Chemotherapy-Induced Peripheral Neuropathy
Neuropathie périphérique induite par chimiothérapie : évaluation de l'acupuncture
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 |
| ☆☆ | Evidence for effectiveness of acupuncture |
| ☆ | Limited evidence for effectiveness of acupuncture |
| Ø | No evidence or insufficient evidence |
1.1. Generic Acupuncture
1.1.1. Xu 2022 ⊕⊕⊕
Xu Z, Wang X, Wu Y, Wang C, Fang X. The effectiveness and safety of acupuncture for chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. Front Neurol. 2022 Oct 3;13:963358. https://doi.org/10.3389/fneur.2022.963358
| Objectives | This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of acupuncture on chemotherapy-induced peripheral neuropathy (CIPN). |
| Methods | We searched for relevant randomized controlled trials (RCTs) in PubMed, Cochrane Library, and Embase databases from their inception to 1 April 2022. The Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx), Brief Pain Inventory-Short Form (BPI-SF), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 (EORTC QLQ-C30), Numerical Rating Scale (NRS), and adverse events were the outcome measures. All studies had at least one of these outcome measures. Mean differences (MDs) with 95% confidence intervals (CIs) were assessed in the meta-analysis using the RevMan 5.3 software. |
| Results | Five studies were included in the analysis. The results showed that acupuncture and placebo acupuncture were not significantly different in reducing chemotherapy-induced neurotoxicity and functional disability (random-effects estimates; MD: 4.30; 95% CI: -0.85~9.45; P = 0.10; I2 = 74%). Acupuncture was better than placebo acupuncture in reducing pain severity and pain interference with patients' daily function (fixed-effect estimates; MD: -1.14; 95% CI: 1.87 to -0.42; P = 0.002; I2 = 13%). Acupuncture was not significantly different from placebo acupuncture in relieving CIPN symptoms (MD: -0.81; 95% CI: -2.02 to 0.40, P = 0.19). Acupuncture improved quality of life better than placebo acupuncture (MD: 10.10; 95% CI: 12.34 to 17.86, P = 0.01). No severe adverse events were recorded in all five studies. |
| Conclusion | This meta-analysis suggests that acupuncture may be more effective and safer in reducing pain severity and pain interference with patients' daily function than placebo acupuncture. Additionally, acupuncture may improve the quality of life of patients with CIPN. However, large sample size studies are needed to confirm this conclusion. |
1.1.2. Liu 2021 ☆
Liu Yu-Fei, Lai Bao-Yon, An Tian, et al. [Efficacy of Acupuncture for Chemotherapy-induced Peripheral Neuropathy: a Systematic Review and Meta-analysis]. Shanghai Journal of Acupuncture and Moxibustion. 2021;40(4):511. [219067].
| Objective | To evaluate the efficacy of acupuncture for the treatment of chemotherapy-induced peripheral neuropathy (CIPN). |
| Method | The databases of CNKI, Wanfang Data, VIP, PubMed and Cochrane Library were searched up to April 20, 2020. Meta-analysis was performed using RevMan 5.3 and Stata 15.0 software after two independent researchers independently completed literature screening, data extraction and risk assessment for bias. |
| Result | A total of 904 patients were enrolled in 1 8 studies, including 453 in the experimental group and 45 1 in the control group. Meta-analysis results showed that acupuncture could improve motor nerve conduction velocity [SMD=0.58, 95%CI(0.13, 1.03)] and sensory nerve conduction velocity [SMD=O.40, 95%CI(0.18, 0.61)] ofthe common peroneal nerve, and could improve NRS score [SMD=-1 .36, 95%CI(-1 .96, -0.76)], but there was no significant difference in median nerve conduction velocity between the two groups (P>0.05). |
| Conclusion | The present study indicated that acupuncture could effectively improve the common peroneal nerve conduction velocity and relieve pain symptoms. However, the conclusion still needs to be verified by large-sample and high-quality randomized controlled trials. |
1.1.3. Jin 2020 ☆☆
Jin Y, Wang Y, Zhang J, Xiao X, Zhang Q. Efficacy and Safety of Acupuncture against Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2020. [214017]. doi
| Objective | To determine the effectiveness and safety of acupuncture for chemotherapy-induced peripheral neuropathy. The review has been registered on the “PROSPERO” website; the registration number is CRD42020151654. |
| Methods | A comprehensive literature search was performed on 7 electronic databases from the time of inception to March 2020. RCTs studies on acupuncture for CIPN compared with medication or sham acupuncture were included. Statistical analysis was carried out using RevMan 5.3. |
| Results | In total, 19 RCTs covering 1174 patients were enrolled. The results showed that acupuncture significantly increased the effective rate of CIPN compared with medicine and sham acupuncture. And acupuncture had a good effect on the recovery of nerve conduction velocity and improving pain. Among the acupoints involved in the treatment of CIPN, LI4, LI11, ST36, EX10 ( bafeng ), and EX-UE 9 ( baxie ) were the most commonly used. |
| Conclusion | The use of acupuncture in the management of CIPN is safe and effective. The most used acupoints for CIPN are LI4, LI11, ST36, EX10 ( bafeng ), and EX-UE 9 ( baxie ). |
1.1.4. Hwang 2020 ⊕⊕
Hwang MS, Lee HY, Choi TY, Lee JH, Ko YS, Jo DC, Do K, Lee JH, Park TY. A systematic review and meta-analysis of the efficacy of acupuncture and electroacupuncture against chemotherapy-induced peripheral neuropathy. Medicine (Baltimore). 2020;99(17):e19837. [208843]. doi
| Background | Chemotherapy -induced peripheral neuropathy (CIPN) occurs in 68.1% of patients within the first month of undergoing chemotherapy; however, standardized treatment for CIPN has not been established yet. The efficacy of acupuncture, a widely used treatment for CIPN in South Korea, has not been studied sufficiently. This study aimed to review the studies that evaluated the efficacy of acupuncture or electroacupuncture (EA) in treating CIPN. |
| Methods | A literature search was performed on relevant international databases - MEDLINE, Embase, the Allied and Complementary Medicine Databases, and China National Knowledge Infrastructure - as well as Korean databases - the National Digital Science Library, Oriental Medicine Advanced Searching Integrated System, DBpia, and Korean Studies Information Service System. Randomized controlled trials (RCTs) that aimed to treat CIPN symptoms with acupuncture or EA and set not only a control group with a conventional pharmacological treatment or injection, but also a placebo control or sham-acupuncture group, were included. Meta-analysis was conducted to elucidate the efficacy of acupuncture/EA on the basis of symptom score. |
