Skip to main content
Top
Published in: Supportive Care in Cancer 6/2024

Open Access 01-06-2024 | Acupuncture | Research

Acupuncture for the treatment of the pain-fatigue-sleep disturbance-numbness/tingling symptom cluster in breast cancer survivors: a feasibility trial

Authors: Ki Kyung Kwon, Judith Lacey, Kim Kerin-Ayres, Gillian Heller, Suzanne Grant

Published in: Supportive Care in Cancer | Issue 6/2024

Login to get access

Abstract

Purpose

Breast cancer survivors following disease-modifying treatment frequently experience multiple-concurrent symptoms (Jansana et al. in Int J Cancer 149(10):1755 1767, 2021), negatively impacting their quality of life and increasing the risk of polypharmacy (Alwhaibi et al. in J Oncol Pharm Pract 26(5):1052 1059, 2020). This study evaluates the feasibility and acceptability of acupuncture for the management of the pain-fatigue-sleep disturbance-numbness/tingling symptom cluster in breast cancer survivors, and investigates relationships between the symptom cluster and Traditional Chinese Medicine (TCM) syndrome diagnosis.

Methods

This was a single-arm, pre-test/post-test feasibility trial conducted at Chris O’Brien Lifehouse Hospital, Australia. Breast cancer survivors who completed treatment and experienced clinically significant levels of two or more symptoms (pain, fatigue, sleep disturbance, numbness/tingling) were eligible to participate in the individualized, pragmatic 6-week acupuncture intervention. The primary outcome was feasibility and acceptability. Effectiveness was explored using a symptom cluster mean score.

Results

Twenty women enrolled in the study over an 11-week period and 90% completed the study. Most women agreed or completely agreed that acupuncture was feasible (85%), acceptable (90%), and appropriate (90%). Both mean and composite symptom cluster scores were significantly reduced (p < 0.001), as were individual symptom scores in fatigue (p < 0.001), sleep disturbance (p = 0.04), and numbness/tingling (p = 0.01). TCM syndromes most closely associated with this symptom cluster were Spleen qi deficiency and Heart fire. No adverse events were reported.

