Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews
Identifieur interne : 000954 ( Pmc/Curation ); précédent : 000953; suivant : 000955Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews
Auteurs : Xinyin Wu [Hong Kong] ; Vincent Ch Chung [Hong Kong] ; Edwin P. Hui [Hong Kong] ; Eric Tc Ziea [Hong Kong] ; Bacon Fl Ng [Hong Kong] ; Robin St Ho [Hong Kong] ; Kelvin Kf Tsoi [Hong Kong] ; Samuel Ys Wong [Hong Kong] ; Justin Cy Wu [Hong Kong]Source :
- Scientific Reports [ 2045-2322 ] ; 2015.
Abstract
Acupuncture and related therapies such as moxibustion and transcutaneous electrical nerve stimulation are often used to manage cancer-related symptoms, but their effectiveness and safety are controversial. We conducted this overview to summarise the evidence on acupuncture for palliative care of cancer. Our systematic review synthesised the results from clinical trials of patients with any type of cancer. The methodological quality of the 23 systematic reviews in this overview, assessed using the Methodological Quality of Systematic Reviews Instrument, was found to be satisfactory. There is evidence for the therapeutic effects of acupuncture for the management of cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopenia in patients with cancer. There is conflicting evidence regarding the treatment of cancer-related pain, hot flashes and hiccups, and improving patients’ quality of life. The available evidence is currently insufficient to support or refute the potential of acupuncture and related therapies in the management of xerostomia, dyspnea and lymphedema and in the improvement of psychological well-being. No serious adverse effects were reported in any study. Because acupuncture appears to be relatively safe, it could be considered as a complementary form of palliative care for cancer, especially for clinical problems for which conventional care options are limited.
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DOI: 10.1038/srep16776
PubMed: 26608664
PubMed Central: 4660374
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Kong.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Hong Kong</country><wicri:regionArea>, Pittsburgh</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="a2"><institution>Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong</institution>, Hong Kong.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Hong Kong</country><wicri:regionArea>, Pittsburgh</wicri:regionArea></affiliation></author><author><name sortKey="Hui, Edwin P" sort="Hui, Edwin P" uniqKey="Hui E" first="Edwin P" last="Hui">Edwin P. 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We conducted this overview to summarise the evidence on acupuncture for palliative care of cancer. Our systematic review synthesised the results from clinical trials of patients with any type of cancer. The methodological quality of the 23 systematic reviews in this overview, assessed using the Methodological Quality of Systematic Reviews Instrument, was found to be satisfactory. There is evidence for the therapeutic effects of acupuncture for the management of cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopenia in patients with cancer. There is conflicting evidence regarding the treatment of cancer-related pain, hot flashes and hiccups, and improving patients’ quality of life. The available evidence is currently insufficient to support or refute the potential of acupuncture and related therapies in the management of xerostomia, dyspnea and lymphedema and in the improvement of psychological well-being. No serious adverse effects were reported in any study. Because acupuncture appears to be relatively safe, it could be considered as a complementary form of palliative care for cancer, especially for clinical problems for which conventional care options are limited.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Levy, M H" uniqKey="Levy M">M. H. Levy</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Lu, W D" uniqKey="Lu W">W. D. Lu</name></author><author><name sortKey="Dean Clower, E" uniqKey="Dean Clower E">E. Dean-Clower</name></author><author><name sortKey="Doherty Gilman, A" uniqKey="Doherty Gilman A">A. Doherty-Gilman</name></author><author><name sortKey="Rosenthal, D S" uniqKey="Rosenthal D">D. S. Rosenthal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chao, L F" uniqKey="Chao L">L. F. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Sci Rep</journal-id><journal-id journal-id-type="iso-abbrev">Sci Rep</journal-id><journal-title-group><journal-title>Scientific Reports</journal-title></journal-title-group><issn pub-type="epub">2045-2322</issn><publisher><publisher-name>Nature Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26608664</article-id><article-id pub-id-type="pmc">4660374</article-id><article-id pub-id-type="pii">srep16776</article-id><article-id pub-id-type="doi">10.1038/srep16776</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Xinyin</given-names></name><xref ref-type="aff" rid="a1">1</xref><xref ref-type="aff" rid="a2">2</xref></contrib><contrib contrib-type="author"><name><surname>Chung</surname><given-names>Vincent CH</given-names></name><xref ref-type="corresp" rid="c1">a</xref><xref ref-type="aff" rid="a1">1</xref><xref ref-type="aff" rid="a2">2</xref></contrib><contrib contrib-type="author"><name><surname>Hui</surname><given-names>Edwin P</given-names></name><xref ref-type="aff" rid="a1">1</xref><xref ref-type="aff" rid="a3">3</xref></contrib><contrib contrib-type="author"><name><surname>Ziea</surname><given-names>Eric TC</given-names></name><xref ref-type="aff" rid="a4">4</xref></contrib><contrib contrib-type="author"><name><surname>Ng</surname><given-names>Bacon FL</given-names></name><xref ref-type="aff" rid="a4">4</xref></contrib><contrib contrib-type="author"><name><surname>Ho</surname><given-names>Robin ST</given-names></name><xref ref-type="aff" rid="a2">2</xref></contrib><contrib contrib-type="author"><name><surname>Tsoi</surname><given-names>Kelvin KF</given-names></name><xref ref-type="aff" rid="a2">2</xref><xref ref-type="aff" rid="a5">5</xref></contrib><contrib contrib-type="author"><name><surname>Wong</surname><given-names>Samuel YS</given-names></name><xref ref-type="aff" rid="a1">1</xref><xref ref-type="aff" rid="a2">2</xref></contrib><contrib contrib-type="author"><name><surname>Wu</surname><given-names>Justin CY</given-names></name><xref ref-type="aff" rid="a1">1</xref><xref ref-type="aff" rid="a6">6</xref></contrib><aff id="a1"><label>1</label><institution>Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong</institution>, Hong Kong.</aff><aff id="a2"><label>2</label><institution>Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong</institution>, Hong Kong.</aff><aff id="a3"><label>3</label><institution>Comprehensive Cancer Trials Unit, The Chinese University of Hong Kong</institution>, Hong Kong.</aff><aff id="a4"><label>4</label><institution>Chinese Medicine Department, Hong Kong Hospital Authority</institution>, Hong Kong.</aff><aff id="a5"><label>5</label><institution>Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong</institution>, Hong Kong.</aff><aff id="a6"><label>6</label><institution>Department of Medicine & Therapeutics, The Chinese University of Hong Kong</institution>, Hong Kong.</aff></contrib-group><author-notes><corresp id="c1"><label>a</label><email>vchung@cuhk.edu.hk</email></corresp></author-notes><pub-date pub-type="epub"><day>26</day><month>11</month><year>2015</year></pub-date><pub-date pub-type="collection"><year>2015</year></pub-date><volume>5</volume><elocation-id>16776</elocation-id><history><date date-type="received"><day>18</day><month>03</month><year>2015</year></date><date date-type="accepted"><day>16</day><month>10</month><year>2015</year></date></history><permissions><copyright-statement>Copyright © 2015, Macmillan Publishers Limited</copyright-statement><copyright-year>2015</copyright-year><copyright-holder>Macmillan Publishers Limited</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/"><pmc-comment>author-paid</pmc-comment>
