An editorial published in the Annals of Palliative Medicine in response to the study done by Molassiotis et al, which is the first large, multi-site trail examining the potential of acupuncture in effectively managing cancer-related fatigue (CRF) after chemotherapy.
Although prior small-scale randomized controlled trials have shown the potential of acupuncture in effectively managing cancer-related fatigue (CRF) after chemotherapy (1), the study by Molassiotis et al (2) is the first large, multi-site trial examining this question. In their study, 302 outpatients with breast cancer experiencing persistent long-term fatigue were assigned to one of two groups: usual care, consisting of an information booklet related to fatigue, or acupuncture plus usual care. In the acupuncture treatment group, acupuncture were standardized 20-min sessions that consisted of needling three acupoints (ST36, SP6, LI4) with the addition of alternate points chosen by the therapists to reflect real, individualized Chinese medical practice. The primary outcomes related to general fatigue were measured through self-reports by patients using the Multidimensional Fatigue Inventory (MFI) at 6 weeks. Mental fatigue, activity, and motivation, anxiety and depression, and quality of life were also measured. Results found significant improvements on all measured outcomes for the acupuncture plus usual care group. The study thus demonstrated acupuncture’s effect on the successful management of clusters of symptoms rather than single symptoms alone. The investigators suggest that future studies should include an active control arm such as education, alongside a no treatment or wait-list arm, such that the nonspecific effects of acupuncture can also be evaluated. Bower (3) elaborated further on the Molassiotis study by addressing the need to determine an optimal acupuncture protocol for treating CRF, and pointed to the potential of including other promising nonpharmacologic treatments to enhance long-term effects. We applaud the study team for conducting a trial of this magnitude and significantly advancing scientific knowledge in this field. In this editorial, we would like to contribute to this important discussion by sharing our own clinical approach at the UCLA Center for East-West Medicine (CEWM). We begin with a discussion of acupuncture treatment for fatigue, using this as a springboard for a broader invitation to consider the ways in which an integrative East-West health model, such as that in place at CEWM, can be used to create a unique system of person-centered care that is also able to address multiple problems simultaneously.
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Editorial citation: Hui KK, Zhang L. Using acupuncture as part of a comprehensive program in helping patients with breast cancer beyond fatigue. Ann Palliat Med 2013;2(1):4-6. doi: 10.3978/j.issn.2224-5820.2013.01.14