Acupuncture-Point Stimulation for Chemotherapy-Induced Nausea and Vomiting [Ezzo J, Vickers A et al. J Clin Oncol 2005; 28: 7188–7199

Abstract

PurposeAssess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting incancer patients. Materials and MethodsRandomized trials of acupuncture-point stimulation by needles, electricalstimulation, magnets, or acupressure were retrieved. Data were provided by investigators of the original trials and pooled using a fixed-effects model. ResultsEleven trials (N 1,247) were pooled. Overall, acupuncture-point stimulation reduced the proportion of acute vomiting (relativerisks [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. ConclusionThis 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 didnot 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.