhongguo Zhen Jiu. 2006 Apr;26(4):291-4. Chinese.
Preliminary evidence of better intestinal bacteria after colorectal resection surgery among people with colorectal cancer treated with warm needle acupuncture and moxibustion
- Higher levels of beneficial intestinal bacteria (Bifidobacterium and Lactobacillus) and lower levels of harmful bacteria (Escherichia coli and Enterococcus) among people with colorectal cancer who underwent radical colorectal resection surgery treated with conventional medication plus warm-needle acupuncture and moxibustion stimulation compared to conventional medication alone in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects13Sun H, Zhang B, Qian HH, Chen ZC. [Effect of warm-needle moxibustion intervention on immune function and intestinal flora in patients after colorectal cancer radical operation]. Zhen Ci Yan Jiu. 2021 Jul 25;46(7):592-7. Chinese.
Managing side effects and promoting wellness
Is acupuncture linked to fewer or less severe side effects or symptoms? Is it linked to less toxicity from cancer treatment? Does it support your quality of life or promote general well-being? We present the evidence.
Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of less anxiety before surgery among people treated with acupuncture
Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of less anxiety or worry, irritation, and tenseness during or after chemotherapy among people treated with acupuncture
No evidence of additional benefitoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. to massage therapy for anxiety during reconstructive surgery among people with breast cancer treated with acupuncture in a preliminary study
During or after treatment: preliminary evidence of less anxiety or worry, irritation, and tenseness during or after chemotherapy among people treated with acupuncture
- Lower anxiety scores after chemotherapy for solid tumors among people treated with either acupuncture or sham acupuncture added to usual care compared to usual care alone in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects14Bao T, Baser R et al. Health-related quality of life in cancer survivors with chemotherapy-induced peripheral neuropathy: a randomized clinical trial. Oncologist. 2021 Nov;26(11):e2070-e2078.
- Lower levels of worry, irritation, and tenseness during or after chemotherapy for breast cancer among people treated with 2 sessions per week for 8 consecutive weeks of electroacupuncture plus manual acupuncture compared to minimal acupuncture stimulation (MAS) to In a small RCT15Zhang ZJ, Man SC et al. Electroacupuncture trigeminal nerve stimulation plus body acupuncture for chemotherapy-induced cognitive impairment in breast cancer patients: An assessor-participant blinded, randomized controlled trial. Brain, Behavior, and Immunity. 2020 Aug;88:88-96.
During breast reconstruction: no evidence of additional benefit to massage therapy for anxiety during reconstructive surgery among people with breast cancer treated with acupuncture in a preliminary study
- No additional benefit for anxiety among people undergoing autologous tissue breast reconstruction with acupuncture and massage compared to massage alone in a small RCT16Dilaveri CA, Croghan IT et al. Massage compared with massage plus acupuncture for breast cancer patients undergoing reconstructive surgery. Journal of Alternative and Complementary Medicine. 2020 Jul;26(7):602-609.
With surgery: modest evidence of less anxiety before surgery among people treated with acupuncture
- Less anxiety before surgery, mostly for brain tumors, among people treated with acupuncture compared to people with less anxiety in a review of 7 RCTs17Oteri V, Martinelli A, Crivellaro E, Gigli F. The impact of preoperative anxiety on patients undergoing brain surgery: a systematic review. Neurosurgical Review. 2021 Feb 19.
Modest evidence of less therapy-induced bone marrow suppression during cancer treatment among people with lung cancer treated with acupuncture
Preliminary evidence of better white blood cell counts after radical resection of colorectal cancer among people treated with warm-needle acupuncture and moxibustion
During treatment: modest evidence of less therapy-induced bone marrow suppression during cancer treatment among people with lung cancer treated with acupuncture
- Less therapy-induced bone marrow suppression (hemoglobin, platelet, and white blood cell reduction) during cancer treatment among people with lung cancer treated with acupoint stimulation compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 31 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial; study authors’ note: “Acupoint stimulation varies from needle insertion, pressure, plaster application, and moxibustion to herbal extraction on the acupoints.”18Chen HY, Li SG, Cho WC, Zhang ZJ. The role of acupoint stimulation as an adjunct therapy for lung cancer: a systematic review and meta-analysis. BMC Complementary and Alternative Medicine. 2013 Dec 17;13:362.
With surgery: preliminary evidence of better white blood cell counts after radical resection of colorectal cancer among people treated with warm-needle acupuncture and moxibustion
- Lower leukopenia after radical resection of colorectal cancer among people treated with warm-needle acupuncture and moxibustion stimulation and conventional medication compared to conventional medication alone in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects19Sun H, Zhang B, Qian HH, Chen ZC. [Effect of warm-needle moxibustion intervention on immune function and intestinal flora in patients after colorectal cancer radical operation]. Zhen Ci Yan Jiu. 2021 Jul 25;46(7):592-7. Chinese.
Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of weight gain and less muscle loss during chemotherapy among people with gastrointestinal cancer treated with acupuncture
- A weak trend towards weight gain and lower markers of muscle loss (LDH), but no significant change in markers of nutrition and protein mass (prealbumin levels and fat-free mass) during chemotherapy among people with gastrointestinal cancer with cachexia treated with 8 weekly sessions of targeted acupuncture compared to modified sham (nontargeted) acupuncture in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects20Grundmann O, Yoon SL, Williams JJ, Gordan L, George TJ Jr. Augmentation of cancer cachexia components with targeted acupuncture in patients with gastrointestinal cancers: a randomized controlled pilot study. Integrative Cancer Therapies. 2019 Jan-Dec;18:1534735418823269.
Modest evidence of less breathlessness among people with advanced diseases including cancer treated with acupuncture
- Less severe breathlessness among people with advanced diseases including cancer treated with at least 3 weeks of acupuncture compared to sham acupuncture in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 12 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects21von Trott P, Oei SL, Ramsenthaler C. Acupuncture for breathlessness in advanced diseases: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2020 Feb;59(2):327-338.e3.
Weak evidence of better appetite among people with gastrointestinal cancer treated with acupuncture
- A weak trend toward better appetite (less anorexia) among people with gastrointestinal cancer treated with acupuncture compared to conventional interventions in a review of 18 systematic reviews of moderate to high quality22Zhang F, Shen A, Jin Y, Qiang W. The management strategies of cancer-associated anorexia: a critical appraisal of systematic reviews. BMC Complementary and Alternative Medicine. 2018 Aug 9;18(1):236.
Preliminary evidence of better cognitive function due to less sleep disturbance among people with cancer treated with acupuncture
- Improved attention, memory and subjective cognitive function among people with cancer with insomnia and baseline cognitive difficulties treated with 8 weeks of acupuncture compared to baseline, but only among those with fewer insomnia symptoms after treatment, and comparable to benefits with cognitive behavioral therapy for insomnia in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects23Liou KT, Root JC et al. Effects of acupuncture versus cognitive behavioral therapy on cognitive function in cancer survivors with insomnia: a secondary analysis of a randomized clinical trial. Cancer. 2020;126(13):3042-3052.
Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of less depression among people with cancer treated with acupuncture
No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on mood distress among people with cancer treated with acupuncture in combined analysis of studies
No evidence of additional benefit to massage therapy for mood during autologous tissue breast reconstruction among people treated with acupuncture in a preliminary study
Without regard to treatment phase
Good evidence of less depression among people with cancer treated with acupuncture
- Lower depression scores among people with breast cancer with climacteric-like symptoms treated with acupuncture compared to sham acupuncture or controls in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects24D’Alessandro EG, da Silva AV et al. Acupuncture for climacteric-like symptoms in breast cancer improves sleep, mental and emotional health: a randomized trial. Medical Acupuncture. 2022 Feb 1;34(1):58-65.
- Less depression among people with breast cancer treated with acupuncture compared to usual care or waitlist controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of of 20 RCTs25Li H, Schlaeger JM et al. Acupuncture improves multiple treatment-related symptoms in breast cancer survivors: a systematic review and meta-analysis. Journal of Alternative and Complementary Medicine. 2021 Dec;27(12):1084-1097.
