Written by Karen Pilkington, Vinjar Fønnebø and the CAM-Cancer Consortium.
Updated April 27, 2016

Acupuncture for chemotherapy-associated nausea and vomiting

Does it work?

Systematic reviews

Two systematic reviews published in 2005 (10) and 2009 (11) specifically addressing acupuncture and/or acupressure in chemotherapy-induced nausea and vomiting in adults were identified. They both included 11 trials in their analyses; the 2005 review, a Cochrane review, had a total of 1247 patients in the 11 trials, while the 2009 review had 761 patients in their 11 included trials. The 2009 review had chemotherapy-induced nausea and vomiting as one of several therapy-related adverse events studied in breast cancer patients.(11) Both reviews reported that stimulation of acupoints (mainly P6) reduced nausea and/or vomiting. The Cochrane 2005 review reported that the effect was mainly seen on vomiting, while the second review included mainly trials where emesis reduction was the endpoint. Subsequently, the Cochrane review has been withdrawn from the Cochrane database as the authors were unable to complete updating in the required timescale.

Five further systematic reviews have been published since 2013. The first of these focused on acupuncture as an adjunct therapy in lung cancer patients.(12) It appears that there were either 2 or 3 RCTs of acupuncture and 2 of acupressure in chemotherapy-associated nausea and vomiting included, all of which were published after the Cochrane review. It is difficult to interpret the results of this review as the trials reported in the tables and text do not match. Therefore, the conclusion that all forms of acupuncture treatment assessed significantly attenuated the grade of nausea and vomiting cannot be confirmed.

A second review, in which searches were conducted up to the end of 2011, found 11 RCTs.(13) Four of these had been included in the 2005 Cochrane review and 7 had not (5 because they were published subsequently). Of the 11 RCTs, 8 were at high risk of bias, in 2 the extent of bias was unclear with 1 at low risk of bias. Positive results for acupuncture were reported; non-specific effects contributed to the effects although the specific effects were reported to be larger.

Of the remaining three reviews, one focused on a treatment approach whereby medication is injected at acupuncture points and so the effects of acupuncture therapy alone cannot be determined.(14) Two assessed specific forms of treatment; one focused on self-acupressure and only located 2 studies.(15) Only one these was an RCT and, therefore, there was not a sufficient basis for firm conclusions on effectiveness. The final review focused on auricular therapy (ear acupuncture).(16) No between-group comparison was reported which does not allow conclusions to be drawn, particularly as significant methodological flaws were identified.

Clinical trials

Subsequent to these reviews, 8 RCTs have been published. For details please see Table 2.

Three trials investigated the effects of acupressure. Two trials of acupressure at P6 using a wrist band reported no difference between this and a ‘placebo band’. (17,18,19) One of these reported the effect of acupoint stimulation on chemotherapy-induced nausea and vomiting in 120 patients with breast, gynecological or lung cancer.17 The authors reported that “real acupressure application is not an effective approach in decreasing the experience, occurrence, and problem of nausea-vomiting-retching” but there were several limitations in the reporting of the trials. The other trial involved a large sample of 500 patients and was rigorously reported.(18,19)  A third acupressure trial reported synergistic effects of P6 acupressure with nurse-provided counselling.(20)

The remaining 4 trials include one in which wrist-ankle acupuncture combined with ginger moxibustion was compared with tropisetron hydrochloride and dexamethasone in gynaecological cancer patients.(21) The acupuncture combination was reported to be more effective than conventional anti-emetic therapy but the trial was not blinded and so patient expectation may have influenced the result. A trial comparing acupuncture at P6 point with ondansetron also reported better effects of the acupuncture treatment but some details of the methods used in this trial are missing.(22) No difference in effect was also observed in a trial of acustimulation at the K1 acupoint compared with electrostimulation at a placebo point.(23)

The final trial compared the effects of needleless transcutaneous electroacupuncture at Neiguan (PC6) and Jianshi (PC5) against electroacupuncture at non-acupoints.(24) Stimulation at the acupoints was reported to improve emesis and reduces nausea in the delayed phase of chemotherapy but equivalent additive effects were not recorded in the acute phase.

Citation Karen Pilkington, Vinjar Fønnebø, CAM-Cancer Consortium. Acupuncture for chemotherapy-associated nausea and vomiting [online document]. http://ws.cam-cancer.org/The-Summaries/Mind-body-interventions/Acupuncture-for-chemotherapy-associated-nausea-and-vomiting. April 27, 2016.

References

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