Conclusion

This study demonstrated that acupuncture was safe and feasible, justifying a powered randomized control trial. Preliminary findings suggest beneficial effects of acupuncture for the management of the pain-fatigue-sleep disturbance-numbness/tingling symptom cluster for women with breast cancer. TCM syndromes identified in this trial may be used to guide acupuncture treatment protocols.
Clinical trial registration: This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000590763) on 21 April 2022.
Appendix
Available only for authorised users
Literature
1.
go back to reference de Rooij BH et al (2021) Symptom clusters in 1330 survivors of 7 cancer types from the PROFILES registry: a network analysis. Cancer 127(24):4665–4674CrossRefPubMed de Rooij BH et al (2021) Symptom clusters in 1330 survivors of 7 cancer types from the PROFILES registry: a network analysis. Cancer 127(24):4665–4674CrossRefPubMed
3.
go back to reference Ehsan AN et al (2023) Financial toxicity among patients with breast cancer worldwide: a systematic review and meta-analysis. JAMA Netw Open 6(2):e2255388–e2255388CrossRefPubMedPubMedCentral Ehsan AN et al (2023) Financial toxicity among patients with breast cancer worldwide: a systematic review and meta-analysis. JAMA Netw Open 6(2):e2255388–e2255388CrossRefPubMedPubMedCentral
5.
go back to reference Jansana A et al (2021) Multimorbidity clusters among long-term breast cancer survivors in Spain: results of the SURBCAN study. Int J Cancer 149(10):1755–1767CrossRefPubMed Jansana A et al (2021) Multimorbidity clusters among long-term breast cancer survivors in Spain: results of the SURBCAN study. Int J Cancer 149(10):1755–1767CrossRefPubMed
6.
go back to reference Alwhaibi M et al (2020) Polypharmacy and comorbidities among ambulatory cancer patients: a cross-sectional retrospective study. J Oncol Pharm Pract 26(5):1052–1059CrossRefPubMed Alwhaibi M et al (2020) Polypharmacy and comorbidities among ambulatory cancer patients: a cross-sectional retrospective study. J Oncol Pharm Pract 26(5):1052–1059CrossRefPubMed
7.
go back to reference Topaloğlu US, Özaslan E (2020) Comorbidity and polypharmacy in patients with breast cancer. J Breast Cancer 27(3):477–482CrossRef Topaloğlu US, Özaslan E (2020) Comorbidity and polypharmacy in patients with breast cancer. J Breast Cancer 27(3):477–482CrossRef
8.
go back to reference Mohamed MR et al (2020) Associations of polypharmacy and inappropriate medications with adverse outcomes in older adults with cancer: a systematic review and meta-analysis. Oncologist 25(1):e94–e108CrossRefPubMed Mohamed MR et al (2020) Associations of polypharmacy and inappropriate medications with adverse outcomes in older adults with cancer: a systematic review and meta-analysis. Oncologist 25(1):e94–e108CrossRefPubMed
9.
go back to reference Kim H-J et al (2005) Symptom clusters: concept analysis and clinical implications for cancer nursing. Cancer Nurs 28(4):270–282CrossRefPubMed Kim H-J et al (2005) Symptom clusters: concept analysis and clinical implications for cancer nursing. Cancer Nurs 28(4):270–282CrossRefPubMed
10.
go back to reference Miaskowski C, Barsevick A, Berger A, Casagrande R, Grady PA, Jacobsen P, Kutner J, Patrick D, Zimmerman L, Xiao C, Matocha M, Marden S (2017) Advancing symptom science through symptom cluster research: expert panel proceedings and recommendations. J Natl Cancer Inst 109(4):djw253. https://doi.org/10.1093/jnci/djw253 Miaskowski C, Barsevick A, Berger A, Casagrande R, Grady PA, Jacobsen P, Kutner J, Patrick D, Zimmerman L, Xiao C, Matocha M, Marden S (2017) Advancing symptom science through symptom cluster research: expert panel proceedings and recommendations. J Natl Cancer Inst 109(4):djw253. https://​doi.​org/​10.​1093/​jnci/​djw253
12.
go back to reference G Lopez et al (2018) Outpatient acupuncture effects on patient self-reported symptoms in oncology care: a retrospective analysis 9 19 3613 G Lopez et al (2018) Outpatient acupuncture effects on patient self-reported symptoms in oncology care: a retrospective analysis 9 19 3613
13.
go back to reference Pachman DR et al (2012) Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain. J Clin Oncol 30(30):3687–3696CrossRefPubMed Pachman DR et al (2012) Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain. J Clin Oncol 30(30):3687–3696CrossRefPubMed
14.
go back to reference Kwekkeboom KL, Abbott-Anderson K, Wanta B (2010) Feasibility of a patient-controlled cognitive behavioral intervention for pain, fatigue, and sleep disturbance in cancer. Oncol Nurs Forum 37(3):E151CrossRefPubMedPubMedCentral Kwekkeboom KL, Abbott-Anderson K, Wanta B (2010) Feasibility of a patient-controlled cognitive behavioral intervention for pain, fatigue, and sleep disturbance in cancer. Oncol Nurs Forum 37(3):E151CrossRefPubMedPubMedCentral
15.
go back to reference Bjerkeset E, Röhrl K, Schou-Bredal I (2020) Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: prevalence and characteristics. Breast Cancer Res Treat 180(1):63–71CrossRefPubMedPubMedCentral Bjerkeset E, Röhrl K, Schou-Bredal I (2020) Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: prevalence and characteristics. Breast Cancer Res Treat 180(1):63–71CrossRefPubMedPubMedCentral