<license-p>This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link></license-p></license></permissions><abstract><p>Acupuncture and related therapies such as moxibustion and transcutaneous electrical nerve stimulation are often used to manage cancer-related symptoms, but their effectiveness and safety are controversial. We conducted this overview to summarise the evidence on acupuncture for palliative care of cancer. Our systematic review synthesised the results from clinical trials of patients with any type of cancer. The methodological quality of the 23 systematic reviews in this overview, assessed using the Methodological Quality of Systematic Reviews Instrument, was found to be satisfactory. There is evidence for the therapeutic effects of acupuncture for the management of cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopenia in patients with cancer. There is conflicting evidence regarding the treatment of cancer-related pain, hot flashes and hiccups, and improving patients’ quality of life. The available evidence is currently insufficient to support or refute the potential of acupuncture and related therapies in the management of xerostomia, dyspnea and lymphedema and in the improvement of psychological well-being. No serious adverse effects were reported in any study. Because acupuncture appears to be relatively safe, it could be considered as a complementary form of palliative care for cancer, especially for clinical problems for which conventional care options are limited.</p></abstract></article-meta></front><floats-group><fig id="f1"><label>Figure 1</label><caption><title>Flowchart of literature selection on systematic reviews of acupuncture for cancer palliative care Keys: SR, systematic review.</title></caption><graphic xlink:href="srep16776-f1"></graphic></fig><table-wrap position="float" id="t1"><label>Table 1</label><caption><title>Characteristics of included systematic reviews of RCT on needle acupuncture for cancer palliative care.</title></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="center"></col><col align="center"></col></colgroup><thead valign="bottom"><tr><th align="left" valign="top" charoff="50">Firstauthor andyear ofpublication</th><th align="left" valign="top" charoff="50">Includedstudydesign</th><th align="left" valign="top" charoff="50">Diagnosis</th><th align="left" valign="top" charoff="50">Searchperiod</th><th align="left" valign="top" charoff="50">Nature of acupuncture and relatedinterventions</th><th align="left" valign="top" charoff="50">Nature of controlinterventions</th><th align="left" valign="top" charoff="50">Outcomes</th><th align="center" valign="top" charoff="50">No. ofstudies(No. of patients)included</th><th align="center" valign="top" charoff="50">Meta-analysisconducted?</th></tr></thead><tbody valign="top"><tr><td align="left" valign="top" charoff="50">Lee, 2009b</td><td align="left" valign="top" charoff="50">OnlyRCT</td><td align="left" valign="top" charoff="50">Breastcancer</td><td align="left" valign="top" charoff="50">Aug.2008</td><td align="left" valign="top" charoff="50">Acupuncture with needle insertion: needle acupuncture or electro-acupuncture. Related therapies including laser acupuncture and moxibustion were excluded.</td><td align="left" valign="top" charoff="50">No restriction on type of control. Controls included sham acupuncture, conventional care or relaxation.</td><td align="left" valign="top" charoff="50">Hot flushes.</td><td align="center" valign="top" charoff="50">6 (202)</td><td align="center" valign="top" charoff="50">Yes</td></tr><tr><td align="left" valign="top" charoff="50">Peng, 2010</td><td align="left" valign="top" charoff="50">OnlyRCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Jun.2008</td><td align="left" valign="top" charoff="50">Needle acupuncture, electro-acupuncture, or auricular acupuncture.</td><td align="left" valign="top" charoff="50">No restriction on type of control. Controls included conventional care, sham acupuncture or no treatment.</td><td align="left" valign="top" charoff="50">Cancer related pain.</td><td align="center" valign="top" charoff="50">7 (634)</td><td align="center" valign="top" charoff="50">No</td></tr><tr><td align="left" valign="top" charoff="50">Pu, 2010</td><td align="left" valign="top" charoff="50">OnlyRCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Jun.2009</td><td align="left" valign="top" charoff="50">Needle acupuncture or electro-acupuncture.</td><td align="left" valign="top" charoff="50">Conventional care.</td><td align="left" valign="top" charoff="50">Nausea, vomiting and treatment related gastrointestinal adverse reaction.</td><td align="center" valign="top" charoff="50">6 (461)</td><td align="center" valign="top" charoff="50">Yes</td></tr><tr><td align="left" valign="top" charoff="50">Choi, 2012a</td><td align="left" valign="top" charoff="50">OnlyRCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Apr.2011</td><td align="left" valign="top" charoff="50">Needle acupuncture, auricular acupuncture, electro-acupuncture or “fire needle”.</td><td align="left" valign="top" charoff="50">Sham acupuncture or conventional care. </td><td align="center" valign="top" charoff="50">Cancer related pain, operation related pain. </td><td align="center" valign="top" charoff="50">15 (1157)</td><td align="center" valign="top" charoff="50">Yes</td></tr><tr><td align="left" valign="top" charoff="50">Hurlow, 2012</td><td align="left" valign="top" charoff="50">OnlyRCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Oct.2010</td><td align="left" valign="top" charoff="50">Single or dual channel TENS</td><td align="left" valign="top" charoff="50">Placebo or placebo plus conventional care.</td><td align="left" valign="top" charoff="50">Cancer related pain.</td><td align="center" valign="top" charoff="50">3 (88)</td><td align="center" valign="top" charoff="50">No</td></tr><tr><td align="left" valign="top" charoff="50">Paley, 2012</td><td align="left" valign="top" charoff="50">OnlyRCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Jun.2012</td><td align="left" valign="top" charoff="50">Penetrating acupuncture: including needle acupuncture or auricular acupuncture.</td><td align="left" valign="top" charoff="50">Sham acupuncture or conventional care.</td><td align="left" valign="top" charoff="50">Cancer related pain.</td><td align="center" valign="top" charoff="50">3 (204)</td><td align="center" valign="top" charoff="50">No</td></tr><tr><td align="left" valign="top" charoff="50">Posadzki, 2013</td><td align="left" valign="top" charoff="50">OnlyRCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Nov.2012</td><td align="left" valign="top" charoff="50">Needle acupuncture plus electro-acupuncture; or needle acupuncture plus education.</td><td align="left" valign="top" charoff="50">No restriction on type of control. Controls included sham acupuncture or conventional care.</td><td align="left" valign="top" charoff="50">Cancer-related fatigue</td><td align="center" valign="top" charoff="50">7 (548)</td><td align="center" valign="top" charoff="50">No</td></tr><tr><td align="left" valign="top" charoff="50">Zeng, 2013</td><td align="left" valign="top" charoff="50">OnlyRCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">May2013</td><td align="left" valign="top" charoff="50">Needle acupuncture. Trials using acupuncture without needle insertion was excluded.