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--- acupuncture:evaluation:gyneco-obstetrique:07. cancer du sein [11 Dec 2020 09:06]
Nguyen Johan Replacement automatique de '==== Critère d' par '==== Special outcome ===='
+++ acupuncture:evaluation:gyneco-obstetrique:07. cancer du sein [31 Jan 2024 18:34] (Version actuelle)
Nguyen Johan [1.2.3.1. Kannan 2022]
@@ Ligne 1: / Ligne 1: @@
-====== Cancer du sein : évaluation de l'acupuncture  ======
+/*English:Breast Cancer*/
+====== Breast Cancer ======
+====== Cancer du sein ======
 | //Articles connexes// : - évaluation du [[qigong et taijiquan medical:evaluation:gynecologie-obstetrique:07. cancer du sein|taiji-qigong]] - évaluation de la [[pharmacopee:evaluation:gynecologie-obstetrique:07. cancer du sein|pharmacopée chinoise]] - [[acupuncture:evaluation:oncologie:04. bouffees de chaleur chez le patient cancereux|bouffées de chaleur chez le patient cancéreux]] - |
-===== Revues systématiques et méta-analyses  =====
+ ===== Systematic Reviews and Meta-Analysis =====
 | ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture |
 | ☆☆ | Evidence for effectiveness of acupuncture |
@@ Ligne 10: / Ligne 13: @@
 | Ø |No evidence or insufficient evidence |
-==== Generic Acupuncture ====
+==== Generic Acupuncture  ====
-=== Pan 2020 ===
+=== Chan 2021 ===
+Chan YT, Wang N, Tam CW, Tan HY, Lu Y, So TH, Chau-Leung Yu E, Lao L, Feng Y. Systematic Review with Meta-Analysis: Effectiveness and Safety of Acupuncture as Adjuvant Therapy for Side Effects Management in Drug Therapy-Receiving Breast Cancer Patients. Evid Based Complement Alternat Med. 2021.   [222725]. https://doi.org/10.1155/2021/9949777
+^Objective| To investigate the potential benefits and safety of acupuncture on managing side effects induced by drug therapies in patients with breast cancer using a PRISMA standard systematic review and meta-analysis. |
+^Methods| Published randomised controlled trials from nine databases in English and Chinese language were searched. Trials with a real acupuncture treatment group and a control group with sham acupuncture, no treatment, or waitlist control were included. The primary outcome of this study was the therapeutic effects on five symptoms induced by drug therapies, including gastrointestinal disorder, neuropathy, arthralgia, joint symptoms, and cognitive impairment. The quality of life was assessed as a secondary outcome. The risk of bias of each study was analysed according to the Cochrane Handbook. |
+^Results| **Sixteen randomised controlled trials with 1189 participants** were included in the meta-analysis. The primary outcome and all subgroup analyses showed statistically significant improvements in the management of side effects by real acupuncture. The quality of life of patients has enhanced during the treatment. |
+^Conclusion| Although the number of publications is limited, a clear preliminary conclusion could be drawn by the meta-analysis, suggesting the beneficial adjuvant role of acupuncture in patients with breast cancer who receive drug therapies. No serious adverse events were observed from all the RCTs, and the safety of acupuncture is ascertained. More standardised and sophisticated large-scale randomised controlled trials are needed to evaluate the findings further.|
+=== Zhang 2021 ===
+Zhang Y, Sun Y, Li D, Liu X, Fang C, Yang C, Luo T, Lu H, Li H, Zhang H, Liang Q, Wu J, Huang L, Xu R, Ren L, Chen Q. Acupuncture for Breast Cancer: A Systematic Review and Meta-Analysis of Patient-Reported Outcomes. Front Oncol. 2021. [219482].
+ [[https://doi.org/10.3389/fonc.2021.646315|doi]]
+^Objective| The present systematic review and meta-analysis was undertaken to evaluate the effects of acupuncture in women with breast cancer (BC), focusing on patient-reported outcomes (PROs). |
+^Methods|A comprehensive literature search was carried out for randomized controlled trials (RCTs) reporting PROs in BC patients with treatment-related symptoms after undergoing acupuncture for at least four weeks. Literature screening, data extraction, and risk bias assessment were independently carried out by two researchers. |
+^Results|Out of the 2, 524 identified studies, **29 studies** representing 33 articles were included in this meta-analysis. At the end of treatment (EOT), the acupuncture patients' quality of life (QoL) was measured by the QLQ-C30 QoL subscale, the Functional Assessment of Cancer Therapy-Endocrine Symptoms (FACT-ES), the Functional Assessment of Cancer Therapy-General/Breast (FACT-G/B), and the Menopause-Specific Quality of Life Questionnaire (MENQOL), which depicted a significant improvement. The use of acupuncture in BC patients lead to a considerable reduction in the scores of all subscales of the Brief Pain Inventory-Short Form (BPI-SF) and Visual Analog Scale (VAS) measuring pain. Moreover, patients treated with acupuncture were more likely to experience improvements in hot flashes scores, fatigue, sleep disturbance, and anxiety compared to those in the control group, while the improvements in depression were comparable across both groups. Long-term follow-up results were similar to the EOT results. |
+^Conclusions| Current evidence suggests that acupuncture might improve BC treatment-related symptoms measured with PROs including QoL, pain, fatigue, hot flashes, sleep disturbance and anxiety. However, a number of included studies report limited amounts of certain subgroup settings, thus more rigorous, well-designed and larger RCTs are needed to confirm our results. |
+=== Jang 2020 ===
+Jang S, Ko Y, Sasaki Y, Park S, Jo J, Kang NH, Yoo ES, Park NC, Cho SH, Jang H, Jang BH, Hwang DS, Ko SG. Acupuncture as an adjuvant therapy for management of treatment-related symptoms in breast cancer patients: Systematic review and meta-analysis (PRISMA-compliant). Medicine (Baltimore). 2020;99(50).   {{:medias securises:acupuncture:evaluation:gyneco-obstetrique:jang-216086.pdf|[216086]}}. [[https://doi.org/10.1097/md.0000000000021820|doi]]
+^Background|Although randomized controlled trials have revealed the considerable effectiveness of acupuncture in breast cancer patients, there have been no studies exploring current acupuncture research trends for treatment induced various symptoms in breast cancer patients. This review evaluated the effectiveness of acupuncture for treatment-induced symptoms in breast cancer patients. |
+^Methods| We performed a systematic review and meta-analysis of the literature regarding acupuncture to treat symptoms associated with breast cancer therapies. The following databases were searched for relevant RCTs published before June 2018: MEDLINE, EMBASE, the Cochrane Library, AMED, CINAHL, OASIS, CNKI, and CiNii. |
+^Results|Among the 19,483 records identified, 835 articles remained after screening titles and abstracts. A total of **19 RCTs** were included in this qualitative synthesis. Among the studies, 8 explored climacteric symptoms, 4 explored pain, 2 explored lymphedemas, 2 explored nausea and vomiting and 3 investigated miscellaneous symptoms explored miscellaneous symptoms due to cancer treatments. Most of the studies reported that acupuncture can alleviate various symptoms of breast cancer treatment. However, there is a lack of evidence as to whether accupuncture can alleviate chemotherapy associated side effects|
+^Conclusions|Acupuncture may alleviate the treatment-related symptoms of breast cancer; however, further studies are necessary to obtain conclusive evidence of the effectiveness of acupuncture in treating breast cancer. |
+ === Pan 2020  ===
@@ Ligne 24: / Ligne 59: @@
-=== Pan 2018 ===
+ === Pan 2018  ===
@@ Ligne 35: / Ligne 70: @@
 ^ 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. |
-=== Kim 2018 ===
+ === Kim 2018  ===
@@ Ligne 44: / Ligne 79: @@
 ^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. |
-=== Lee 2016 ☆===
+ === Lee 2016 ☆ ===
@@ Ligne 54: / Ligne 89: @@
-=== Dos Santos 2010  ===
+ === 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.   {{:medias securises:acupuncture:evaluation:gyneco-obstetrique:dos-santos-146883.pdf|[146883].}}
@@ Ligne 63: / Ligne 98: @@
-=== Chao 2009 ===
+ === 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.   {{:medias securises:acupuncture:evaluation:gyneco-obstetrique:chao-159367.pdf|[159367]}}
@@ Ligne 71: / Ligne 106: @@
 ^ 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. |
-==== Special outcome ===='évaluation particulier ====
+ ==== Special outcome  ====
-=== Bouffées de chaleur dans le cancer du sein ===
+=== Hot Flushes in breast cancer  ===
-| Voir l' [[acupuncture:evaluation:oncologie:04. bouffees de chaleur chez le patient cancereux|article correspondant]] |
+| see ' [[acupuncture:evaluation:oncologie:04. bouffees de chaleur chez le patient cancereux|corresponding item]] |
-===== Revues de revue systématique =====
-==== Sasaki 2019 ====
+=== Cancer-Related Fatigue in Breast Cancer ===
+== Choi 2022 ==
+Choi TY, Ang L, Jun JH, Alraek T, Birch S, Lu W, Lee MS. Acupuncture for Managing Cancer-Related Fatigue in Breast Cancer Patients: A Systematic Review and Meta-Analysis. Cancers (Basel). 2022 Sep 11;14(18):4419.  https://doi.org/10.3390/cancers14184419
+^Background|Breast cancer (BC) is the most common cancer in women and is a serious threat to women's health. Cancer-related fatigue (CRF) is a distressing symptom in BC patients during and after chemotherapy or radiation therapy that severely affects quality of life (QoL). AT is widely used for fatigue management. However, the effect of AT on CRF is still uncertain. This study aimed to evaluate the efficacy and safety of AT in the management of CRF in patients with BC.|
+^Methods| Eleven databases were searched through June 2022. Two researchers independently performed the database search, study selection, data extraction, and risk of bias assessment. Study selection was performed based on predefined Participants, Intervention, Comparators, Outcomes, Study design (PICOS) criteria, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed when reporting the results. A meta-analysis was performed according to the Cochrane systematic review method using RevMan 5.3. |
+^Results|A total of **12 studies** including a total of **1084 participants** were included. The results showed that AT had a beneficial effect compared with sham AT (n = 256, SMD = -0.26, 95% CI [-0.51, -0.01], p = 0.04, I2 = 0%) and a long-term effect on fatigue score (n = 209, MD = -0.32, 95% CI [-0.59, -0.04], p = 0.02, I2 = 0%). Meta-analysis showed that AT had a beneficial effect compared with usual care (UC) on fatigue scores (n = 238, SMD = -0.39, 95% CI [-0.66 to -0.12], p = 0.005, I2 = 0%). Of the 12 articles, 3 articles were judged as having a low risk of bias in all domains and hence were of high quality. No serious adverse effects were identified. |
+^Conclusions|AT is an effective and safe treatment for CRF, and AT is more effective than sham AT or UC or wait-list control (WLC). Nevertheless, the methodological quality of most of these studies was low, and the included studies/sample sizes were small, so the ability to derive decisive implications was limited. Further research is needed to confirm these findings.|
+== Pan 2020  ==
+Pan Yuanqing, Tang Yong, Liang Haiqian, Chen Gen, Xiping Shen, Jin Dong, Cui Qi, Qi Miaomiao. Acupuncture for Hormone Therapy-Related Side Effects in Breast Cancer Patients: A GRADE-Assessed Systematic Review and Updated Meta-Analysis. Integr Cancer Ther. 2020.   {{:medias securises:acupuncture:evaluation:gyneco-obstetrique:pan-212315.pdf|[212315]}}.  [[https://doi.org/10.1177/1534735420940394|doi]]
+^Purpose| To determine the efficacy of acupuncture on the management of hormone therapy-related side effects in breast cancer patients. |
+^Methods| Randomized controlled trials of acupuncture versus a control or placebo in breast cancer patients that examined reductions in therapy-related side effects were retrieved from PubMed, EMBASE, Web of Science, and the Cochrane Library through April 2020. Data on patient symptoms (hot flashes, fatigue, pain, stiffness, and gastrointestinal symptoms), physical capacity, cytokines, and general psychosomatic well-being were analyzed. We evaluated and analyzed the quality of all included studies with the 5.2 Cochrane Handbook standards using Stata software (version 10.0) and Revman software (version 5.2), respectively. We assessed the risk of bias using the Cochrane Risk of Bias tool and evaluated the quality of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. |
