Lim, J.T., Wong, E.T., & Aung, S.K. (2011). Is there a role for acupuncture in the symptom management of patients receiving palliative care for cancer? A pilot study of 20 patients comparing acupuncture with nurse-led supportive care. Acupuncture in Medicine, 29(3), 173–179.

To document changes in symptoms after acupuncture or nurse-led supportive care in patients with incurable cancer and to determine the feasibility of carrying out a randomized trial in acupuncture for patients with advanced incurable cancer

Patients were randomly assigned to either an acupuncture group or a nurse-led supportive care group. In the acupuncture group, traditional Chinese medical acupuncture was performed by the principle investigator, a radiation oncologist, and a certified medical acupuncturist. The acupuncture points were chosen based on the symptoms experienced. The acupuncture needles were connected to an electric stimulator, and a 0.3 ms duration, 4 Hz alternating current was delivered. The needles were stimulated for 20 minutes and then removed.

In the nurse-led supportive care group, patients met for 20–30 minutes with an experienced palliative care nurse weekly for four weeks, comparable to the time spent in acupuncture. The nurse explored their most troubling symptoms and discussed medications and nonpharmacologic therapies such as relaxation therapy, professional counseling, exercise, or judicious rest. The patient’s interpretation of the causes of the symptoms and how they could be ameliorated were discussed. The nurse also addressed issues such as improving the scheduling and dosing of the medications and alternative therapies to drugs, such as foods for managing constipation. Useful strategies for coping with daily activities and emotional support were discussed.

• The study reported on a final sample of 18 patients.
• Mean patient age was 55 years in the acupuncture group and 64.9 years in the nurse-led supportive care group.
• Males represented 11% of the intervention group and 6% of the nurse-led supportive care group. Females represented 44% of the intervention group and 39% of the nurse-led supportive care group.
• Cancer sites were breast, rectum, endometrium, cervix, oropharynx, bladder, kidney, lung, cecum, and esophagus, in addition to leukemia and myeloma.

• 80 clinics
• Outpatient setting
• BC Cancer Agency at the Vancouver Island Centre in Victoria (Pain and Symptom Clinic for palliative management of cancer and treatment-related symptoms)

• Patients were receiving end-of-life care.
• The study has clinical applicability for end-of-life and palliative care.

This pilot study was a single-blind, randomized controlled trial.

The Edmond Symptom Assessment System (ESAS) was used to measure any changes in the symptoms experienced by patients before and after the intervention.

The treatment was well tolerated with no significant unexpected side effects. The compliance rate was 90% for acupuncture and 80% for nurse-led supportive care. All nine symptoms (pain, tiredness/fatigue, nausea, depression, anxiety, drowsiness, loss of appetite, lack of well-being, and shortness of breath) were improved immediately after acupuncture, with improvement continuing in six of these symptoms after six weeks. Six symptom scores improved immediately following nurse-led supportive care visits, with all nine symptoms showing improvement after six weeks. Total symptoms were reduced by an average of 22% after each acupuncture visit and by 14% after each nurse-led supportive care visit. ESAS scores at the end of the follow-up period were reduced by 19% for the acupuncture group and 26% for the nurse-led supportive care group. At six weeks after acupuncture, symptoms of pain, nausea, and loss of appetite did not maintain improvement. Only 48% of eligible patients consented to the study, and it was closed due to poor recruitment.

The study suggests that patients can benefit from incorporating acupuncture and supportive interventions to help with symptom management in advanced incurable cancer. Findings suggest that nurse attention provided over the long term benefited patients and that acupuncture may provide some immediate symptom improvements.

• The study had a small sample size, with less than 30 patients.
• No patient blinding with self-report outcome measures may be subject to validity threats.

Nurse-led supportive care can improve symptoms in these patients. These improvements can likely be attributed to increased attention and quality feedback being provided from the nurse to the medical team, who were able to initiate positive changes in medication and other supportive measures.