| Results | Of the 13 studies included in the literature review, 12 RCTs compared acupuncture and pharmacological treatments. There were 3 EA RCTs, but only 1 RCT compared EA and sham-EA. A total of 832 participants were included in these studies. Five RCTs showed that acupuncture was more effective than pharmacological treatment in terms of efficacy rate. Regarding the risk of bias summary, the quality of included studies was poor. Only 1 study compared the efficacy of EA and sham EA; therefore, the specific efficacy of acupuncture could not be elucidated. |
| Conclusion | Acupuncture is safe, but the symptom-alleviating effect on CIPN can hardly be determined because of methodological deficiencies of the included studies. In terms of the clinical efficacy rate, acupuncture was more effective than conventional pharmacological treatments. |
1.1.5. Chien 2019 ☆☆
Chien TJ, Liu CY, Fang CJ, Kuo CY. The Efficacy of Acupuncture in Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Meta-Analysis. Integr Cancer Ther. 2019. [201982]. -DOI-
| Background | Chemotherapy-induced peripheral neuropathy (CIPN) has no cure, but acupuncture may provide relief through its known neuromodulation or neuroendocrine adjustment. This review aimed to assess the efficacy of acupuncture in treating CIPN. |
| Method | A literature review following the PRISMA Statement was performed, searching 7 databases from inception through August 2019. All studies were clinical trials of the effect of acupuncture on CIPN. The methodological quality of these trials was assessed using Cochrane criteria; meta-analysis software (RevMan 5.2) was used to analyze the data. Data Sources: The databases searched were the following: MEDLINE (Ovid), Embase, Cochrane CENTRAL, Scopus, World Health Organization International Clinical Trials Registry Platform, CNKI (China National Knowledge Infrastructure), and Wanfang Med Online. |
| Results | We examined 386 cancer patients from 6 randomized control trials, which had high quality, based on the modified Jadad scale. Meta-analysis showed that acupuncture led to significant improvements in pain scores (-1.21, 95% confidence interval [CI] = -1.61 to -0.82, P < .00001) and nervous system symptoms based on Functional Assessment of Cancer Therapy/Neurotoxicity questionnaire scores (-2.02, 95% CI = -2.21 to -1.84, P < .00001). No significant change was noted in nerve conduction velocity (1.58, 95% CI = -2.67 to 5.83, P = .47). |
| Conclusion | Acupuncture can effectively relieve CIPN pain and functional limitation. The limited number of subjects warrants a larger scale study. |
1.1.6. Li 2019 ∼
Li K, Giustini D, Seely D. A systematic review of acupuncture for chemotherapy-induced peripheral neuropathy. Curr Oncol. 2019;26(2):e147–e154. [202648]. -DOI-
| Objectives | In cancer patients, chemotherapy-induced peripheral neuropathy (cipn) is a common complication, characterized by pain, loss of sensation, and numbness. Medical treatment for peripheral neuropathies has been shown to be ineffective for cipn. Acupuncture has been shown to be safe and effective in treating cancer-related symptoms and other peripheral neuropathies. For the present review, we aimed to evaluate the efficacy of acupuncture for the treatment of cipn. |
| Design | Comprehensive searches for relevant studies were conducted in Ovid embase, the Web of Science, Ovid medline, the Cochrane Central Register of Controlled Trials (central), cinahl (ebsco Information Services, Ipswich, MA, U.S.A.), and the ClinicalTrials.gov Web site. References from previous systematic reviews were also searched. Additional trials were found in the reference lists of relevant papers and in searches of Google Scholar and acupuncture-specific Web sites. Included studies were randomized controlled trials (rcts) of any type of acupuncture used to treat patients with cipn. |
| Results | Three clinical trials (203 participants) were included. Two studies found acupuncture to be effective in alleviating cipn pain and improving quality of life. One study found no benefit in improving neuropathic pain, symptoms, or quality of life. Study quality was variable and included a moderate overall risk of bias. |
| Conclusions | The evidence is insufficient to recommend acupuncture for the treatment or prevention of cipn. Further research is needed to evaluate the effects of acupuncture in the treatment of cipn. Given that acupuncture is considered safe and might provide relief for patients, it can be considered at the clinician's discretion. |
1.1.7. Baviera 2019 ∼
[No Acupuncture RCTs]
Baviera AF , Olson K , Paula JM , Toneti BF , Sawada NO. Acupuncture in adults with Chemotherapy-Induced Peripheral Neuropathy: a systematic review. Rev Lat Am Enfermagem. 2019. [196367]. doi
| Objective | to analyze and synthesize knowledge about the effect of acupuncture on chemotherapy-induced peripheral neuropathy symptoms in adults with cancer. |
| Method | the method used was a Systematic Review. Potential articles were identified by searching in the PubMed of National Library of Medicine, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane Central and Scopus. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses strategy, 607 articles were identified. After removing the duplicates, all titles and abstracts were reviewed, and seven articles were selected for full review. After the full review, five studies were selected for inclusion. |
| Results: | of the five articles included, four were cohort studies and one was a quasi-experimental study. All articles showed that acupuncture was associated with an improvement in the peripheral neuropathy, but the type of protocol, use of medications, time of treatment, and different outcome measures made it difficult to compare the studies. |
| Conclusion | the use of acupuncture appears to be associated with an improvement in the symptoms of chemotherapy-induced peripheral neuropathy and has no side effects. In order to improve the evidence about benefits associated with acupuncture, more experimental studies using both subjective and objective measures are needed. |
1.1.8. Hou 2018 Ø
[No Acupuncture RCTs]
