Tong, T., Pei, C., Chen, J., Lv, Q., Zhang, F., & Cheng, Z. (2018). Efficacy of acupuncture therapy for chemotherapy-related cognitive impairment in breast cancer patients. Medical Science Monitor, 24, 2919–2927.

To determine the efficacy of acupuncture in decreasing chemotherapy-induced cognitive impairment

Eligibility included self-report of memory concerns prior to chemotherapy. Acupuncture was administered daily for five days for four weeks, followed by a three-day rest period, then this process was repeated for another four weeks for a total of eight weeks. Sterile, disposable needles (40 mm long and 0.25 mm in diameter) were inserted at the following puncture points: Baihui, Sishencong, Taixi as well as other sites as indicated based on patient symptoms. After acupuncture stimulation was initiated, needles remained in situ for 30 minutes.   Neurological assessment, incorporating subjective and objective measures of cognition function, as well as serum BDNF levels, were evaluated prior to the initial acupuncture treatment and repeated after the final acupuncture therapy was completed.

• N = 75 (39 intervention and 36 control)
• AGE: 43 years (average)
• FEMALES: 100%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: Post-surgical breast cancer undergoing one of three chemotherapy regimens (i.e., docetaxel plus cyclophosphamide [TC]; docetaxel plus carboplatin [TCb]; doxorubicin plus cyclophosphamide [AC] followed by docetaxel)
• OTHER KEY SAMPLE CHARACTERISTICS: Premenopausal, self-reported memory problems validated by family members

• SITE: Single site   
• SETTING TYPE: Not specified    
• LOCATION: Affiliated Hospital of Jiangnan University in China

PHASE OF CARE: Active anti-tumor treatment

Prospective longitudinal randomized study

• Functional Assessment of Cancer Treatment–Cognition (FACT-COG), version 3
• Auditory-Verbal Learning Test (AVLT)
• Verbal Fluency Test (VFT)
• Symbol Digit Modality Test (SDMT)
• Clock Drawing Test (CDT)
• Trail Making Test (TMT) – part B
• Serum Brain-Derived Neurotrophic Factor (BDNF)
• Mini-Mental State Exam (MMSE)      
• State Anxiety Inventory (SAI)
• Beck Depression Inventory (BDI)

The intervention group was observed to have significant improvement from baseline to 8 weeks on FACT-COG scales for perceived cognitive functioning (p < 0.001), perceived cognitive impairments (p = 0.027) and perceived cognitive abilities (p = 0.014) in contrast to the control group. Similarly, although the intervention group improved in CDT (p = 0.002) and one subtest of the AVLT for recognition (AVLT3, p = 0.026), there was no improvement in the control group. However, no differences were found in other objective measurements of cognitive functioning (e.g., VFT, AVLT1, AVLT2, SDMT, TMT-B). Those who completed acupuncture treatment had a significant increase in BDNF expression (p < 0.01). Of note, BDNF expression was found to be positively correlated with the subjective (FACT-COG, PCA) and objective measures (AVLT3, CDT) that improved in the treatment group (p < 0.005).

Acupuncture may be an effective treatment to alleviate cognitive impairment in patients with breast cancer undergoing chemotherapy.

• Small sample (< 100)
• Risk of bias (no blinding)
• Intervention expensive, impractical, or training needs
• Subject withdrawals ≥ 10%

Acupuncture may improve some cognitive functions during the immediate post-chemotherapy interval in patients receiving treatment. Additional research with larger sample sizes and longer follow-up are needed to validate its effectiveness and determine whether these results are sustainable.