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Acupuncture-Point Stimulation for Chemotherapy-Induced Nausea and Vomiting

From JPS Enterprises, Baltimore, MD; Memorial Sloan-Kettering Cancer Center, New York, NY; National Foundation for Alternative Medicine, Washington, DC

Address reprint requests to Jeanette Ezzo, MPH, PhD, Director of Research, JPS Enterprises, 1905 W Rogers Ave, Baltimore, MD 21209; e-mail: jeanetteezzo{at}prodigy.net

PURPOSE: Assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients.

MATERIALS AND METHODS: Randomized trials of acupuncture-point stimulation by needles, electrical stimulation, magnets, or acupressure were retrieved. Data were provided by investigators of the original trials and pooled using a fixed-effects model.

RESULTS: Eleven trials (N = 1,247) were pooled. Overall, acupuncture-point stimulation reduced the proportion of acute vomiting (relative risks [RR] = 0.82; 95% CI, 0.69 to 0.99; P = .04), but not the mean number of acute emetic episodes or acute or delayed nausea severity compared with controls. By modality, stimulation with needles reduced the proportion of acute vomiting (RR = 0.74; 95% CI, 0.58 to 0.94; P = .01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% CI, 0.60 to 0.97; P = .02), but manual acupuncture did not; delayed symptoms were not reported. Acupressure reduced mean acute nausea severity (standardized mean difference = –0.19; 95% CI, –0.38 to –0.01; P = .03) and most severe acute nausea, but not acute vomiting or delayed symptoms. Noninvasive electrostimulation showed no benefit for any outcome. All trials used concomitant pharmacologic antiemetics, and all, except electroacupuncture trials, used state-of-the-art antiemetics.

CONCLUSION: This review complements data on postoperative nausea and vomiting, suggesting a biologic effect of acupuncture-point stimulation. Electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies with state-of-the-art antiemetics as well as studies for refractory symptoms are needed to determine clinical relevance. Acupressure seems to reduce chemotherapy-induced acute nausea severity, though studies did not involve a placebo control. Noninvasive electrostimulation seems unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.

Supported by the Danish Cancer Society and ViFab (Videns- og Forsknings-Center for Alternative Behandling; The Knowledge and Research Center for Alternative Medicine), the National Cancer Institute, and the National Center for Complementary and Alternative Medicine. Early funding was provided by the National Institutes of Health Grant No. U24 CA66826-03 through the National Center for Complementary and Alternative Medicine and the National Cancer Institute.

The results of this study have not been published or presented elsewhere.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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