Hou S, Huh B, Kim HK, Kim KH, Abdi S. Treatment of Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Recommendations. Pain Physician. 2018;21(6):571-592. [189237]. doi
| Background | Chemotherapy-induced peripheral neuropathy (CIPN) is a commonly encountered disease entity following chemotherapy for cancer treatment. Although only duloxetine is recommended by the American Society of Clinical Oncology (ASCO) for the treatment of CIPN in 2014, the evidence of the clinical outcome for new pharmaceutic therapies and non-pharmaceutic treatments has not been clearly determined. |
| Objective | To provide a comprehensive review and evidence-based recommendations on the treatment of CIPN. STUDY DESIGN: A systematic review of each treatment regimen in patients with CIPN. |
| Methods | The literature on the treatment of CIPN published from 1990 to 2017 was searched and reviewed. The 2011 American Academy of Neurology Clinical Practice Guidelines Process Manual was used to grade the evidence and risk of bias. We reviewed and updated the recommendations of the ASCO in 2014, and evaluated new approaches for treating CIPN. |
| Results | A total of 26 treatment options in 35 studies were identified. Among these, 7 successful RCTs, 6 failed RCTs, 18 prospective studies, and 4 retrospective studies were included. The included studies examined not only pharmacologic therapy but also other modalities, including laser therapy, scrambler therapy, magnetic field therapy and acupuncture, etc. Most of the included studies had small sample sizes, and short follow-up periods. Primary outcome measures were highly variable across the included studies. No studies were prematurely closed owing to its adverse effects. LIMITATIONS: The limitations of this systematic review included relatively poor homogeneous, with variations in timing of treatment, primary outcomes, and chemotherapeutic agents used. |
| Conclusion | The evidence is considered of moderate benefit for duloxetine. Photobiomodulation, known as low level laser therapy, is considered of moderate benefit based on the evidence review. Evidence did not support the use of lamotrigine and topical KA (4% ketamine and 2% amitriptyline). The evidence for tricyclic antidepressants was inconclusive as amitriptyline showed no benefit but nortriptyline had insufficient evidence. Further research on CIPN treatment is needed with larger sample sizes, long-term follow-up, standardized outcome measurements, and standardized treatment timing. |
| Acupuncture | Level of Strength of Evidence: Class IV. Level of Confidence in Evidence: Very low. Strength of the Recommendations: Level U Insufficient. |
1.1.9. Oh 2018 ☆
Oh PJ, Kim YL. [Effectiveness of Non-Pharmacologic Interventions in Chemotherapy Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis]. J Korean Acad Nurs. 2018;48(2):123-142. [Article in Korean] [158610]. doi
| Purpose | This study was conducted to evaluate the effectiveness of non-pharmacologic interventions in chemotherapy-induced peripheral neuropathy (CIPN). |
| Methods | PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL, and several Korean databases (Until August 2017) were searched. The main search strategy combined terms for peripheral neuropathy and presence of neoplasms. The risk of bias was assessed using the Cochrane's Risk of Bias tool for randomized studies and the Risk of Bias Assessment tool for non-randomized studies. To estimate the effect size, a meta-analysis of the studies was performed using the Rev Man 5.3 program of the Cochrane Library random-effects models were used in the analyses. |
| Results | Twenty-two studies with a total of 954 participants met the inclusion criteria. Of the 22 studies, 12 were used to estimate the effect size of the non-pharmacologic interventions. The non-pharmacologic interventions used in patients with CIPN were exercise, acupuncture, massage, and foot bath. The acupuncture significantly reduced CIPN symptoms and signs (d=-0.71) and CIPN pain (d=-0.73) (p<.001). Massage and foot bath were also effective in reducing CIPN symptoms (d=-0.68; 95% CI=-1.05, -0.30; p<.001; I²=19%).Exercises were effective in improving muscle strength and endurance(d=-0.55) and quality of life (d=-2.96), but they were not significantly effective in improving CIPN. |
| Conclusion | Although these results provide little evidence of the effectiveness of acupuncture, massage, and foot bath in the treatment of CIPN, they suggest that these interventions can reduce CIPN symptoms in patients with cancer. However, the findings of this study should be interpreted with caution as there is a relative lack of data in this field, and additional well-designed studies are needed. |
1.1.10. Brami 2016 Ø
Brami C, Bao T, Deng G. Natural products and complementary therapies for chemotherapy-induced peripheral neuropathy: A systematic review. Crit Rev Oncol Hematol. 2016;98:325-34. [190348].
| Objectives | Chemotherapy-induced peripheral neuropathy (CIPN) is a serious dose-limiting side-effect without any FDA-approved treatment option. Prior reviews focus mostly on pharmacological interventions, but nonpharmaceutical interventions have also been evaluated. |
| Methods | A Web of Science and PubMed database search to identify relevant RCTs from January 2005 to May 2015 included the terms: CIPN, cancer; and supplements, vitamin E, goshajinkigan, kampo, acetyl-L-carnitine, carnitine, alpha-lipoic acid, omega-3, glutamine, or glutamate; or massage, acupuncture, mind-body practice, yoga, meditation, Tai-Chi, physical activity, or exercise. |
| Results | Of 1465 publications screened, 12 RCTs evaluated natural products and one evaluated electroacupuncture. Vitamin E may help prevent CIPN. L-Glutamine, goshajinkigan, and omega-3 are also promising. Acetyl-L-carnitine may worsen CIPN and alpha-lipoic acid activity is unknown. Electroacupuncture was not superior to placebo. No RCTs were published regarding other complementary therapies, although some studies mention positive incidental findings. |
| Conclusions | Natural products and complementary therapies deserve further investigation, given the lack of effective CIPN interventions. |
1.1.11. Lau 2016 Ø
Lau CH, Wu X, Chung VC, Liu X, Hui EP, Cramer H, Lauche R, Wong SY, Lau AY, Sit RS, Ziea ET, Ng BF, Wu JC. Acupuncture and related therapies for symptom management in palliative cancer care: systematic review and meta-analysis. Medicine (Baltimore). 2016;95(9):e2901. [160606].
