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acupuncture:evaluation:oncologie:04. neuropathie peripherique induite par chimiotherapie [29 Sep 2024 15:09] Nguyen Johan [1.2.1.1. Zhang 2023] |
acupuncture:evaluation:oncologie:04. neuropathie peripherique induite par chimiotherapie [28 Aug 2025 19:06] (Version actuelle) Nguyen Johan [2. Overviews of Systematic Reviews] |
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| ====== Chemotherapy-Induced Peripheral Neuropathy ====== | ====== Chemotherapy-Induced Peripheral Neuropathy ====== | ||
| - | ====== Neuropathie périphérique induite par chimiothérapie ====== | + | ====== Neuropathie périphérique induite par chimiothérapie : évaluation de l'acupuncture ====== |
| | //Articles connexes//: - [[pharmacopee:evaluation:oncologie:04. neuropathie peripherique induite par chimiotherapie|pharmacopée]] - | | | //Articles connexes//: - [[pharmacopee:evaluation:oncologie:04. neuropathie peripherique induite par chimiotherapie|pharmacopée]] - | | ||
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| ===== Revues systématiques et méta-analyses ===== | ===== Revues systématiques et méta-analyses ===== | ||
| - | ** GRADE certainty of evidence** \\ | ||
| - | |⊕⊕⊕⊕|High|The authors have a lot of confidence that the true effect is similar to the estimated effect | | ||
| - | |⊕⊕⊕⊖|Moderate |The authors believe that the true effect is probably close to the estimated effect| | ||
| - | |⊕⊕⊖⊖|Low|The true effect might be markedly different from the estimated effect| | ||
| - | |⊕⊖⊖⊖|Very low| The true effect is probably markedly different from the estimated effect| | ||
| - | If no GRADE, GERA indicative score | ||
| - | | ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture | | + | ==== Generic Acupuncture ==== |
| - | | ☆☆ | Evidence for effectiveness of acupuncture | | + | |
| - | | ☆ |Limited evidence for effectiveness of acupuncture | | + | |
| - | | Ø |No evidence or insufficient evidence | | + | |
| + | === Zhao 2025 === | ||
| - | ==== Generic Acupuncture ==== | + | Zhao Y, Cao W, Zhang H, Rong Q, He M, Wu M, Zhao Y, Yang P. The efficacy of acupuncture in the treatment of chemotherapy-induced peripheral neuropathy in cancer patients: a systematic review and meta-analysis. J Cancer Surviv. 2025 Aug 19. doi: 10.1007/s11764-025-01869-3 |
| + | ^Purpose|Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect in cancer patients, often emerging within the first month of chemotherapy. Severe CIPN can disrupt daily life, necessitating chemotherapy adjustments or discontinuation, which may increase cancer mortality. No standardized treatment exists, but acupuncture is widely used in China for CIPN.This study aimed to comprehensively assess the actual efficacy of acupuncture in treating CIPN in cancer patients.| | ||
| + | ^Methods| We searched PubMed, Web of Science, Embase, and Cochrane Library up to October 2024 for randomized controlled trials (RCTs) on acupuncture for CIPN, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methodological quality was assessed using the Cochrane risk-of-bias tool (RoB 2.0) and the modified Jadad scale. A random-effects model was used to analyze the Effect Size (ES) and 95% Confidence Interval (CI).Data analysis was performed using RevMan 5.3 software.| | ||
| + | ^Results| The final analysis incorporated** 1,048 patients from 18 studies**. The results presented in the forest plot demonstrated that, when compared to the control group, acupuncture exhibited superior efficacy in improving CIPN symptoms (RR = 1.11, 95%CI [1.01,1.21]), alleviating pain (SMD = -0.93, 95%CI [-1.63,-0.22]), enhancing quality of life (QoL) (MD = - 1.14, 95%CI [- 1.97, - 0.31]), and reducing chemotherapy-related neurotoxicity (MD = - 3.34, 95%CI [- 5.24, - 1.44]). Additionally, in alleviating CIPN-related pain, simple acupuncture demonstrates superior efficacy compared to electroacupuncture.| | ||
| + | ^Conclusion| This study clearly demonstrates that acupuncture offers more substantial benefits to CIPN patients compared to usual care, medication, vitamin, and sham acupuncture. This research serves as a valuable reference for cancer patients, physicians, nurses, and other professional medical practitioners.| | ||
| + | |||
| + | === Li 2024 === | ||
| + | Li L, Huang Y, An C, Jing N, Xu C, Wang X, Li H, Tan T. Acupuncture in the treatment of chemotherapy-induced peripheral neuropathy: a meta-analysis and data mining. Front Neurol. 2024 Oct 29;15:1442841. https://doi.org/10.3389/fneur.2024.1442841. | ||
