Supportive Care in Cancer

, Volume 25, Issue 12, pp 3807–3814 | Cite as

Acupuncture for cancer-related fatigue in lung cancer patients: a randomized, double blind, placebo-controlled pilot trial

  • Chien-shan Cheng
  • Lian-yu Chen
  • Zhou-yu Ning
  • Chen-yue Zhang
  • Hao Chen
  • Zhen Chen
  • Xiao-yan Zhu
  • Jing Xie
Original Article

Abstract

Background

Cancer-related fatigue (CRF) is a distressing symptom that is the most common unpleasant side effect experienced by lung cancer patients and is challenging for clinical care workers to manage.

Methods

We performed a randomized, double-blind, placebo-controlled pilot trial to evaluate the clinical effect of acupuncture on CRF in lung cancer patients. Twenty-eight patients presenting with CRF were randomly assigned to active acupuncture or placebo acupuncture groups to receive acupoint stimulation (LI-4, Ren-6, St-36, KI-3, and Sp-6) twice per week for 4 weeks, followed by 2 weeks of follow-up. The primary outcome was the change in intensity of CFR based on the Chinese version of the Brief Fatigue Inventory (BFI-C). As the secondary endpoint, the Functional Assessment of Cancer Therapy-Lung Cancer Subscale (FACT-LCS) was adopted to assess the influence of acupuncture on patients’ quality of life (QOL). Adverse events and safety of treatments were monitored throughout the trial.

Results

Our pilot study demonstrated feasibility among patients with appropriate inclusion criteria and good compliance with acupuncture treatment. A significant reduction in the BFI-C score was observed at 2 weeks in the 14 participants who received active acupuncture compared with those receiving the placebo (P < 0.01). At week 6, symptoms further improved according to the BFI-C (P < 0.001) and the FACT-LCS (P = 0.002). There were no significant differences in the incidence of adverse events in either group (P > 0.05).

Conclusion

Fatigue is a common symptom experienced by lung cancer patients. Acupuncture may be a safe and feasible optional method for adjunctive treatment in cancer palliative care, and appropriately powered trials are warranted to evaluate the effects of acupuncture.

Keywords

Acupuncture Lung cancer Cancer-related fatigue Quality of life 

Notes

Acknowledgements

The authors would like to thank Professor Zhiqiang Meng for his contributions to the organization of this study and his valuable advices. This study was supported by grants from the Comprehensive and Integrative Medicine Institute (CIMI) and the National Natural Science Foundation of China (No. 81403248).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Written informed consent was obtained from all individual participants included in the study. All procedures performed in studies were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and with the ethical standards of the Shanghai Cancer Center, Fudan University (ClinicalTrials.gov Identifier: NCT01881516).