+^ Results| The pooled results suggested that **acupuncture led to moderate improvements** in hot flashes, **fatigue**, and stiffness. No significant differences were observed in pain, gastrointestinal symptoms, Kupperman index scores, Overall quality of life, tumor necrosis factor levels, and interleukin levels. |
+^Conclusions| Evidence for outcome indicators of symptom management were downgraded by the GRADE system for inconsistency, indirectness, and imprecision in the included RCTs. Nonetheless, acupuncture is a moderately appropriate alternative therapy for hormone therapy-related side effects in breast cancer patients. However, it still lacks large-sample, multicenter, prospective RCTs. Future research should focus on standardizing comparison groups and treatment methods, be at least single-blinded, assess biologic mechanisms, have adequate statistical power, and involve multiple acupuncturists. |
+=== Post-mastectomy pain syndrome ===
+== Kannan 2022 ==
+Kannan P, Lam HY, Ma TK, Lo CN, Mui TY, Tang WY. Efficacy of physical therapy interventions on quality of life and upper quadrant pain severity in women with post-mastectomy pain syndrome: a systematic review and meta-analysis. Qual Life Res. 2022 Apr;31(4):951-973.  https://doi.org/10.1007/s11136-021-02926-x
+^Purpose|To determine the efficacy of physical therapy interventions on quality of life (QoL) and pain severity in post-mastectomy pain syndrome (PMPS).|
+^Methods|Multiple databases were searched from database inception to October 2020. Searches were limited to human studies published in either English or Chinese in peer-reviewed journals with full text available for randomized controlled trials conducted on females. Trials comparing the effectiveness of physical therapy interventions against control conditions on QoL and pain were included.|
+^Results|Eighteen trials were included in the review. The pooled analysis of the four exercise trials revealed a significant effect of the intervention on general [standardized mean difference [SMD]: 0.87 (95%CI: 0.36, 1.37); p = 0.001], physical [SMD: 0.34 (95%CI: 0.01, 0.66); p = 0.044], and mental health components [SMD: 0.27 (95%CI: 0.03, 0.51); p = 0.027] of QoL compared with the control condition. Meta-analyses of six exercise trials, two myofascial release trials, and **two acupuncture trials** revealed a significant improvement in pain severity in the treatment group than in the control group. However, meta-analyses of two studies revealed a non-significant effect of compression therapy compared to control on pain severity.|
+^Conclusion|Our meta-analyses found that exercise is beneficial for improving the QoL and pain severity of women with PMPS. Future studies are needed to determine the optimal parameters for exercise interventions designed to improve QoL and pain severity in women with PMPS. The effect of **acupuncture**, myofascial release, and compression therapy remains inconclusive, and future research is required to validate the effect of these interventions on PMPS.|
+=== Stress in breast cancer patients ===
+== Ding 2024 ==
+Ding X, Zhao F, Zhu M, Wang Q, Wei S, Xue J, Li Z. A systematic review and meta-analysis of interventions to reduce perceived stress in breast cancer patients. Complement Ther Clin Pract. 2024 Feb;54:101803.  https://doi.org/10.1016/j.ctcp.2023.101803
+^Purpose| Breast cancer (BC) patients commonly face stress that causes severe psychological and physiological problems. The main objective of the review was to confirm the effect of interventions on breast cancer patients' perceived stress, and the secondary objective was to explore the impact of interventions on anxiety, depression, and inflammatory markers.|
+^Methods| A systematic and comprehensive search for randomized controlled trials (RCTs) that reported interventions' effects on perceived stress in breast cancer patients was performed in nine databases.|
+^Results| **Twenty-four RCTs, including 1887 participants**, met the inclusion criteria, summarizing six categories for the intervention group: mindfulness and yoga, exercise, cognitive-behavioral stress management, self-regulation, relaxation training, and acupuncture. Compared with usual care or other types of care, mindfulness and yoga had excellent effects against perceived stress, anxiety, and depression; self-regulation could reduce perceived stress and anxiety; exercise could reduce perceived stress; acupuncture could reduce the level of depression; mindfulness could improve the TNF-α level, and yoga can reduce the level of salivary cortisol and DNA damage.|
+^Conclusion| This systematic review indicated that nondrug interventions, such as mindfulness and yoga, effectively reduce perceived stress, anxiety, and depression. Rigorous studies with large sample sizes are needed to address the limitations of small sample sizes and shortcomings in methodology in this area.|
+ ===== Overviews of Systematic Reviews  =====
+ ==== Sasaki 2019  ====
@@ Ligne 90: / Ligne 177: @@
 ^Results|Thirty-four SRs met a set of criteria. According to interventions, there were twenty SRs which included yoga, acupuncture, and herbal medicines. Meta-analysis of 19 out of 34 reviews showed the followings: (1) **acupuncture had a beneficial effect on the frequency of hot flushes**, (2) yoga had a beneficial effect on depression and health-related QOL, (3) mindfulness-based stress reduction (MBSR) had a beneficial effect on anxiety and depression, (4) combination of herbal medicine and chemotherapy synergistically improved clinical outcomes, (5) **acupuncture did not show significant effect on the severity of hot flushes and cancer-related pain**, (6) yoga was unable to be confirmed as having an effect on cancer-related pain and physical well-being. Given the results of AMSTAR, 9 out of 34 reviews were of high quality and 3 reviews were deemed to be of low quality. In conclusion, since most SRs were at moderate or high-quality levels, CAM could be helpful for treating specific symptoms related to breast cancer. |
-===== Clinical Practice Guidelines =====
+ ===== Clinical Practice Guidelines  =====
@@ Ligne 96: / Ligne 183: @@
-==== National Institute for Health and Clinical Excellence (NICE, UK) 2018 ⊕====
+==== Institut National du Cancer (INC, France) 2023 ⊕ ====
+Prévention et gestion des effets indésirables des anticancéreux - Hormonothérapies dans le traitement adjuvant des cancers du sein. Institut National du Cancer. 2023. https://www.e-cancer.fr/Expertises-et-publications/Catalogue-des-publications/Prevention-et-gestion-des-effets-indesirables-des-anticancereux-Hormonotherapies-dans-le-traitement-adjuvant-des-cancers-du-sein
+|//Douleurs articulaires et musculosquelettiques// (Inhibiteurs de l’aromatase. Agonistes de la GNRH. Tamoxifène). Discuter les approches non pharmacologiques telles que kinésithérapie, physiothérapie, balnéothérapie, **acupuncture**, techniques de relaxation.\\ //Bouffées de chaleur// (tamoxifène, agonistes de la GNRH). En complément, selon le groupe de travail, le recours au yoga, à l’hypnose et à la thérapie cognitivocomportementale peut être envisagé selon les possibilités du patient. Des essais cliniques ont évalué l’impact de l’**acupuncture** sur les bouffées de chaleur sous hormonothérapie. Cependant leurs résultats ne permettent pas de conclure sur son efficacité dans cette situation. L’activité physique adaptée n’a pas montré d’effet significatif sur la gestion des bouffées de chaleur.|
+<wrap lo>Ref. \\
+- Liu X, et al. Acupuncture for Arthralgia Induced by Aromatase Inhibitors in Patients with Breast Cancer: A Systematic Review and Meta-analysis. Integr Cancer Ther. 2021 Jan-Dec ; 20:1534735420980811 \\
+- Hershman DL, et al. Effect of Acupuncture vs Sham Acupuncture or Waitlist Control on Joint Pain Related to Aromatase Inhibitors Among Women With Early-Stage Breast Cancer: A Randomized Clinical Trial. JAMA. 2018 Jul 10 ; 320(2):167-176</wrap>
+==== Cancer Australia (CA, Australia) 2020 ⊕ ====
+Guidance for the management of early breast cancer. Recommendations and practice points. Cancer Australia. 2020.32P.   [216640]. [[https://www.canceraustralia.gov.au/sites/default/files/publications/guidance-management-early-breast-cancer-recommendations-and-practice-points/pdf/guidance_for_the_management_of_early_breast_cancer_recommendations_and_pps_2020_0.pdf|URL]]
+|Practice Point. Offer information regarding effective evidence-based complementary therapies (such as yoga, **acupuncture**, and meditation) for symptom control in patients with breast cancer.|
+==== American Society of Clinical Oncology  (ASCO, USA) 2018 ⊕ ====
+Lyman GH, Greenlee H, Bohlke K, Bao T, DeMichele AM, Deng GE, Fouladbakhsh JM, Gil B, Hershman DL, Mansfield S, Mussallem DM, Mustian KM, Price E, Rafte S, Cohen L. Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. J Clin Oncol. 2018.   [155475].  [[https://doi.org/10.1200/jco.2018.79.2721|doi]].