- Lower depression scores among people with cancer-related depression treated with sertraline hydrochloride and Tiaodu Jieyu acupuncture for 6 weeks compared to sertraline hydrochloride alone in a small RCT26Lian JL, Wu XM, Sun X, Wang YJ, Li YH. [Effect of Tiaodu Jieyu acupuncture on cancer-related depression: a randomized controlled trial]. Zhongguo Zhen Jiu. 2021 Apr 12;41(4):381-5. Chinese.
No evidence of an effect on mood distress among people with cancer treated with acupuncture in a combined analysis of studies
- No evidence of an effect on mood distress among people with cancer treated with acupuncture compared to controls in a meta-analysis of 67 RCTs of low to moderate quality27Tao WW, Jiang H et al. Effects of acupuncture, tuina, tai chi, qigong, and traditional Chinese medicine Five-Element Music Therapy on symptom management and quality of life for cancer patients: a meta-analysis. Journal of Pain and Symptom Management. 2016 Apr;51(4):728-747.
During treatment: no evidence of additional benefit to massage therapy for mood during autologous tissue breast reconstruction among people treated with acupuncture in a preliminary study
- No additive benefit for mood among people undergoing autologous tissue breast reconstruction treated with acupuncture and massage compared to massage alone in a small RCT28Dilaveri CA, Croghan IT et al. Massage compared with massage plus acupuncture for breast cancer patients undergoing reconstructive surgery. Journal of Alternative and Complementary Medicine. 2020 Jul;26(7):602-609.
People treated with acupuncture have shown less fatigue, including during cancer treatment.
No evidence of additional benefit to massage therapy for fatigue during autologous tissue breast reconstruction among people treated with acupuncture in a preliminary study
Without regard to treatment phase: modest evidence of less cancer-related fatigue among people treated with acupuncture
- Less cancer-related fatigue among people treated with acupuncture compared to controls in a large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 182 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects29Wu C, Zheng Y et al. Nonpharmacological Interventions for cancer-related fatigue: a systematic review and Bayesian network meta-analysis. Worldviews on Evidence-Based Nursing. 2019 Apr;16(2):102-110.
- Lower fatigue scores among people with cancer-related fatigue treated with acupuncture compared to either sham acupuncture or usual care in a meta-analysis of 9 RCTs of moderate or high quality30Jang A, Brown C et al. The effects of acupuncture on cancer-related fatigue: updated systematic review and meta-analysis. Integrative Cancer Therapies. 2020 Jan-Dec;19:1534735420949679.
- No evidence of an effect on cancer-related fatigue among people treated with acupuncture compared to sham acupuncture in a meta-analysis of 3 RCTs of high quality31Zeng Y, Luo T, Finnegan-John J, Cheng AS. Meta-analysis of randomized controlled trials of acupuncture for cancer-related fatigue. Integrative Cancer Therapies. 2014 May;13(3):193-200.
- Less fatigue among people with lung cancer treated with acupuncture compared to conventional interventions in a review of 18 systematic reviews of moderate to high quality32Zhang F, Shen A, Jin Y, Qiang W. The management strategies of cancer-associated anorexia: a critical appraisal of systematic reviews. BMC Complementary and Alternative Medicine. 2018 Aug 9;18(1):236.
- Less cancer-related fatigue among people treated with acupuncture compared to controls but not compared to conventional care in an overview of systematic reviews33Wu X, Chung VC et al. Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews. Scientific Reports. 2015 Nov 26;5:16776.
- Less fatigue among people with cancer treated with acupuncture compared to controls using one measure of fatigue in a meta-analysis of 5 RCTs of low to moderate quality, but worse fatigue in a meta-analysis of 2 RCTs using a different measure34Tao WW, Jiang H et al. Effects of acupuncture, tuina, tai chi, qigong, and traditional Chinese medicine Five-Element Music Therapy on symptom management and quality of life for cancer patients: a meta-analysis. Journal of Pain and Symptom Management. 2016 Apr;51(4):728-747.
- Less fatigue among people with breast cancer treated with acupuncture compared to usual care or waitlist controls in a subgroup analysis of a meta-analysis of 20 RCTs35Li H, Schlaeger JM et al. Acupuncture improves multiple treatment-related symptoms in breast cancer survivors: a systematic review and meta-analysis. Journal of Alternative and Complementary Medicine. 2021 Dec;27(12):1084-1097.
- Less cancer-related fatigue among people with breast cancer treated with acupuncture and an education intervention related to exercise, nutrition and stress management compared to usual care in a small RCT36Johnston MF, Hays RD et al. Patient education integrated with acupuncture for relief of cancer-related fatigue randomized controlled feasibility study. BMC Complement Altern Med. 2011 Jun 25;11:49.
During or after treatment
Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of less fatigue during or after cancer treatment among people treated with acupuncture
- Less fatigue among people with breast cancer receiving hormone therapy treated with acupuncture compared to controls or placebo in a meta-analysis of 20 RCTs of moderate quality37Yuanqing P, Yong T et al. Acupuncture for hormone therapy-related side effects in breast cancer patients: a grade-assessed systematic review and updated meta-analysis. Integrative Cancer Therapies. 2020 Jan-Dec;19:1534735420940394.
- Less fatigue among people with cancer, both during and after anticancer treatment, who were treated with acupuncture compared to either sham acupuncture or usual care in a meta-analysis of 10 RCTs38Zhang Y, Lin L, Li H, Hu Y, Tian L Effects of acupuncture on cancer-related fatigue: a meta-analysis. Supportive Care in Cancer. 2018 Feb;26(2):415-425.
No evidence of additional benefit to massage therapy for fatigue during autologous tissue breast reconstruction among people treated with acupuncture in a preliminary study
- No additional benefit for fatigue during autologous tissue breast reconstruction among people treated with acupuncture and massage compared to massage alone in a small RCT39Dilaveri CA, Croghan IT et al. Massage compared with massage plus acupuncture for breast cancer patients undergoing reconstructive surgery. Journal of Alternative and Complementary Medicine. 2020 Jul;26(7):602-609.
People with cancer treated with acupuncture experienced less diarrhea, constipation, and nausea and vomiting after surgery or during chemotherapy, but not during hormone therapy.
Gastrointestinal symptoms as a whole: no evidence of an effect on gastrointestinal symptoms during hormone therapy among people with breast cancer treated with acupuncture in a combined analysis of studies
- No change in gastrointestinal symptoms among people with breast cancer receiving hormone therapy and treated with acupuncture compared to control or placebo in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 20 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of moderate quality40Yuanqing P, Yong T et al. Acupuncture for hormone therapy-related side effects in breast cancer patients: a grade-assessed systematic review and updated meta-analysis. Integrative Cancer Therapies. 2020 Jan-Dec;19:1534735420940394.
Bowel function as a whole: preliminary evidence of quicker return of bowel function and less nausea and vomiting after colorectal cancer surgery among people treated with acupuncture
- Shorter times to passing gas and bowel movement after open or laparoscopic resection for colorectal cancer when receiving simo decoction (SMD, a traditional Chinese medicine) and acupuncture for 5 consecutive days following surgery compared to chewing gum or no intervention in a mid-sized RCT41Yang Y, Zuo HQ et al. Comparison of efficacy of simo decoction and acupuncture or chewing gum alone on postoperative ileus in colorectal cancer resection: a randomized trial. Scientific Reports. 2017 Jan 19;7:37826.
Constipation: modest evidence of less constipation among people with cancer treated with acupuncture, including after surgery and during chemotherapy
- Less constipation after brain tumor resection among people treated with acupuncture compared to no treatment in a mid-sized RCT42Li D, Li H et al. Impact of electroacupuncture stimulation on postoperative constipation for patients undergoing brain tumor surgery. Journal of Neuroscience Nursing. 2020 Oct;52(5):257-262.
- Less constipation among people refractory cancer pain treated with wrist-ankle needle acupuncture once a day for 10 days, with acupoints selected according to the pain site and the primary focus, added to opioid drugs in accordance with the three-step analgesic principle and other auxiliary drugs compared to the drugs alone in a small RCT43Wu QL, Cao W et al. [Wrist-ankle needle combined with opioid drugs on refractory cancer pain: a randomized controlled trial]. Zhongguo Zhen Jiu. 2019 Oct 12;39(10):1051-4. Chinese.