</td><td align="left" valign="top" charoff="50">Sham acupuncture, conventional care, self- acupressure, no treatment or waiting list.</td><td align="left" valign="top" charoff="50">Cancer-related fatigue, quality of life, functional well-being</td><td align="center" valign="top" charoff="50">7 (689)</td><td align="center" valign="top" charoff="50">Yes</td></tr><tr><td align="left" valign="top" charoff="50">Lian, 2014</td><td align="left" valign="top" charoff="50">OnlyRCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Jun.2010</td><td align="left" valign="top" charoff="50">Needle acupuncture or electro-acupuncture</td><td align="left" valign="top" charoff="50">Chemotherapy, conventional care or sham acupuncture</td><td align="left" valign="top" charoff="50">Vomiting, abdominal discomfort, diarrhea, peripheral neuropathy; cancer pain, post-operative urinary retention, quality of life, vasomotor syndrome, recovery of gastrointestinal function. </td><td align="center" valign="top" charoff="50">33 (2503)</td><td align="center" valign="top" charoff="50">No</td></tr></tbody></table><table-wrap-foot><fn id="t1-fn1"><p>Keys: RCT, randomized controlled trial; TENS, Transcutaneous electrical nerve stimulation.</p></fn></table-wrap-foot></table-wrap><table-wrap position="float" id="t2"><label>Table 2</label><caption><title>Characteristics of included systematic reviews of RCT on acupuncture and related therapies for cancer palliative care.</title></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="center"></col><col align="center"></col></colgroup><thead valign="bottom"><tr><th align="left" valign="top" charoff="50">First authorand year ofpublication</th><th align="left" valign="top" charoff="50">Includedstudy design</th><th align="left" valign="top" charoff="50">Diagnosis</th><th align="left" valign="top" charoff="50">Searchperiod</th><th align="left" valign="top" charoff="50">Nature of acupunctureand relatedinterventions</th><th align="left" valign="top" charoff="50">Nature ofcontrolinterventions</th><th align="left" valign="top" charoff="50">Outcomes</th><th align="center" valign="top" charoff="50">No. of studies(No. of patients)included</th><th align="center" valign="top" charoff="50">Meta- analysisconducted?</th></tr></thead><tbody valign="top"><tr><td align="left" valign="top" charoff="50">Chen, 2013</td><td align="left" valign="top" charoff="50">Only RCT</td><td align="left" valign="top" charoff="50">Lung cancer</td><td align="left" valign="top" charoff="50">Jun. 2013</td><td align="left" valign="top" charoff="50">Needle acupuncture, acupoints injection, moxibustion, and applications of acupoint plaster or magnet.</td><td align="left" valign="top" charoff="50">No restriction on type of control. Controls included conventional care or CHM alone.</td><td align="left" valign="top" charoff="50">Various outcomes, including nausea and vomiting, tumor response, quality of life (measured by Karnofsky performance status & EORCT-QLQ-C30).</td><td align="center" valign="top" charoff="50">31 (1758)</td><td align="center" valign="top" charoff="50">Yes</td></tr><tr><td align="left" valign="top" charoff="50">Lee, 2014</td><td align="left" valign="top" charoff="50">Only RCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Apr. 2013</td><td align="left" valign="top" charoff="50">Moxibustion (direct, indirect, heat-sensitive, moxa burner, or natural moxibustion).</td><td align="left" valign="top" charoff="50">Conventional care.</td><td align="left" valign="top" charoff="50">Cancer-related fatigue</td><td align="center" valign="top" charoff="50">4 (374)</td><td align="center" valign="top" charoff="50">Yes</td></tr><tr><td align="left" valign="top" charoff="50">Cheon, 2014</td><td align="left" valign="top" charoff="50">Only RCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Mar. 2013</td><td align="left" valign="top" charoff="50">Acupoints injection with Chinese herbal extract solution; or with conventional medications.</td><td align="left" valign="top" charoff="50">Conventional care</td><td align="left" valign="top" charoff="50">Cancer related pain, chemotherapy-induced nausea and vomiting, lleus, hiccup, fever, quality of life and gastrointestinal symptoms</td><td align="center" valign="top" charoff="50">22 (2459)</td><td align="center" valign="top" charoff="50">Yes</td></tr><tr><td align="left" valign="top" charoff="50">Ezzo, 2014</td><td align="left" valign="top" charoff="50">Only RCT</td><td align="left" valign="top" charoff="50">Various,</td><td align="left" valign="top" charoff="50">Not reported</td><td align="left" valign="top" charoff="50">Needle acupuncture; acupressure; electro-acupuncture or TENS.</td><td align="left" valign="top" charoff="50">No restriction on type of control. Controls included conventional care, sham acupuncture, or conventional care plus sham acupuncture.</td><td align="left" valign="top" charoff="50">Chemotherapy-induced nausea or vomiting, or both.</td><td align="center" valign="top" charoff="50">11 (1247)</td><td align="center" valign="top" charoff="50">Yes</td></tr></tbody></table><table-wrap-foot><fn id="t2-fn1"><p>Keys: CHM: Chinese herbal medicine; RCT, randomized controlled trial; TENS, Transcutaneous electrical nerve stimulation.</p></fn></table-wrap-foot></table-wrap><table-wrap position="float" id="t3"><label>Table 3</label><caption><title>Characteristics of included systematic reviews of various study design on acupuncture and related therapies for cancer palliative care.</title></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col><col align="center"></col><col align="center"></col></colgroup><thead valign="bottom"><tr><th align="left" valign="top" charoff="50">First authorand year ofpublication</th><th align="left" valign="top" charoff="50">Includedstudy design</th><th align="left" valign="top" charoff="50">Diagnosis</th><th align="left" valign="top" charoff="50">Searchperiod</th><th align="left" valign="top" charoff="50">Nature ofacupuncture andrelated interventions</th><th align="left" valign="top" charoff="50">Nature ofcontrolinterventions</th><th align="left" valign="top" charoff="50">Outcomes</th><th align="center" valign="top" charoff="50">No. of studies(No. of patients)included</th><th align="center" valign="top" charoff="50">Meta analysisconducted?</th></tr></thead><tbody valign="top"><tr><td align="left" valign="top" charoff="50">Lee, 2005</td><td align="left" valign="top" charoff="50">Quasi-RCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Feb. 2004</td><td align="left" valign="top" charoff="50">Needle acupuncture, ear acupuncture or electro-acupuncture. Other related therapies including laser acupuncture, acupressure, moxibustion and TENS were not reviewed.</td><td align="left" valign="top" charoff="50">Conventional care or sham acupuncture.</td><td align="left" valign="top" charoff="50">Cancer related pain, operation related pain. </td><td align="center" valign="top" charoff="50">7 (368)</td><td align="center" valign="top" charoff="50">No</td></tr><tr><td align="left" valign="top" charoff="50">Lu, 2007</td><td align="left" valign="top" charoff="50">RCT or quasi-RCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">2004</td><td align="left" valign="top" charoff="50">Needle acupuncture, electro-acupuncture with warming needle or acupuncture point injection with saline.</td><td align="left" valign="top" charoff="50">Chemotherapy alone or chemotherapy with vitamins or non-herbal supplements</td><td align="left" valign="top" charoff="50">Leukocytes level.</td><td align="center" valign="top" charoff="50">11 (960)</td><td align="center" valign="top" charoff="50">Yes</td></tr><tr><td align="left" valign="top" charoff="50">Lee, 2009a</td><td align="left" valign="top" charoff="50">RCT, quasi-RCT, or observational studies</td><td align="left" valign="top" charoff="50">Prostate cancer </td><td align="left" valign="top" charoff="50">Dec. 2008</td><td align="left" valign="top" charoff="50">Needle acupuncture, electro-acupuncture or auricular acupuncture.</td><td align="left" valign="top" charoff="50">Conventional care.</td><td align="left" valign="top" charoff="50">Hot flushes.</td><td align="center" valign="top" charoff="50">6 (132)</td><td align="center" valign="top" charoff="50">No</td></tr><tr><td align="left" valign="top" charoff="50">Chao, 2009</td><td align="left" valign="top" charoff="50">RCT, quasi-RCT, or case series study</td><td align="left" valign="top" charoff="50">Breast cancer</td><td align="left" valign="top" charoff="50">Oct. 2008</td><td align="left" valign="top" charoff="50">Needle acupuncture, electro-acupuncture, acupoints injection, self-acupressure or acupoints stimulation by devices.</td><td align="left" valign="top" charoff="50">No restriction on type of control. Controls included placebo, conventional care or no treatment.</td><td align="left" valign="top" charoff="50">Cancer therapy-related adverse events: hot flashes, nausea and vomiting, lymphedema, leukopenia.</td><td align="center" valign="top" charoff="50">26 (1548)</td><td align="center" valign="top" charoff="50">No</td></tr><tr><td align="left" valign="top" charoff="50">Dos Santos, 2010</td><td align="left" valign="top" charoff="50">RCT and case series</td><td align="left" valign="top" charoff="50">Breast cancer</td><td align="left" valign="top" charoff="50">Apr. 2009</td><td align="left" valign="top" charoff="50">Needle acupuncture, electro-acupuncture, acupuncture plus acupressure or auricular acupuncture.</td><td align="left" valign="top" charoff="50">No restriction on type of control. Controls included sham acupuncture, conventional care, waiting list or no treatment.</td><td align="left" valign="top" charoff="50">Cancer therapy-related adverse events: hot flashes, fatigue, pain, dyspnea, psychological well-being, lymphedema and vomiting.</td><td align="center" valign="top" charoff="50">12 (612)</td><td align="center" valign="top" charoff="50">No</td></tr><tr><td align="left" valign="top" charoff="50">O’Sullivan, 2011</td><td align="left" valign="top" charoff="50">RCTs and SR of RCTs</td><td align="left" valign="top" charoff="50">Head and neck cancer</td><td align="left" valign="top" charoff="50">2010</td><td align="left" valign="top" charoff="50">Needle acupuncture or electro-acupuncture. ‘Non-needling’ techniques including laser acupuncture, acupressure or acupuncture-like TENS were not considered. </td><td align="left" valign="top" charoff="50">Sham acupuncture or conventional care.</td><td align="left" valign="top" charoff="50">Irradiation-induced xerostomia </td><td align="center" valign="top" charoff="50">3 (123)</td><td align="center" valign="top" charoff="50">No</td></tr><tr><td align="left" valign="top" charoff="50">Choi, 2012b</td><td align="left" valign="top" charoff="50">RCT and quasi-RCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Jul. 2011</td><td align="left" valign="top" charoff="50">Needle acupuncture or electro-acupuncture. Other related therapies, including laser acupuncture, acupressure, auricular acupuncture using pressure device, acupoints injection and moxibustion were not considered.</td><td align="left" valign="top" charoff="50">Conventional care.</td><td align="left" valign="top" charoff="50">Cancer related hiccups.</td><td align="center" valign="top" charoff="50">5 (296)</td><td align="center" valign="top" charoff="50">Yes</td></tr><tr><td align="left" valign="top" charoff="50">Finnegan-John, 2013</td><td align="left" valign="top" charoff="50">RCT and quasi-RCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Jun. 2012</td><td align="left" valign="top" charoff="50">Needle acupuncture or acupressure.</td><td align="left" valign="top" charoff="50">Sham acupuncture.</td><td align="left" valign="top" charoff="50">Cancer-related fatigue</td><td align="center" valign="top" charoff="50">1 (35)</td><td align="center" valign="top" charoff="50">No</td></tr><tr><td align="left" valign="top" charoff="50">Zheng, 2014</td><td align="left" valign="top" charoff="50">RCT and quasi-RCT</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">2013</td><td align="left" valign="top" charoff="50">Needle acupuncture alone or needle acupuncture plus conventional care.</td><td align="left" valign="top" charoff="50">Conventional care alone.</td><td align="left" valign="top" charoff="50">Cancer related pain</td><td align="center" valign="top" charoff="50">5 (395)</td><td align="center" valign="top" charoff="50">Yes</td></tr><tr><td align="left" valign="top" charoff="50">Frisk, 2014</td><td align="left" valign="top" charoff="50">RCT and case series</td><td align="left" valign="top" charoff="50">Various</td><td align="left" valign="top" charoff="50">Oct. 2012</td><td align="left" valign="top" charoff="50">Needle acupuncture, electro-acupuncture or auricular acupuncture.</td><td align="left" valign="top" charoff="50">No restriction on type of control. Controls included conventional care, sham acupuncture or no treatment.</td><td align="left" valign="top" charoff="50">Hot flushes.</td><td align="center" valign="top" charoff="50">17 (599)</td><td align="center" valign="top" charoff="50">No</td></tr></tbody></table><table-wrap-foot><fn id="t3-fn1"><p>Keys: RCT, randomized controlled trial; SR, systematic review; TENS, Transcutaneous electrical nerve stimulation.</p></fn></table-wrap-foot></table-wrap><table-wrap position="float" id="t4"><label>Table 4</label><caption><title>Methodological quality of included systematic reviews on acupuncture and related treatment for cancer palliative care.</title></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="center"></col><col align="center"></col><col align="center"></col><col align="center"></col><col align="center"></col><col align="center"></col><col align="center"></col><col align="center"></col><col align="center"></col><col align="center"></col><col align="center"></col></colgroup><thead valign="bottom"><tr><th rowspan="2" align="left" valign="top" charoff="50">First author andpublication year</th><th colspan="11" align="center" valign="top" charoff="50">AMSTAR item<hr></hr></th></tr><tr><th align="center" valign="top" charoff="50">1</th><th align="center" valign="top" charoff="50">2</th><th align="center" valign="top" charoff="50">3</th><th align="center" valign="top" charoff="50">4</th><th align="center" valign="top" charoff="50">5</th><th align="center" valign="top" charoff="50">6</th><th align="center" valign="top" charoff="50">7</th><th align="center" valign="top" charoff="50">8</th><th align="center" valign="top" charoff="50">9</th><th align="center" valign="top" charoff="50">10</th><th align="center" valign="top" charoff="50">11</th></tr></thead><tbody valign="top"><tr><td align="left" valign="top" charoff="50">Lee, 2005</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">NA</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Lu, 2007</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Lee, 2009a</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NA</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Lee, 