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Sommaire
Cancer du sein : évaluation de l'acupuncture
| Articles connexes : - évaluation du taiji-qigong - évaluation de la pharmacopée chinoise - bouffées de chaleur chez le patient cancéreux - |
1. Revues systématiques et méta-analyses
| ☆☆☆ | Preuves en faveur d’une efficacité et d’un effet spécifique de l’acupuncture |
| ☆☆ | Preuves en faveur d’une efficacité de l’acupuncture |
| ☆ | Preuves limitées en faveur d’une efficacité de l’acupuncture |
| Ø | Absence de preuve ou preuves insuffisantes |
1.1. Pan 2018
Pan Y, Yang K, Shi X, Liang H, Shen X, Wang R, Ma L, Cui Q, Yu R, Dong Y. Clinical Benefits of Acupuncture for the Reduction of Hormone Therapy-Related Side Effects in Breast Cancer Patients: A Systematic Review. Integr Cancer Ther. 2018;17(3):602-618. [166845].
| Importance | Acupuncture can help reduce unpleasant side effects associated with endocrine therapy for breast cancer. Nevertheless, comprehensive evaluation of current evidence from randomized controlled trials (RCTs) is lacking. |
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| Objective | To estimate the efficacy of acupuncture for the reduction of hormone therapy-related side effects in breast cancer patients. |
| Methods | EVIDENCE REVIEW: RCTs of acupuncture in breast cancer patients that examined reductions in hormone therapy-related side effects were retrieved from PubMed, EMBASE, Web of Science, Ovid MEDLINE, and Cochrane Library databases through April 2016. The quality of the included studies was evaluated according to the 5.2 Cochrane Handbook standards, and CONSORT and STRICTA (Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture) statements. INTERVENTION: Interventions included conventional acupuncture treatment compared with no treatment, placebo, or conventional pharmaceutical medication. Major outcome measures were the alleviation of frequency and symptoms and the presence of hormone therapy-related side effects. |
| Findings/Results | A total of 17 RCTs, including a total of 810 breast cancer patients were examined. The methodological quality of the trials was relatively rigorous in terms of randomization, blinding, and sources of bias. Compared with control therapies, the pooled results suggested that acupuncture had moderate effects in improving stiffness. No significant differences were observed in hot flashes, fatigue, pain, gastrointestinal symptoms, Kupperman index, general well-being, physical well-being, tumor necrosis factor (TNF), and interleukin (IL). |
| Conclusions | Acupuncture therapy appears to be potentially useful in relieving functional stiffness. However, further large-sample trials with evidence-based design are still needed to confirm these findings. |
1.2. Kim 2018
Kim TH, Kang JW, Lee MS. Current evidence of acupuncture for symptoms related to breast cancer survivors: A PRISMA-compliant systematic review of clinical studies in Korea. Medicine (Baltimore). 2018;97(32). [168683].
| Background | Breast cancer survivors experience various symptoms associated with their cancer interventions, and the benefits of acupuncture for these symptoms have been evaluated in clinical trials worldwide. The purpose of this review was to discuss the current status of clinical research regarding the use of acupuncture as a part of traditional Korean medicine (KM) for various symptoms associated with breast cancer therapies. |
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| Methods | We conducted a systematic review of the literature regarding the use of acupuncture as a part of traditional KM to treat symptoms associated with breast cancer therapies. The following databases were searched for content up to February 2017: MEDLINE, EMBASE, the Cochrane library, 4 Korean databases, and conference proceedings from major Korean medical societies. |
| Results | Among the 1228 identified articles, 8 observational studies (3 case series and 5 case reports), and 1 randomized controlled trial (RCT) were included in this review. Among these studies, 3 investigated lymphedema, 2 investigated chemotherapy-induced peripheral neuropathy, 1 investigated hot flushes, 1 investigated constipation, and 2 investigated miscellaneous symptoms in breast cancer survivors; all studies concluded that acupuncture can alleviate the symptom in question. However, we identified only 1 relevant RCT, and the included studies had limitations in terms of reporting quality. |
| Conclusion | There is a lack of conclusive evidence regarding the benefits of acupuncture for the treatment of breast cancer survivors in Korea. More rigorous RCTs are necessary in the future to establish stronger clinical evidence regarding the use of acupuncture to better reflect the clinical context of Korea. |
1.3. Lee 2016 ☆
Lee PL, Tam KW, Yeh ML, Wu WW. Acupoint stimulation, massage therapy and expressive writing for breast cancer: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. 2016;:87-101. [186757].
| OBJECTIVE | A systematic review and meta-analysis were conducted to determine the effects on the quality of life, negative emotions and disease-related symptoms among women with breast cancer. |
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| METHODS | Two independent researchers performed a structured search using data sources including MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, PubMed and PsychINFO from the beginning of time until the first week of January 2015. A total of 23 acupoint stimulation, massage therapy and expressive writing RCTs were included in the review. |
| RESULTS | The study showed that no single intervention could be put under the spotlight exhibiting an overall effective result on all measured outcomes; however, looking into each one in detail shows different results in specific outcomes. Among the three interventions, acupoint stimulation has a treatment effect for general pain (MD=-1.46, 95% CI=-2.38 to -0.53) and fatigue (MD=-2.22, 95% CI=-3.68 to -0.77), massage therapy has a treatment effect for anxiety (MD=-0.50, 95% CI=-0.77 to -0.24), and expressive writing has a treatment effect for quality of life (MD=7.18, 95% CI=0.38 to 13.98). The measurement other outcomes showed either ineffective or equivocal results. |
| CONCLUSION | Non-pharmacologic interventions including acupoint stimulation, massage therapy and expressive writing have an effect on a middle-age woman with breast cancer. However, because of limitations, the seemingly promising results should be interpreted with caution. |
1.4. Dos Santos 2010
Dos Santos S, Hill N, Morgan A, Smith J, Thai C, Cheifetz O. Acupuncture for treating common side effects associated with breast cancer treatment: a systematic review. Medical Acupuncture. 2010; 22(2): 81-97. [146883].
| Background | Although breast cancer treatment is associated with improved survival rates, it is also associated with numerous side effects, which can decrease overall quality of life for patients. Recent research indicates acupuncture may be useful in decreasing the incidence and duration of some side effects associated with cancer treatment. |
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| Objective | To assess the evidence surrounding the role of acupuncture in treating side effects associated with breast cancer treatment. Design: Systematic review based on search of PubMed, EMBASE (1996 to 2009 week 17), AMED (1985 to April 2009), and Ovid MEDLINE (1996 to April 2009) databases for relevant studies published up to April 2009. Authors of recent studies were contacted to determine if additional studies were taking place. Fourteen articles were independently appraised by 4 blinded reviewers. |
| Results | Twelve studies met inclusion criteria: 9 investigated effects of traditional acupuncture and 3 addressed electroacupuncture. Seven different side effects were examined (hot flashes, fatigue, pain, dyspnea, psychological well-being, decreased range of motion with lymphedema, and emesis). The findings support the potential use of traditional acupuncture to decrease hot flashes, fatigue, and pain, whereas electroacupuncture may be useful in treating emesis and hot flashes. There is a paucity of high-quality evidence to support the use of acupuncture to treat dyspnea, emesis, and decreased range of motion with lymphedema or to improve psychological well-being. |
| Conclusion | Current evidence suggests that traditional acupuncture may be useful in reducing hot flashes, fatigue, and pain, whereas electroacupuncture may be useful in treating emesis and hot flashes. Due to limitations in study designs and heterogeneity in treatment protocols, results should be viewed with caution and combined with clinical reasoning. |
1.5. Chao 2009
Chao LF, Zhang AL, Liu HE, Cheng MH, Lam HB, Lo SK. The Efficacy of Acupoint Stimulation for the Management of Therapy-Related Adverse Events in Patients with Breast Cancer: A Systematic Review. Breast Cancer Res Treat. 2009;118(2):255-67. [159367]
| Objectifs | The aim of the present study was to scrutinize the evidence on the use of acupoint stimulation for managing therapy-related adverse events in breast cancer. |
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| Méthodes | A comprehensive search was conducted on eight English and Chinese databases to identify clinical trials designed to examine the efficacy of acupressure, acupuncture, or acupoint stimulation (APS) for the management of adverse events due to treatments of breast cancer. Methodological quality of the trials was assessed using a modified Jadad scale. |
| Résultats | Using pre-determined keywords, 843 possibly relevant titles were identified. Eventually 26 papers, 18 in English and eight in Chinese, satisfied the inclusion criteria and entered the quality assessment stage. The 26 articles were published between 1999 and 2008. They assessed the application of acupoint stimulation on six disparate conditions related to anticancer therapies including vasomotor syndrome, chemotherapy-induced nausea and vomiting, lymphedema, post-operation pain, aromatase inhibitors-related joint pain and leukopenia. Modalities of acupoint stimulation used included traditional acupuncture, acupressure, electroacupuncture, and the use of magnetic device on acupuncture points. Overall, 23 trials (88%) reported positive outcomes on at least one of the conditions examined. However, only nine trials (35%) were of high quality; they had a modified Jadad score of 3 or above. Three high quality trials revealed that acupoint stimulation on P6 (NeiGuang) was beneficial to chemotherapy-induced nausea and vomiting. For other adverse events, the quality of many of the trials identified was poor; no conclusive remarks can be made. Very few minor adverse events were observed, and only in five trials. |
| Conclusion | APS, in particular acupressure on the P6 acupoint, appears beneficial in the management of chemotherapy-induced nausea and vomiting, especially in the acute phase. More well-designed trials using rigorous methodology are required to evaluate the effectiveness of acupoint stimulation interventions on managing other distress symptoms. |
2. Recommandation de bonne pratique
| ⊕ recommandation positive (quel que soit le niveau de preuve annoncé) Ø recommandation négative (ou absence de preuve) |
2.1. National Institute for Health and Clinical Excellence (NICE, UK) 2018 ⊕
Nice CKS Clinical knowledge summaries).. Breast cancer - managing FH; London (UK): National Institute for Health and Clinical Excellence (NICE). 2018:18p. [196020].
