Zeng Yingchun, Luo Taizhen, Finnegan-John Jennifer, Cheng Andy S K
The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Integr Cancer Ther. 2014 May;13(3):193-200. doi: 10.1177/1534735413510024. Epub 2013 Nov 25.
Fatigue is a distressing and pervasive problem for people with cancer. In recent years, acupuncture has gained increasing attention among researchers as an alternative management strategy for cancer-related fatigue (CRF). This review aimed to evaluate the effectiveness of acupuncture for CRF.
Five databases (Medline, CINAHL, Scopus, the Cochrane Library, and CAJ Full-text Database) were searched up to May 2013. Randomized controlled trials (RCTs) of acupuncture for the treatment of CRF were considered for inclusion.
Seven RCTs were included for meta-analysis, involving a total of 689 subjects. Three studies compared acupuncture with sham acupuncture for CRF with follow-up at 10 weeks; the standardized mean difference (SMD) for general CRF change values was -0.82 (95% confidence interval [CI] = -1.90 to 0.26). When acupuncture plus education intervention was compared with usual care, there was a statistically significant difference for the change score of general CRF (SMD = -2.12; 95% CI = -3.21 to -1.03). The SMD for general CRF change scores between acupuncture with no treatment or wait-list control was -1.46 (95% CI = -3.56 to 0.63). Finally, the SMD for general CRF change scores between acupuncture with acupressure or self-acupuncture was -1.12 (95% CI = -3.03 to 0.78). Three trials reported data for general quality of life and functioning status, reporting enough data for statistical pooling but showing no statistically significant difference (Zscore = 1.15,P= .25, SMD = 0.99, 95% CI = -0.70 to 2.68 andZscore = 1.13,P= .26, SMD = 1.38, 95% CI = -1.02 to 3.79, respectively). TheI(2)statistics of all statistically pooled data were higher than 50%, indicating heterogeneity between the trials.
There were 4 sets of comparison for the effectiveness of acupuncture for CRF; statistical pooling of the reduction in CRF from baseline to follow-up showed in favor of acupuncture. However, 3 sets of comparison for the pooled estimates of effect sizes had no statistical significance. Although one set of comparison (acupuncture plus education interventions vs usual care) had statistically significant differences, it is unclear whether this pooled positive outcome is attributable to the effects of acupuncture or to the education intervention. In addition, the duration of follow-up in these included trials was up to 10 weeks, and some RCTs had methodological flaws. Further rigorously designed RCTs adhering to acceptable standards of trial methodology are required to determine the effectiveness of acupuncture and its long-term effects on CRF.
疲劳是癌症患者面临的一个令人苦恼且普遍存在的问题。近年来，针灸作为癌症相关疲劳（CRF）的一种替代管理策略，越来越受到研究人员的关注。本综述旨在评估针灸治疗CRF的有效性。
检索了截至2013年5月的五个数据库（Medline、CINAHL、Scopus、Cochrane图书馆和中国学术期刊全文数据库）。纳入了针灸治疗CRF的随机对照试验（RCT）。
纳入七项RCT进行荟萃分析，共涉及689名受试者。三项研究比较了针灸与假针灸治疗CRF的效果，随访10周；一般CRF变化值的标准化平均差（SMD）为-0.82（95%置信区间[CI]=-1.90至0.26）。当将针灸加教育干预与常规护理进行比较时，一般CRF变化评分有统计学显著差异（SMD=-2.12；95%CI=-3.21至-1.03）。未治疗或等待名单对照的针灸与一般CRF变化评分的SMD为-1.46（95%CI=-3.56至0.63）。最后，指压或自我针灸的针灸与一般CRF变化评分的SMD为-1.12（95%CI=-3.03至0.78）。三项试验报告了一般生活质量和功能状态的数据，报告的数据足以进行统计合并，但未显示出统计学显著差异（Z分数=1.15，P=.25，SMD=0.99，95%CI=-0.70至2.68；Z分数=1.13，P=.26，SMD=1.38，95%CI=-1.02至3.79）。所有统计合并数据的I²统计量均高于50%，表明各试验之间存在异质性。
针灸治疗CRF的有效性有4组比较；从基线到随访CRF降低的统计合并结果显示支持针灸。然而，3组效应大小合并估计的比较无统计学意义。虽然一组比较（针灸加教育干预与常规护理）有统计学显著差异，但尚不清楚这种合并的阳性结果是归因于针灸的效果还是教育干预。此外，这些纳入试验的随访时间长达10周，一些RCT存在方法学缺陷。需要进一步严格设计符合可接受试验方法标准的RCT，以确定针灸的有效性及其对CRF的长期影响。
