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Xu Y, Yu J, Shen R, Shan X, Zhou W, Wang J. Comparison efficacy and safety of acupuncture and moxibustion therapies in breast cancer-related lymphedema: A systematic review and network meta-analysis. PLoS One 2024; 19:e0303513. [PMID: 38743748 PMCID: PMC11093363 DOI: 10.1371/journal.pone.0303513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 04/19/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE Although several acupuncture and moxibustion therapies have been tested in managing breast cancer-related lymphedema (BCRL), there is little consensus regarding the best options for treating this condition. This systematic review and network meta-analysis compared the efficacy of various acupuncture and/or moxibustion therapies for BCRL. METHODS Seven databases and two clinical registration centers were searched from their inception to December 1st, 2023. The Cochrane Collaboration risk-of-bias assessment tool evaluated the quality of included RCTs. A pairwise meta-analysis was performed in STATA 16.0, while a network meta-analysis was performed in R 4.2.2. RESULTS 18 studies were included in this analysis. Our results showed that acupuncture and moxibustion methods had great advantages in improving BCRL of patients with breast cancer. In particular, needle-warming moxibustion (NWM) could be the optimal acupuncture and moxibustion method for improving clinical effectiveness and reducing the degree of swelling of affected limbs. CONCLUSION Our findings suggest that NWM has great potential in treating BCRL. It may reduce arm circumference, lower swelling levels, and improve clinical effectiveness. Nevertheless, more multi-center, high-quality, and large sample RCTs will be needed in the future.
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Affiliation(s)
- Yawen Xu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiangxuan Yu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rui Shen
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xueqi Shan
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wenlu Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Junjie Wang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Jamali Dastjerdi M, Azadvari M, Kordafshari G, Zhao BX, Adel-Mehraban MS, Alipour R, Karimi M, Kazemi AH, Sourani A, Vafaie Sefti A. Comparative efficacy of acupuncture, venesection, and physical therapy on chronic low back pain outcomes: a randomized clinical trial. Ann Med Surg (Lond) 2024; 86:2729-2738. [PMID: 38694293 PMCID: PMC11060228 DOI: 10.1097/ms9.0000000000001944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/02/2024] [Indexed: 05/04/2024] Open
Abstract
Objective Chronic low back pain (CLBP) imposes considerable financial and social burden with poor response to medical and surgical treatments. Alternatively, acupuncture and venesection(Fasd) are traditionally used to alleviate nociceptive and musculoskeletal pains. This study aimed to evaluate the effectiveness and the safety of acupuncture and venesection on CLBP and patient functionality. Methods The current study was a single-blinded, randomized clinical trial with balanced allocation, conducted in the Department of Physical Medicine & Rehabilitation Medicine, in 2022. One hundred five CLBP patients who had no back pain-attributable structural or major diseases were randomly allocated into three parallel arms and received either physical therapy (PTG), acupuncture (APG), or venesection (VSG). Pain severity and functional aspects were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) during the study. VAS and ODI scores were defined as the primary outcomes. Results Ninety-five patients were reviewed in the final analysis (PTG=33, APG=30, VSG=31). Demographic data showed equal group distribution. Statistical analysis showed all procedures had reduced VAS score immediately after the first session, after the last session, and after follow-up; however, APG and VSG values were significantly lower (P<0.05). Pain reduction results in follow-up period were more sustainable in APG and VSG as compared to PTG (P<0.01). ODI results revealed global improvement after the last session of the treatment in all groups, while APG had more significant results (P<0.05). During the follow-up period, ODI still tended to decrease in VSG, non-significantly increased in APG, and significantly increased in PTG. Only two patients reported fainting after receiving venesection. Conclusion Considering the pain and functional scores, both acupuncture and venesection can reproduce reliable results. Acupuncture and venesection both have sustained effects on pain and daily function of the patients even after treatment termination, while physical therapy had more relapse in pain and functional limitations.