| + | ^Backgound| The efficacy and acupoint selection of acupuncture in treating chemotherapy-induced peripheral neuropathy (CIPN) remain controversial. This study aims to explore the specific efficacy and acupoint selection of acupuncture in treating CIPN through a meta-analysis and data mining.| | ||
| + | ^Methods| Searching for clinical trials on acupuncture treatment for CIPN in 8 databases, evaluating its efficacy and safety through a meta-analysis, and exploring its acupoint selection through data mining.| | ||
| + | ^Results| The meta-analysis included **21 studies and 2,121 patients**, showing that compared with the control group, the acupuncture group could significantly improve neuropathic pain intensity (SMD = -0.66, 95% CI [-1.07, -0.25], p = 0.002), significantly reduce the NCI-CTCAE (MD = -0.29, 95%CI [-0.50, -0.08], p < 0.01), significantly reduce the FACT-NXT score (MD = 2.09, 95% CI [0.73,3.45], p < 0.05), significantly increase the motor conduction velocities (MCV) of median nerve (MD = 2.38, 95% CI [2.10, 2.67], p < 0.001), the sensory conduction velocities (SCV) of the median nerve (MD = 0.56, 95 %CI [-1.45, 2.57], p = 0.58), the SCV of the tibial nerve (MD = 1.78, 95% CI [0.50, 3.05], p < 0.01), and the SCV of sural nerves (MD = 4.60, 95% CI [0.17, 9.02], p < 0.05), as well as improving the quality of life score (MD =7.35, 95% CI [1.53, 13.18], p = 0.01). Data mining showed that the core acupoints for acupuncture treatment of CIPN were LI4, ST36, LI11, LR3, and SP6.| | ||
| + | ^Conclusion| Acupuncture can improve the neuropathic pain intensity, the intensity of the CIPN, MCV of the median nerve, SCV of the tibial nerve and peroneal nerve, quality of life, and has good safety in CIPN patients. LI4 (Hegu), ST36 (Zusanli), LI11 (Quchi), LR3 (Taichong), and SP6 (Sanyinjiao) are the core acupuncture points for treating CIPN, and this protocol has the potential to become a supplementary treatment for CIPN.¬| | ||
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| ==== Special Acupuncture Techniques ==== | ==== Special Acupuncture Techniques ==== | ||
| === Comparison of Acupuncture techniques === | === Comparison of Acupuncture techniques === | ||
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| + | == Li 2025 == | ||
| + | |||
| + | Li Y, Liu S, Qiao HF. Acupuncture-moxibustion for chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis. World J Acupunct Moxibustion. 2025 Jul;35(3):197-207. https://doi.org/10.1016/j.wjam.2025.06.001. | ||
| + | ^Background| Chemotherapy-induced peripheral neuropathy (CIPN) is a common neurotoxic reaction for patients undergoing anticancer regimens. More and more studies show that acupuncture-moxibustion plays a positive role in the management and prevention of CIPN. | | ||
| + | ^Objective| To evaluate the clinical effect of acupuncture-moxibustion in patients with CIPN, with a focus on assessing its effectiveness on improving treatment response rates, alleviating pain, enhancing quality of life (QoL), and improving nerve conduction. Additionally, the study compares the differences in clinical effectiveness among various acupuncture therapies for CIPN management. | | ||
| + | ^Methods| Six databases (PubMed, Embase, Cochrane Library, Web of Science, OVID, and China National knowledge infrastructure [CNKI]) were searched from earliest available dates to December 1, 2024, and only randomized controlled trials (RCTs) containing relevant search terms were included. Network meta-analysis of the RCT data were conducted to assess the effective rate of the treatment as the primary outcome. Nerve conduction, pain scores, and QoL were assessed as secondary outcomes. The version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to examine methodological quality, and Stata 15.1 was used to take network meta-analysis. | | ||
| + | ^Results| A total of **34 RCTs involving 2039 participants** and 9 acupuncture-moxibustion therapies were included. The network meta-analysis evaluated the effect of different acupuncture therapies across four outcomes: effective rate, pain scores, QoL, and nerve conduction. For effective rate, electroacupuncture combined with moxibustion ranked first with a surface under the cumulative ranking curve (SUCRA) value of 62.9 %, followed by acupoint application (56.9 %) and moxibustion (52.3 %). Electroacupuncture combined with moxibustion had the highest effective rate compared to standard of care treatments (odds ratio [OR] = 1.62, 95 % confidence interval [CI] −5.18 to 8.43). For alleviating pain, auricular acupressure had the highest SUCRA value (85.9 %), while electroacupuncture and electroacupuncture combined with three-edged needle ranked second (63.4 %) and third (51.0 %), respectively. Auricular acupressure significantly reduced pain (SMD= −1.73, 95 % CI −3.54 to 0.08). For QoL, warming needle ranked first (SUCRA= 92.0 %), followed by electroacupuncture (48.7 %) and filiform needle (43.0 %). Warming needle significantly improved QoL scores (SMD= −0.75, 95 % CI −1.66 to 0.15). For nerve conduction, electroacupuncture combined with three-edged needle had the highest SUCRA value (100 %), while moxibustion and filiform needle ranked second (65.3 %) and third (39.2 %), respectively. Electroacupuncture combined with three-edged had the best neuroprotective effect (SMD = 1.85, 95 % CI 1.23 to 2.47). | | ||
| + | ^Conclusion| Network meta-analysis based on the primary outcome (effective rate) suggests that electroacupuncture combined with moxibustion seems to be the optimal acupuncture therapy for chemotherapy-induced peripheral neuropathy (CIPN). Secondary outcomes exhibited considerable heterogeneity: auricular acupressure demonstrated superior efficacy in pain relief, electroacupuncture combined with three-edged needle showed greater advantages in improving nerve conduction function, while warm needling was associated with more significant improvements in QoL. Given the variability in interventions across different outcome measures and the methodological limitations of included studies, the current evidence requires cautious interpretation| | ||
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| + | == Yeh 2024 == | ||
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| + | |||
| + | Yeh ML, Liao RW, Yeh PH, Lin CJ, Wang YJ. Acupuncture-related interventions improve chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis. BMC Complement Med Ther. 2024 Aug 19;24(1):310. https://doi.org/10.1186/s12906-024-04603-1 | ||
| + | ^Backgound| The previous effects of acupuncture-related interventions in improving chemotherapy-induced peripheral neuropathy (CIPN) symptoms and quality of life (QoL) remain unclear in terms of pairwise comparisons.| | ||
| + | ^Aims| This systematic review and network meta-analysis aimed to determine the hierarchical effects of acupuncture-related interventions on symptoms, pain, and QoL associated with CIPN in cancer patients undergoing chemotherapy.| | ||
| + | ^Methods| Nine electronic databases were searched, including PubMed, Embase, Cochrane Library, EBSCO, Medline Ovid, Airiti Library, China National Knowledge Infrastructure (CNKI), China Journal full-text database (CJFD), and Wanfang. Medical subject heading terms and text words were used to search for eligible randomized controlled trials published from database inception to May 2023.| | ||
| + | ^Results| A total of **33 studies involving 2,027 participants** were included. Pairwise meta-analysis revealed that acupuncture-related interventions were superior to usual care, medication, or dietary supplements in improving CIPN symptoms, CIPN pain, and QoL. Furthermore, network meta-analysis indicated that acupuncture plus electrical stimulation (acupuncture-E) had the greatest overall effect among the various interventions. The surface under the cumulative ranking curve (SUCRA) revealed that acupuncture-E ranked the highest in improving CINP symptoms. Acupuncture alone was most effective in reducing CIPN pain, and acupuncture plus moxibustion (acupuncture-M) ranked highest in enhancing QoL.| | ||
| + | ^Conclusion| This finding suggests that acupuncture-related interventions can provide patients with benefits in improving CIPN symptoms, pain, and QoL. In particular, acupuncture-E could be the most effective approach in which the provided evidence offers diverse options for cancer patients and healthcare professionals.| | ||
| + | ^Implication for the profession and/or patient care| These findings provide valuable insights into the potential benefits of acupuncture-related interventions for managing symptoms, pain, and QoL associated with CIPN in patients undergoing chemotherapy. Among the various interventions studied, overall, acupuncture-E had the most significant impact and was effective for a minimum duration of 3 weeks. On the other hand, transcutaneous electrical acupoint/nerve stimulation (TEAS) was identified as a noninvasive and feasible alternative for patients who had concerns about needles or the risk of bleeding. It is recommended that TEAS interventions should be carried out for a longer period, preferably lasting 4 weeks, to achieve optimal outcomes.| | ||
| == Zhang 2023 == | == Zhang 2023 == | ||
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| - | ===== Overviews of Systematic Reviews ===== | ||
| + | |||
| + | ===== Overviews of systematic reviews ===== | ||
| + | |||
| + | ==== Yeh 2025 ==== | ||
| + | |||
