New findings from the phase II ENHANCE clinical trial indicate that both real and sham acupuncture improve breast cancer survivors’ perceived cognitive impairment more effectively than usual care alone, while real acupuncture improves objective measures of cognitive performance better than sham acupuncture. The results were presented at the 2025 San Antonio Breast Cancer Symposium (Abstract GS3-04) by Jun J. Mao, MD, MSCE, of Memorial Sloan Kettering Cancer Center.
Jun J. Mao, MD, MSCE
Background and Study Details
According to the study authors, almost half of all breast cancer survivors experience cancer-related cognitive challenges, sometimes termed “brain fog” or “chemo brain,” which can negatively impact quality of life. However, very few treatments have been proven effective in addressing these challenges.
In a previous trial, researchers had observed that acupuncture improved insomnia and its associated cognitive effects among breast cancer survivors. Building on these results, they designed a three-arm study to compare real acupuncture to sham acupuncture (which mimics the experience of real acupuncture, but the needles do not penetrate the skin) vs usual care.
The importance of evaluating both types of acupuncture was explained by Dr. Mao: “Acupuncture should be seen as a complex intervention that involves both the needling and the care being delivered. Just believing you’re receiving a helpful treatment and engaging in relaxation by lying down for 20–30 minutes can have potential therapeutic benefits even if the needles aren’t inserted or aren’t placed in specific therapeutic points. By comparing real acupuncture to sham acupuncture, and not just to usual care, we were able to better understand whether the benefits were due to the acupuncture technique itself or to the overall experience.”
The trial enrolled 260 women (mean age = 56.6 years) with stage 0 to III breast cancer who had completed breast cancer treatment and reported moderate or greater cognitive difficulties and insomnia. Participants were randomly assigned 2:1:1 to receive real acupuncture (n = 129), sham acupuncture (n = 70), or usual care (n = 61). Treatments were administered weekly for 10 weeks, with cognitive function assessed at baseline, 10 weeks, and 26 weeks using both patient-reported and standardized neurocognitive tools.
Results
By week 10, perceived cognitive impairment—as measured by the Functional Assessment of Cancer Therapy–Cognitive Function—improved by 10.3 points in the real acupuncture group and 10.5 points in the sham group, compared with a 4.8-point improvement with usual care. These improvements were sustained at week 26 for both acupuncture groups.
Objective cognitive function was assessed using the Hopkins Verbal Learning Test–Revised. While sham acupuncture did not improve objective scores, real acupuncture produced a statistically significant improvement at week 10, surpassing sham acupuncture by four points. Among the subset of patients who had documented baseline objective impairment, real acupuncture showed a promising trend toward better memory outcomes compared with both sham acupuncture and usual care.
Adverse events were minimal and occurred only in the real acupuncture arm, with mild bruising reported in 3.1% of participants. The study also affirmed a strong link between sleep quality and cognitive performance, as insomnia and sleep fragmentation correlated with poorer scores on objective cognitive measures.
Conclusions
According to Dr. Mao, these results suggest that acupuncture—either as a structured therapeutic experience or through specific needling effects—may provide a nonpharmacologic option for breast cancer survivors struggling with cognitive symptoms.
“Cognitive difficulties for women with breast cancer are complex and involve finding ways to address both the distress associated with perceived cognitive abilities as well as objective function. While this trial showed that acupuncture’s ability to improve a patient’s perceived cognitive difficulty is likely due to the process of receiving acupuncture care rather than specific needling techniques, it is still reasonable for women with breast cancer to try a course of acupuncture to see if it can help improve their sense of cognitive difficulty,” he stated.
Disclosure: The study was funded by the National Cancer Institute and the National Institutes of Health’s Cancer Center Support Grant. For full disclosures of the study authors, visit sabcs.org.
