Acupuncture for Cancer-Related Fatigue in Patients With Breast Cancer: A Pragmatic Randomized Controlled Trial

© 2012 by American Society of Clinical Oncology

1. Alexander Molassiotis⇓, Joy Bardy, Jennifer Finnegan-John, Peter Mackereth,
2. David W. Ryder, Jacqueline Filshie, Emma Ream and Alison Richardson

+ Author Affiliations

1. Alex Molassiotis and Joy Bardy, School of Nursing, Midwifery, and Social Work, University of Manchester; Peter Mackereth and David W. Ryder, Christie National Health Service (NHS) Foundation Trust, Manchester; Jennifer Finnegan-John and Emma Ream, Florence Nightingale School of Nursing and Midwifery, King's College London; Jacqueline Filshie, The Royal Marsden Hospital NHS Foundation Trust, London; and Alison Richardson, University of Southampton, Southampton, United Kingdom.

1. Corresponding author: Alexander Molassiotis, RN, PhD, Professor of Cancer and Supportive Care, University of Manchester, School of Nursing, University Place, Manchester M13 9PL, United Kingdom; e-mail: alex.molassiotis@manchester.ac.uk.

Abstract

Purpose We aimed to assess the effectiveness of acupuncture for cancer-related fatigue (CRF) in patients with breast cancer.

Patients and Methods We conducted a pragmatic, randomized controlled trial comparing acupuncture with enhanced usual care. Three hundred two outpatients with breast cancer participated. We randomly assigned 75 patients to usual care and 227 patients to acupuncture plus usual care (random assignment of 1:3 respectively) with minimization controlling for baseline general fatigue and maintenance treatment. Treatment was delivered by acupuncturists once a week for 6 weeks through needling three pairs of acupoints. The usual care group received a booklet with information about fatigue and its management. Primary outcome was general fatigue at 6 weeks, measured with the Multidimensional Fatigue Inventory (MFI). Other measurements included the Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy–General quality-of-life scale, and expectation of acupuncture effect. Analyses were by intention to treat.

Results Two hundred forty-six of 302 patients randomly assigned provided complete data at 6 weeks. The difference in the mean General Fatigue score, between those who received the intervention and those who did not, was −3.11 (95% CI, −3.97 to −2.25; P < .001). The intervention also improved all other fatigue aspects measured by MFI, including Physical Fatigue and Mental Fatigue (acupuncture effect, −2.36 and −1.94, respectively; both at P < .001), anxiety and depression (acupuncture effect, −1.83 and −2.13, respectively; both at P < .001), and quality of life (Physical Well-Being effect, 3.30; Functional Well-Being effect, 3.57; both at P < .001; Emotional Well-Being effect, 1.93; P = .001; and Social Functioning Well-Being effect, 1.05; P < .05).

Conclusion Acupuncture is an effective intervention for managing the symptom of CRF and improving patients' quality of life.

Footnotes

• See accompanying editorial on page 4449
• Supported by a grant from Breakthrough Breast Cancer.
• Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
• Clinical trial information: NCT00957112.

• Received January 4, 2012.
• Accepted July 26, 2012.