| + | Yeh ML, Hsu CC, Lin M, Lin CJ, Lin JG. Effects of Acupuncture-related Intervention on Chemotherapy-Induced Peripheral Neuropathy and Quality of Life: An Umbrella Review. Complement Ther Med. 2025 Feb 1:103131. https://doi.org/10.1016/j.ctim.2025.103131 | ||
| + | ^Backgound| Numerous studies have explored the role of acupuncture-related treatments in alleviating chemotherapy-induced peripheral neuropathy (CIPN) and improving the quality of life for patients with cancer, resulting in mixed findings. This umbrella review aimed to synthesize existing systematic reviews (SRs) to deliver an updated assessment of the certainty of evidence concerning the effects of acupuncture-related treatments on CIPN and quality of life among a diverse group of patients with cancer.| | ||
| + | ^Methods| This umbrella review considered eligible SRs published on one of nine electronic databases between inception and August 2024. It included adult patients with cancer of any stage who were undergoing chemotherapy. Interventions encompassed acupuncture, either alone or with electrical stimulation or moxibustion, and transcutaneous electrical acupoint/nerve stimulation (TEAS). The outcomes analyzed were changes in CIPN, nerve conduction velocity (NCV), and quality of life.| | ||
| + | ^Results| The outcomes were evaluated using data obtained from **14 SRs** that demonstrated moderate to high methodological and reporting quality. The findings showed that acupuncture (either alone or combined with electrical stimulation) and TEAS effectively alleviated CIPN symptoms, reduced CIPN pain, improved NCV, and enhanced quality of life.| | ||
| + | ^Conclusion| The findings of this umbrella review indicate that these benefits were usually noticeable by the second week of treatment, persisted until the sixth week, and then gradually declined. Sensory nerve recovery occurred more rapidly than motor nerve recovery, often within 1.5 weeks. Although acupuncture combined with moxibustion or acupressure also enhanced patient outcomes, there was insufficient information available for further study analysis.| | ||
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| + | ==== Ye 2025 ==== | ||
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| + | Ye AL, Abdi S. Beyond p-values: a cross-sectional umbrella review of chemotherapy-induced peripheral neuropathy treatments. Front Pain Res (Lausanne). 2025 Mar 19;6:1564662. https://doi.org/10.3389/fpain.2025.1564662 | ||
| + | ^Introduction|Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of neurotoxic chemotherapy agents, significantly impacting the daily lives of many cancer survivors. Despite thousands of articles published on CIPN, we remain no closer to a successful treatment regimen for the condition. In recent years, several new clinical trials and systematic reviews have been published, many exploring nonpharmaceutical interventions, prompting the need for a comprehensive synthesis of this emerging evidence.| | ||
| + | ^Methods| We conducted an umbrella review to identify and appraise the **19 systematic reviews (SRs)** published in 2023 that examined randomized controlled trials (RCTs) for established CIPN treatment. We focused our analysis on the three most researched treatment options: oral drugs, exercise, and acupuncture. RCTs not previously synthesized together were reviewed, and effect size analyses were performed to allow readers to interpret the existing literature beyond binary p-values.| | ||
| + | ^Results| Our analysis of RCTs revealed the following key findings. For cancer survivors with CIPN after completing chemotherapy, serotonin-norepinephrine reuptake inhibitors (SNRIs) as well as **acupuncture** provided at least short-term relief for pain and sensory symptoms. For patients with CIPN who were actively undergoing chemotherapy, home-based balance and strength training exercises appeared to alleviate symptoms. Effect size analyses highlighted variability in treatment responses, underscoring the limitations of relying solely on p-values to assess intervention efficacy.| | ||
| + | ^Discussion|Through an umbrella review approach, we demonstrate that SRs are often less systematic than expected. None of the 19 SRs captured all relevant RCTs within their search timeframe. However, by cross-referencing SRs, we identified 41 RCTs across 42 publications, illustrating the feasibility of an umbrella review approach to uncover relevant trials. Furthermore, many SRs exhibited methodological concerns that limit the interpretability of their findings. Finally, we discuss multiple opportunities for refining methods and reporting in future CIPN treatment trials.| | ||
| ==== Shi 2023 ==== | ==== Shi 2023 ==== | ||