| Purpose | The aim of this systematic review and meta-analysis was to summarize current best evidence on acupuncture and related therapies for palliative cancer care. |
| Methods | Five international and 3 Chinese databases were searched. Randomized controlled trials (RCTs) comparing acupuncture and related thérapies with conventional or sham treatments were considered. Primary outcomes included fatigue, paresthesia and dysesthesias, chronic pain, anorexia, insomnia, limb edema, constipation, and health-related quality of life, of which effective conventional interventions are limited. |
| Results | Thirteen RCTs were included. Compared with conventional interventions, meta-analysis demonstrated that acupuncture and related therapies significantly reduced pain (2 studies, n=175, pooled weighted mean difference-0.76, 95% confidence interval: -0.14 to -0.39) among patients with liver or gastric cancer. Combined use of acupuncture and related therapies and Chinese herbal medicine improved quality of life in patients with gastrointestinal cancer (2 studies, n¼111, pooled standard mean difference: 0.75, 95% confidence interval: 0.36–1.13). Acupressure showed significant efficacy in reducing fatigue in lung cancer patients when compared with sham acupressure. Adverse events for acupuncture and related therapies were infrequent and mild. |
| Conclusion | Acupuncture and related therapies are effective in reducing pain, fatigue, and in improving quality of life when compared with conventional intervention alone among cancer patients. Limitations on current evidence body imply that they should be used as a complement, rather than an alternative, to conventional care. Effectiveness of acupuncture and related therapies for managing anorexia, reducing constipation, paresthesia and dysesthesia, insomnia, and limb edema in cancer patients is uncertain, warranting future RCTs in these areas. |
1.1.12. Franconi 2013 Ø
Franconi G, Manni L, Schröder S, Marchetti P, Robinson N. A systematic review of experimental and clinical acupuncture in chemotherapy-induced peripheral neuropathy. Evid Based Complement Alternat Med. 2013. [166737].
| Background | Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect that can be very disabling and can limit or delay the dose of chemotherapy that can be administered. Acupuncture may be effective for treating peripheral neuropathy. |
| Aim | The aim of this study was to review the available literature on the use of acupuncture for CIPN. The systematic literature search was performed using MEDLINE, Google Scholar, Cochrane Database, CINHAL, and ISI Proceedings. Hand searching was conducted, and consensus was reached on all extracted data. Only papers in the English language were included, irrespective of study design. |
| Results | From 3989 retrieved papers, 8 relevant papers were identified. One was an experimental study which showed that electroacupuncture suppressed CIPN pain in rats. In addition, there were 7 very heterogeneous clinical studies, 1 controlled randomised study using auricular acupuncture, 2 randomized controlled studies using somatic acupuncture, and 3 case series/case reports which suggested a positive effect of acupuncture in CIPN. Conclusions. Only one controlled randomised study demonstrated that acupuncture may be beneficial for CIPN. All the clinical studies reviewed had important methodological limitations. |
| Conclusions | Further studies with robust methodology are needed to demonstrate the role of acupuncture for treating CIPN resulting from cancer treatment. |
1.2.1. Jung 2016 (Pediatric Oncology) ☆
Jung M, Rein N, Fuchs B. [Physical Therapy for Chemotherapy-induced Peripheral Neuropathy in Pediatric Oncology]. Klin Padiatr. 2016;228(6-07):313-318. [Article in German] [189374].
| Background | Chemotherapy-induced peripheral neuropathy is a frequent side-effect of drugs that are used in the treatment of cancer. Affected individuals can suffer from motor, sensory or autonomy nerve damage. Further medication is used for the treatment of CIPN which can cause further side-effects. Patients should be offered physical therapy treatment to relieve the symptoms. |
| Objective | The aim of this article is to give an overview of available literature investigating physical therapy in CIPN in pediatric oncology. |
| Methods | To determine relevant literature, a systematic review was conducted in the databases CINAHL, The Cochrane Library, ERIC, MEDPILOT, PEDro, PsycARTICLES, PsycINFO, PubMed and DIMDI. Besides the methodological quality of the identified literature is supposed to be reviewed. |
| Results | There is no current literature regarding the subject of this article, so no evaluation of the quality could be carried out. Although several publications concerning adults could be identified and transfer could be established for pediatrics. |
| Conclusion | Acupuncture appeared to be effective in the treatment of CIPN in adults. Good results appeared especially regarding pain. Sensorimotor training, balance training, electrotherapy and alternative methods like Reiki and Yoga showed good results for patients symptoms. These treatment methods give a future prospect how CIPN in children can be treated successfully - but further pediatric research is necessary. |
1.2.2. Derksen 2017 (Colorectal Cancer) Ø
Derksen TM, Bours MJ, Mols F, Weijenberg MP. Lifestyle-Related Factors in the Self-Management of Chemotherapy-Induced Peripheral Neuropathy in Colorectal Cancer: A Systematic Review. Evid Based Complement Alternat Med. 2017. [99415].
| Background | Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of chemotherapy treatment in colorectal cancer (CRC), negatively affecting the daily functioning and quality of life of CRC patients. Currently, there are no established treatments to prevent or reduce CIPN. |
| Objective | The purpose of this systematic review was to identify lifestyle-related factors that can aid in preventing or reducing CIPN, as such factors may promote self-management options for CRC patients suffering from CIPN. |
| Methods | A literature search was conducted through PubMed, Embase, and Google Scholar. Original research articles investigating oxaliplatin-related CIPN in CRC were eligible for inclusion. |
| Results | In total, 22 articles were included, which suggested that dietary supplements, such as antioxidants and herbal extracts, as well as physical exercise and complementary therapies, such as acupuncture, may have beneficial effects on preventing or reducing CIPN symptoms. However, many of the reviewed articles presented various limitations, including small sample sizes and heterogeneity in study design and measurements of CIPN. |
| Conclusions | No strong conclusions can be drawn regarding the role of lifestyle-related factors in the management of CIPN in CRC patients. Certain dietary supplements and physical exercise may be beneficial for the management of CIPN, but further research is warranted. |
2. Overviews of Systematic Reviews
2.1. Hao 2020 ☆
Hao J, Zhu X, Bensoussan A. Effects of Nonpharmacological Interventions in Chemotherapy-Induced Peripheral Neuropathy: An Overview of Systematic Reviews and Meta-Analyses. Integr Cancer Ther. 2020. [211585]. doi
| Introduction | Chemotherapy-induced peripheral neuropathy (CIPN) is one of the prevalent and disabling side effects of cancer treatment. However, management strategies for CIPN currently remain elusive, with treatment restricted to neuropathic pain medications, supportive care, and chemotherapy dosing adjustments. This overview explores evidence on the potential benefits and safety of nonpharmacological interventions in preventing and treating CIPN in cancer patients. |
| Methods | Seven databases were searched for systematic reviews of randomized controlled trials (RCTs). The methodological quality of the selected reviews was assessed by AMSTAR 2, and the quality of evidence was judged by GRADE. Twenty-eight systematic reviews were considered eligible for this review. |
| Results | It was found that nonpharmacological interventions (acupuncture, exercise, herbal medicine, nutritional supplements) provided potential benefits for patients with CIPN. Furthermore, Chinese herbal medicine, administered orally or externally, significantly prevented and/or relieved the incidence and severity of CIPN in comparison to control groups (no additional treatment, placebo, and conventional western medicine). However, the quality of evidence and strength of recommendations were compromised by the inconsistencies and imprecision of included studies. The main concerns regarding the quality of systematic reviews included the lack of sufficiently rigorous a priori protocols, and the lack of protocol registration adopted in the included studies. |
| Conclusions | Though looking across reviews, Chinese herbal medicine appear generally effective in CIPN, uncertainty remains about the effects of many other nonpharmacological interventions. The evidence on what works was particularly compromised by reporting and methodological limitations, which requires further investigation to be more certain of their effects. |
3. Clinical Practice Guidelines
⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation (or lack of evidence) |
3.1. American Society of Clinical Oncology / Society for Integrative Oncology (ASCO/SIO, USA 2022) ⊕
Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative Medicine for Pain Management in Oncology: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol. 2022 Sep 19:JCO2201357. https://doi.org/10.1200/JCO.22.01357
| Chemotherapy-induced peripheral neuropath. Recommendation 1.8. Acupuncture may be offered to patients experiencing chemotherapy-induced peripheral neuropathy from cancer treatment (Type: Evidence based-informal consensus, benefits outweigh harms; Evidence quality: Low; Strength of recommendation: Weak). Recommendation 1.9.Reflexology or acupressure may be offered to patients experiencing chemotherapy-induced peripheral neuropathy from cancer treatment (Type: Evidence based, benefits outweigh harms; Evidence quality: Low; Strength of recommendation: Weak). |
3.2. Gynecologic Cancer Intergroup (GCIG, International) 2022 ⊕
Woopen H, Sehouli J, Davis A, Lee YC, Cohen PA, Ferrero A, Gleeson N, Jhingran A, Kajimoto Y, Mayadev J, Barretina-Ginesta MP, Sundar S, Suzuki N, van Dorst E, Joly F. GCIG-Consensus guideline for Long-term survivorship in gynecologic Cancer: A position paper from the gynecologic cancer Intergroup (GCIG) symptom benefit committee. Cancer Treat Rev. 2022;107:102396. [211605]. https://doi.org/10.1016/j.ctrv.2022.102396
| Neuropathy: Supportive care such as physiotherapy, physical activity, referral to podiatrists, patient education i.e. adequate footwear, acupuncture, support in daily activities can be helpful. |
3.3. German Cancer Society, German Cancer Aid, Association of the Scientific Medical Societies (DKG, DK, AWMF, Germany) 2021 ⊕
Interdisciplinary Evidenced-based Practice Guideline for the Early Detection, Diagnosis, Treatment and Follow-up of Breast Cancer. German Guideline Program in Oncology (German Cancer Society, German Cancer Aid, AWMF). 2021. [219442]. https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/S3_Guideline_Breast_Cancer.pdf
| It is recommended that general practitioners in private practice ask about pain using pain scales. They should offer interventions such as taking acetaminophen, NSAIs, physical activity and/or acupuncture. They should also refer you to a suitable specialist. They should also ask about peripheral neuropathies, especially numbness and paraesthesias in the upper and lower extremities, and offer therapeutic measures such as physical activity or drug therapy such as duloxetine. |
3.4. American Society of Clinical Oncology (ASCO, USA) 2020 Ø
Loprinzi CL, Lacchetti C, Bleeker J, Cavaletti G, Chauhan C, Hertz DL, Kelley MR, Lavino A, Lustberg MB, Paice JA, Schneider BP, Lavoie Smith EM, Smith ML, Smith TJ, Wagner-Johnston N, Hershman DL. Prevention and Management of Chemotherapy-Induced Peripheral Neuropathy in Survivors of Adult Cancers: ASCO Guideline Update. J Clin Oncol. 2020;38(28):3325-3348.. [219308].
doi
| Outside the context of a clinical trial, no recommendations can be made on the use of the following interventions for the prevention of CIPN: Acupuncture,Cryotherapy, Compression therapy, Exercise therapy, Ganglioside-monosialic acid (GM-1). Type of recommendation: no recommendation; Evidence quality: low; Strength of recommendation: not applicable). Note: While preliminary evidence suggests a potential for benefit from these interventions, larger sample–sized definitive studies are needed to confirm efficacy and clarify risks. |
3.5. Association of the Scientific Medical Societies, German Cancer Society, German Cancer Aid, (AWMF, DKG, DK, Germany) 2020 Ø
3.6. European Society for Medical Oncology (ESMO), European Oncology Nursing Society (EONS) and European Association of Neuro-Oncology (EANO) 2020 ⊕
Jordan B, Margulies A, Cardoso F, Cavaletti G, Haugnes HS, Jahn P, Le Rhun E, Preusser M, Scotté F, Taphoorn MJB, Jordan K; ESMO Guidelines Committee. Systemic anticancer therapy-induced peripheral and central neurotoxicity: ESMO-EONS-EANO Clinical Practice Guidelines for diagnosis, prevention, treatment and follow-up. Ann Oncol. 2020;31(10):1306-1319. [202043]. doi
| Acupuncture might be considered in selected patients to treat CIPN symptoms [II, C]. |
3.7. Arbeitsgemeinschaft Gynäkologische Onkologie (AGO, Germany) 2018 Ø
| Chemotherapy-induced Peripheral Neuropathy – Prevention : Electro-acupuncture; Level of evidence : 1b (individual RCT), grade of evidence (B), AGO recommendation grade (-) This examination or therapeutic intervention may be for the patient be disadvantageous and should not be done. |
| Treatment of chemotherapy induced polyneuropathy. Acupuncture. Prophylactically. Level of evidence : 1b (individual RCT), grade of evidence (B), AGO recommendation grade (-) This examination or therapeutic intervention may be for the patient be disadvantageous and should not be done. Therapeutically. Level of evidence : 2b (individual Cohort Study), grade of evidence (B), AGO recommendation grade (+/-) This examination or therapeutic intervention has for the patient no advantage shown. It can be done in individual cases. Based on current knowledge, there is currently no general recommendation to be pronounced. |
3.8. Pallaborative North West (UK) 2018 ⊕
Coyle S, McGlynn L, Ting G et al. Guidelines for the Management of Cancer Related Neuropathic. Pallaborative North West. 2018. https://drive.google.com/file/d/1JqFxWxzkaiv4HY7uoMazlbR_GSSXmbM7/view
| Non Pharmacological Options. Although the evidence is lacking for cancer-related neuropathic pain, non-pharmacological approaches should be considered alongside pharmacological therapies. This may include: transcutaneous electrical nerve stimulation (TENS); acupuncture; hydrotherapy and psychological interventions. |
3.9. American Cancer Society/American Society of Clinical Oncology (ACS/ ASCO, USA) 2016 ⊕
Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, Cannady RS, Pratt-Chapman ML, Edge SB, Jacobs LA, Hurria A, Marks LB, LaMonte SJ, Warner E, Lyman GH, Ganz PA. American Cancer Society/American Society of Clinical Oncology Breast Cancer SurvivorshipCare Guideline. J Clin Oncol. 2016;34(6):611-35. [198256].
| Pain and neuropathy Recommendation 3.9: It is recommended that primary care clinicians : (b) should offer interventions, such as acetaminophen, nonsteroidal anti-inflammatory drugs, physical activity, and/or acupuncture, for pain (LOE 5 I). |
3.10. 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. |
3.11. American Society of Clinical Oncology (ASCO, USA) 2014 Ø
Hershman DL, Lacchetti C, Dworkin RH, et al. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2014;32(18):1941-67. [202743]. DOI
| A number of nonpharmacologic interventions have been investigated for their role in preventing or treating peripheral neuropathy. However, the paucity of RCT evidence prohibited inclusion of those studies in this systematic review. Moreover, the studies were often conducted in diabetic populations, with no specific focus on CIPN. Nevertheless, several of the interventions have been tested in populations that included patients with cancer experiencing CIPN and, as such, merit further examination. Evidence of the efficacy and effectiveness of one such intervention, acupuncture, was systematically reviewed by Franconi et al for the treatment of CIPN. Seven clinical studies of varying designs and methodological rigor were identified. Although there were some indications of improvement in symptoms and pain scores in most included studies, the current available evidence is limited. |
3.12. Association Francophone des Soins Oncologiques de Support (AFSOS) 2014 ⊕
Association Francophone des Soins Oncologiques de Support (AFSOS). Fiches Réferentiels : L’acupuncture en onco-hématologie MAJ 2014 (URL)
| Neuropathies périphériques chimio-induites : acupuncture (niveau de preuve HAS : C ) |
3.13. British Columbia Cancer (BCA, Canada) 2014 ⊕
Symptom Management Guidelines: chemotherapy- induced peripheral neuropathy BC Cancer Agency. 2014. 6P . [178738].
| Complementary Alternative Medicŕine (CAM) therapy may be helpful for some individuals: Massage, Acupuncture, Transcutaneous electrical nerve stimulation(TENS) |
3.14. Alberta Health Services, Alberta Provincial Breast Tumour Team (Canada) 2013 Ø
Alberta Provincial Breast Tumour Team. Follow-up care for early-stage breast cancer. Edmonton (Alberta): CancerControl Alberta. 2013; 26P. [167265].
| 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. |
3.15. American College of Chest Physicians (ACCP, USA) 2013 ⊕
Deng GE, Rausch SM, JoneS LW, Gulati A, Kumar NB, GreenleE H, Pietanza MC, Cassileth BR. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College Of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2013;143(5 Suppl):420-36. [159371].
| Recommendation 2.5.3.2. In patients with cancer related pain and peripheral neuropathy, acupuncture is suggested as an adjunct treatment in patients with inadequate control of symptoms (Grade 2C ). |
3.16. American College of Chest Physicians (ACCP, USA) 2007 ⊕
Cassileth BR, Deng GE, Gomez JE, Johnstone PA, Kumar N, Vickers AJ; American College of Chest Physicians. Complementary therapies and integrative oncology in lung cancer: Accp Evidence-Based Clinical Practice Guidelines (2nd Edition). Chest. 2007;132(3sup:340s-54s. [146961]
Recommendation 7. Acupuncture is recommended as a complementary therapy when pain is poorly controlled or when side effects such as neuropathy or xerostomia from other modalities are clinically significant. Grade of recommendation, 1A
Recommendation 11. In patients with lung cancer with symptoms such as dyspnea, fatigue, chemotherapyinduced neuropathy, or postthoracotomy pain, a trial of acupuncture is recommended. Grade of recommendation, 2C
|
4. Randomized Controlled Trials
4.1. Sources incluses
Acudoc2: Base de données du centre de documentation du GERA. ECR non inclus dans les autres sources citées.
Xu 2022 : Xu Z, Wang X, Wu Y, Wang C, Fang X. The effectiveness and safety of acupuncture for chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. Front Neurol. 2022 Oct 3;13:963358.
https://doi.org/10.3389/fneur.2022.963358 (n=5).
Chien 2019: Chien TJ, Liu CY, Fang CJ, Kuo CY. The Efficacy of Acupuncture in Chemotherapy-Induced Peripheral Neuropathy: Systematic Review and Meta-Analysis. Integr Cancer Ther. 2019. [201982].
Li 2019: Li K, Giustini D, Seely D. A systematic review of acupuncture for chemotherapy-induced peripheral neuropathy. Curr Oncol. 2019;26(2):e147–e154. [202648].
Oh 2018 : Oh PJ, Kim YL. [Effectiveness of Non-Pharmacologic Interventions in Chemotherapy Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis]. J Korean Acad Nurs. 2018;48(2):123-142. [158610].
Brami 2016: Brami C, Bao T, Deng G. Natural products and complementary therapies for chemotherapy-induced peripheral neuropathy: A systematic review. Crit Rev Oncol Hematol. 2016;98:325-34. [190348].
Lau 2016: Lau CH, Wu X, Chung VC, Liu X, Hui EP, Cramer H, Lauche R, Wong SY, Lau AY, Sit RS, Ziea ET, Ng BF, Wu JC. Acupuncture and related therapies for symptom management in palliative cancer care: systematic review and meta-analysis. Medicine (Baltimore). 2016;95(9):e2901. [160606].
Franconi 2013: Franconi G, Manni L, Schröder S, Marchetti P, Robinson N. A systematic review of experimental and clinical acupuncture in chemotherapy-induced peripheral neuropathy. Evid Based Complement Alternat Med. 2013. [166737].
4.2. List
| | | |
| 2022 | Ben-Arye E, Hausner D, Samuels N, Gamus D, Lavie O, Tadmor T, Gressel O, Agbarya A, Attias S, David A, Schiff E. Impact of acupuncture and integrative therapies on chemotherapy-induced peripheral neuropathy: A multicentered, randomized controlled trial. Cancer. 2022 Oct;128(20):3641-3652. https://doi.org/10.1002/cncr.34422 | Acudoc2 |
| | Chan K, Lui L, Lam Y, Yu K, Lau K, Lai M, Lau W, Tai L, Mak C, Bian Z, Zhong LL. Efficacy and safety of electroacupuncture for oxaliplatin-induced peripheral neuropathy in colorectal cancer patients: a single-blinded, randomized, sham-controlled trial. Acupunct Med. 2022 Nov 3. https://doi.org/10.1177/09645284221125421 | Acudoc2 |
| D'Alessandro EG, Nebuloni Nagy DR, de Brito CMM, Almeida EPM, Battistella LR, Cecatto RB. Acupuncture for chemotherapy-induced peripheral neuropathy: a randomised controlled pilot study. BMJ Support Palliat Care. 2022 Mar;12(1):64-72. https://doi.org/10.1136/bmjspcare-2018-001542 | Acudoc2 |
| Stringer J, Ryder WD, Mackereth PA, Misra V, Wardley AM. A randomised, pragmatic clinical trial of ACUpuncture plus standard care versus standard care alone FOr Chemotherapy Induced peripheral Neuropathy (ACUFOCIN). Eur J Oncol Nurs. 2022 Oct;60:102171. https://doi.org/10.1016/j.ejon.2022.102171 | Acudoc2 |
| 2021 | Bao T, Baser R, Chen C, Weitzman M, Zhang YL, Seluzicki C, Li QS, Piulson L, Zhi WI. Health-Related Quality of Life in Cancer Survivors with Chemotherapy-Induced Peripheral Neuropathy: A Randomized Clinical Trial. Oncologist. 2021 Nov;26(11):e2070-e2078. https://doi.org/10.1002/onco.13933 | Xu 2022 |
| | Huang CC, Ho TJ, Ho HY, Chen PY, Tu CH, Huang YC, Lee YC, Sun MF, Chen YH. Acupuncture Relieved Chemotherapy-Induced Peripheral Neuropathy in Patients with Breast Cancer: A Pilot Randomized Sham-Controlled Trial. J Clin Med. 2021 Aug 20;10(16):3694. https://doi.org/10.3390/jcm10163694 | Xu 2022 |
| 2020 | Bao T, Patil S, Chen C, Zhi IW, Li QS, Piulson L, Mao JJ. Effect of Acupuncture vs Sham Procedure on Chemotherapy-Induced Peripheral Neuropathy Symptoms: A Randomized Clinical Trial. JAMA Netw Open. 2020 Mar 2;3(3):e200681. https://doi.org/10.1001/jamanetworkopen.2020.0681 | Xu 2022 |
| | Iravani S, Kazemi Motlagh AH, Emami Razavi SZ, Shahi F, Wang J, Hou L, Sun W, Afshari Fard MR, Aghili M, Karimi M, Rezaeizadeh H, Zhao B. Effectiveness of Acupuncture Treatment on Chemotherapy-Induced Peripheral Neuropathy: A Pilot, Randomized, Assessor-Blinded, Controlled Trial. Pain Res Manag. 2020 Jun 29;2020:2504674. https://doi.org/10.1155/2020/2504674 | Acudoc2 |
| Lu W, Giobbie-Hurder A, Freedman RA, Shin IH, Lin NU, Partridge AH, Rosenthal DS, Ligibel JA. Acupuncture for Chemotherapy-Induced Peripheral Neuropathy in Breast Cancer Survivors: A Randomized Controlled Pilot Trial. Oncologist. 2020 Apr;25(4):310-318. https://doi.org/10.1634/theoncologist.2019-0489 | Xu 2022 |
| 2019 | Molassiotis A, Suen LKP, Cheng HL, Mok TSK, Lee SCY, Wang CH, Lee P, Leung H, Chan V, Lau TKH, Yeo W. A Randomized Assessor-Blinded Wait-List-Controlled Trial to Assess the Effectiveness of Acupuncture in the Management of Chemotherapy-Induced Peripheral Neuropathy. Integr Cancer Ther. 2019;18:1-12. [203375]. | Chien 2019 |
| 2017 | Han X, Wang L, Shi H, Zheng G, He J, Wu W, Shi J, Wei G, Zheng W, Sun J, Huang H, Cai Z. Acupuncture combined with methylcobalamin for the treatment of chemotherapy-induced peripheral neuropathy in patients with multiple myeloma. BMC Cancer. 2017;17(1):40. [190531]. DOI | Chien 2019, Li 2019 |
| | Lu W, Giobbie-Hurder A, Freedman R, Yung R, Lin N, Partridge A, Shockro L, Stecker K, O'Connor KA, Rosenthal DS, Ligibel JA. Acupuncture for chemotherapy-induced peripheral neuropathy in breast cancer, preliminary results of a pilot randomized controlled trial [Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10;]. Cancer Res. 2017;77 supp 4:. [201979]. DOI | Chien 2019, Li 2019 |
| Zhang SQ, Wu TT, Zhang HS, Yang Y, Jiang HY, Cao SC, Xie F, Xia XT, Lü JQ, Zhong Y. Effect of electroacupuncture on chemotherapy-induced peripheral neuropathy in patients with malignant tumor: a single-blinded, randomized controlled trial. Journal of TCM. 2017;37(2):179-84. [198642]. | Chien 2019 |
| 2016 | Greenlee H, Crew KD, Capodice J, Awad D, Buono D, Shi Z, Jeffres A, Wyse S, Whitman W, Trivedi MS, Kalinsky K, Hershman DL. Randomized sham-controlled pilot trial of weekly electro-acupuncture for the prevention of taxane-induced peripheral neuropathy in women with early stage breast cancer. Breast Cancer Res Treat. 2016;156(3):453-64. [190384]. https://doi.org/10.1007/s10549-016-3759-2 | Xu 2022, Chien 2019, exclu de Li 2019 (prévention et non traitement) |
| | Xiong Zhi-Feng, Wang Ting, Gan Lin, Ran Jun, Min Jie, Lu Gang. Clinical efficacy of acupoint injection for chemotherapy-induced peripheral neuropathy of patients with breast cancer. World Journal of Acupuncture-Moxibustion. 2016;26(2):20. [189265]. | Acudoc2 |
| 2013 | Rostock M, Jaroslawski K, Guethlin C, Ludtke R, Schröder S, Bartsch HH. Chemotherapy-induced Peripheral Neuropathy in Cancer Patients: A Four-Arm Randomized Trial on the Effectiveness of Electroacupuncture. Evid Based Complement Alternat Med. 2013. [169708]. DOI | Chien 2019, Li 2019, Oh 2018, Brami 2016, Lau 2016 |
| 2012 | Sun Xian-Jun, He Sheng-Li, Chen Hao. [Clinical Study of electroacupuncture treatment for oxaliplatin neurotoxicity]. Shanghai Journal of Acupuncture and Moxibustion. 2012;31(10):727. [175672]. | Acudoc2 |
| | Yan Yu-jiang, He Chun-ling, Dong Chang-hu. [Clinical Study on Acupuncture for Treatment of Peripheral Neuropathy Induced by Chemotherapeutic Drugs]. Journal of Liaoning University of TCM. 2012;8:. [187841]. | Acudoc2 |
| 2011 | Tian Yan-Ping, Zhang Ying, Jia Ying-Jie. [The curative effect of warm acupuncture and moxibustion on peripheral neurotoxicity caused by oxaliplatin]. Tianjin Journal of TCM. 2011;28(3):212-3. [201832]. | Franconi 2013 |
| 2010 | Xu WR, Hua BJ, Hou W, Bao YJ. [Clinical randomized controlled study on acupuncture for treatment of peripheral neuropathy induced by chemotherapeutic drugs]. Chinese Acupuncture and Moxibustion. 2010;30(6):457-60. [155664]. | Acudoc2 |
| 2007 | Rostock M, Lacour M, Jaroslawski K, Guethlin C, Zunder T, Luedtke R, Bartsch HH. Chemotherapy-induced peripheral neuropathy in cancer patients: evaluation of acupuncture vs. Electrotherapy vs. Vitamin b - a prospective randomized placebo controlled pilot-study (Abstract). Forschende Komplementärmedizin. 2007;14(S1):34. [146181]. | Acudoc2 |
| 2003 | Alimi D, Rubino C, Pichard-Léandri E, Fermand-Brulé S, Dubreuil-Lemaire ML, Hill C. Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial. J Clin Oncol. 2003;21(22):4120-6. [117516]. | Franconi 2013 |
