Acupuncture for breast cancer‑related lymphedema: a randomized controlled trial

Ting Bao1 · Wanqing Iris Zhi,· Emily A. Vertosick, Qing Susan Li, Janice DeRito, Andrew Vickers, Barrie R. Cassileth, Jun J. Mao, Kimberly J. Van Zee1. Breast Cancer Research and Treatment

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Acupuncture for breast cancerrelated lymphedema: a randomized controlled trial

Ting Bao1 · Wanqing Iris Zhi,· Emily A. Vertosick, Qing Susan Li, Janice DeRito, Andrew Vickers, Barrie R. Cassileth, Jun J. Mao,  Kimberly J. Van Zee1. Breast Cancer Research and Treatment

Purpose Approximately 20% of breast cancer survivors develop breast cancer-related lymphedema (BCRL), and current therapies are limited. We compared acupuncture (AC) to usual care wait-list control (WL) for treatment of persistent BCRL.

Methods Women with moderate BCRL lasting greater than six months were randomized to AC or WL. AC included twice weekly manual acupuncture over six weeks. We evaluated the difference in circumference and bioimpedance between affected and unaffected arms. Responders were defined as having a decrease in arm circumference difference greater than 30% from baseline. We used analysis of covariance for circumference and bioimpedance measurements and Fisher’s exact to determine the proportion of responders.

Results Among 82 patients, 73 (89%) were evaluable for the primary endpoint (36 in AC, 37 in WL). 79 (96%) patients received lymphedema treatment before enrolling in our study; 67 (82%) underwent ongoing treatment during the trial. We found no significant difference between groups for arm circumference difference (0.38 cm greater reduction in AC vs. WL, 95% CI − 0.12 to 0.89, p = 0.14) or bioimpedance difference (1.06 greater reduction in AC vs. WL, 95% CI − 5.72 to 7.85, p = 0.8). There was also no difference in the proportion of responders: 17% AC versus 11% WL (6% difference, 95% CI – 10 to 22%, p = 0.5). No severe adverse events were reported.

Conclusions Our acupuncture protocol appeared to be safe and well tolerated. However, it did not significantly reduce BCRL in pre-treated patients receiving concurrent lymphedema treatment. This regimen does not improve upon conventional lymphedema treatment for breast cancer survivors with persistent BCRL.

Main findings

  • It has been suggested that acupuncture stimulates the body to drain “dampness,” a traditional Chinese medicine concept similar to oedema.
  • Evaluation included lymphedema staging, arm circumference measurement, and bioimpedance measurement.
  • 6 weeks of acupuncture treatment.
  • A total of 82 eligible patients were enrolled and participated in the study, with 40 patients in the acupuncture group and 42 patients in the wait-list control group.
  • This study is limited in that almost all of the patients had received prior lymphoedema treatment, and acupuncture was offered concurrently with other ongoing lymphoedema treatments, which makes it difficult to discern the effect of acupuncture alone on BCRL. In addition, because they did not include other patient-reported outcomes, they were not able to demonstrate whether acupuncture alleviated the symptoms associated with lymphoedema such as pain, limited range of motion of the affected arm, distress, and anxiety. These outcomes should be included in future studies.