Background & Aims

Chronic pain affects significant portion of breast cancer patients leading to
poor quality of life. In the context of integrative and complementary practices offered during
and after breast cancer treatment, the American Society of Clinical Oncology (ASCO)
mentions that acupuncture can be offered for the treatment of pain, with a recommendation
grade of C, which indicates benefit for selected patients. Aim: This study aimed to analyze
the evidence on the effects of systemic and/or auricular acupuncture on pain management in
breast cancer patients.

Methods

Systematic review according to PRISMA recommendations, carried out on the following databases: CINAHL, COCHRANE, LILACS, MTCI, PubMed, SCOPUS, Web of Science, published between 2010 and August 2022. The GRADE system was used to classify the articles and the Cochrane Collaboration Risk of Bias Tool was used to analyze the risk of bias. The searches were carried out in August 2022 independently by two authors, and any disagreements found in the extracted data were assessed by a third author. The terms used in the search strategy were descriptors selected from DeCS, MeSH
and CINAHL titles combined using the Boolean operators OR and AND as follows: (“Breast Neoplasms”;) AND (“Acupuncture, Ear”; OR “Acupuncture”; OR “Acupuncture Analgesia”; OR “Acupuncture Therapy”;) AND (“Pain”; OR “Pain Management”; OR “Cancer Pain”). The protocol was registered in the Prospective Register of Ongoing Systematic Reviews (PROSPERO) under number CRD42022328279.

Results

The search retrieved 493 articles, and 4 studies were included in the review. The objectives of the studies ranged from assessing pain and other symptoms in the post-operative context to assessing pain and musculoskeletal symptoms in women taking aromatase inhibitors. With regard to methodological quality, 02 articles had high methodological quality, 01 had moderate quality and 01 had low methodological quality. In the analysis of risk of bias, only one study presented risk of bias in terms of randomization, two studies presented risk of bias when it came to missing results, and one study was classified as uncertain risk of bias in other sources. With regard to pain management, 3 studies showed statistical differences (p=0.001) in pain reduction between the groups that underwent real acupuncture and simulated acupuncture, and only 1 study showed no differences in pain reduction.

Conclusions

The studies in this review showed a potential benefit in the use of acupuncture for pain relief in
breast cancer patients in clinical and surgical scenarios, even in the presence of heterogeneous interventions. However, in some scenarios, such as the maintenance of the effect after intervention, pre-established treatment protocols and simulated acupuncture modalities in the comparison groups, no significant results were found.

References

World Health Organization (WHO). Breast Cancer [Internet]. Genebra; 2021.

Lyman GH, Greenlee H, Bohlke K, et al. Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. J Clin Oncol. 2018;36(25)

Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7)

Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. SystRev. 2015;4:1-9.

Higgins JPT, Thomas J, Chandler J, et al, (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.3 (updated February 2022). Cochrane, 2022.

Balshem H, Helfand M, Schünemann HJ, et al. Grade guidelines: 3 rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401-406.

Presenting Author

Ruan Nilton Rodrigues Melo

Poster Authors

Ruan Melo

Master's Student

University of São Paulo, School of Nursing, São Paulo, SP, Brazil

Lead Author

Nayara de Castro Pereira - Master Student

A.C.Camargo Cancer Center

Lead Author

Lailah Maria Pinto Nunes

National Cancer Institute, HC III, Rio de Janeiro, RJ, Brazil

Lead Author

Topics

  • Evidence, Clinical Trials, Systematic Review, Guidelines, and Implementation Science