Guest Editor’s Note: Chemotherapy-induced peripheral neuropathy is a common and potentially debilitating side effect of neurotoxic chemotherapy. It worsens the quality of life for many cancer survivors, with limited treatment options. In this installment of The ASCO Post’s Integrative Oncology series, Ting Bao, MD, DABMA, MS, summarizes the findings from a recently published randomized clinical trial conducted by her group. The study aimed to investigate the effects of acupuncture on the health-related quality of life of cancer survivors experiencing moderate-to-severe chemotherapy-induced peripheral neuropathy.
Ting Bao, MD, DABMA, MS
Overview
Chemotherapy-induced peripheral neuropathy may cause many symptoms that negatively impact patients’ quality of life, such as paresthesia, hyperalgesia, allodynia, pain, worsened dexterity, and gait disturbance. Current treatments are limited, with suboptimal efficacy and side effects. Acupuncture is a safe, nonpharmacologic practice that has been studied for its potential to reduce symptoms of chemotherapy-induced peripheral neuropathy and improve quality of life.
Acupuncture Trial
We previously reported on our pilot randomized trial (n = 75). Compared with sham acupuncture and usual care, 8 weeks of real acupuncture affected significant improvements in symptoms related to chemotherapy-induced peripheral neuropathy,1 with few side effects. In the current study, we report the health-related quality-of-life outcomes.2
We measured changes in (1) function and quality of life using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity (FACT/GOG-Ntx) questionnaire; (2) anxiety based on the Hospital Anxiety and Depression Scale (HADS); and (3) insomnia using the Insomnia Severity Index (ISI).
We found that both real acupuncture and sham acupuncture affected statistically significant improvements in FACT/GOG-Ntx scores at the end of 8-week treatment when compared with usual care. Whereas real acupuncture improved the scores by an average of 4.02 points (95% confidence interval [CI] = 2.26–5.77), sham acupuncture improved them by 3.24 points (95% CI = 1.44–5.04). There was no change in the usual care arm (–0.15 [95% CI = −2.05 to 1.75]). Even though real acupuncture and sham acupuncture were significantly better than usual care, there was no significant difference between the acupuncture arms in improving FACT/GOG-Ntx.
GUEST EDITOR
Jun J. Mao, MD, MSCE
Our findings are consistent with those of prior acupuncture vs usual care trial, which showed that acupuncture improved FACT/GOG-Ntx by an average of 8.7 points (standard deviation = 8.9).3
In addition, we found that both real acupuncture and sham acupuncture treatments reduced symptoms of anxiety (real acupuncture: −1.05 [95% CI = −2.01 to −0.09]; sham acupuncture: −0.90 [95% CI = −1.88 to 0.08]) when compared with baseline, whereas usual care remained the same (0.17 [95% CI = −0.85 to 1.20]). However, the reductions in the real acupuncture and sham acupuncture arms were not clinically significant, as they did not meet the 1.5 to 1.7 reduction threshold for clinical significance, established by previous studies.4,5 Similarly, the two-point improvement in ISI scores in real and sham acupuncture arms also did not reach the clinically significant change of 8 points.6 These results could be due to the low rates of depression and anxiety in our trial participants, leaving little room for improvement. In addition, these data suggest that the acupuncture protocol we used may be more specific to symptoms of chemotherapy-induced peripheral neuropathy than to anxiety or insomnia.
Study Implications and Limitations
Our study is the first trial of acupuncture for chemotherapy-induced peripheral neuropathy to incorporate a sham control to demonstrate the benefits of acupuncture in improving the symptoms of chemotherapy-induced peripheral neuropathy and health-related quality-of-life outcomes. The lack of significant difference between the real and sham acupuncture arms is suggestive of a possible placebo effect and justifies further study to determine the true benefits of acupuncture in managing the symptoms of chemotherapy-induced peripheral neuropathy and quality of life.
Limitations of our trial include small sample size and short follow-up period, which restrict our ability to delineate the placebo effect and understand the long-term effects of acupuncture on health-related quality-of-life outcomes. A large randomized controlled trial with long-term follow-up is underway to further evaluate the effect of acupuncture in improving the symptoms of chemotherapy-induced peripheral neuropathy and quality of life in patients with chemotherapy-induced peripheral neuropathy (ClinicalTrials.gov identifier NCT04917796).
Recommendations
Our study has shown that acupuncture is a safe, nonpharmacologic therapy with the potential to treat persistent chemotherapy-induced peripheral neuropathy pain and to improve quality of life. Patients with cancer or cancer survivors with persistent moderate-to-severe chemotherapy-induced peripheral neuropathy may benefit from participating in future trials that aim to further the evidence base of acupuncture in improving chemotherapy-induced peripheral neuropathy and overall quality of life.
Dr. Bao is Director of Integrative Breast Oncology at the Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York.
DISCLOSURE: Dr. Bao has been a consultant or advisor to Eisai.
REFERENCES
1. Bao T, Patil S, Chen C, et al: Effect of acupuncture vs sham procedure on chemotherapy-induced peripheral neuropathy symptoms: A randomized clinical trial. JAMA Netw Open 3:e200681, 2020.
2. Bao T, Baser R, Chen C, et al: Health-related quality of life in cancer survivors with chemotherapy-induced peripheral neuropathy: A randomized clinical trial. Oncologist 26:e2070-e2078, 2021.
3. Lu W, Giobbie-Hurder A, Freedman RA, et al: Acupuncture for chemotherapy-induced peripheral neuropathy in breast cancer survivors: A randomized controlled pilot trial. Oncologist 25:310-318, 2020.
4. Puhan MA, Frey M, Büchi S, et al: The minimal important difference of the Hospital Anxiety and Depression Scale in patients with chronic obstructive pulmonary disease. Health Qual Life Outcomes 6:46, 2008.
5. Lemay KR, Tulloch HE, Pipe AL, et al: Establishing the minimal clinically important difference for the Hospital Anxiety and Depression Scale in patients with cardiovascular disease. J Cardiopulm Rehabil Prev 39:E6-E11, 2019.
6. Morin CM, Belleville G, Bélanger L, et al: The Insomnia Severity Index: Psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 34:601-608, 2011.
