title: Systematic review of acupuncture in cancer care: a synthesis of the evidence.
abstract: OBJECTIVE
  Many cancer centers offer acupuncture services. To date, a comprehensive systematic review of acupuncture in cancer care has not been conducted. The purpose of this review was to evaluate the efficacy of acupuncture for symptom management in patients with cancer.
  
  
  METHODS
  Medline, Embase, CINAHL, Cochrane (all databases), Scopus, and PubMed were searched from inception through December 2011 for prospective randomized clinical trials (RCT) evaluating acupuncture for symptom management in cancer care. Only studies involving needle insertion into acupuncture points were included. No language limitations were applied. Studies were assessed for risk of bias (ROB) according to Cochrane criteria. Outcomes by symptom were designated as positive, negative, or unclear.
  
  
  RESULTS
  A total of 2,151 publications were screened. Of those, 41 RCTs involving eight symptoms (pain, nausea, hot flashes, fatigue, radiation-induced xerostomia, prolonged postoperative ileus, anxiety/mood disorders, and sleep disturbance) met all inclusion criteria. One positive trial of acupuncture for chemotherapy-induced nausea and vomiting had low ROB. Of the remaining studies, eight had unclear ROB (four positive, three negative, and one with unclear outcomes). Thirty-three studies had high ROB (19 positive, 11 negative, and three with both positive and negative outcomes depending on the symptom).
  
  
  CONCLUSIONS
  Acupuncture is an appropriate adjunctive treatment for chemotherapy-induced nausea/vomiting, but additional studies are needed. For other symptoms, efficacy remains undetermined owing to high ROB among studies. Future research should focus on standardizing comparison groups and treatment methods, be at least single-blinded, assess biologic mechanisms, have adequate statistical power, and involve multiple acupuncturists.
authors: University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0462, Houston, TX 77030, USA.
authors: M Kay
authors: MK
authors: Garcia
authors: Jennifer
authors: J
authors: McQuade
authors: Robin
authors: R
authors: Haddad
authors: Sonya
authors: S
authors: Patel
authors: Richard
authors: R
authors: Lee
authors: Peiying
authors: P
authors: Yang
authors: J Lynn
authors: JL
authors: Palmer
authors: Lorenzo
authors: L
authors: Cohen
mesh_terms: D015670:Acupuncture Therapy; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001007:Anxiety / Q000209:etiology / Q000628:therapy; D019317:Evidence-Based Medicine; D005221:Fatigue / Q000209:etiology / Q000628:therapy; D019584:Hot Flashes / Q000209:etiology / Q000628:therapy; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000209:etiology / Q000628:therapy; D019964:Mood Disorders / Q000209:etiology / Q000628:therapy; D009325:Nausea / Q000209:etiology / Q000628:therapy; D009369:Neoplasms / Q000150:complications* / Q000628:therapy*; D015588:Observer Variation; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D011878:Radiotherapy / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D012893:Sleep Wake Disorders / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D014987:Xerostomia / Q000209:etiology / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents