Abstract
PURPOSE:
Chemotherapy-induced peripheral neuropathy is a complex side effect with few available treatment options. The aim of the study was to test the effectiveness of an 8-week course of acupuncture in the management of chemotherapy-induced peripheral neuropathy in cancer patients who were receiving or had received neurotoxic chemotherapy.
METHODS:
Randomized assessor-blinded controlled trial with 2 arms; one arm received acupuncture twice weekly for 8 weeks, while the other arm was a wait-list control group receiving only standard care. Primary outcome was pain intensity and interference over the past week using the Brief Pain Inventory at the end of the intervention. Secondary outcomes included clinical assessment (CTCAE [Common Toxicity Criteria for Adverse Events] grading and Total Neuropathy Score-Clinical Version) and nerve conduction studies; and patient-reported outcome measures (Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-Neurotoxicity Quality of Life scale and Symptom Distress Scale) assessed at baseline, end of treatment (8 weeks), week 14, and week 20 from the beginning of treatment.
RESULTS:
Eighty-seven patients were randomized to the experimental arm (n = 44) and to the standard care wait-list control arm (n = 43). Significant changes at 8 weeks were detected in relation to primary outcome (pain), the clinical neurological assessment, quality of life domains, and symptom distress (all P < .05). Improvements in pain interference, neurotoxicity-related symptoms, and functional aspects of quality of life were sustained in the 14-week assessment ( P < .05), as were physical and functional well-being at the 20-week assessment ( P < .05).
CONCLUSIONS:
Acupuncture is an effective intervention for treating chemotherapy-induced peripheral neuropathy and improving patients‘ quality of life and experience with neurotoxicity-related symptoms with longer term effects evident.
Intervention
The acupuncture intervention is described below based on the STRICTA (Standards for Reporting Interventions in Clinical Trials of Acupuncture) recommendations for reporting acupuncture trials. In the acupuncture group, patients received, in addition to standard care, a standardized 30-minute acupuncture session needling specific body points; there was flexibility in case some points could not be punctured (ie, in case of lymphedema), and alternative points (as in routine practice) were selected by the therapists using their discretion to maintain an equal dose of treatment to all patients. The points were standardized according to the clinical manifestations of the subjects: if upper limbs were involved, we used LI4, LI11, PC7, TE5, and/or Baxie points (Ex-UE9; since the effect of Ex-UE9, PC7, and TE5 are similar, only 1 out of the 3 was chosen); if lower limbs were affected (most common), we used SP6, ST36, LV3, ST41, and/or Bafeng (Ex-LE10; since the effect of LV3, Ex-LE10, and ST41 are similar, only 1 out of the 3 was chosen) reflecting a traditional Chinese medicine diagnosis of “blood and qi stagnation and accumulation of dampness.” If the pain threshold of the patients was low, TE5 for upper limbs and/or ST41 for lower limbs were chosen. An equal “dose” of points was used for all patients (4 points bilaterally). Stimulation of the acupoints to achieve de qi sensation was done manually through rotation of the needle backward and forward for a few seconds, done twice during each treatment session (just after inserting the needle and before removing the needle).
Authors: Molassiotis A, Suen LKP, Cheng HL, Mok TSK, Lee SCY, Wang CH, Lee P, Leung H, Chan V, Lau TKH, Yeo W.
Published in: Integr Cancer Ther. 2019 Jan-Dec;18:1534735419836501. doi: 10.1177/1534735419836501.