| Provide information on non-hormonal and non-pharmacological treatments, such as antidepressants (selective serotonin reuptake inhibitor), vaginal moisturisers and lubricants, cognitive behavioural therapy (CBT), hypnosis, acupuncture, and relaxation techniques, for the management of symptoms. |
2.2. European School of Oncology (ESO) and the European Society for Medical Oncology (ESMO) 2018 ⊕
Cardoso F, Senkus E, Costa A, Papadopoulos E, Aapro M, André F et al. 4th ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4)†. Ann Oncol. 2018;29(8):1634-57. [196973].
| Acupuncture may help against induced nausea and vomiting, fatigue and hot flashes; |
2.3. Spanish Society of Medical Oncology (SEOM, Spain) 2018 ⊕
Barnadas A, Algara M, Cordoba O, Casas A, Gonzalez M, Marzo M, Montero A, Muñoz M, Ruiz A, Santolaya F, Fernandez T. Recommendations for the follow-up care of female breast cancer survivors: a guideline of the Spanish Society of Medical Oncology (SEOM), Spanish Society of General Medicine (SEMERGEN), Spanish Society for Family and Community Medicine (SEMFYC) et al. Clin Transl Oncol. 2018;20(6):687-694. [175865].
| Hot flashes secondary to menopause: Acupuncture has demonstrated efficacy. Joint pain: Acupuncture can be beneficial. |
2.4. Cancer Australia (CA, Australia) 2016
Management of menopausal symptoms in women with a history of breast cancer. Cancer Australia. 2016. [115384].
| - Acupuncture and electro-acupuncture can be considered for the management of moderate to severe vasomotor symptoms in women with a history of breast cancer noting there is inconsistent evidence regarding their effectiveness (grade D). Limited evidence of an inconsistent effect of acupuncture on the frequency and severity of hot flushes, Limited evidence for an inconsistent effect on vasomotor symptoms with acupuncture. - Acupuncture can be considered for the management of sleep disturbance in women with a history of breast cancer (grade C) ; Limited evidence that acupuncture improves sleep. - Vulvovaginal Symptoms and Sexual function. No evidence. - Breast cancer recurrence. Not reported |
2.5. Alberta Health Services (AHS, Canada) 2015 Ø
Follow-up care for early-stage breast cancer. Clinical Practice Guideline. Alberta Health Services. 2015. 29P. [177969].
| Peripheral Neuropathy. Other alternative treatment modalities, such as acupuncture, capsaicin cream, alpha-lipoic acid, and biofeedback have been used to manage the symptoms of peripheral neuropathy; however, these methods have not been tested rigorously. |
2.6. Society for Integrative Oncology (SIO, USA) 2014 ⊕
Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, Mumber M, Perlmutter J, Seely D, Sen A, Zick SM, Tripathy D; Society for Integrative Oncology. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. 2014;50:346-58. [167074].
| Anxiety/stress reduction. Recommendations: Acupuncture can be considered for reducing anxiety in fatigued BC patients. Strength of evidence: C Depression/mood. Recommendations: Acupuncture can be considered for improving mood in postmenopausal women experiencing hot flashes or fatigue. Strength of evidence: C Fatigue. Recommendations: Acupuncture can be considered for the treatment of fatigue after the completion of cancer treatments. Strength of evidence: C Quality of life and physical functioning. Recommendations: Acupuncture can be considered for improving quality of life among cancer patients. Strength of evidence: C CINV. Recommendations: Acupressure can be considered for BC patients receiving CT as an addition to antiemetics to help control nausea and vomiting during CT. Electroacupuncture can be considered for BC patients as an addition to antiemetics to control vomiting during CT Strength of evidence: B Pain. Recommendations: Acupuncture can be considered as a nonpharmacologic approach to the short-term treatment of AIMSS. Electroacupuncture can be considered as a nonpharmacologic approach to the short-term treatment of AIMSS. Strength of evidence: C Hot flashes. Recommendations: Acupuncture can be considered for decreasing the number of hot flashes in BC patients. Electroacupuncture can be considered for decreasing the number of hot flashes in BC patients. Strength of evidence: C |
