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Acupuncture Compared To Placebo Acupuncture in Radiotherapy-induced Nausea: a Randomized Controlled Study
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science.
Department of Oncology, University Hospital, Lund, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institute, Stockholm, Sweden.
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2012 (English)In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 23, no 5, p. 1353-1361Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate if verum (real) acupuncture is effective against nausea and vomiting during radiotherapy.

PATIENTS AND METHODS: We randomised blinded cancer patients to verum; penetrating “deqi” creating acupuncture (n=109) in the antiemetic acupuncture point PC6 (three cm above the wrist), or sham (n=106) with a non-penetrating sham needle at a non-acupuncture point six cm above the wrist 2-3 times/week. The patients daily during the radiotherapy period documented nausea and vomiting. Primary endpoint was number of patients with at least one episode of nausea during the whole radiotherapy period. RESULTS: Data was provided by 205 patients (95 %). In the verum acupuncture group, 70 % experienced nausea at least once during the radiotherapy period (p=0.12 compared to the sham group) (mean number of days of 10.1), 25 % vomited and 42 % used antiemetic drugs at least once. In the sham group 62 % experienced nausea (mean number of days 8.7), 28 % vomited and 37 % consumed antiemetic drugs. Ninety five percent in the verum and 96 % in the sham acupuncture group believed that the treatment had been effective against nausea. In both groups 67 % experienced positive effects on relaxation, mood, sleep or pain-reduction, and 89 % wished to receive the treatment again.

CONCLUSION: Acupuncture creating deqi is not more effective than sham in radiotherapy-induced nausea, but in this study nearly all patients in both groups experienced that the treatment was effective for nausea.

Place, publisher, year, edition, pages
2012. Vol. 23, no 5, p. 1353-1361
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-17235DOI: 10.1093/annonc/mdr402ISI: 000303336400040OAI: oai:DiVA.org:liu-17235DiVA, id: diva2:207683
Note

funding agencies|Swedish Cancer Society| 04 0483 |Swedish Institute for Health Sciences (the Vardal institute)||County Council of Ostergotland| LIO-4998 2005-279-83 LIO-4762 LIO-7433 LIO-10456 LIO-20071 |University of Linkoping| C 40111 |Vardal Foundation-for Health Care Sciences and Allergy Research||Ostgota Cancer Fund||

Available from: 2009-03-12 Created: 2009-03-12 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Nausea and vomiting in patients receiving acupuncture, sham acupuncture or standard care during radiotherapy
Open this publication in new window or tab >>Nausea and vomiting in patients receiving acupuncture, sham acupuncture or standard care during radiotherapy
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aim: Many patients with cancer experience emesis (nausea and vomiting) during radiotherapy. The overall aim of this thesis was to improve the situation for patients with risk for emesis during radiotherapy, by evaluating emesis in patients receiving verum (genuine) acupuncture, sham (simulated) acupuncture or standard care during radiotherapy.

Methods: In study I, a cross-sectional sample (n=368) treated with radiotherapy over various fields answered a study-specific questionnaire. In study II, 80 healthy volunteers were randomized to receive needling with verum acupuncture or non-penetrating telescopic sham needles by one of four physiotherapists. In study III, 215 patients were randomly allocated to verum (n=109) or non-penetrating telescopic sham (n=106) acupuncture during their entire radiotherapy period over abdominal or pelvic fields. The same 215 patients were also included in study IV. They were compared to 62 patients irradiated over abdominal or pelvic fields, selected from study I.

Results: In study I, the weekly prevalence of nausea was 39 % in all radiotherapy-treated patients and 63 % in abdominal or pelvic irradiated patients. Age younger than 40 years and previous experience of nausea in other situations were characteristics associated with an increased risk for nausea. Of the 145 nauseous patients, 34 % considered their antiemetic treatment as insufficient. Patients with nausea reported lower level of quality of life compared to patients free from nausea. In study II, most individuals needled with verum (68 %) or sham (68 %) acupuncture could not identify needling type, and that blinding result varied from 55 to 80 % between the four therapists. In study III, nausea was experienced by 70 % (mean number of days=10.1) and 25 % vomited during the radiotherapy period. In the sham group 62 % experienced nausea (mean number of days=8.7) and 28 % vomited. Ninety five percent in the verum and 96 % in the sham group believed that the treatment had been effective for nausea. In both groups, 67 % experienced other positive effects, on relaxation, mood, sleep or pain-reduction, and 89 % were interested in receiving the treatment again. In study IV, the weekly prevalence of nausea and vomiting was 38 and 8 % in the verum group, 37 and 7 % in the sham group and 63 and 15 % in the standard care group. The nausea difference between the acupuncture and the standard care cohort was statistically significant, also after overall adjustments for potential confounding factors. The nausea intensity in the acupuncture cohort was lower compared to the standard care cohort (p=0.002). Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (Relative risk 1.6).

Conclusions and implications: Nausea was common during abdominal or pelvic field irradiation in patients receiving standard care. Verum acupuncture did not reduce emesis compared to sham acupuncture, while reduced emesis was seen in both patients treated with verum or sham acupuncture. Health-care professionals may consider identifying and treating patients with increased risk for nausea in advance. The telescopic sham needle was credible. Researchers may thus use and standardize the sham procedure in acupuncture control groups. The choice of performing acupuncture during radiotherapy cannot be based on arguments that the specific characters of verum acupuncture have effects on nausea. It is important to further study what components in the acupuncture procedures that produce the dramatic positive but yet not fully understood antiemetic effect, making it possible to use those components to further increase quality of care during radiotherapy.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2008. p. 69
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1088
Keywords
Acupuncture, Cancer, Emesis, Placebo, Radiotherapy
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17237 (URN)978-91-7393-754-2 (ISBN)
Public defence
2008-12-05, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2009-03-12 Created: 2009-03-12 Last updated: 2020-03-29Bibliographically approved

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Enblom, AnnaHammar, MatsBörjeson, Sussanne

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