16.
go back to reference Grant SJ et al (2021) Characteristics and symptom burden of patients accessing acupuncture services at a cancer hospital. Integr Cancer Ther 20:15347354211002252CrossRefPubMedPubMedCentral Grant SJ et al (2021) Characteristics and symptom burden of patients accessing acupuncture services at a cancer hospital. Integr Cancer Ther 20:15347354211002252CrossRefPubMedPubMedCentral
18.
go back to reference Sheikh-Wu SF (2020) Interventions for managing a symptom cluster of pain, fatigue, and sleep disturbances during cancer survivorship: a systematic review. Oncol Nurs Forum 47(4):E107–E119CrossRefPubMed Sheikh-Wu SF (2020) Interventions for managing a symptom cluster of pain, fatigue, and sleep disturbances during cancer survivorship: a systematic review. Oncol Nurs Forum 47(4):E107–E119CrossRefPubMed
19.
go back to reference Lyman GH et al (2018) Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. J Clin Oncol 36(25):2647–2655CrossRefPubMed Lyman GH et al (2018) Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. J Clin Oncol 36(25):2647–2655CrossRefPubMed
21.
go back to reference Zia FZ, Olaku O, Bao T, Berger A, Deng G, Fan AY, Garcia MK, Herman PM, Kaptchuk TJ, Ladas EJ, Langevin HM, Lao L, Lu W, Napadow V, Niemtzow RC, Vickers AJ, Shelley Wang X, Witt CM, Mao JJ (2017) The National cancer institute's conference on acupuncture for symptom management in oncology: State of the science, evidence, and research gaps. J Natl Cancer Inst Monogr 2017(52):lgx005. https://doi.org/10.1093/jncimonographs/lgx005 Zia FZ, Olaku O, Bao T, Berger A, Deng G, Fan AY, Garcia MK, Herman PM, Kaptchuk TJ, Ladas EJ, Langevin HM, Lao L, Lu W, Napadow V, Niemtzow RC, Vickers AJ, Shelley Wang X, Witt CM, Mao JJ (2017) The National cancer institute's conference on acupuncture for symptom management in oncology: State of the science, evidence, and research gaps. J Natl Cancer Inst Monogr 2017(52):lgx005. https://​doi.​org/​10.​1093/​jncimonographs/​lgx005
22.
go back to reference Zhou X et al (2014) Clinical phenotype network: the underlying mechanism for personalized diagnosis and treatment of traditional Chinese medicine. Front Med 8:337–346CrossRefPubMed Zhou X et al (2014) Clinical phenotype network: the underlying mechanism for personalized diagnosis and treatment of traditional Chinese medicine. Front Med 8:337–346CrossRefPubMed
23.
go back to reference Jiang M et al (2012) Syndrome differentiation in modern research of traditional Chinese medicine. J Ethnopharmacol 140(3):634–642CrossRefPubMed Jiang M et al (2012) Syndrome differentiation in modern research of traditional Chinese medicine. J Ethnopharmacol 140(3):634–642CrossRefPubMed
24.
go back to reference Li H et al (2021) Acupuncture improves multiple treatment-related symptoms in breast cancer survivors: a systematic review and meta-analysis. J Altern Complement Med Res 27(12):1084–1097CrossRef Li H et al (2021) Acupuncture improves multiple treatment-related symptoms in breast cancer survivors: a systematic review and meta-analysis. J Altern Complement Med Res 27(12):1084–1097CrossRef
25.
go back to reference Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E (2022) Integrative medicine for pain management in oncology: society for integrative oncology-ASCO Guideline. J Clin Oncol 40(34):3998–4024. https://doi.org/10.1200/JCO.22.01357CrossRefPubMed Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E (2022) Integrative medicine for pain management in oncology: society for integrative oncology-ASCO Guideline. J Clin Oncol 40(34):3998–4024. https://​doi.​org/​10.​1200/​JCO.​22.​01357CrossRefPubMed
26.
go back to reference Bao T et al (2020) Effect of acupuncture vs sham procedure on chemotherapy-induced peripheral neuropathy symptoms: a randomized clinical trial. JAMA Netw Open 3(3):e200681–e200681CrossRefPubMedPubMedCentral Bao T et al (2020) Effect of acupuncture vs sham procedure on chemotherapy-induced peripheral neuropathy symptoms: a randomized clinical trial. JAMA Netw Open 3(3):e200681–e200681CrossRefPubMedPubMedCentral
27.
go back to reference Choi TY et al (2022) Acupuncture for managing cancer-related fatigue in breast cancer patients: a systematic review and meta-analysis. Cancers 14(18):4419CrossRefPubMedPubMedCentral Choi TY et al (2022) Acupuncture for managing cancer-related fatigue in breast cancer patients: a systematic review and meta-analysis. Cancers 14(18):4419CrossRefPubMedPubMedCentral
28.
go back to reference Lee B et al (2022) Electroacupuncture for treating cancer-related insomnia: a multicenter, assessor-blinded, randomized controlled, pilot clinical trial. BMC Complement Med Ther 22(1):1–13CrossRef Lee B et al (2022) Electroacupuncture for treating cancer-related insomnia: a multicenter, assessor-blinded, randomized controlled, pilot clinical trial. BMC Complement Med Ther 22(1):1–13CrossRef
29.