+|**Acupuncture**, massage, and relaxation can be considered for reducing anxiety. (Grade C). **Acupressure** can be considered as an addition to antiemetic drugs to control nausea and vomiting during chemotherapy (Grade B). **Electroacupuncture** can be considered as an addition to antiemetic drugs to control vomiting during chemotherapy  (Grade B). **Acupuncture**, healing touch, and stress management can be considered for improving mood disturbance and depressive symptoms (Grade C). **Acupuncture** and yoga can be considered for improving post-treatment fatigue (Grade C).  **Acupuncture**, healing touch, hypnosis, and music therapy can be considered for the management of pain (Grade C). **Acupuncture**, mistletoe, qigong, reflexology, and stress management can be considered for improving quality of life (Grade C). **Acupuncture** can be considered for improving hot flashes (Grade C).|
+==== 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.   {{:medias securises:acupuncture:evaluation:gyneco-obstetrique:nice-196020.pdf|[196020]}}.
@@ Ligne 103: / Ligne 214: @@
-==== European School of Oncology (ESO) and the European Society for Medical Oncology (ESMO) 2018 ⊕ ====
+ ==== European School of Oncology (ESO) and the European Society for Medical Oncology (ESMO) 2018 ⊕  ====
@@ Ligne 109: / Ligne 220: @@
 |Acupuncture may help against induced nausea and vomiting, fatigue and hot flashes;|
-==== Spanish Society of Medical Oncology (SEOM, Spain) 2018 ⊕====
+ ==== Spanish Society of Medical Oncology (SEOM, Spain) 2018 ⊕ ====
@@ Ligne 115: / Ligne 226: @@
 |//Hot flashes secondary to menopause//: Acupuncture has demonstrated efficacy.\\ // Joint pain//: Acupuncture can be beneficial. |
-==== American Cancer Society/American Society of Clinical Oncology  (ACS/ ASCO, USA) 2016 ⊕ ====
+ ==== American Cancer Society/American Society of Clinical Oncology  (ACS/ ASCO, USA) 2016 ⊕  ====
@@ Ligne 125: / Ligne 236: @@
-==== Cancer Australia (CA, Australia) 2016 ⊕====
+ ==== Cancer Australia (CA, Australia) 2016 ⊕ ====
@@ Ligne 132: / Ligne 243: @@
 | - 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|
-==== Alberta Health Services (AHS, Canada) 2015 Ø ====
+ ==== Alberta Health Services (AHS, Canada) 2015 Ø  ====
 Follow-up care for early-stage breast cancer. Clinical Practice Guideline. Alberta Health Services. 2015. 29P.   {{:medias securises:acupuncture:evaluation:gyneco-obstetrique:ahs-177969.pdf|[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.|
-==== Society for Integrative Oncology  (SIO, USA) 2014 ⊕====
+ ==== 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.   {{:medias securises:acupuncture:evaluation:oncologie:greenlee-167074.pdf|[167074].

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