Lee, M.S., Kim, K.H., Choi, S.M., & Ernst, E. (2009). Acupuncture for treating hot flashes in breast cancer patients: A systematic review. Breast Cancer Research and Treatment, 115, 497–503. 

DOI Link

Purpose

STUDY PURPOSE: To access the effectiveness of acupuncture as a treatment option for hot flashes in patients with breast cancer through a systematic review

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE, CINAHL, EMBASE, PsycINFO, Korean Studies Information, DBPIA, Korea Institute of Science and Technology Information, Korea-Med, Research Information Center for Health Database, China Academic Journal, Century Journal Project, China Doctor/Master Dissertation Full-Text Database, China Proceedings Conference Full-Text Database, and The Cochrane Library 2008, issue 3.
 
YEARS INCLUDED: From each of the databases inception through August 2008
 
INCLUSION CRITERIA: Randomized, clinical trials of patients with breast cancer who were treated with needle acupuncture with or without stimulation for hot flashes; no language restrictions; dissertations and abstracts were included.
 
EXCLUSION CRITERIA: Trials using other forms of acupuncture, such as laser acupuncture or moxibustion; studies comparing two different forms of acupuncture and those in which no clinical data were reported were excluded.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 67
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Articles were reviewed by two independent reviewers who extracted data according to predefined data. The modified Jadad score was calculated by assessing three criteria: description of randomization, blinding, and withdrawals. Using the Cochrane Collaboration’s software (Review Manager, version 5, for Windows Copenhagen), the effects of acupuncture on outcomes during and post-treatment compared with baseline was determined. The variance of the changes was imputed using a correlation factor of 0.5. The X² test, ۲², and the Higgins I² test were used to assess heterogeneity.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 6
  • TOTAL PATIENTS INCLUDED IN REVIEW = 281
  • SAMPLE RANGE ACROSS STUDIES: Sample size ranged from 20–72.
  • KEY SAMPLE CHARACTERISTICS: Women with breast cancer experiencing hot flashes

Phase of Care and Clinical Applications

PHASE OF CARE: Transition phase after active treatment

Results

Of the six studies that were reviewed, three compared the effects of manual acupuncture with sham acupuncture, one compared the effects of electroacupuncture (EA) with hormone replacement therapy, one compared acupuncture with venlafaxine, and one compared manual acupuncture with relaxation therapy. Of the studies examined, all were randomized, controlled trials. Of the three comparing manual acupuncture with sham, one showed favorable results of acupuncture reducing the frequency of hot flashes, whereas the other two studies failed to do so. The study comparing EA with hormone therapy demonstrated that hormone replacement therapy was more effective in controlling hot flashes than EA. The study comparing acupuncture and venlafaxine showed no difference. When relaxation therapy was compared with acupuncture, no intergroup difference occurred.

Conclusions

This systematic review of six articles using acupuncture to treat hot flashes in women with breast cancer failed to demonstrate that acupuncture was a clearly effective treatment tool. When comparing acupuncture with sham acupuncture, the three studies were not consistent in their findings, with one demonstrating that acupuncture was effective and two that did not. In the additional three studies, acupuncture was not found to be superior to hormone replacement therapy, venlafaxine, or relaxation therapy.

Limitations

  • Limited number of studies included
  • High heterogeneity
  • The researchers acknowledged that some of the studies had suboptimal data in the primary study reviewed.

Nursing Implications

This review of randomized studies did not demonstrate that acupuncture was a superior therapy to hormone replacement, venlafaxine, or relaxation therapy in controlling hot flashes in women with breast cancer.

Legacy ID

6361