2009b</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Chao, 2009</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NA</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Peng, 2010</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NA</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Dos Santos, 2010</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NR</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NA</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Pu, 2010</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NR</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">O’Sullivan, 2010</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NR</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NA</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Choi, 2012a</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Hurlow, 2012</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NR</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NR</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NA</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Paley, 2012</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NR</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NA</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Choi, 2012b</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Posadzki, 2013</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NA</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Zeng, 2013</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Finnegan-John, 2013</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NA</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Chen, 2013</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Zheng, 2014</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">NR</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Lee, 2014</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Frisk, 2014</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">NR</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">NA</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Cheon, 2014</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Ezzo, 2014</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50">Lian, 2014</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">Y</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">NA</td><td align="center" valign="top" charoff="50">N</td><td align="center" valign="top" charoff="50">N</td></tr><tr><td align="left" valign="top" charoff="50"># of Yes (%)</td><td align="center" valign="top" charoff="50">5 (21.7)</td><td align="center" valign="top" charoff="50">18 (78.3)</td><td align="center" valign="top" charoff="50">23 (100.0)</td><td align="center" valign="top" charoff="50">13 (56.5)</td><td align="center" valign="top" charoff="50">6 (26.1)</td><td align="center" valign="top" charoff="50">12 (52.2)</td><td align="center" valign="top" charoff="50">22 (95.6)</td><td align="center" valign="top" charoff="50">18 (78.3)</td><td align="center" valign="top" charoff="50">9 (39.1)</td><td align="center" valign="top" charoff="50">0 (0.0)</td><td align="center" valign="top" charoff="50">0 (0.0)</td></tr></tbody></table><table-wrap-foot><fn id="t4-fn1"><p>Keys: N, no; NA, not applicable; NR, not reported; Y, yes (SR fulfilling the criteria); # of Yes, number of yes; AMSTAR item: 1. Was an ‘a priori’ design provided? 2. Was there duplicate study selection and data extraction? 3. Was a comprehensive literature search performed? 4. Was the status of publication (i.e. grey literature) used as an inclusion criterion? 5. Was a list of studies (included and excluded) provided? 6. Were the characteristics of the included studies provided? 7. Was the scientific quality of the included studies assessed and documented? 8. Was the scientific quality of the included studies used appropriately in formulating conclusions? 9. Were the methods used to combine the findings of studies appropriate? 10. Was the likelihood of publication bias assessed? 11. Was the conflict of interest included?</p></fn></table-wrap-foot></table-wrap><table-wrap position="float" id="t5"><label>Table 5</label><caption><title>Clinical evidence on the effectiveness of needle acupuncture on cancer palliative care related symptoms-evidence from SR of RCT.</title></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col></colgroup><thead valign="bottom"><tr><th align="left" valign="top" charoff="50">First author and publication year</th><th align="left" valign="top" charoff="50">Outcome assessment method</th><th align="left" valign="top" charoff="50">Main results</th><th align="left" valign="top" charoff="50">Notes on interpretation</th></tr></thead><tbody valign="top"><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Cancer related pain</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Peng, 2010</td><td align="left" valign="top" charoff="50">Total response rate or VAS</td><td align="left" valign="top" charoff="50">One RCT with low RoB reported that auricular acupuncture provides statistically significant relief on CRP when compared to sham acupuncture on Day 30 (p = 0.02) and Day 60 (p < 0.001). </td><td align="left" valign="top" charoff="50">This SR included the same low RoB RCT as Lee 2005 did. All the other six studies suggested positive effect of acupuncture in reducing CRP, although they are judged to have high RoB according to the Jadad scale. Five out of the six studies used total response rate as the primary outcome, which was not a validated outcome.</td></tr><tr><td align="left" valign="top" charoff="50">Choi, 2012a</td><td align="left" valign="top" charoff="50">Validated scales or VAS</td><td align="left" valign="top" charoff="50">Acupuncture showed positive add-on effect on response rate when compared to conventional care alone. No significant differences were found in the comparisons of acupuncture versus conventional care on response rate, or acupuncture versus sham acupuncture on pain score.</td><td align="left" valign="top" charoff="50">Considerable heterogeneity (I<sup>2</sup> > = 67%) was observed in all three meta-analyses. One study was the same low RoB trial identified by Lee, 2005. All the other trials had poor reporting quality, and were judged as having unclear RoB. </td></tr><tr><td align="left" valign="top" charoff="50">Hurlow, 2012</td><td align="left" valign="top" charoff="50">Validated scales </td><td align="left" valign="top" charoff="50">When comparing TENS with placebo, the results suggested that TENS may improve bone pain during movement. No superior effect in other pain outcomes when comparing TENS with placebo or sham TENS.</td><td align="left" valign="top" charoff="50">All the three trials had small sample sizes (n = 15, 24 and 49). All of them had either unclear RoB for allocation concealment or blinding of outcome assessment.</td></tr><tr><td align="left" valign="top" charoff="50">Paley, 2012</td><td align="left" valign="top" charoff="50">Validated scales</td><td align="left" valign="top" charoff="50">One RCT with low RoB found that auricular acupuncture provided statistically significant relief on CRP when compared to sham acupuncture on Day 30 (p = 0.02) and Day 60 (p < 0.001).</td><td align="left" valign="top" charoff="50">Evidence from the only well designed RCT indicated effective ness of auricular acupuncture in relieving CRP. The other two studies were non-blinded and had incomplete outcome data.</td></tr><tr><td align="left" valign="top" charoff="50">Lian, 2014</td><td align="left" valign="top" charoff="50">VAS or efficacy rate</td><td align="left" valign="top" charoff="50">Results from all six studies suggested that acupuncture is effective in reducing CRP.</td><td align="left" valign="top" charoff="50">RoB of the six studies were assessed with Jadad scale in this SR, of which all scored 2-3 out of a total of 5. However, rationale for supporting these ratings was not given.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Cancer related fatigue</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Posadzki, 2013</td><td align="left" valign="top" charoff="50">Validated scales for measuring fatigue</td><td align="left" valign="top" charoff="50">In the two trials with low RoB, one (n = 29) reported significant reduction in fatigue level at 2 weeks in the needle acupuncture group, as compared with the sham acupuncture group. Another study (n = 23) found no significant difference between the acupuncture and sham acupuncture groups.</td><td align="left" valign="top" charoff="50">Acupuncture may be useful for reducing CRF but both trials were underpowered due to small sample size.</td></tr><tr><td align="left" valign="top" charoff="50">Zeng, 2013</td><td align="left" valign="top" charoff="50">General CRF change score</td><td align="left" valign="top" charoff="50">All four sets of comparison favored acupuncture; however, only one comparison (acupuncture plus education versus conventional care) reached statistically significant difference on general CRF level. </td><td align="left" valign="top" charoff="50">All the comparisons had high heterogeneity (I<sup>2</sup> values ranged from 65% to 94%, under random effect model.). Three trials had low RoB while the other four trials was judged to have high RoB. One had incomplete outcome data the other three lacked of allocation concealment and blinding. </td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Hot Flashes</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Lee, 2009b</td><td align="left" valign="top" charoff="50">diary or logbooks</td><td align="left" valign="top" charoff="50">Results from meta-analysis suggested that acupuncture is effective in reducing hot flashes frequency during treatment when compared to sham acupuncture. However, such difference was not seen after the treatment. </td><td align="left" valign="top" charoff="50">These studies were judged to have low RoB using the Jadad scale, with scoring ranged from 4 to 5 out of 5. Allocation concealment procedures were properly implemented.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Nausea and vomiting</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Pu, 2010</td><td align="left" valign="top" charoff="50">Effective rate </td><td align="left" valign="top" charoff="50">Results from meta-analyses indicate that electro-acupuncture and conventional care had similar effect for reducing CINV.</td><td align="left" valign="top" charoff="50">Clinical evidence was from one single clinical trial with poor reporting quality. RoB of this trial was judged to be unclear.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Quality of Life</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Zeng, 2013</td><td align="left" valign="top" charoff="50">Change in general QoL scores</td><td align="left" valign="top" charoff="50">Acupuncture showed no favorable effect in improving QoL when compared to sham acupuncture at 10-week follow-up.</td><td align="left" valign="top" charoff="50">These three studies had low RoB. Considerable heterogeneity was found among the three studies (I<sup>2</sup> = 92%, random effect model was used).</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Quality of Life</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Lian, 2014</td><td align="left" valign="top" charoff="50">QoL assessment scales and various indexes</td><td align="left" valign="top" charoff="50">Both studies suggested that acupuncture plus conventional care can significantly improve quality of life in cancer patients compared to conventional care alone.</td><td align="left" valign="top" charoff="50">These two trials were judged to have 2 or 3 scores out of 5 in the Jadad scale. However, no rationale was provided on how these scorings were rated.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Other symptoms</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Choi, 2012b</td><td align="left" valign="top" charoff="50">Response rates on reducing hiccup </td><td align="left" valign="top" charoff="50">Results from meta-analysis suggested a favorable effect of acupuncture on response rate for patients’ hiccup as compared to conventional care. </td><td align="left" valign="top" charoff="50">All the three studies had poor reporting quality on RoB related information, and were judged to have unclear RoB.</td></tr></tbody></table><table-wrap-foot><fn id="t5-fn1"><p>Keys: CINV, chemotherapy induced nausea and vomiting; CRF, cancer related fatigue; CRP, cancer related pain; MFI, multidimensional fatigue inventory; QoL, quality of life; RCT, randomized controlled trial; RoB, risk of bias; SR, systematic review; TENS, Transcutaneous electrical nerve stimulation; VAS, Visual analog scale for pain.</p></fn></table-wrap-foot></table-wrap><table-wrap position="float" id="t6"><label>Table 6</label><caption><title>Clinical evidence on the effectiveness of acupuncture related therapies on cancer palliative care related symptoms-evidence from SR of RCT.</title></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col></colgroup><thead valign="bottom"><tr><th align="left" valign="top" charoff="50">First author and publication year</th><th align="left" valign="top" charoff="50">Outcome assessment method</th><th align="left" valign="top" charoff="50">Main results</th><th align="left" valign="top" charoff="50">Notes on interpretation</th></tr></thead><tbody valign="top"><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Cancer related pain</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Cheon, 2014</td><td align="left" valign="top" charoff="50">Response rate</td><td align="left" valign="top" charoff="50">Controversial results were reported among the eight studies. As compared to conventional care, seven studies suggested benefit of acupoint injection in alleviating CRP. While the other one failed to find any positive effect from acupoint injection. </td><td align="left" valign="top" charoff="50">All included trials had high RoB for blinding, and unclear RoB on allocation concealment. All the included trails used response rate as the primary outcome, which was not a validated instrument.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Cancer related fatigue</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Lee, 2014</td><td align="left" valign="top" charoff="50">Response rate</td><td align="left" valign="top" charoff="50">Compared to conventional care alone, combination of moxibustion and conventional care showed favorable effect on response rate for CRF.</td><td align="left" valign="top" charoff="50">All the four trials had poor reporting quality. They were judged as having unclear RoB for both allocation concealment and blinding of outcome assessment. Considerable heterogeneity (I<sup>2</sup> = 74%) was found in this random effect meta-analysis.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Nausea and vomiting</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Chen, 2013</td><td align="left" valign="top" charoff="50">Effective rate in reducing of nausea and vomiting (Grade II-IV)</td><td align="left" valign="top" charoff="50">The occurrence of chemotherapy-induced nausea and vomiting at Grade II-IV was remarkably reduced in the acupuncture plus conventional care when compared to conventional care alone.