Minchom, A., Punwani, R., Filshie, J., Bhosle, J., Nimako, K., Myerson, J., . . . O'Brien, M.E. (2016). A randomised study comparing the effectiveness of acupuncture or morphine versus the combination for the relief of dyspnoea in patients with advanced non-small cell lung cancer and mesothelioma. European Journal of Cancer, 61, 102–110.

To investigate the use of acupuncture for the relief of dyspnea

Patients were randomized to acupuncture alone, morphine and acupuncture, or morphine alone groups. Patients in the acupuncture alone arm were provided morphine for rescue if needed. Oral morphine at 2.5 mg every four hours with breakthrough doses were given to the morphine group. In the combination group, patients received morphine before acupuncture. Study measures were conducted at 30 minutes, 90 minutes, 4 hours, and on days 2, 7, and 14.

• N = 145, 175 in intent-to-treat analysis 
• MEDIAN AGE = 73 years
• MALES: 65.1%, FEMALES: 44.9%
• CURRENT TREATMENT: Not applicable
• KEY DISEASE CHARACTERISTICS: Non-small cell lung cancer or mesothelioma
• OTHER KEY SAMPLE CHARACTERISTICS: The baseline mean visual analog scale (VAS) for dyspnea was 6.5.

• SITE: Single site   
• SETTING TYPE: Not specified    
• LOCATION: United Kingdom

• PHASE OF CARE: End-of-life care
• APPLICATIONS: Palliative care 

Three-group, randomized trial

• Forced expiratory volume measured during the first second of forced breath (FEV1)
• Peak expiratory flow rate (PEFR)
• Hospital Anxiety and Depression (HADS) scale for anxiety
• Borg Dyspnea Scale
• European Organization for Research and Treatment of Cancer (EORTC) QLC-30 questionnaire for quality of life
• Visual analog scale (VAS) dyspnea and anxiety

No difference existed between groups in VAS dyspnea scores from baseline to after the interventions. VAS scores for anxiety declined in the acupuncture-only group (p < 0.001) and the combination group (p < 0.001) compared to the morphine-only group by day 14. At 30 minutes, Borg Dyspnea Scale scores were lower in the groups receiving acupuncture compared to the morphine-only group (p = 0.003). Twenty-one percent of patients receiving acupuncture took morphine as a rescue medication.

Acupuncture may play a role in the management of dyspnea in patients with advanced lung cancer; however, additional research is needed to determine efficacy and determine how it is best provided.

• Risk of bias (no blinding)
• Measurement/methods not well described
• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10% 
• It appears that acupuncture was provided once, but the timing was not clearly stated.
• Although VAS scores for anxiety showed a response, HAD scale scores did not.

Acupuncture may have some benefit in the management of dyspnea in patients with advanced disease; however, additional research in this area is needed.