Chemotherapy-induced nausea and vomiting
Of all the investigated effects of acupuncture on cancer-related or chemotherapy-related symptoms and disorders, the positive effect of acupuncture on chemotherapy-induced nausea and vomiting (N/V) is the most convincing, as demonstrated by the consistency of the results of a variety of clinical study types, including randomized clinical trials (RCTs), nonrandomized trials, prospective consecutive case series, and retrospective studies (refer to Table 3 at the end of this section). Consistent with the findings from clinical studies of acupuncture on N/V due to other causes such as postoperative N/V and morning sickness, these studies showed acupuncture to be effective in the treatment of chemotherapy-induced N/V. A well-documented example is discussed below.
A systematic review of the effect of acupuncture on N/V describes five clinical trials of chemotherapy-induced N/V, conducted by different investigators on different groups of patients and using different forms of acupuncture point stimulation. All five trials yielded positive results. These consistent results support the claim that acupuncture is useful for treating chemotherapy-induced N/V. More recently, the efficacy of acupuncture point stimulation for chemotherapy-induced N/V has been reviewed, suggesting that acupuncture is more effective for acute vomiting than for acute or chronic nausea.
A number of clinical studies of the effect of acupuncture on chemotherapy-induced N/V have been reported.[23,24,25,26,27,28,29,30,31,32,33,34,35]
A randomized placebo-controlled clinical trial investigated the effect of EA on chemotherapy-induced emesis in 104 patients with breast cancer who were undergoing a highly emetogenic chemotherapy regimen. The patients were randomly assigned to receive low-frequency EA at classic antiemetic acupuncture points once daily for 5 days (n = 37), minimal needling at control points with mock EA on the same schedule (n = 33), or no adjunct needling (n = 34). All patients received concurrent antiemetic drugs (prochlorperazine,lorazepam, and diphenhydramine) and high-dose chemotherapy (cyclophosphamide,cisplatin, and carmustine). The main outcome measures were the total number of emesis episodes and the proportion of emesis-free days occurring during the 5-day study period. The data revealed fewer emesis episodes in the EA treatment group than in the minimal needling and drug-only control groups (P < .001), although differences among the groups were not significant during the 9-day follow-up period (P = .18). These findings are consistent with results reported by other investigators.[23,24,26,27,29,30,33] However, another published study showed that acupuncture had no additional effect on the prevention of acute N/V in patients receiving high-dose chemotherapy combined with ondansetron. One RCT of acupuncture and vitamin B6 versus acupuncture or vitamin B6 intramuscular injection alone for N/V in women with ovarian cancer undergoing highly emetogenic chemotherapy, found a statistically significant benefit of both vitamin B6 and acupuncture. Results also showed that acupuncture alone, compared with vitamin B6, had a greater benefit in reducing the frequency of emesis. One study suggested decreased delayed nausea from acupressure at point p6 compared with sham acupressure. One study involving 34 patients with gynecologic cancer suggested that the acupressure applied to P6 acupuncture point with wristbands may be effective in reducing chemotherapy-related nausea and may decrease the antiemetic use after chemotherapy.