Acupuncture Provides Significant Quality-of-Life Improvements Among Breast Cancer Patients With Aromatase Inhibitor–Related Joint Pain


Key Points

  • Roughly 50% of patients taking aromatase inhibitors report joint pain, which can lead to fatigue, anxiety, depression, and sleep disturbances that ultimately may cause premature discontinuation of the drug.
  • Use of electroacupuncture significantly reduced fatigue, anxiety, and depression in patients with early-stage breast cancer experiencing aromatase inhibitor–related joint pain.
  • The effects were seen as early as week 8 of treatment and persisted for at least 4 weeks following treatment.

Use of electroacupuncture—a form of acupuncture where a small electric current is passed between pairs of acupuncture needles—produces significant improvements in fatigue, anxiety, and depression in as little as 8 weeks for early-stage breast cancer patients experiencing joint pain related to the use of aromatase inhibitors to treat breast cancer. The results of a randomized, placebo-controlled trial examining the intervention led by researchers at the Perelman School of Medicine at the University of Pennsylvania were published in Cancer. The study is the first demonstration of electroacupuncture’s efficacy for both joint pain relief, as well as these other common symptoms.

Common but Serious Side Effect

The results build upon earlier findings reported in November 2013, showing that electroacupuncture can decrease the joint pain reported by roughly 50% of breast cancer patients taking aromatase inhibitors, the most commonly prescribed medications to prevent disease recurrence among postmenopausal women with early-stage, hormone receptor–positive breast cancer.

Despite their efficacy, the joint pain associated with the use of aromatase inhibitors often leads to fatigue, anxiety, depression, and sleep disturbances for these patients, which researchers suggest may cause premature discontinuation of the drug. Previous studies have shown that nearly half of women taking aromatase inhibitors do not complete their recommended course of treatment, and that those who stop taking the drugs or don’t take them as prescribed have a higher chance of dying of both breast cancer and other causes.

“Since many patients experience pain, fatigue, anxiety, and depression simultaneously, our results provide an opportunity to offer patients one treatment that may target multiple symptoms,” said lead author Jun Mao, MD, MSCE, Associate Professor of Family Medicine and Community Health in Penn’s Perelman School of Medicine, who directs the Integrative Oncology program in the Abramson Cancer Center.

Study Details

In the 8-week trial, researchers evaluated the short-term effects and safety of electroacupuncture for aromatase inhibitor–related joint pain and other side effects, compared with sham acupuncture (a nonelectric, placebo acupuncture where the needles are not actually inserted into the skin), and usual care. The study participants, who were all receiving aromatase inhibitor therapy and experiencing joint pain, were randomly assigned to receive electroacupuncture, sham acupuncture, or usual care. Patient-reported experiences of fatigue and psychological distress were measured prior to the study and periodically throughout the duration, with additional follow-up 4 weeks after treatment.

Compared with usual care, patients receiving electroacupuncture had a greater reduction in the fatigue score at week 8 and the effect was maintained at week 12. On average, patients reported a 2.0 point reduction in fatigue on the Brief Fatigue Inventory, an instrument designed to assess fatigue severity on a numerical scale ranging from 0 to 10.

By week 12, patients receiving electroacupuncture reported a significant improvement in their anxiety score, whereas patients receiving sham acupuncture did not. On average, patients in the electroacupuncture group reported a 2.2 point reduction in anxiety on the Hospital Anxiety and Depression Scale (HADS) compared to the usual-care group.

Patients in both electroacupuncture and sham acupuncture groups reported a significant improvement in HADS-Depression scores (2.4 points and 2.0 points, respectively) compared with the usual-care group by week 8. The effects of both electroacupuncture and sham acupuncture on depression were maintained at week 12.

“Our study provides a novel understanding of how fatigue, sleep, and psychological distress relate to pain in patients with aromatase inhibitor–related joint pain. More importantly, we found that acupuncture helped reduce these symptoms and the effects persisted for at least 4 weeks following treatment,” said Dr. Mao. “There is a small but growing body of literature showing that acupuncture is effective for the management of pain, fatigue, anxiety and depression. However, studies with larger sample sizes and longer follow-up periods are needed to provide more in-depth knowledge about how these treatments, combined with usual care, are improving quality of life for our patients.”

Dr. Mao is the corresponding author for the Cancer article.

The study was supported with grants from the National Institutes of Health.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.