- Lower incidence of constipation among people treated with acupuncture at P6 point before chemotherapy infusion in addition to 5 mg oral dexamethasone twice a day for 3 days compared to 8 mg intravenous ondansetron 30 minutes before chemotherapy infusion plus more if they experienced emesis in addition to dexamethasone in a small RCT44Rithirangsriroj K, Manchana T, Akkayagorn L. Efficacy of acupuncture in prevention of delayed chemotherapy induced nausea and vomiting in gynecologic cancer patients. Gynecologic Oncology. 2015 Jan;136(1):82-6.
Diarrhea: modest evidence of less chemotherapy-induced diarrhea among people treated with acupuncture
- Less diarrhea among people with spleen and stomach deficiency syndrome after colon cancer surgery and receiving hyperthermic intraperitoneal chemotherapy when treated with acupuncture and ondansetron compared to ondansetron alone in a mid-sized RCT45Gu XY, Gao ZQ, Zhang ZJ, Huang ZM, Xie XH. [Influence of warming needling technique on gastrointestinal reaction after hyperthermic intrape-ritoneal chemotherapy in patients with postoperation of colon cancer] [Article in Chinese]. Zhen Ci Yan Jiu. 2020;45(4):315-319.
- Fewer incidents of diarrhea among people with breast cancer during or after chemotherapy treated with 2 sessions per week for 8 consecutive weeks of electroacupuncture plus manual acupuncture compared to minimal acupuncture stimulation (MAS) to in a small RCT46Zhang ZJ, Man SC et al. Electroacupuncture trigeminal nerve stimulation plus body acupuncture for chemotherapy-induced cognitive impairment in breast cancer patients: An assessor-participant blinded, randomized controlled trial. Brain, Behavior, and Immunity. 2020 Aug;88:88-96.
Nausea and vomiting
Without regard to treatment phase: modest evidence of less nausea and vomiting without regard to treatment phase among people with cancer treated with acupuncture
- Less nausea and vomiting among people refractory cancer pain treated with wrist-ankle needle acupuncture once a day for 10 days, with acupoints selected according to the pain site and the primary focus, added to opioid drugs in accordance with the three-step analgesic principle and other auxiliary drugs compared to the drugs alone in a small RCT47Wu QL, Cao W et al. [Wrist-ankle needle combined with opioid drugs on refractory cancer pain: a randomized controlled trial]. Zhongguo Zhen Jiu. 2019 Oct 12;39(10):1051-4. Chinese.
- Less nausea and vomiting among people with cancer treated with acupuncture in a meta-analysis of 2 RCTs of low to moderate quality48Tao WW, Jiang H et al. Effects of acupuncture, tuina, tai chi, qigong, and traditional Chinese medicine Five-Element Music Therapy on symptom management and quality of life for cancer patients: a meta-analysis. Journal of Pain and Symptom Management. 2016 Apr;51(4):728-747.
During cancer treatment
Modest evidence of less nausea and vomiting during chemotherapy among people treated with acupuncture
- Lower incidence of delayed chemotherapy-induced nausea and vomiting and fewer doses of additional oral ondansetron among people treated with acupuncture at P6 point before chemotherapy infusion in addition to 5 mg oral dexamethasone twice a day for 3 days compared to 8 mg intravenous ondansetron 30 minutes before chemotherapy infusion plus more if they experienced emesis in addition to dexamethasone in a small RCT49Rithirangsriroj K, Manchana T, Akkayagorn L. Efficacy of acupuncture in prevention of delayed chemotherapy induced nausea and vomiting in gynecologic cancer patients. Gynecologic Oncology. 2015 Jan;136(1):82-6.
- Less nausea and vomiting during chemotherapy among people with lung cancer treated with acupoint stimulation compared to controls in a meta-analysis of 8 controlled trials of moderate quality; study authors’ note: “Acupoint stimulation varies from needle insertion, pressure, plaster application, and moxibustion to herbal extraction on the acupoints”50Chen HY, Li SG, Cho WC, Zhang ZJ. The role of acupoint stimulation as an adjunct therapy for lung cancer: a systematic review and meta-analysis. BMC Complementary and Alternative Medicine. 2013 Dec 17;13:362.
- Lower incidence of acute vomiting, but not acute or delayed nausea severity during chemotherapy among people taking antiemetic medication with acupuncture-point stimulation compared to medication alone in a systematic review of 11 studies51Ezzo JM, Richardson MA et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database of Systematic Reviews. 2006 Apr 19;(2):CD002285.Our note: acupuncture-point stimulation therapies in this meta-analysis include stimulation with needle, electroacupuncture, and acupressure
Modest evidence of less nausea and vomiting after surgery among people with colon cancer treated with acupuncture
- Less nausea and vomiting among people who underwent radical resection of colorectal cancer treated with warm-needle acupuncture and moxibustion stimulation and conventional medication compared to conventional medication alone in a small RCT52Sun H, Zhang B, Qian HH, Chen ZC. [Effect of warm-needle moxibustion intervention on immune function and intestinal flora in patients after colorectal cancer radical operation]. Zhen Ci Yan Jiu. 2021 Jul 25;46(7):592-7. Chinese.
- Less nausea, vomiting and abdominal distention among people with spleen and stomach deficiency syndrome after colon cancer surgery and receiving hyperthermic intraperitoneal chemotherapy when treated with acupuncture and ondansetron compared to ondansetron alone in a mid-sized RCT53Gu XY, Gao ZQ, Zhang ZJ, Huang ZM, Xie XH. [Influence of warming needling technique on gastrointestinal reaction after hyperthermic intrape-ritoneal chemotherapy in patients with postoperation of colon cancer] [Article in Chinese]. Zhen Ci Yan Jiu. 2020;45(4):315-319.
No evidence of additional benefit to massage therapy for nausea during autologous tissue breast reconstruction among people treated with acupuncture in a preliminary study
- No additive benefit for nausea during autologous tissue breast reconstruction among people treated with acupuncture and massage compared to massage alone in a small RCT54Dilaveri CA, Croghan IT et al. Massage compared with massage plus acupuncture for breast cancer patients undergoing reconstructive surgery. Journal of Alternative and Complementary Medicine. 2020 Jul;26(7):602-609.
Modest but somewhat conflicting evidence of fewer hot flashes without regard to treatment phase among people with cancer, mostly with breast cancer, treated with acupuncture
Good evidence of fewer hot flashes during cancer treatment, including hormone therapy, among people with breast cancer treated with acupuncture
Weak evidence of fewer hot flashes during androgen deprivation therapy among men with advanced prostate cancer treated with standardized full body and auricular acupuncture
Weak evidence of fewer hot flashes after treatment among people with breast cancer or prostate cancer treated with acupuncture
Modest evidence of fewer adverse effects among people treated with acupuncture compared to non-hormonal medication for hot flashes
Without regard to treatment phase: modest but somewhat conflicting evidence of fewer hot flashes among people with cancer, mostly with breast cancer, treated with acupuncture
- Better Menopause Rating Scale scores among people with breast cancer with climacteric-like symptoms treated with acupuncture compared to controls but not compared to sham acupuncture in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects(D’Alessandro EG, da Silva AV et al. Acupuncture for climacteric-like symptoms in breast cancer improves sleep, mental and emotional health: a randomized trial. Medical Acupuncture. 2022 Feb 1;34(1):58-65.))
- Lower scores of hot flash-related daily interference, with small effect sizes, and sustained during follow-up, among people with breast cancer treated with acupuncture compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 16 RCTs55Tao WW, Tao XM, Song CL. Effects of non-pharmacological supportive care for hot flushes in breast cancer: a meta-analysis. Supportive Care in Cancer. 2017 Jul;25(7):2335-2347.
- Fewer hot flashes among women with breast cancer with acupuncture compared to controls, but not consistently compared to sham acupuncture, in a meta-analysis of 9 RCTs56Chen YP, Liu T et al. Acupuncture for hot flashes in women with breast cancer: asystematic review. Journal of Cancer Research and Therapeutics. 2016 Apr-Jun;12(2):535-42.
- No evidence of an effect on reducing the frequency of hot flashes among people with breast cancer with acupuncture compared to controls in a meta-analysis of 12 RCTs57Salehi A, Marzban M, Zadeh AR. Acupuncture for treating hot flashes in breast cancer patients: an updated meta-analysis. Supportive Care in Cancer. 2016 Dec;24(12):4895-4899.
- Less hot flash severity among people with breast cancer with acupuncture compared to usual care or waitlist controls in a meta-analysis 20 RCTs58Li H, Schlaeger JM et al. Acupuncture improves multiple treatment-related symptoms in breast cancer survivors: a systematic review and meta-analysis. Journal of Alternative and Complementary Medicine. 2021 Dec;27(12):1084-1097.
- No change in the frequency of hot flashes among people with breast cancer with acupuncture compared to controls in a meta-analysis of 3 RCTs of moderate quality59Jang S, Ko Y et al. Acupuncture as an adjuvant therapy for management of treatment-related symptoms in breast cancer patients: systematic review and meta-analysis (PRISMA-compliant). Medicine (Baltimore). 2020 Dec 11;99(50):e21820.
- No evidence of an effect on hot flashes among people with cancer treated with acupuncture compared to controls in a meta-analysis of 3 RCTs of low to moderate quality60Tao WW, Jiang H et al. Effects of acupuncture, tuina, tai chi, qigong, and traditional Chinese medicine Five-Element Music Therapy on symptom management and quality of life for cancer patients: a meta-analysis. Journal of Pain and Symptom Management. 2016 Apr;51(4):728-747.
During cancer treatment
Good evidence of fewer hot flashes during cancer treatment, including hormone therapy, among people with breast cancer treated with acupuncture
Weak evidence of fewer hot flashes during androgen deprivation therapy among men with advanced prostate cancer treated with standardized full body and auricular acupuncture
- Fewer hot flashes during cancer treatment among people with breast cancer with acupuncture compared to sham acupuncture in a meta-analysis of 7 RCTs of moderate or high quality61Wang XP, Zhang DJ, Wei XD, Wang JP, Zhang DZ. Acupuncture for the relief of hot flashes in breast cancer patients: a systematic review and meta-analysis of randomized controlled trials and observational studies. Journal of Cancer Research and Therapeutics. 2018 Sep;14(Supplement):S600-S608.
- Fewer or less severe hot flashes among people with breast cancer receiving hormone therapy with acupuncture compared to control or placebo in a meta-analysis of 20 RCTs of moderate quality62Yuanqing P, Yong T et al. Acupuncture for hormone therapy-related side effects in breast cancer patients: a grade-assessed systematic review and updated meta-analysis. Integrative Cancer Therapies. 2020 Jan-Dec;19:1534735420940394.
- Fewer hot flashes during cancer treatment among people with breast cancer with acupuncture compared to sham acupuncture in a meta-analysis of 3 RCTs with low-certainty evidence63Lee MS, Kim KH, Choi SM, Ernst E. Acupuncture for treating hot flashes in breast cancer patients: a systematic review. Breast Cancer Research and Treatment. 2009 Jun;115(3):497-503.
- Fewer hot flashes and better quality of life in the hormone domain during androgen deprivation therapy for 28 weeks among men with advanced prostate cancer treated with standardized full body and auricular acupuncture once a week for 14 weeks compared to baseline in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design64Capodice JL, Cheetham P, Benson MC, McKiernan JM, Katz AE. Acupuncture for the treatment of hot flashes in men with advanced prostate cancer. International Journal of Clinical Medicine. 2011;2(1):51-55.
After cancer treatment: weak evidence of fewer hot flashes after cancer treatment among people with breast cancer or prostate cancer treated with acupuncture
- Fewer menopause symptoms, but not hot flashes, for at least 3 months after treatment ended among people with breast cancer-related symptoms compared to controls in meta-analyses of 13 RCTs, including those of medium-to-high quality65Chien TJ, Liu CY, Fang CJ, Kuo CY. The maintenance effect of acupuncture on breast cancer-related menopause symptoms: a systematic review. Climacteric. 2020 Apr;23(2):130-139; Chien TJ, Hsu CH, Liu CY, Fang CJ. Effect of acupuncture on hot flush and menopause symptoms in breast cancer—a systematic review and meta-analysis. PLoS One. 2017 Aug 22;12(8):e0180918.
- A weak trend toward fewer hot flashes among people with breast cancer after completing cancer treatment and during follow-up with acupuncture compared to sham acupuncture in a meta-analysis of RCTs of moderate or high quality66Wang XP, Zhang DJ, Wei XD, Wang JP, Zhang DZ. Acupuncture for the relief of hot flashes in breast cancer patients: a systematic review and meta-analysis of randomized controlled trials and observational studies. Journal of Cancer Research and Therapeutics. 2018 Sep;14(Supplement):S600-S608.
- A weak trend toward fewer hot flashes among people with breast cancer after completing cancer treatment with acupuncture compared to sham acupuncture in a meta-analysis of RCTs with low-certainty evidence67Lee MS, Kim KH, Choi SM, Ernst E. Acupuncture for treating hot flashes in breast cancer patients: a systematic review. Breast Cancer Research and Treatment. 2009 Jun;115(3):497-503.
- Substantially lower hot flash severity scores continuing until 8 months after treatment among men with a history of androgen ablation therapy for prostate cancer treated with acupuncture compared to baseline in a small uncontrolled trial68Ashamalla H, Jiang ML et al. Acupuncture for the alleviation of hot flashes in men treated with androgen ablation therapy. International Journal of Radiation Oncology, Biology, Physics. 2011 Apr 1;79(5):1358-1363.
Modest evidence of fewer adverse effects among people treated with acupuncture compared to non-hormonal medication for hot flashes
- Fewer adverse effects among people with breast cancer with acupuncture compared to non-hormonal medication for hot flashes in a meta-analysis of 12 RCTs69Hervik JB, Stub T. Adverse effects of non-hormonal pharmacological interventions in breast cancer survivors, suffering from hot flashes: a systematic review and meta-analysis. Breast Cancer Research and Treatment. 2016 Nov;160(2):223-236.
Weak evidence of fewer symptoms of breast cancer-related lymphedemaswelling caused by a blockage in the lymphatic system, most commonly caused by lymph node removal or damage due to cancer treatment among people treated with acupuncture
Weak evidence of fewer symptoms of cancer-related lymphedemaswelling caused by a blockage in the lymphatic system, most commonly caused by lymph node removal or damage due to cancer treatment among people treated with acupuncture
- A weak trend of less breast cancer-related lymphedema swelling among people treated with acupuncture compared to controls in a review of reviews, systematic reviews, and meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study70Marchica P, D’Arpa S et al. Integrated treatment of breast cancer-related lymphedema: a descriptive review of the state of the art. Anticancer Research. 2021 Jul;41(7):3233-3246.
- A weak trend towards lower levels of lymphedema among people with breast cancer treated with acupuncture compared to sham acupuncture in a meta-analysis of 20 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects71(Li H, Schlaeger JM et al. Acupuncture Improves Multiple Treatment-Related Symptoms in Breast Cancer Survivors: A Systematic Review and Meta-Analysis. Journal of Alternative and Complementary Medicine. 2021 Dec;27(12):1084-1097.
- Higher effective treatment rate for lymphedema but no significant improvements in front flexion or back extension among people with breast cancer-related lymphedema treated with acupuncture compared to controls in a meta-analysis of 8 RCTs of low quality72Yu S, Zhu L, Xie P, Jiang S, Yang Z, He J, Ren Y. Effects of acupuncture on breast cancer-related lymphoedema: a systematic review and meta-analysis. Explore (NY). 2020 Mar-Apr;16(2):97-102.
- Smaller arm circumference among people with breast cancer treated with acupuncture compared to controls in a meta-analysis of 2 RCTs73Jang S, Ko Y et al. Acupuncture as an adjuvant therapy for management of treatment-related symptoms in breast cancer patients: systematic review and meta-analysis (PRISMA-compliant). Medicine (Baltimore). 2020 Dec 11;99(50):e21820.
- No change in arm circumference among people with breast cancer-related lymphedema treated with acupuncture compared to controls in a meta-analysis of 2 RCTs of medium to high quality74Chien TJ, Liu CY, Fang CJ. The effect of acupuncture in breast cancer-related lymphoedema (BCRL): a systematic review and meta-analysis. Integrative Cancer Therapies. 2019 Jan-Dec;18:1534735419866910.
- Substantial reduction in circumference of elbow joints and effectiveness rate among people with breast cancer-related lymphedema treated with acupuncture compared to usual care in a meta-analysis of 2 RCTs of low to medium quality75Zhang X, Wang X, Zhang B, Yang S, Liu D. Effects of acupuncture on breast cancer-related lymphoedema: a systematic review and meta-analysis of randomised controlled trials. Acupuncture in Medicine. 2019 Feb;37(1):16-24.
People with chemotherapy-induced peripheral neuropathy treated with acupuncture show fewer symptoms and pain.
- Less neuropathy among people with breast cancer treated with acupuncture compared to usual care or waitlist controls in a subgroup analysis of a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 20 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects76Li H, Schlaeger JM et al. Acupuncture improves multiple treatment-related symptoms in breast cancer survivors: a systematic review and meta-analysis. Journal of Alternative and Complementary Medicine. 2021 Dec;27(12):1084-1097.
- Less chemotherapy-induced peripheral neuropathy symptoms and pain among people treated with acupuncture compared to controls in a meta-analysis of 6 RCTs of high quality77Chien TJ, Liu CY, Fang CJ, Kuo CY. The efficacy of acupuncture in chemotherapy-induced peripheral neuropathy: systematic review and meta-analysis. Integrative Cancer Therapies. 2019 Jan-Dec;18:1534735419886662.
Modest evidence of less effect at least three small but well-designed RCTs, or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis found less effect (this is the CancerChoices definition; other researchers and studies may define this differently) than cholinergic agonists in relieving symptoms of dry mouth among people treated with acupuncture
Preliminary evidence of fewer dry mouth symptoms among people treated with acupuncture compared to sham acupuncture or controls
Compared to drugs that increase saliva (cholinergic agonists): modest evidence of less effect in relieving symptoms of dry mouth among people with head and neck cancer treated with acupuncture
- Less relief of symptoms of dry mouth among people with head and neck cancer treated with acupuncture compared to cholinergic agonists in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 8 intervention trials78Lovelace TL, Fox NF, Sood AJ, Nguyen SA, Day TA. Management of radiotherapy-induced salivary hypofunction and consequent xerostomia in patients with oral or head and neck cancer: meta-analysis and literature review. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2014 May;117(5):595-607.
Compared to usual care or other controls: preliminary evidence of fewer symptoms of dry mouth among people treated with acupuncture
- Fewer symptoms but no change in salivary flow rate among people with cancer with radiation-induced dry mouth (xerostomia) treated with acupuncture compared to sham acupuncture, standard oral care, usual care, or no treatment in a meta-analysis of 3 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of low quality79Ni X, Tian T et al. Acupuncture for radiation-induced xerostomia in cancer patients: a systematic review and meta-analysis. Integrative Cancer Therapies. 2020 Jan-Dec;19:1534735420980825.
- A very small increase in unstimulated whole saliva and stimulated whole saliva, but no evidence of an effect on symptoms, and also more adverse effects (mild and temporary tiny bruises and tiredness) among people with dry mouth treated with acupuncture compared to controls in a meta-analysis of 9 RCTs of low quality80Furness S, Bryan G, McMillan R, Worthington HV. Interventions for the management of dry mouth: non-pharmacological interventions. Cochrane Database of Systematic Reviews. 2013 Aug 30;(8):CD009603.
- Less dry mouth among people with head and neck cancer treated with acupuncture compared to baseline (all studies) or controls (1 study) in a review of 3 RCTs of low to moderate quality81O’Sullivan EM, Higginson IJ. Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review. Acupuncture in Medicine. 2010 Dec;28(4):191-9.
- Insufficient evidence to draw conclusions about effects on dry mouth in a systematic review of 10 RCTs of low quality82Assy Z, Brand HS. A systematic review of the effects of acupuncture on xerostomia and hyposalivation. BMC Complementary and Alternative Medicine. 2018 Feb 13;18(1):57.
Good evidence of less cancer-related pain without regard to treatment phase among people treated with acupuncture, whether alone or in addition to conventional pain treatments
Preliminary evidence of fewer headaches during or after chemotherapy among people with breast cancer treated with acupuncture
Good evidence of less pain related to surgery among people with cancer treated with acupuncture
Modest evidence of less pain related to aromatase inhibitors among people treated with acupuncture
No evidence of an effect on pain during chemotherapy, radiotherapy, or hormone therapy among people treated with acupuncture in combined analyses of studies
Without regard to treatment phase: good evidence of less cancer-related pain among people treated with acupuncture, whether alone or in addition to conventional pain treatments
- Less pain among people with liver or gastric cancer treated with acupuncture compared to conventional interventions in a review of 18 systematic reviews of moderate to high quality83Zhang F, Shen A, Jin Y, Qiang W. The management strategies of cancer-associated anorexia: a critical appraisal of systematic reviews. BMC Complementary and Alternative Medicine. 2018 Aug 9;18(1):236.
- Less pain related to malignancy among people treated with acupuncture compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 29 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects84Chiu HY, Hsieh YJ, Tsai PS. Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. European Journal of Cancer Care (Engl). 2017 Mar;26(2).
- Less pain among people with cancer treated with acupuncture compared to controls in a meta-analysis of 8 RCTs of low to moderate quality85Tao WW, Jiang H et al. Effects of acupuncture, tuina, tai chi, qigong, and traditional Chinese medicine Five-Element Music Therapy on symptom management and quality of life for cancer patients: a meta-analysis. Journal of Pain and Symptom Management. 2016 Apr;51(4):728-747.
- Less cancer pain among people treated with manual or auricular acupuncture compared to sham in a meta-analysis of 7 RCTs of high quality and moderate certainty86He Y, Guo X et al. Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta-analysis. JAMA Oncology. 2020 Feb 1;6(2):271-278.
- Less cancer pain and analgesic use among people treated with manual acupuncture with auricular acupressure and with conventional analgesic compared to analgesic alone in a meta-analysis of 6 RCTs87He Y, Guo X et al. Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta-analysis. JAMA Oncology. 2020 Feb 1;6(2):271-278.
- Less cancer pain among people treated with manual acupuncture compared to wait-list controls in a meta-analysis of 3 RCTs88He Y, Guo X et al. Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta-analysis. JAMA Oncology. 2020 Feb 1;6(2):271-278.
- Less cancer pain among people treated with wrist and ankle acupuncture, either with or without drug therapy, but greater effects with drug therapy, compared to drug therapy alone in a meta-analysis of 13 RCTs of medium quality89Dong B, Lin L et al. Wrist-ankle acupuncture has a positive effect on cancer pain: a meta-analysis. BMC Complementary Medicine Therapies. 2021 Jan 7;21(1):24.
- Less pain among people with head and neck cancer treated with acupuncture compared to conventional treatment in a review of 7 RCTs with low-certainty evidence90Almeida KAM, Rocha AP, Carvas N, Pinto ACPN. Rehabilitation interventions for shoulder dysfunction in patients with head and neck cancer: systematic review and meta-analysis. Physical Therapy. 2020 Oct 30;100(11):1997-2008.
- Less cancer-related pain among people treated with acupuncture and conventional care compared to conventional care alone, but not with acupuncture compared to conventional care in an overview of 4 systematic reviews91Wu X, Chung VC et al. Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews. Scientific Reports. 2015 Nov 26;5:16776.
- Lower pain intensity among people with cancer treated with acupuncture and derived therapies such as electroacupuncture, laser acupuncture, and transcutaneous electrical nerve stimulation added to conventional analgesics compared to conventional analgesics alone in a meta-analysis of 41 controlled trials92Dai L, Liu Y, Ji G, Xu Y. Acupuncture and derived therapies for pain in palliative cancer management: systematic review and meta-analysis based on single-arm and controlled trials. Journal of Palliative Medicine. 2021 Jul;24(7):1078-1099.
- Less cancer pain among people treated with acupuncture compared to wait-list controls in a meta-analysis of 3 RCTs93He Y, Guo X et al. Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta-analysis. JAMA Oncology. 2020 Feb 1;6(2):271-278.
- Less pain intensity among people with breast cancer treated with acupuncture compared to usual care or waitlist controls in a subgroup analysis of a meta-analysis of 20 RCTs94Li H, Schlaeger JM et al. Acupuncture improves multiple treatment-related symptoms in breast cancer survivors: a systematic review and meta-analysis. Journal of Alternative and Complementary Medicine. 2021 Dec;27(12):1084-1097.
- Less persistent (chronic) musculoskeletal pain among people with cancer treated with auricular acupuncture compared to usual care in a mid-sized RCT95Mao JJ, Liou KT et al. Effectiveness of electroacupuncture or auricular acupuncture vs usual care for chronic musculoskeletal pain among cancer survivors: The PEACE Randomized Clinical Trial. JAMA Oncology. 2021 Mar 18.
- Less pain intensity and daily opioid consumption among people with cancer with moderate or severe pain treated with pharmacotherapy and acupuncture for pain for 1 week compared to pharmacotherapy alone in a small RCT96He Y, Zhang H et al. Acupuncture combined with opioids for cancer pain: a pilot pragmatic randomized controlled trial. Acupuncture in Medicine. 2022 Apr;40(2):133-141.
During chemotherapy
No evidence of less pain among people undergoing chemotherapy and treated with acupuncture in a combined analysis of studies
Preliminary evidence of fewer headaches during or after chemotherapy among people with breast cancer treated with acupuncture
- No less pain during chemotherapy among people treated with acupuncture compared to controls in a meta-analysis of 29 RCTs97Chiu HY, Hsieh YJ, Tsai PS. Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. European Journal of Cancer Care (Engl). 2017 Mar;26(2).
- Fewer headaches during or after chemotherapy among people with breast cancer treated with 2 sessions per week for 8 consecutive weeks of electroacupuncture plus manual acupuncture compared to minimal acupuncture stimulation (MAS) to in a small RCT98Zhang ZJ, Man SC et al. Electroacupuncture trigeminal nerve stimulation plus body acupuncture for chemotherapy-induced cognitive impairment in breast cancer patients: An assessor-participant blinded, randomized controlled trial. Brain, Behavior, and Immunity. 2020 Aug;88:88-96.
During radiotherapy: no evidence of less pain during radiotherapy among people undergoing and treated with acupuncture in a combined analysis of studies
- No less pain related to radiation therapy among people treated with acupuncture compared to controls in a meta-analysis of 29 RCTs99Chiu HY, Hsieh YJ, Tsai PS. Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. European Journal of Cancer Care (Engl). 2017 Mar;26(2).
With surgery: modest evidence of less pain related to surgery among people with cancer treated with acupuncture
- Less pain related to surgery among people with cancer treated with acupuncture compared to controls in a meta-analysis of 29 RCTs100Chiu HY, Hsieh YJ, Tsai PS. Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. European Journal of Cancer Care (Engl). 2017 Mar;26(2).
- Less use of general anesthesia during rectal cancer surgery with acupuncture and anesthesia compared to anesthesia alone, especially if used before anesthesia, in a small RCT101Yin LH, Li WS, Zhao WX, Li WY. [Role of acupuncture anesthesia in operation of rectal cancer] [Article in Chinese]. Zhongguo Zhen Jiu. 2005;25(12):876-878.
- No additional benefit for pain among people undergoing autologous tissue breast reconstruction with acupuncture and massage compared to massage alone in a small RCT102Dilaveri CA, Croghan IT et al. Massage compared with massage plus acupuncture for breast cancer patients undergoing reconstructive surgery. Journal of Alternative and Complementary Medicine. 2020 Jul;26(7):602-609.
With hormone therapy
No evidence of less pain during hormone therapy among people treated with acupuncture in a combined analyses of studies
Modest evidence of less pain related to aromatase inhibitors among people treated with acupuncture
- No less pain related to hormone therapy among people treated with acupuncture compared to controls in a meta-analysis of 29 RCTs103Chiu HY, Hsieh YJ, Tsai PS. Systematic review and meta-analysis of acupuncture to reduce cancer-related pain. European Journal of Cancer Care (Engl). 2017 Mar;26(2).
- No change in pain among people with breast cancer receiving hormone therapy and treated with acupuncture compared to control or placebo in a meta-analysis of 20 RCTs of moderate quality104Yuanqing P, Yong T et al. Acupuncture for hormone therapy-related side effects in breast cancer patients: a grade-assessed systematic review and updated meta-analysis. Integrative Cancer Therapies. 2020 Jan-Dec;19:1534735420940394.
- Less aromatase inhibitor-associated joint pain among postmenopausal female breast cancer survivors—but not those with metastatic cancer—treated with acupuncture compared to controls, with moderate effect sizes in a meta-analysis of 19 intervention studies105Yang GS, Kim HJ et al. Interventions for the treatment of aromatase inhibitor-associated arthralgia in breast cancer survivors: a systematic review and meta-analysis. Cancer Nursing. 2017 Jul/Aug;40(4):E26-E41.
- Less pain among people with aromatase inhibitor-induced joint pain (arthralgia) treated with 6 to 8 weeks of acupuncture compared to controls in a meta-analysis of 5 RCTs106Chen L, Lin CC et al. Effect of acupuncture on aromatase inhibitor-induced arthralgia in patients with breast cancer: a meta-analysis of randomized controlled trials. Breast. 2017 Jun;33:132-138.
Modest evidence of better quality of life and physical function without regard to treatment phase among people treated with acupuncture
Modest evidence of better physical performance and quality of life during conventional treatment among people treated with acupuncture
Preliminary evidence of better function during chemotherapy after colon cancer surgery among people treated with acupuncture
Good evidence of less stiffness but no evidence of an effect on quality of life during hormone therapy among people with breast cancer treated with acupuncture
Modest evidence of better quality of life among people with advanced disease treated with acupuncture
Without regard to treatment phase: Modest evidence of better quality of life and physical function among people treated with acupuncture
- Better quality of life scores among people treated with acupuncture at P6 point before chemotherapy infusion in addition to 5 mg oral dexamethasone twice a day for 3 days compared to 8 mg intravenous ondansetron 30 minutes before chemotherapy infusion plus more if they experienced emesis in addition to dexamethasone in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects107Rithirangsriroj K, Manchana T, Akkayagorn L. Efficacy of acupuncture in prevention of delayed chemotherapy induced nausea and vomiting in gynecologic cancer patients. Gynecologic Oncology. 2015 Jan;136(1):82-6.
- Better quality of life among people with gastrointestinal cancer treated with acupuncture compared to conventional interventions in a review of 18 systematic reviews of moderate to high quality108Zhang F, Shen A, Jin Y, Qiang W. The management strategies of cancer-associated anorexia: a critical appraisal of systematic reviews. BMC Complementary and Alternative Medicine. 2018 Aug 9;18(1):236.
- A very weak trend toward better quality of life and functioning status among people with cancer treated with acupuncture compared to sham acupuncture in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 3 RCTs of high quality109Zeng Y, Luo T, Finnegan-John J, Cheng AS. Meta-analysis of randomized controlled trials of acupuncture for cancer-related fatigue. Integrative Cancer Therapies. 2014 May;13(3):193-200.
- No evidence of an effect on health-related quality of life among people with cancer treated with acupuncture compared to controls in a meta-analysis of 34 RCTs of low quality110Lin WF, Zhong MF et al. Efficacy of complementary and integrative medicine on health-related quality of life in cancer patients: a systematic review and meta-analysis. Cancer Management and Research. 2019;11:6663-6680.
- Less dysfunction among people with head and neck cancer treated with acupuncture compared to conventional treatment in a review of 7 RCTs with low-certainty evidence111Almeida KAM, Rocha AP, Carvas N, Pinto ACPN. Rehabilitation interventions for shoulder dysfunction in patients with head and neck cancer: systematic review and meta-analysis. Physical Therapy. 2020 Oct 30;100(11):1997-2008.
- Better daily activity among people with myeloma treated with acupuncture combined with methylcobalamin (a B vitamin) compared to methylcobalamin alone in a mid-sized RTC112Han X, Wang L et al. Acupuncture combined with methylcobalamin for the treatment of chemotherapy-induced peripheral neuropathy in patients with multiple myeloma. BMC Cancer. 2017 Jan 9;17(1):40.
During treatment
Modest evidence of better physical performance and quality of life during conventional treatment among people treated with acupuncture
Preliminary evidence of better function during chemotherapy after colon cancer surgery among people treated with acupuncture
- Better physical performance and quality of life during conventional treatment among people with lung cancer treated with acupoint stimulation compared to controls in a meta-analysis of 31 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial; study authors’ note: “Acupoint stimulation varies from needle insertion, pressure, plaster application, and moxibustion to herbal extraction on the acupoints”113Chen HY, Li SG, Cho WC, Zhang ZJ. The role of acupoint stimulation as an adjunct therapy for lung cancer: a systematic review and meta-analysis. BMC Complementary and Alternative Medicine. 2013 Dec 17;13:362.
- No improvement in disease-specific quality-of-life scores during chemotherapy among people with breast cancer treated with acupuncture and standard treatment compared to standard treatment alone in a mid-sized RCT114Brinkhaus B, Kirschbaum B et al. Prophylactic acupuncture treatment during chemotherapy with breast cancer: a randomized pragmatic trial with a retrospective nested qualitative study. Breast Cancer Research and Treatment. 2019;178(3):617–628.
- Better function during hyperthermic intraperitoneal chemotherapy after colon cancer surgery among people with spleen and stomach deficiency syndrome treated with acupuncture and ondansetron compared to ondansetron alone in a mid-sized RCT115Gu XY, Gao ZQ, Zhang ZJ, Huang ZM, Xie XH. [Influence of warming needling technique on gastrointestinal reaction after hyperthermic intrape-ritoneal chemotherapy in patients with postoperation of colon cancer] [Article in Chinese]. Zhen Ci Yan Jiu. 2020;45(4):315-319.
During hormone therapy
Good evidence of less stiffness but no evidence of an effect on quality of life during hormone therapy among people with breast cancer treated with acupuncture
- Less stiffness but no change in quality of life during hormone therapy among people with breast cancer treated with acupuncture compared to control or placebo in meta-analyses of 17 RCTs of moderate to high quality116Pan Y, Yang K et al. Clinical benefits of acupuncture for the reduction of hormone therapy-related side effects in breast cancer patients: a systematic review. Integrative Cancer Therapies. 2018 Sep;17(3):602-618. and 20 RCTs of moderate quality117Yuanqing P, Yong T et al. Acupuncture for hormone therapy-related side effects in breast cancer patients: a grade-assessed systematic review and updated meta-analysis. Integrative Cancer Therapies. 2020 Jan-Dec;19:1534735420940394.
Advanced cancer: modest evidence of better quality of life among people treated with acupuncture
- Better quality of life among people with terminal cancer treated with acupuncture in a meta-analysis of 4 RCTs of low to moderate quality118Tao WW, Jiang H et al. Effects of acupuncture, tuina, tai chi, qigong, and traditional Chinese medicine Five-Element Music Therapy on symptom management and quality of life for cancer patients: a meta-analysis. Journal of Pain and Symptom Management. 2016 Apr;51(4):728-747.
- Better quality of life among people with advanced diseases including cancer treated with at least 3 weeks of acupuncture compared to sham acupuncture among 4 of 6 RCTs reviewed119von Trott P, Oei SL, Ramsenthaler C. Acupuncture for breathlessness in advanced diseases: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2020 Feb;59(2):327-338.e3.
Preliminary evidence of fewer urogenital symptoms among people with breast cancer with climacteric-like symptoms treated with acupuncture
- Better Menopause Rating Scale urogenital component scores among people with breast cancer with climacteric-like symptoms treated with acupuncture compared to controls but not compared to sham acupuncture in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects120D’Alessandro EG, da Silva AV et al. Acupuncture for climacteric-like symptoms in breast cancer improves sleep, mental and emotional health: a randomized trial. Medical Acupuncture. 2022 Feb 1;34(1):58-65.
Good evidence of less sleep disturbance without regard to treatment phase among people treated with acupuncture
Good evidence of better sleep quality scores during active cancer treatments among people with breast cancer treated with acupuncture compared to controls, although no evidence of an effect compared to sham acupuncture
Weak evidence of less sleep disturbance during chemotherapy among people with ovarian cancer treated with acupuncture
Without regard to treatment phase: good evidence of less sleep disturbance among people treated with acupuncture
- Less self-reported sleep disturbance among people with cancer treated with acupuncture compared to enhanced supportive care in a network meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 24 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects121Cheung DST, Xu X et al. Invasive or noninvasive? A systematic review and network meta-analysis of acupuncture and acupressure to treat sleep disturbance in cancer patients. Worldviews on Evidence-Based Nursing. 2022 Dec 21.
- Comparable improvements in sleep quality scores immediately after treatment among people with breast cancer treated with either acupuncture or estazolam, and better scores 1 week after treatment compared to estazolam, in a meta-analysis of 22 RCTs122Zhang J, Zhang Z et al. Acupuncture for cancer-related insomnia: a systematic review and meta-analysis. Phytomedicine. 2022 Jul 20;102:154160.
- Better sleep quality scores among people with breast cancer with climacteric-like symptomssymptoms that are common during menopause, including hot flashes, vaginal dryness, and to a lesser extent, sleep disturbances treated with acupuncture compared to sham acupuncture or controls in a small RCT123D’Alessandro EG, da Silva AV et al. Acupuncture for climacteric-like symptoms in breast cancer improves sleep, mental and emotional health: a randomized trial. Medical Acupuncture. 2022 Feb 1;34(1):58-65.
- Less sleep disturbance among people with cancer treated with acupuncture compared to controls in a meta-analysis of 2 RCTs of low to moderate quality124Tao WW, Jiang H et al. Effects of acupuncture, tuina, tai chi, qigong, and traditional Chinese medicine Five-Element Music Therapy on symptom management and quality of life for cancer patients: a meta-analysis. Journal of Pain and Symptom Management. 2016 Apr;51(4):728-747.
- Less sleep disruption, continuing for 24 weeks of follow up, among people with cancer with clinically significant sleep disturbance and chronic musculoskeletal pain treated with auricular acupuncture for 10 weeks compared to usual care in a mid-sized RCT125Yang M, Baser RE et al. Effect of acupuncture versus usual care on sleep quality in cancer survivors with chronic pain: secondary analysis of a randomized clinical trial. Cancer. 2023 Mar 29.
- Less sleep disturbance among people with lung cancer treated with acupuncture compared to controls, but only during active interventions and not persisting after completing acupuncture in a meta-analysis of 22 intervention studies of low to moderate quality126Papadopoulos D, Papadoudis A, Kiagia M, Syrigos K. Nonpharmacologic interventions for improving sleep disturbances in patients with lung cancer: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2018 May;55(5):1364-1381.e5.
- A weak trend towards lower levels of sleep disturbance among people with breast cancer treated with acupuncture compared to sham acupuncture in a subgroup analysis of a meta-analysis of 20 RCTs127Li H, Schlaeger JM et al. Acupuncture improves multiple treatment-related symptoms in breast cancer survivors: a systematic review and meta-analysis. Journal of Alternative and Complementary Medicine. 2021 Dec;27(12):1084-1097.
During cancer treatment
Good evidence of better sleep quality scores during active cancer treatments among people with breast cancer treated with acupuncture compared to controls, although no evidence of an effect compared to sham acupuncture
- Better sleep quality scores during active cancer treatments among people with breast cancer treated with acupuncture compared to controls, although no evidence of an effect compared to sham acupuncture, in a meta-analysis of 22 RCTs128Zhang J, Zhang Z et al. Acupuncture for cancer-related insomnia: a systematic review and meta-analysis. Phytomedicine. 2022 Jul 20;102:154160.
- Lower incidence of insomnia among people treated with acupuncture at P6 point before chemotherapy infusion in addition to 5 mg oral dexamethasone twice a day for 3 days compared to 8 mg intravenous ondansetron 30 minutes before chemotherapy infusion plus more if they experienced emesis in addition to dexamethasone in a small RCT129Rithirangsriroj K, Manchana T, Akkayagorn L. Efficacy of acupuncture in prevention of delayed chemotherapy induced nausea and vomiting in gynecologic cancer patients. Gynecologic Oncology. 2015 Jan;136(1):82-6.
Weak evidence of less sleep disturbance during chemotherapy among people with ovarian cancer treated with acupuncture
- Less insomnia during chemotherapy among women with ovarian cancer treated with acupuncture compared to baseline but not compared to sham acupuncture in a small RCT130Lu W, Matulonis UA et al. The feasibility and effects of acupuncture on quality of life scores during chemotherapy in ovarian cancer: results from a pilot, randomized sham-controlled trial. Medical Acupuncture. 2012 Dec;24(4):233-240.
Weak evidence of less stress without regard to treatment phase among people with cancer treated with acupuncture
No evidence of additional benefit to massage therapy for stress during autologous tissue breast reconstruction among people treated with acupuncture in a preliminary study
Without regard to treatment phase: weak evidence of less stress among people with cancer treated with acupuncture
- Less self-rated stress among people with cancer with acupuncture compared to baseline in an uncontrolled triala study in which a therapy is used, but without a comparison group to judge outcomes against; an uncontrolled trial is considered a weak study design131Fink J, Burns J et al. A quality brief of an oncological multisite massage and acupuncture therapy program to improve cancer-related outcomes. Journal of Alternative and Complementary Medicine. 2020 Sep;26(9):820-824.
During surgery: no evidence of additional benefit to massage therapy for stress during autologous tissue breast reconstruction among people treated with acupuncture in a preliminary study
- No additional benefit for relaxation during autologous tissue breast reconstruction among people treated with acupuncture and massage compared to massage alone in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects132Dilaveri CA, Croghan IT et al. Massage compared with massage plus acupuncture for breast cancer patients undergoing reconstructive surgery. Journal of Alternative and Complementary Medicine. 2020 Jul;26(7):602-609.
Preliminary evidence of shorter hospital stays after surgery for colorectal cancer among people treated with acupuncture
Weak evidence of less ringing in ears (tinnitus) among people with breast cancer during or after chemotherapy
Preliminary evidence of shorter hospital stays after surgery for colorectal cancer among people treated with acupuncture
- Shorter hospital stays during intraperitoneal chemotherapy after colon cancer surgery among people with spleen and stomach deficiency syndrome treated with acupuncture and ondansetron compared to ondansetron alone in a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects133Gu XY, Gao ZQ, Zhang ZJ, Huang ZM, Xie XH. [Influence of warming needling technique on gastrointestinal reaction after hyperthermic intrape-ritoneal chemotherapy in patients with postoperation of colon cancer] [Article in Chinese]. Zhen Ci Yan Jiu. 2020;45(4):315-319.
During or after chemotherapy: weak evidence of less ringing in ears (tinnitus) among people with breast cancer during or after chemotherapy
- Fewer incidents of tinnitus during or after chemotherapy among people with breast cancer treated with 2 sessions per week for 8 consecutive weeks of electroacupuncture plus manual acupuncture compared to minimal acupuncture stimulation (MAS) to In a small RCT134Zhang ZJ, Man SC et al. Electroacupuncture trigeminal nerve stimulation plus body acupuncture for chemotherapy-induced cognitive impairment in breast cancer patients: An assessor-participant blinded, randomized controlled trial. Brain, Behavior, and Immunity. 2020 Aug;88:88-96.
Modest evidence of less breast cancer-related lymphedema among people treated with acupuncture combined with drugs or functional exercise
Preliminary evidence of less pain among people with myeloma treated with acupuncture combined with methylcobalamin
Preliminary evidence of shorter hospital stays after open or laparoscopic resection for colorectal cancer among people treated with simo decoction and acupuncture
Acupuncture combined with drugs or functional exercise: modest evidence of less breast cancer-related lymphedema among people treated with acupuncture combined with drugs or functional exercise
- Less breast cancer-related lymphedema among people treated with acupuncture combined with drugs or functional exercise compared with controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 13 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of low quality135Hou W, Pei L et al. Acupuncture therapy for breast cancer-related lymphedema: a systematic review and meta-analysis. Journal of Obstetrics and Gynaecology Research. 2019 Dec;45(12):2307-2317.
Acupuncture combined with methylcobalamin (a B vitamin): preliminary evidence of less pain among people with myeloma treated with acupuncture combined with methylcobalamin
- Less pain among people with myeloma treated with acupuncture combined with methylcobalamin compared to methylcobalamin alone in a mid-sized RCT136Han X, Wang L et al. Acupuncture combined with methylcobalamin for the treatment of chemotherapy-induced peripheral neuropathy in patients with multiple myeloma. BMC Cancer. 2017 Jan 9;17(1):40.
Acupuncture and simo decoction (SMD, a traditional Chinese medicine): preliminary evidence of Shorter hospital stays after open or laparoscopic resection for colorectal cancer among people treated with simo decoction and acupuncture
- Shorter hospital stays after open or laparoscopic resection for colorectal cancer among people treated with simo decoction and acupuncture for 5 consecutive days following surgery compared to chewing gum or no intervention in a mid-sized RCT137Yang Y, Zuo HQ et al. Comparison of efficacy of simo decoction and acupuncture or chewing gum alone on postoperative ileus in colorectal cancer resection: a randomized trial. Scientific Reports. 2017 Jan 19;7:37826.
Preliminary evidence of less clinical depression among people treated with acupuncture
Good evidence of comparable effects on hot flashes among people treated with acupuncture compared to non-hormonal drugs
Modest evidence of higher frequency of hot flashes among people treated with acupuncture compared to hormonal therapy
Depression: preliminary evidence of less clinical depression among people treated with acupuncture
- Better depression remission rates among people with clinical depression treated with manual acupuncture compared to antidepressant medications in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 19 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of low quality138Haller H, Anheyer D, Cramer H, Dobos G. Complementary therapies for clinical depression: an overview of systematic reviews. BMJ Open. 2019 Aug 5;9(8):e028527.
- Less severe depression among people with clinical depression with manual acupuncture compared to usual care or when added to usual care in a meta-analysis of 4 RCTs of very low quality, but only a weak trend toward less severe depression compared to sham treatment (7 RCTs) or antidepressant medications (19 RCTs) in meta-analyses of RCTs of very low quality139Haller H, Anheyer D, Cramer H, Dobos G. Complementary therapies for clinical depression: an overview of systematic reviews. BMJ Open. 2019 Aug 5;9(8):e028527.
- No evidence of an effect on depression remission rates among people with clinical depression with manual acupuncture compared to sham treatment (7 RCTs), usual care (4 RCTs), or when added to usual care (8 RCTs) in meta-analyses of RCTs of low quality140Haller H, Anheyer D, Cramer H, Dobos G. Complementary therapies for clinical depression: an overview of systematic reviews. BMJ Open. 2019 Aug 5;9(8):e028527.
Good evidence of comparable effects on hot flashes among people treated with acupuncture compared to non-hormonal drugs
Modest evidence of higher frequency of hot flashes among people treated with acupuncture compared to hormonal therapy
- Comparably fewer hot flashes among menopausal women treated with acupuncture or non-hormonal drugs including selective serotonin reuptake inhibitors / serotonin-norepinephrine reuptake inhibitors and neuroleptic agents such as gabapentin and escitalopram in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 17 meta-analyses of medium to high quality141Li T, Zhang Y et al. Quantitative study on the efficacy of acupuncture in the treatment of menopausal hot flashes and its comparison with nonhormonal drugs. Menopause. 2021 Mar 15;28(5):564-572.
- More hot flashes per day but no difference in severity among menopausal women with acupuncture compared to hormonal therapy in a meta-analysis of 16 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects with low or very low quality evidence142Dodin S, Blanchet C et al. Acupuncture for menopausal hot flushes. Cochrane Database of Systematic Reviews. 2013 Jul 30;2013(7):CD007410.
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.
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Dr. Ryan served as a research associate for CancerChoices. She is a licensed and board certified naturopathic physician and acupuncturist in Oregon. Dr. Ryan is the founder of Gentle Natural Wellness, a clinic specializing in bridging classical Chinese medicine with naturopathic medicine to provide individualized, compassionate care for people in the community. A Doctorate of Naturopathic Medicine and Master of Science in Oriental Medicine with honors from the National University of Natural Medicine, research in medical anthropology at the University of Hawai’i and George Mason University, language and culture programs at Obirin University (Tokyo) and Sogang University (Seoul), and studies of Chinese herbal medicine and qigong in China have provided a diverse background that has helped form a foundation for her community health and healing path.
Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.
For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.
Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.
Dr. Spitzer is a family physician and cancer survivor. She received her medical degree from Virginia Commonwealth University School of Medicine and specializes in complementary and integrative medicine.
Last update: August 28, 2024
Last full literature review: February 2022
CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.
Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.
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