Reference
Molassiotis A, Bardy J, Finnegan-John J, et al. Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized controlled trial. J Clin Oncol. 2012;30(36):4470-4476.
Design
A randomized multicenter controlled trial comparing acupuncture with enhanced usual care. Treatment was delivered by acupuncturists weekly for 6 weeks through needling 3 pairs of acupoints.
Participants
The study included 302 outpatients with stage I to IIIA breast cancer and moderate to severe fatigue. A group of 75 was assigned to usual care and 227 were assigned to acupuncture plus usual care (random assignment of 1:3 respectively). The usual care group received a booklet with information about fatigue and its management.
Primary Outcome Measures
Primary outcome was general fatigue at 6 weeks, measured with the Multidimensional Fatigue Inventory (MFI), Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy—General Quality-of-Life Scale, and expectation of acupuncture effect.
Key Findings
At 6 weeks, 246 patients of 302 patients provided complete data. The difference in the mean General Fatigue score between those who received the intervention and those who did not was -3.11 (95% CI: -3.97 to -2.25; P<0.001). The intervention also improved all other fatigue aspects measured by MFI, including physical fatigue and mental fatigue (acupuncture effect: -2.36 and -1.94, respectively; P<0.001 for both), anxiety and depression (acupuncture effect: -1.83 and -2.13, respectively; P<0.001 for both), and quality of life (physical well-being effect: 3.30, functional well-being effect: 3.57, P<0.001 for both; emotional well-being effect: 1.93, P=0.001; and social functioning well-being effect: 1.05, P<0.05). The study authors concluded that acupuncture is an effective intervention for managing the symptom of cancer-related fatigue and improving patients’ quality of life.
Practice Implications
Many providers of complementary and integrative medicine, including naturopathic physicians, acupuncturists, and other therapists and clinicians frequently provide adjunctive care for patients who have been diagnosed with cancer and are undergoing conventional medical therapies. Due to conflicting research findings, biases, and concerns about treatment interference and efficacy, practitioners often find themselves limited in the types of care they are able to provide their patients. For example, the use of antioxidants has been shown to interfere with certain types of chemotherapy, and patients are routinely instructed to avoid antioxidant supplementation irrespective of the specific treatment protocol utilized, even though many antioxidant-oncology treatment interactions have been shown to be positive ones.1,2 In my experience, patients are routinely told to avoid all herbal medicines for a variety of reasons including quality control and worries about the effects of herbs on pharmacokinetics of chemotherapy drugs, even though some herbal protocols have been shown to support conventional cancer treatment protocols.3 These limitations can influence and limit practitioners' ability to help their patients with supportive therapies during the cancer treatment process.
Acupuncture, however, is an adjunctive therapy that appears to be one of the least controversial of the CAM therapies available to cancer patients. It is often sought out by cancer patients wishing to support their current treatment and improve their health and wellness during and after their treatments. Unlike herbal medicines and nutritional supplements, there are fewer concerns about treatment interference or conflicts in care.
While fatigue was the primary outcome measure, study participants also reported significant improvements in anxiety, depression and quality of life.
Fatigue is one of the most common adverse effects of cancer treatment, with up to 99% of patients experiencing some level of fatigue during their conventional treatments.4,5 While fatigue resolves over time in most cancer patients, 30% may experience chronic fatigue that may endure for 10 years or more.5 As Bower states in her editorial, “given its prevalence and impact, fatigue is an important target for identification and treatment.”4
While fatigue was the primary outcome measure, it is worth noting that study participants also reported significant improvements in anxiety, depression, and quality of life.
This study demonstrates clearly that acupuncture has significant positive effects on cancer-related fatigue and quality-of-life in patients undergoing cancer therapies. It should be high on the practitioner’s lists of interventions for this common complaint by cancer patients.
