Acupuncture for patients with cancer in a palliative care team in Japan: A prospective case series study.

193 Background: In the joint guideline of the Society for Integrative Oncology and ASCO, acupuncture is recommended for general or musculoskeletal pain from cancer, chemotherapy-induced peripheral neuropathy, and other conditions. However, Japanese acupuncture needles are thinner and less stimulating than those used in other countries. To assess whether adding Japanese-style acupuncture to usual palliative care alleviates subjective symptoms in hospitalized cancer patients, we conducted a prospective case series study at an urban core hospital in Japan. Methods: Acupuncture treatment was administered to participating cancer patients once or twice a week, for a maximum of six sessions over three weeks. Each treatment session lasted approximately 30 minutes. Patients in the study continued to receive standard care. The main outcome measure was the change in the 10 cm visual analog scale (VAS) for the primary subjective symptoms immediately after treatment. We regarded a reduction in VAS of 20% or more as a minimal clinically important difference (MCID). The protocol of the study was approved by the Clinical Research Ethics Committee of Osaka General Medical Center (CRB5180013). Results: During the study period, 83 cancer patients gave written consent to receive acupuncture treatment. The mean age was 66.1 years (SD 10.7), with 66% of patients in stage 4, and 70% using opioids. Significant reductions in VAS scores for subjective symptoms were observed immediately after treatment for pain (1st session: from 5.4 to 3.9 on average, P<0.001; 2nd: 4.9 to 3.4, P<0.001; 3rd: 3.9 to 2.6, P<0.001; 4th: 4.7 to 2.8, P=0.002), edema (2nd: 5.5 to 3.7, P<0.001), paresthesia (2nd: 6.2 to 4.6, P=0.005), nausea (1st: 6.5 to 3.9, P=0.012; 2nd: 3.3 to 2.0, P=0.008), stiffness (1st: 6.8 to 3.1, P=0.011; 2nd: 4.3 to 2.8, P=0.022), and breathing difficulty (1st: 5.9 to 3.2, P=0.012). However, there was no significant improvement in malaise across any sessions. The maximum percentages of patients experiencing symptom relief beyond MCID in pain, edema, paresthesia, nausea, stiffness, and breathing difficulty were 67%, 75%, 60%, 80%, 88%, and 83%, respectively, across the treatment sessions for each symptom. There was no significance in odds ratios for age, sex, previous acupuncture experience, or opioid use associated with clinically meaningful pain reduction. All recorded adverse events were mild and transient. Conclusions: The symptom relief observed in this study is only a short-term effect immediately after treatment and includes non-specific effects such as the placebo effect. Future research should explore the specific effects of acupuncture using an exploratory trial design. However, determining the appropriate control group for acupuncture trials remains controversial. At least from a clinical perspective, acupuncture may be a possible option for palliative care for cancer patients, including in Japan.