References

  1. 1.
    Borneman T, Piper BF, Sun VC, Koczywas M, Uman G, Ferrell B (2007) Implementing the fatigue guidelines at one NCCN member institution: process and outcomes. J Natl Compr Cancer Netw 5:1092–1101CrossRefGoogle Scholar
  2. 2.
    Hoffman AJ, Brintnall RA, Brown JK, Eye A, Jones LW, Alderink G, Ritz-Holland D, Enter M, Patzelt LH, Vanotteren GM (2013) Too sick not to exercise: using a 6-week, home-based exercise intervention for cancer-related fatigue self-management for postsurgical non-small cell lung cancer patients. Cancer Nurs 36:175–188CrossRefPubMedGoogle Scholar
  3. 3.
    Iwase S, Kawaguchi T, Tokoro A, Yamada K, Kanai Y, Matsuda Y, Kashiwaya Y, Okuma K, Inada S, Ariyoshi K, Miyaji T, Azuma K, Ishiki H, Unezaki S, Yamaguchi T (2015) Assessment of cancer-related fatigue, pain, and quality of life in cancer patients at palliative care team referral: a multicenter observational study (JORTC PAL-09). PLoS One 10:e0134022CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Ahlberg K, Ekman T, Gaston-Johansson F, Mock V (2003) Assessment and management of cancer-related fatigue in adults. Lancet 362:640–650CrossRefPubMedGoogle Scholar
  5. 5.
    Cella D, Davis K, Breitbart W, Curt G, Fatigue C (2001) Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. J Clin Oncol 19:3385–3391CrossRefPubMedGoogle Scholar
  6. 6.
    Sood A, Barton DL, Bauer BA, Loprinzi CL (2007) A critical review of complementary therapies for cancer-related fatigue. Integr Cancer Ther 6:8–13CrossRefPubMedGoogle Scholar
  7. 7.
    Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N (2000) Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer Fatigue Forum Ann Oncol 11:971–975PubMedGoogle Scholar
  8. 8.
    Finnegan-John J, Molassiotis A, Richardson A, Ream E (2013) A systematic review of complementary and alternative medicine interventions for the management of cancer-related fatigue. Integr Cancer Ther 12:276–290CrossRefPubMedGoogle Scholar
  9. 9.
    Alraek T, Lee MS, Choi TY, Cao H, Liu J (2011) Complementary and alternative medicine for patients with chronic fatigue syndrome: a systematic review. BMC Complement Altern Med 11:87CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Battaglini CL, Mills RC, Phillips BL, Lee JT, Story CE, Nascimento MG, Hackney AC (2014) Twenty-five years of research on the effects of exercise training in breast cancer survivors: A systematic review of the literature. World J Clin Oncol 5:177–190CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Chien TJ, Liu CY, Hsu CH (2013) Integrating acupuncture into cancer care. J Tradit Complement Med 3:234–239CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Johnston MF, Hays RD, Hui KK (2009) Evidence-based effect size estimation: an illustration using the case of acupuncture for cancer-related fatigue. BMC Complement Altern Med 9:1CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Chung VC, Wu X, Lu P, Hui EP, Zhang Y, Zhang AL, Lau AY, Zhao J, Fan M, Ziea ET, Ng BF, Wong SY, Wu JC (2016) Chinese Herbal Medicine for Symptom Management in Cancer Palliative Care: Systematic Review And Meta-analysis. Medicine (Baltimore) 95:e2793CrossRefGoogle Scholar
  14. 14.
    Dean-Clower E, Doherty-Gilman AM, Keshaviah A, Baker F, Kaw C, Lu W, Manola J, Penson RT, Matulonis UA, Rosenthal DS (2010) Acupuncture as palliative therapy for physical symptoms and quality of life for advanced cancer patients. Integr Cancer Ther 9:158–167CrossRefPubMedGoogle Scholar
  15. 15.
    Deng G, Chan Y, Sjoberg D, Vickers A, Yeung KS, Kris M, Straus D, Cassileth B (2013) Acupuncture for the treatment of post-chemotherapy chronic fatigue: a randomized, blinded, sham-controlled trial. Support Care Cancer 21:1735–1741CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    He XR, Wang Q, Li PP (2013) Acupuncture and moxibustion for cancer-related fatigue: a systematic review and meta-analysis. Asian Pac J Cancer Prev 14:3067–3074CrossRefPubMedGoogle Scholar
  17. 17.
    Tao WW, Jiang H, Tao XM, Jiang P, Sha LY, Sun XC (2016) Effects of acupuncture, Tuina, Tai Chi, Qigong, and traditional Chinese medicine five-element music therapy on symptom management and quality of life for cancer patients: a meta-analysis. J Pain Symptom Manag 51:728–747CrossRefGoogle Scholar
  18. 18.
