Nausea and vomiting during chemotherapy

Many patients undergoing chemotherapy experience nausea and vomiting (Gralla 1999; Hesketh 1998). The symptoms can be severe, impairing a patient’s quality of life (Osoba 1997), causing emotional distress (Love 1989), and aggravating cancer-related symptoms such as cachexia, lethargy and weakness (Griffin 1996; Roscoe 2000).

This article reviews the research evidence for the effectiveness of acupuncture in these circumstances.

The best evidence for acupuncture’s effectiveness is with postoperative nausea and vomiting (PONV) (Ezzo 2006a). The latest systematic review, based on 40 trials and nearly 5,000 patients, found acupuncture to be significantly better than sham treatment and at least as good as anti-emetic drugs, with minimal side-effects (Lee 2009). Trials published since this review gathered its data have also been consistently positive: acupressure at P6 (Soltani 2010), acupoint injection of droperidol at P6 (Zhu 2010), 24-hour acupoint stimulation (Frey 2009), acupuncture at several points (Ayoglu 2009), acupuncture at P6 (Puyang 2009, Frey 2009) and ear acupuncture (Sahmaddini 2008). There is one less consistently favourable review but that looked specifically at caesarean delivery under neuraxial anaesthesia (6 trials only): (Allen 2008).

 

For chemotherapy-induced nausea and vomiting, there is also substantial evidence supporting acupuncture and associated procedures, although it is not as consistent as that for PONV. The latest systematic review (Ezzo 2006b) is now several years old. It found that electro- (but not manual) acupuncture reduced the incidence of acute vomiting and self-administered acupressure appears to have a protective effect for acute nausea and can readily be taught to patients. Subsequent individual trials of acupuncture or electroacupuncture (Yang 2009; You 2009; Sima 2009; Gottschling 2008) have all reported significant benefits, while those for acupressure applied using a wristband have been mixed (Jones 2008; Molassiotis 2007; Shin 2006).