</td><td align="left" valign="top" charoff="50">The SR authors did not provide details on RoB among the included studies.</td></tr><tr><td align="left" valign="top" charoff="50">Cheon, 2014</td><td align="left" valign="top" charoff="50">Response rate </td><td align="left" valign="top" charoff="50">Acupoints injection is suggested to be more effective than conventional care for CINV.</td><td align="left" valign="top" charoff="50">All the included trials had high RoB for blinding, and unclear RoB on allocation concealment.</td></tr><tr><td align="left" valign="top" charoff="50">Ezzo, 2014</td><td align="left" valign="top" charoff="50">Proportion of patients with vomiting/nausea and Mean nausea/nausea severity </td><td align="left" valign="top" charoff="50">Acupuncture is effective in reducing the proportion of patients experiencing acute vomiting, but not in reducing the mean number of delayed vomiting episode, and in reducing severity of acute or delayed nausea. </td><td align="left" valign="top" charoff="50">The authors mentioned that only trials with low RoB were included, but there are no detailed assessment results on RoB for each of the trials.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Quality of Life</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Chen, 2013</td><td align="left" valign="top" charoff="50">QLQ-C30 total score</td><td align="left" valign="top" charoff="50">Acupuncture can improve QoL for lung cancer patients as compared to conventional care. </td><td align="left" valign="top" charoff="50">The SR authors did not provide details on RoB assessment for these two studies.</td></tr><tr><td align="left" valign="top" charoff="50">Cheon, 2014</td><td align="left" valign="top" charoff="50">Responder rate (% in Karnofsky score)</td><td align="left" valign="top" charoff="50">Acupoints injection significantly improved QoL compared to conventional care (responder rate: 50% versus 25%, p < 0.01).</td><td align="left" valign="top" charoff="50">Evidence was reported from one single study (n = 108). Details on RoB of this study were not provided by the SR authors.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Other symptoms</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Cheon, 2014</td><td align="left" valign="top" charoff="50">Response rates on reducing hiccup</td><td align="left" valign="top" charoff="50">Both trials reported a higher responder rate in the acupoints injection group as compared to conventional care. Result from one study reached statistically significance while the other did not.</td><td align="left" valign="top" charoff="50">The two studies had unclear RoB for allocation concealment and high RoB for blinding.</td></tr></tbody></table><table-wrap-foot><fn id="t6-fn1"><p>Keys: CINV, chemotherapy induced nausea and vomiting; CRF, cancer related fatigue; CRP, cancer related pain; QoL, quality of life; RCT, randomized controlled trial; RoB, risk of bias; SR, systematic review.</p></fn></table-wrap-foot></table-wrap><table-wrap position="float" id="t7"><label>Table 7</label><caption><title>Clinical evidence on the effectiveness of acupuncture and related therapies on cancer palliative care related symptoms-evidence from SR on various types of study design.</title></caption><table frame="hsides" rules="groups" border="1"><colgroup><col align="left"></col><col align="left"></col><col align="left"></col><col align="left"></col></colgroup><thead valign="bottom"><tr><th align="left" valign="top" charoff="50">First author and publication year</th><th align="left" valign="top" charoff="50">Outcome assessment method</th><th align="left" valign="top" charoff="50">Main results</th><th align="left" valign="top" charoff="50">Notes on interpretation</th></tr></thead><tbody valign="top"><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Cancer related pain</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Lee, 2005</td><td align="left" valign="top" charoff="50">VAS or patients’ verbal assessment</td><td align="left" valign="top" charoff="50">One RCT with low RoB found auricular acupuncture provides statistically significant relief on CRP when compared to sham acupuncture on Day 30 (p = 0.02) and Day 60 (p < 0.001). </td><td align="left" valign="top" charoff="50">Evidence from the only well designed RCT indicated the effective ness of auricular acupuncture on relieving CRP. The other studies were either non-blinded (n = 2) or designed as case series (n = 4).</td></tr><tr><td align="left" valign="top" charoff="50">Chao, 2009</td><td align="left" valign="top" charoff="50">VAS </td><td align="left" valign="top" charoff="50">Controversial results were reported among the three studies. Significant positive effect from acupuncture was found in studies using VAS and number of analgesia applied (p < 0.05) as measures for CRP, but such result was not seem on Sedation score (p > 0.05).</td><td align="left" valign="top" charoff="50">RoB of the three studies were assessed with Jadad scale in this SR. No details on each RoB domain were provided to facilitate judgment on the overall trustworthy of evidence.</td></tr><tr><td align="left" valign="top" charoff="50">Dos Santos, 2010</td><td align="left" valign="top" charoff="50">VAS, or validated scales</td><td align="left" valign="top" charoff="50">Evidence from both studies suggested that acupuncture is useful in reducing CRP. </td><td align="left" valign="top" charoff="50">One study was the same low RoB trial identified by Lee, 2005. The other study was judged to have high RoB for lack of allocation concealment and blinding.</td></tr><tr><td align="left" valign="top" charoff="50">Zheng, 2014</td><td align="left" valign="top" charoff="50">Symptoms improvement rate</td><td align="left" valign="top" charoff="50">Insufficient evidence to judge the effectiveness of wrist ankle acupuncture in treating cancer pain.</td><td align="left" valign="top" charoff="50">All the included studies were judged to have high RoB for allocation concealment and blinding. However, no rationale supporting the RoB assessment results were provided. Symptom improvement rate was used as the primary outcome, which was not a validated instrument.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Cancer related fatigue</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Dos Santos, 2010</td><td align="left" valign="top" charoff="50">MFI</td><td align="left" valign="top" charoff="50">Needle acupuncture group had significantly higher improvement (36%) when compared to either acupressure group (19%) or sham acupressure (0.6%) group.</td><td align="left" valign="top" charoff="50">This trial was judged to have low RoB by the SR authors.</td></tr><tr><td align="left" valign="top" charoff="50">Finnegan-John, 2013</td><td align="left" valign="top" charoff="50">MFI</td><td align="left" valign="top" charoff="50">This SR identified the same trial as Dos Santos, 2010.</td><td align="left" valign="top" charoff="50">See interpretation on results from Dos Santos 2010.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Hot Flashes</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Lee, 2009a</td><td align="left" valign="top" charoff="50">Validated scales or patient diary</td><td align="left" valign="top" charoff="50">One trial with low RoB found both needle acupuncture and needle acupuncture + electro-acupuncture were effective for treating hot flush in prostate cancer patients when compared with baseline. No between group difference was found.