    Wang YY, Li XX, Liu JP, Luo H, Ma LX, Alraek T (2014) Traditional Chinese medicine for chronic fatigue syndrome: a systematic review of randomized clinical trials. Complement Ther Med 22:826–833CrossRefPubMedGoogle Scholar
  19. 19.
    Balk J, Day R, Rosenzweig M, Beriwal S (2009) Pilot, randomized, modified, double-blind, placebo-controlled trial of acupuncture for cancer-related fatigue. J Soc Integr Oncol 7:4–11PubMedGoogle Scholar
  20. 20.
    Berger AM (2013) Does the strength of evidence support recommending acupuncture to relieve cancer-related fatigue? Ann Palliat Med 2:11–13PubMedGoogle Scholar
  21. 21.
    Grant SJ, Smith CA, de Silva N, Su C (2015) Defining the quality of acupuncture: the case of acupuncture for cancer-related fatigue. Integr Cancer Ther 14:258–270CrossRefPubMedGoogle Scholar
  22. 22.
    Johnston MF, Hays RD, Subramanian SK, Elashoff RM, Axe EK, Li JJ, Kim I, Vargas RB, Lee J, Yang L, Hui KK (2011) Patient education integrated with acupuncture for relief of cancer-related fatigue randomized controlled feasibility study. BMC Complement Altern Med 11:49CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kim DI, Choi MS (2013) Guidance for prospective acupuncture treatment on cancer-related fatigue (CRF). Ann Palliat Med 2:7–10PubMedGoogle Scholar
  24. 24.
    Azad A, John T (2013) Do randomized acupuncture studies in patients with cancer need a sham acupuncture control arm? J Clin Oncol 31:2057–2058CrossRefPubMedGoogle Scholar
  25. 25.
    Lu LM, He J, Zeng JC, Liao MX, Jia C, Pan HH (2017) Impact evaluation of CONSORT and STRICTA guidelines on reporting quality for randomized controlled trials of acupuncture conducted in China. Chin J Integr Med 23:10–17CrossRefPubMedGoogle Scholar
  26. 26.
    MacPherson H, Altman DG, Hammerschlag R, Li Y, Wu T, White A, Moher D, Group SR (2010) Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. Acupunct Med 28:83–93CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Lau CH, Wu X, Chung VC, Liu X, Hui EP, Cramer H, Lauche R, Wong SY, Lau AY, Sit RS, Ziea ET, Ng BF, Wu JC (2016) Acupuncture and Related Therapies for Symptom Management in Palliative Cancer Care: Systematic Review and Meta-Analysis. Medicine (Baltimore) 95:e2901CrossRefGoogle Scholar
  28. 28.
    Dagnelie PC, Pijls-Johannesma MC, Lambin P, Beijer S, De Ruysscher D, Kempen GI (2007) Impact of fatigue on overall quality of life in lung and breast cancer patients selected for high-dose radiotherapy. Ann Oncol 18:940–944CrossRefPubMedGoogle Scholar
  29. 29.
    Molassiotis A, Bardy J, Finnegan-John J, Mackereth P, Ryder DW, Filshie J, Ream E, Richardson A (2012) Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized controlled trial. J Clin Oncol 30:4470–4476CrossRefPubMedGoogle Scholar
  30. 30.
    Javdan B, Cassileth B (2015) Acupuncture Research at Memorial Sloan Kettering Cancer Center. J Acupunct Meridian Stud 8:115–121CrossRefPubMedGoogle Scholar
  31. 31.
    Molassiotis A, Sylt P, Diggins H (2007) The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial. Complement Ther Med 15:228–237CrossRefPubMedGoogle Scholar
  32. 32.
    Smith C, Carmady B, Thornton C, Perz J, Ussher JM (2013) The effect of acupuncture on post-cancer fatigue and well-being for women recovering from breast cancer: a pilot randomised controlled trial. Acupunct Med 31:9–15CrossRefPubMedGoogle Scholar
  33. 33.
    Kilian-Kita A, Puskulluoglu M, Konopka K, Krzemieniecki K (2016) Acupuncture: could it become everyday practice in oncology? Contemp Oncol (Pozn) 20:119–123Google Scholar
  34. 34.
    Thompson LM, Osian SR, Jacobsen PB, Johnstone PA (2015) Patient-reported Outcomes of Acupuncture for Symptom Control in Cancer. J Acupunct Meridian Stud 8:127–133CrossRefPubMedGoogle Scholar
  35. 35.
    Zeng Y, Luo T, Finnegan-John J, Cheng AS (2014) Meta-analysis of randomized controlled trials of acupuncture for cancer-related fatigue. Integr Cancer Ther 13:193–200CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Chien-shan Cheng
    • 1
    • 2
  • Lian-yu Chen
    • 1
    • 2
  • Zhou-yu Ning
    • 1
    • 2
  • Chen-yue Zhang
    • 1
    • 2
  • Hao Chen
    • 1
    • 2
  • Zhen Chen
    • 1
    • 2
  • Xiao-yan Zhu
    • 1
    • 2
  • Jing Xie
    • 1
    • 2
  1. 1.Deparment of Integrative OncologyFudan University Shanghai Cancer CenterShanghaiChina
  2. 2.Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina

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