go back to reference Hui D et al (2015) Minimal clinically important differences in the Edmonton Symptom Assessment Scale in cancer patients: a prospective, multicenter study. Cancer 121(17):3027–3035CrossRefPubMed Hui D et al (2015) Minimal clinically important differences in the Edmonton Symptom Assessment Scale in cancer patients: a prospective, multicenter study. Cancer 121(17):3027–3035CrossRefPubMed
30.
go back to reference Hui D, Bruera E (2017) The Edmonton Symptom Assessment System 25 years later: past, present, and future developments. J Pain Symptom Manag 53(3):630–643CrossRef Hui D, Bruera E (2017) The Edmonton Symptom Assessment System 25 years later: past, present, and future developments. J Pain Symptom Manag 53(3):630–643CrossRef
31.
go back to reference Deadman P, Al-Khafaji M, Baker K (2016) A manual of acupuncture. East Sussex, England: Journal Of Chinese Medicine Publications; Vista, California Deadman P, Al-Khafaji M, Baker K (2016) A manual of acupuncture. East Sussex, England: Journal Of Chinese Medicine Publications; Vista, California
32.
go back to reference Xia X (2013) Introduction to Chinese internal medicine. Vol. 4. World Scientific Xia X (2013) Introduction to Chinese internal medicine. Vol. 4. World Scientific
33.
go back to reference Weiner BJ et al (2017) Psychometric assessment of three newly developed implementation outcome measures. Implement Sci 12(1):1–12CrossRef Weiner BJ et al (2017) Psychometric assessment of three newly developed implementation outcome measures. Implement Sci 12(1):1–12CrossRef
34.
go back to reference Yee J et al (2019) Physical activity for symptom management in women with metastatic breast cancer: a randomized feasibility trial on physical activity and breast metastases. J Pain Symptom Manage 58(6):929–939CrossRefPubMed Yee J et al (2019) Physical activity for symptom management in women with metastatic breast cancer: a randomized feasibility trial on physical activity and breast metastases. J Pain Symptom Manage 58(6):929–939CrossRefPubMed
36.
go back to reference Julious SA (2005) Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat J Appl Stat Pharm Ind 4(4):287–291 Julious SA (2005) Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat J Appl Stat Pharm Ind 4(4):287–291
37.
go back to reference Lancaster GA, Dodd S, Williamson PR (2004) Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract 10(2):307–312CrossRefPubMed Lancaster GA, Dodd S, Williamson PR (2004) Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract 10(2):307–312CrossRefPubMed
38.
go back to reference Liou KT, Mao JJ (2020) Moving the needle: promoting the research, dissemination, and implementation of oncology acupuncture. J Altern Complement Med Res 26(2):85–87CrossRef Liou KT, Mao JJ (2020) Moving the needle: promoting the research, dissemination, and implementation of oncology acupuncture. J Altern Complement Med Res 26(2):85–87CrossRef
39.
go back to reference Hughes J et al (2018) Ensuring model validity in a feasibility study of acupuncture to improve quality of life in cancer patients undergoing radiotherapy treatment. Eur J Integr Med 21:50–52CrossRef Hughes J et al (2018) Ensuring model validity in a feasibility study of acupuncture to improve quality of life in cancer patients undergoing radiotherapy treatment. Eur J Integr Med 21:50–52CrossRef
41.
go back to reference Mao JJ et al (2014) Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: a randomized trial. Cancer 120(23):3744–3751CrossRefPubMed Mao JJ et al (2014) Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: a randomized trial. Cancer 120(23):3744–3751CrossRefPubMed
42.
go back to reference Bokmand S, Flyger H (2013) Acupuncture relieves menopausal discomfort in breast cancer patients: a prospective, double blinded, randomized study. Breast 22(3):320–323CrossRefPubMed Bokmand S, Flyger H (2013) Acupuncture relieves menopausal discomfort in breast cancer patients: a prospective, double blinded, randomized study. Breast 22(3):320–323CrossRefPubMed
43.
44.
go back to reference Guo Q et al (2021) Chinese medicine syndromes and stages of early breast cancer: hierarchical cluster analysis and implication for clinical practice. J Alter Complement Med 27(11):904–914CrossRef Guo Q et al (2021) Chinese medicine syndromes and stages of early breast cancer: hierarchical cluster analysis and implication for clinical practice. J Alter Complement Med 27(11):904–914CrossRef
45.
go back to reference So WK et al (2021) Symptom clusters experienced by breast cancer patients at various treatment stages: a systematic review. Cancer Med 10(8):2531–2565CrossRefPubMedPubMedCentral So WK et al (2021) Symptom clusters experienced by breast cancer patients at various treatment stages: a systematic review. Cancer Med 10(8):2531–2565CrossRefPubMedPubMedCentral
Metadata
Title
Acupuncture for the treatment of the pain-fatigue-sleep disturbance-numbness/tingling symptom cluster in breast cancer survivors: a feasibility trial
Authors
Ki Kyung Kwon
Judith Lacey
Kim Kerin-Ayres
Gillian Heller
Suzanne Grant
Publication date
01-06-2024
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 6/2024
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-024-08529-9

Other articles of this Issue 6/2024

Supportive Care in Cancer 6/2024 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine