Acupuncture and Moxibustion for Cancer-related Fatigue: a Systematic Review and Meta-analysis

Background: Faced with highly prevalent and recalcitrant cancer-related fatigue (CRF), together with theabsence of any official guidelines on management, numerous groups have been striving to seek and test alternativetherapies including acupuncture and moxibustion. However, different patients have various feedbacks, andthe many clinical trials have given rise to varied conclusions. In terms of the therapeutic effect of acupunctureand moxibustion, there exist vast inconsistencies.
Objective: The aim of the study was to evaluate the auxiliaryeffectiveness of acupuncture and moxibustion in the treatment of CRF, and to provide more reliable evidenceto guide clinical practice.
Methods: Randomized controlled trials (RCTs) published before December 2012 wereall aggregated, focusing on evaluation of acupuncture or moxibustion for CRF. The quality of the includedstudies was assessed basing on Cochrane handbook 5.1.0, and the available data were analyzed with RevMansoftware (version 5.2.0). Descriptive techniques were performed when no available data could be used.
Results:A total of 7 studies involving 804 participants were eligible. With real acupuncture versus sham acupuncture,subjects receiving true acupuncture benefited more in the reduction of fatigue. With real acupuncture versusacupressure or sham acupressure, fatigue level appeared 36% improved in the acupuncture group, but 19% inthe acupressure group and only 0.6% with sham acupressure. When real acupuncture plus enhanced routinecare was compared with enhanced routine care, the combination group improved mean scores for generalfatigue, together with physical and mental fatigue. With real acupuncture versus sham acupuncture or wait listcontrols, the real acupuncture group displayed significant advantages over the wait list controls at 2 weeks forfatigue improvement and better well-being effects at 6 weeks. When moxibustion plus routine care was comparedwith routine care alone, the meta-analyses demonstrated the combination had a relatively significant benefit inimproving severe fatigue and QLQ-C30.
Conclusion: Up to the search date, there exist few high quality RCTsto evaluate the effect of acupuncture and moxibustion, especially moxibustion in English. Yet acupuncture andmoxibustion still appeared to be efficacious auxiliary therapeutic methods for CRF, in spite of several inherentdefects of the included studies. Much more high-quality studies are urgently needed.