</td><td align="left" valign="top" charoff="50">The only low RoB RCT compared needle acupuncture with electro-acupuncture; no other comparison was reported by the SR authors. The other five trials was judged to have high RoB with the Jadad scale, but no rationale were given on how the scoring was given.</td></tr><tr><td align="left" valign="top" charoff="50">Chao, 2009</td><td align="left" valign="top" charoff="50">Self-administrated questionnaires</td><td align="left" valign="top" charoff="50">One trial with low RoB reported significant positive effect of acupuncture in reducing hot flushes when compared with sham acupuncture. However, other low RoB trial did not find any difference between the two groups.</td><td align="left" valign="top" charoff="50">The other five trials were judged as having high RoB using the Jadad scale; of which two of them were case series studies.</td></tr><tr><td align="left" valign="top" charoff="50">Dos Santos, 2010</td><td align="left" valign="top" charoff="50">Daily diary/log records No. of hot flashes</td><td align="left" valign="top" charoff="50">Two trials with low RoB found that acupuncture was more effective in reducing hot flushes when compared to sham acupuncture, although the results from one of them did not reach statistical significance.</td><td align="left" valign="top" charoff="50">Current evidence from two trials with low RoB suggests that acupuncture may be useful in reducing hot flashes in breast cancer patients. However, two of the other three trials had high RoB. One did not implement no allocation concealment or blinding; and the other one was only a case series study.</td></tr><tr><td align="left" valign="top" charoff="50">Frisk, 2014</td><td align="left" valign="top" charoff="50">Not reported</td><td align="left" valign="top" charoff="50">Results indicated that acupuncture treatment can reduce hot flashes in women with breast cancer and men with prostate cancer over a 3 months period. Nevertheless, it is not reported that how the outcome was measured. </td><td align="left" valign="top" charoff="50">The SR authors reported all the seven trial scored ≥3 score out of 5 in the Jadad scale, however, no rationale on the scorings were given.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Nausea and vomiting</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Chao, 2009</td><td align="left" valign="top" charoff="50">Validated scale </td><td align="left" valign="top" charoff="50">One trial with low RoB reported positive effect of electro-acupuncture in treating CINV when compared with sham acupuncture or conventional care. The effect persisted for five days, and it was not sustained from ninth days onward.</td><td align="left" valign="top" charoff="50">The remaining 10 trials were judged to have high RoB by the Jadad scale, of which two of them were case series studies. However, no rationale on the scorings was given.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Nausea and vomiting</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Dos Santos, 2010</td><td align="left" valign="top" charoff="50">Total no. of vomiting episodes and no. of vomiting free days</td><td align="left" valign="top" charoff="50">Patients in electro-acupuncture group had significantly greater proportion of nausea-and-vomiting-free days than patients in the other two groups during a 5-day treatment period; this benefit did not persist onward to the ninth days follow up. This SR identified the same low RoB trial as in Chao, 2009 above. </td><td align="left" valign="top" charoff="50">This evidence was from one clinical trial with low RoB for allocation concealment and blinding of outcome assessment. However, RoB for blinding of participants and personnel were high.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Other symptoms</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Lu, 2007</td><td align="left" valign="top" charoff="50">Leucopenia (change in WBC count</td><td align="left" valign="top" charoff="50">Results from meta-analysis suggested that acupuncture plus conventional care was an effective option for chemotherapy-induced leukopenia as compared to conventional care alone.</td><td align="left" valign="top" charoff="50">All the included studies were judged to be of high RoB under the Jadad scale. However, no rationale was provided on how these scorings were rated.</td></tr><tr><td align="left" valign="top" charoff="50">Chao, 2009</td><td align="left" valign="top" charoff="50">RILP</td><td align="left" valign="top" charoff="50">The authors reported that WBC level were increased but no further details were provided.</td><td align="left" valign="top" charoff="50">The result is reported from a small case series study.</td></tr><tr><td align="left" valign="top" charoff="50">Chao, 2009 & Dos Santos, 2010</td><td align="left" valign="top" charoff="50">BCRL</td><td align="left" valign="top" charoff="50">In both SRs, acupuncture was found to be effective in treating BCRL. It is mentioned that the participants’ body circulation was enhanced, and sense of heaviness was reduced. Patients have also reported significant improvement on the range of movements, including shoulder flexion and abduction of the affected limbs.</td><td align="left" valign="top" charoff="50">The result is reported from a small case series study</td></tr><tr><td align="left" valign="top" charoff="50">Choi, 2012b</td><td align="left" valign="top" charoff="50">Response rates on reducing hiccup </td><td align="left" valign="top" charoff="50">Results from meta-analysis suggested a favorable effect of acupuncture on response rate for patients’ hiccup as compared to conventional care. </td><td align="left" valign="top" charoff="50">All the three studies had poor reporting quality on RoB related information, and were judged to have unclear RoB.</td></tr><tr><td align="left" valign="top" charoff="50">O’Sullivan, 2011</td><td align="left" valign="top" charoff="50">Improvement on Xerostomia as measured by SFR </td><td align="left" valign="top" charoff="50">All three trials reported significant improvement on SFR when compared to baseline (p < 0.05), but no significant differences were seen between acupuncture and sham acupuncture group. </td><td align="left" valign="top" charoff="50">All the three studies used objective outcome measurements to reduce detection bias. One trial has low RoB for allocation concealment while the other two have unclear RoB.</td></tr><tr><td colspan="4" align="left" valign="top" charoff="50"><italic><bold>Other symptoms</bold></italic></td></tr><tr><td align="left" valign="top" charoff="50">Dos Santos, 2010</td><td align="left" valign="top" charoff="50">Rating scale on dyspnea.</td><td align="left" valign="top" charoff="50">In both groups, significantly improvement on dyspnea scores were observed immediately after treatment (p = 0.003). Dyspnea scores were slightly higher in acupuncture group than sham group, however, no significant differences were seen.</td><td align="left" valign="top" charoff="50">The trial was judged to have low RoB, but there is a lacking of blinding of personnel.</td></tr></tbody></table><table-wrap-foot><fn id="t7-fn1"><p>Keys: BCRL, breast cancer-related lymphedema; CINV, chemotherapy induced nausea and vomiting; CRP, cancer related pain; MFI, multidimensional fatigue inventory; RCT, randomized controlled trial; RILP, radiotherapy induced leukopenia; RoB, risk of bias; SFR, salivary flow rates; SR, systematic review; VAS, Visual analog scale for pain; WBC, white blood cell.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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