Cassileth, B.R., Van Zee, K.J., Yeung, K.S., Coleton, M.I., Cohen, S., Chan, Y.H., … Hudis, C.A. (2013). Acupuncture in the treatment of upper-limb lymphedema: Results of a pilot study. Cancer, 119, 2455–2461.

To evaluate the safety and potential efficacy of acupuncture in the treatment of arm lymphedema in women with breast cancer-related lymphedema

Each patient was given acupuncture treatment twice weekly for four weeks. Treatments lasted 30 minutes, as 14 needles were inserted at apecific points determined on the basis of history and consensus of experienced acupuncturists.  Arm circumference was measured before and after each treatment.

• The study consisted of 33 patients with a mean age of 55 years.
• All of the participants were female and had breast cancer-related arm lymphedema.
• Time from surgery was a median of 3.9 years. 
• Most patients were reported to be on standard lymphedema therapy prior to enrollment.

This was a single-site, outpatient study conducted at Memorial Sloan-Kettering Cancer Center in New York.

This study has clinical applicability for late effects and survivorship.

This was a prospective trial.

• Arm circumference was measured.
• The percent change in lymphedema was calucated by taking the largest pretreatment difference between arms minus the same site posttreatment difference and dividing that number by the largest pretreatment difference.

• Just more than three-fourths of the patients (76%) received all intervention sessions. Of these, 33% showed reduction of 30% or more in lymphedema and 55% showed reduction of 20% or more. Mean reduction in the extent of lymphedema was 0.90 cm (95% confidence interval [CI], 0.72–1.07, p < 0.0005). 
• A segment of patients (12%) reported sustained improvement for four months during follow up; however, the method of obtaining this information was not clearly described. 
• Additionally, 36.4% of patients reported mild bruising or minor pain or tingling in the arm or shoulder at least once. One patient experienced a transient increase in lymphedema.

Findings suggest that acupuncture can be safely provided to patients with arm lymphedema. However, the benefit is unclear because of study design limitations and the fact that the mean change in lymphedema was very small.

• The sample size was small with fewer than 100 patients.
• A risk of bias exists because no control group, blinding, or random assignment was used.
• Unintended interventions or applicable interventions that were not described could have influenced results.
• The measurement methods were not well described.
• The measurement validity and reliability was questionable.
• The method of lymphedema measurement was not as rigorous as possible. The actual “standard” treatments used are not described, and it is not known if any changes occurred in the standard approaches during the study period, such as activity changes. 
• The report of duration of effect on follow-up was not clearly described.

This study provides insufficient evidence to support efficacy of acupuncture for lymphedema management.