Jeong, Y.J., Park, Y.S., Kwon, H.J., Shin, I.H., Bong, J.G., & Park, S.H. (2013). Acupuncture for the treatment of hot flashes in patients with breast cancer receiving antiestrogen therapy: A pilot study in Korean women. Journal of Alternative and Complementary Medicine, 19, 690–696. 

To determine if acupuncture administered to Korean women receiving tamoxifen or anastrozole for breast cancer can be safe and feasible in controlling their hot flashes during eight weeks of intervention

Each intervention session lasted 40 minutes and consisted of 20 ± 5 minutes of acupuncture. Patients received three sessions per week for four weeks for a total of 12 sessions. The following acupuncture points were selected for the intervention: GV 20, M-HN-3, HT 8, KI 10, and LV 2. Acupuncture was administered by a physician with three years of experience.  After appropriate skin preparation, eight needles were inserted 10-20 mm deep into the skin and were manipulated to obtain De Qi.  Needles were rotated after 10 minutes.  Data were recorded at baseline, weekly during the intervention (visits 5, 8, 11, and 13), and four weeks post study.

• N = 10 
• MEAN AGE = 46.60 years ± 4.93 (range = 38–53 years)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer diagnosis; pre-menopause = 80% and post-menopause = 20%
• OTHER KEY SAMPLE CHARACTERISTICS: Previous treatments were surgery, radiotherapy, and chemotherapy in different proportions; any participant took dietary supplements concomitant to the study.

• SITE: Single site  
• SETTING TYPE: Not specified  
• LOCATION: East-West Medical Center at Daegu Catholic University Center in Daegu, Korea

• PHASE OF CARE: Late effects and survivorship
• APPLICATIONS: Elder care, palliative care, and supportive care

Interventional study in a nonrandomized series of cases enrolled prospectively

Data was self-reported using a hot-flash diary to record number and severity of hot flashes. A visual analogue scale was used to record severity of hot flashes. A total score was calculated by multiplying the severity and frequency of hot flashes.

Findings are limited in explaining completely the efficacy of acupuncture to decrease hot flashes in women receiving tamoxifen or anastrozole to treat breast cancer. Although safety and statistical significance result from the study, the sample size, the lack of a random design, and the lack of a control group limit the generalization of data.

• Small sample of < 30
• Baseline sample/group differences of import
• Risk of bias from no control group
• Risk of bias from no blinding
• Risk of bias from no random assignment
• Risk of bias from no appropriate attentional control condition
• Risk of bias related to sample characteristics
• Selective outcomes reporting
• Key sample group differences that could influence results 
• Findings not generalizable
• Other limitations/explanation: Previous cancer treatments in the sample group, such as chemotherapy or radiotherapy, can also affect the final outcome. Pre- and post-menopausal women should not be in the same group in the sample. No control group is the main limitation. Follow-up described to eight weeks is limited. Subjective measures self-reported by participants may differ from other objective ways of measuring the symptom. Comparison with other references in the literature shows that Korean technic and Chinese technic are performed differently.

Implications for cancer nurses are limited since applying this intervention requires professional training. However, oncology nurses are vital in providing information to patients about complementary treatments that are safe and feasible in controlling hot flashes related to hormone cancer treatments. No related adverse events were described.