Haddad Nadia Elisabeth, Palesh Oxana
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Integr Cancer Ther. 2014 Sep;13(5):371-85. doi: 10.1177/1534735413520181. Epub 2014 Feb 4.
Acupuncture is being adopted by cancer patients for a wide range of cancer-related symptoms including highly prevalent psychological symptoms like depression, anxiety, insomnia, and impairment in quality of life. Pharmacological treatment of prevalent symptoms like anxiety, depression, and sleep disturbance can contribute to the high chemical burden already carried by cancer patients, creating additional side effects. As a result, patients and providers alike are interested in evidence-based nonpharmacologic alternatives like acupuncture for these symptoms. This article reviews the current literature (January 2000 through April 2013) for acupuncture in cancer-related psychological symptoms with attention to both efficacy and acupuncture-specific methodology. All published studies that met our review criteria demonstrate a positive signal for acupuncture for the treatment of depression, anxiety, sleep disturbance, and for improving quality of life with most results showing statistical significance. However, there are only a handful of acupuncture studies that were specifically designed to evaluate depression, sleep disturbance, and quality of life as primary outcomes, and no studies were found that looked at anxiety as a primary outcome in this population. Published studies in cancer patients and survivors show that acupuncture treatment is not only safe but also more acceptable with fewer side effects than standard of care pharmacological treatments like antidepressants. Finally, there is wide variability in both the implementation and reporting of acupuncture methods in the literature, with only 2 of 12 studies reporting full details of acupuncture methods as outlined in the revised Standards for Reporting Interventions in Clinical Trials of Acupuncture guidelines, published in 2010 and providing an essential framework for the reporting of acupuncture methodology. This lack of methodological detail affects outcomes, generalizability, and validity of research involving acupuncture. Reasons for ongoing challenges in the development of high-quality acupuncture trials are discussed. In conclusion, results are encouraging for the development of randomized trials to directly evaluate the therapeutic impact of acupuncture in cancer-related psychological symptoms, including depression, anxiety, sleep disturbance, and quality of life, but attention to acupuncture methodological specific challenges in the development of high-quality research is necessary.
癌症患者正在采用针灸来缓解一系列与癌症相关的症状，包括像抑郁、焦虑、失眠等极为常见的心理症状，以及生活质量受损。对焦虑、抑郁和睡眠障碍等常见症状进行药物治疗，可能会增加癌症患者本已很高的化学负担，并产生额外的副作用。因此，患者和医疗服务提供者都对基于证据的非药物替代疗法（如针灸）来缓解这些症状感兴趣。本文回顾了2000年1月至2013年4月期间关于针灸治疗癌症相关心理症状的现有文献，重点关注疗效和针灸特定方法。所有符合我们综述标准的已发表研究都表明，针灸在治疗抑郁、焦虑、睡眠障碍以及改善生活质量方面有积极信号，大多数结果具有统计学意义。然而，专门设计用于评估抑郁、睡眠障碍和生活质量作为主要结局的针灸研究只有少数几项，且未发现有研究将焦虑作为该人群的主要结局进行观察。针对癌症患者和幸存者的已发表研究表明，针灸治疗不仅安全，而且比抗抑郁药等标准护理药物治疗更易接受，副作用更少。最后，文献中针灸方法的实施和报告存在很大差异，在12项研究中只有2项按照2010年发布的《针灸临床试验干预措施报告修订标准》指南中概述的那样报告了针灸方法的全部细节，该指南为针灸方法的报告提供了重要框架。这种方法学细节的缺乏影响了涉及针灸研究的结果、普遍性和有效性。本文讨论了高质量针灸试验发展中持续面临挑战的原因。总之，开展随机试验直接评估针灸对癌症相关心理症状（包括抑郁、焦虑、睡眠障碍和生活质量）的治疗效果，结果令人鼓舞，但在高质量研究的发展中关注针灸方法学的特定挑战是必要的。