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Affiliation(s)
- Moein Jamali Dastjerdi
- Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Azadvari
- Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Kordafshari
- Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Bai-Xiao Zhao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Mohammad Sadegh Adel-Mehraban
- Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran
- Traditional Persian Medicine and Complementary Medicine (PerCoMed) Student Association, Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Reihane Alipour
- Traditional Persian Medicine and Complementary Medicine (PerCoMed) Student Association, Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
- Department of Traditional Medicine, School of Persian medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Karimi
- Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hooman Kazemi
- Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran
- International School, Beijing University of Chinese Medicine, Beijing, China
| | - Arman Sourani
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Vafaie Sefti
- Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran
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Wang L, Du X, Hu P, Zhang Y, Yao M, Che X. Quality of evidence supporting the role of acupuncture for breast cancer-related lymphoedema: an overview of systematic reviews and meta-analyses. J Cancer Res Clin Oncol 2023; 149:16669-16678. [PMID: 37721568 DOI: 10.1007/s00432-023-05419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) may benefit from acupuncture as a therapeutic. However, the findings of systematic reviews (SRs) and meta-analyses (MAs) are inconsistent and their quality needs to be evaluated critically. We aimed to provide an overview of the methodological quality, risk of bias, quality of reporting, and quality of evidence for SRs/MAs of acupuncture for BCRL. METHODS Publications were retrieved from four Chinese databases and four English databases. The methodological quality, risk of bias, reporting quality, and evidence quality of the included SRs/MAs were assessed by two independent researchers using the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), Risk of Bias in Systematic Reviews (ROBIS), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Grading of Recommendations, Assessment, Development and Evaluation (GRADE), respectively. RESULTS There were a total of 8 SRs/MAs included. By AMSTAR-2, all SRs/MAs were graded as having low or very low methodological quality. By ROBIS, all SRs/MAs in phase 1, domain 1, and domain 4 of phase 2 were at low risk, while in domain 2 were at high risk. By PRISMA, reporting weaknesses in protocol and registration, as well as search method, were identified. By GRADE, the level of evidence quality was "low" to "very low", and the most commonly downgraded factor was the risk of bias. CONCLUSIONS Acupuncture may be beneficial in improving BCRL. However, due to the identified limitations and conflicting findings, further more prescriptive and rigorous SRs/MAs are required to give strong evidence for final judgments.
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Affiliation(s)
- Lei Wang
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Xueyuan Du
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Peng Hu
- The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Yaling Zhang
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Mingchao Yao
- Henan University of Chinese Medicine, Zhengzhou, China
| | - Xiaoling Che
- The Quzhou Affiliated Hospital of Wenzhou Medical University (Quzhou People's Hospital), Quzhou, China.
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Zhang XW, Hou WB, Pu FL, Wang XF, Wang YR, Yang M, Cheng K, Wang Y, Robinson N, Liu JP. Acupuncture for cancer-related conditions: An overview of systematic reviews. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 106:154430. [PMID: 36099656 DOI: 10.1016/j.phymed.2022.154430] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/24/2022] [Accepted: 09/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Acupuncture is commonly used for cancer-related conditions worldwide, and evidence is increasing year on year. There is a need to summarize the evidence of acupuncture for cancer-related conditions comprehensively and critically. OBJECTIVE To evaluate and summarize the systematic reviews (SRs) that assess the effects and safety of acupuncture for cancer-related conditions, and to inform clinical practice and future studies. METHODS A comprehensive search was conducted on Pubmed, Embase, the Cochrane Library, Web of Science, CNKI, VIP, Sinomed, and Wanfang from their inception to October 16, 2021. SRs of randomized controlled trials (RCTs) on acupuncture for cancer-related conditions were to be included. Two reviewers screened the eligible articles, and four reviewers in pair extracted data and assessed the methodological quality/risk of bias of all included reviews by AMSTAR 2 and ROBIS tools. The overlap of primary studies was measured by calculating corrected covered areas. Data from the included reviews were synthesized with a summary of meta-analysis or narrative description. RESULTS Fifty-one SRs of RCTs on acupuncture for cancer-related conditions were included and synthesized. The methodological quality of SRs included 1 "high", 5 "low" and 45 "very low" by AMSTAR 2. Sixteen SRs assessed as low risk of bias (31.37%), and 35 SRs had high risk of bias (68.63%) by ROBIS. Acupuncture showed effective on systemic conditions in relation to different cancers, including cancer-related pain (17 SRs, 80 RCTs), fatigue (7 SRs, 18 RCTs), insomnia (4 SRs, 10 RCTs), quality of life (2 SRs, 15 RCTs); conditions in relation to chemo-radiotherapy, including nausea and vomiting (3 SRs, 36 RCTs) and bone marrow suppression (2 SRs, 21 RCTs); and conditions in relation to specific cancers, including breast cancer-related menopause (3 SRs, 6 RCTs), hot flashes (12 SRs, 13 RCTs), arthralgia (5 SRs, 10 RCTs), and nasopharyngeal cancer-related dysphagia (1 SRs, 7 RCTs). Acupuncture appeared to have benefit for patients with lymphoedema (3 SRs, 3 RCTs), gastrointestinal function (5 SRs, 27 RCTs), and xerostomia (4 SRs, 7 RCTs). Limited evidence showed inconsistent results on acupuncture for chemotherapy-induced peripheral neuropathy (3 SRs, 6 RCTs), depression and anxiety (3 SRs, 9 RCTs). Acupuncture was regarded as a safe therapy for cancer patients as no severe adverse events related were reported. CONCLUSION Evidence from SRs showed that acupuncture is beneficial to cancer survivors with cancer-related pain, fatigue, insomnia, improved quality of life, nausea and vomiting, bone marrow suppression, menopausal symptoms, arthralgia, and dysphagia, and may also be potential for lymphoedema, gastrointestinal function, and xerostomia. For neuropathy, depression and anxiety, acupuncture should be used as an option based on individual conditions. Acupuncture is relatively safe without serious adverse events. More well-designed clinical trials of acupuncture are recommended on cancer-related depression and anxiety, arthralgia, xerostomia, gastrointestinal dysfunction and dysphagia.
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Affiliation(s)
- Xiao-Wen Zhang
- Centre for Evidence Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Wen-Bin Hou
- Centre for Evidence Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Feng-Lan Pu
- Centre for Evidence Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xue-Feng Wang
- School of Humanities, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yi-Ran Wang
- School of Humanities, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Ming Yang
- The Third Affiliated Hospital of Beijing University of Chinese Medicine, Beijing 100029, China
| | - Ke Cheng
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yuyi Wang
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400011, China
| | - Nicola Robinson
- Centre for Evidence Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China; Institute of Health and Social Care, London South Bank University, London, UK
| | - Jian-Ping Liu
- Centre for Evidence Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100029, China; The National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Science, UiT The Arctic University of Tromsø, Tromsø 9037, Norway.
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Gao Y, Ma T, Han M, Yu M, Wang X, Lv Y, Wang X. Effects of Acupuncture and Moxibustion on Breast Cancer-Related Lymphedema: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Integr Cancer Ther 2021; 20:15347354211044107. [PMID: 34521235 PMCID: PMC8447094 DOI: 10.1177/15347354211044107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: The aim of this systematic review and meta-analysis of randomized controlled
trials (RCTs) was to evaluate the effects of acupuncture and moxibustion
(AM) in women with breast cancer-related lymphedema (BCRL). Methods: We retrieved RCTs published before January 24, 2021, from the MEDLINE,
EMBASE, Cochrane Library, Web of Science, China National Knowledge
Infrastructure (CNKI), Chongqing VIP (VIP), and Wanfang databases. RCTs that
compared acupuncture and/or moxibustion intervention with other treatments
were included. A random effects or fixed effects model was used based on the
heterogeneity findings. Study quality was evaluated using the Cochrane risk
of bias tool. Results: We included 14 RCTs in the analyses, of which 4 RCTs adopted acupuncture, 4
RCTs used moxibustion, and the rest used both. AM significantly reduced arm
circumference at the elbow crease compared to routine care (Mean deviation
(MD) = −7.26, 95% confidence interval (CI) = −8.30 to −6.21,
P < .00001). There was a significant difference
between AM and diosmin tablets in the effective index for upper limb
lymphedema (MD = 24.68, 95% CI = 24.82-30.53,
P < .00001), the range of motion of the shoulder during
protraction (MD = 6.77, 95% CI = 2.81-10.73, P = .0008),
and adduction (MD = 4.17, 95% CI = 1.02-7.32, P = .01).
There was a significant difference between moxibustion and pneumatic
circulation (MD = −0.51, 95% CI = −0.85 to −0.17, P = .003)
in the visual analog score (VAS) for swelling. Finally, compared to the
blank control, acupuncture reduced the VAS for pain (MD = −1.33, 95%
CI = −1.52 to −1.15, P < .00001; heterogeneity
(I2) = 0%, P = .57). Conclusion: Our results suggest that AM is effective in the treatment of BCRL. AM may
reduce arm circumference at the elbow crease (compared to routine care),
increase effective index for upper limb lymphedema (compared to oral diosmin
tablets), improve the range of motion of the shoulder during protraction and
adduction (compared to oral diosmin tablets), and decrease the VAS for both
swelling (compared to pneumatic circulation) and pain (compared to blank
control).
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Affiliation(s)
- Yu Gao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Tingting Ma
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Mei Han
- Beijing University of Chinese Medicine, Beijing, China
| | - Mingwei Yu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Xiuhui Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Yiren Lv
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Xiaomin Wang
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
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A feasibility trial of acupuncture in cancer patients undergoing radiotherapy treatment. Complement Ther Clin Pract 2021; 43:101372. [PMID: 33839523 DOI: 10.1016/j.ctcp.2021.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/09/2020] [Accepted: 03/15/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We conducted a feasibility trial of acupuncture in cancer patients undergoing radiotherapy treatment. The trial included training radiographers to deliver acupuncture within patients' routine NHS care. METHODS Mixed methods pragmatic randomized parallel-group exploratory feasibility trial comparing standard care to standard care plus acupuncture. RESULTS Most aspects of the research design and acupuncture intervention were acceptable to the 101 participants. Participants' valued the opportunity to receive acupuncture within their NHS care, perceived the treatment as eliciting a number of beneficial effects, and had a positive impact on their NHS cancer treatment. However, quantitative analysis of outcome measure data revealed no consistent significant differences between those receiving standard care and those receiving standard care plus acupuncture. CONCLUSION It is feasible to implement acupuncture in a busy radiotherapy unit provided by specially trained radiographers. The methodology employed appears acceptable for the evaluation of acupuncture for radiotherapy patients.
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