title: Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized controlled trial.
abstract: OBJECTIVE
  We aimed to assess the effectiveness of acupuncture for cancer-related fatigue (CRF) in patients with breast cancer.
  
  
  METHODS
  We conducted a pragmatic, randomized controlled trial comparing acupuncture with enhanced usual care. Three hundred two outpatients with breast cancer participated. We randomly assigned 75 patients to usual care and 227 patients to acupuncture plus usual care (random assignment of 1:3 respectively) with minimization controlling for baseline general fatigue and maintenance treatment. Treatment was delivered by acupuncturists once a week for 6 weeks through needling three pairs of acupoints. The usual care group received a booklet with information about fatigue and its management. Primary outcome was general fatigue at 6 weeks, measured with the Multidimensional Fatigue Inventory (MFI). Other measurements included the Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy-General quality-of-life scale, and expectation of acupuncture effect. Analyses were by intention to treat.
  
  
  RESULTS
  Two hundred forty-six of 302 patients randomly assigned provided complete data at 6 weeks. 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 < .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; both at P < .001), anxiety and depression (acupuncture effect, -1.83 and -2.13, respectively; both at P < .001), and quality of life (Physical Well-Being effect, 3.30; Functional Well-Being effect, 3.57; both at P < .001; Emotional Well-Being effect, 1.93; P = .001; and Social Functioning Well-Being effect, 1.05; P < .05).
  
  
  CONCLUSIONS
  Acupuncture is an effective intervention for managing the symptom of CRF and improving patients' quality of life.
authors.affiliation: School of Nursing, Midwifery, and Social Work, University of Manchester, United Kingdom. alex.molassiotis@manchester.ac.uk
authors.forename: Alexander
authors.initials: A
authors.lastname: Molassiotis
authors.forename: Joy
authors.initials: J
authors.lastname: Bardy
authors.forename: Jennifer
authors.initials: J
authors.lastname: Finnegan-John
authors.forename: Peter
authors.initials: P
authors.lastname: Mackereth
authors.forename: David W
authors.initials: DW
authors.lastname: Ryder
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Filshie
authors.forename: Emma
authors.initials: E
authors.lastname: Ream
authors.forename: Alison
authors.initials: A
authors.lastname: Richardson
mesh_terms: D015669:Acupuncture Points; D015670:Acupuncture Therapy / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001943:Breast Neoplasms / Q000150:complications* / Q000523:psychology / Q000628:therapy*; D005221:Fatigue / Q000139:chemically induced / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome