Effects of acupuncture on breast cancer-related lymphoedema: a systematic review and meta-analysis of randomised controlled trials

Xinyan Zhang, Xiuli Wang, Bingyan Zhang, Sa Yang, and Dongling Liu. Acupuncture in Medicine, 2019

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Effects of acupuncture on breast  cancer-related lymphoedema: a systematic review and meta-analysis  of randomised controlled trials

Xinyan Zhang, Xiuli Wang, Bingyan Zhang, Sa Yang,  and Dongling Liu. Acupuncture in Medicine, 2019

Objective: Breast cancer-related lymphoedema (BCRL) is a common complication after breast cancer treatment. We investigated whether acupuncture could be used to manage limb oedema in women after breast cancer surgery.

Methods: The Cochrane Library, PubMed, Embase, Web of Science, CINAHL, and four Chinese databases were electronically searched for papers published through November 2017. Randomised controlled trials (RCTs) of acupuncture for BCRL were included.

Results: In total, six RCTs with 318 patients were identified. The main analysis revealed a positive overall effect of acupuncture intervention on pre/post-treatment differences in the diameter of the elbow joint, reductions in upper limb lymphoedema and effectiveness index based on arm measurement data in patients with breast cancer. Two studies evaluating the outcome of acupuncture on the diameter of the elbow joint found a significant reduction in diameter between the acupuncture and control groups (weighted mean difference (WMD) 6 cm, 95% CI 5.11 to 6.89 cm; P<0.001). The same two studies investigated the effect of acupuncture on upper limb lymphoedema reduction and found a significant difference between the acupuncture and control groups (risk ratio 1.4, 95% CI 1.17 to 1.67; P<0.001). Two other studies used the effectiveness index to assess the arm and found a significant difference between the acupuncture and control groups (WMD 23.34, 95% CI 10.74 to 35.94; P<0.001). The fifth study used bioelectrical impedance spectroscopy to assess lymphoedema at several points on the arm before and after acupuncture; this study also reported a significant reduction in lymphoedema. The sixth study reported no significant difference in bioimpedance between the groups.

Conclusions: The present meta-analysis and systematic review suggests that acupuncture is effective at reducing BCRL in patients after breast cancer treatment.

Main findings

  • Among the included studies, three reported interventions with warm needle acupuncture (WNA), one study used helium-neon (He-Ne) laser acupuncture treatment, and two studies used traditional acupuncture.
  • The authors suggest that most of the studies demonstrated good reporting quality, and all explicitly reported the details of randomisation. Only two trials mentioned allocation concealment. Two studies were single-blinded, and the other four studies did not describe blinding, indicating a risk of performance and measurement bias. Two studies provided reasons for loss of follow-up. The results of the present meta-analysis were not affected by missing outcome data.
  • Two studies used bioelectrical impedance spectroscopy (BIS) to quantify the reduction in lymphoedema after acupuncture in patients with BCRL.
  • The authors found in this meta-analysis, we identified a positive overall effect of acupuncture in patients with BCRL. The mechanism of action underlying the reduction in lymphoedema following WNA might involve anti-inflammatory effects at the treatment sites, with improved blood circulation after treatment.
  • The meta-analysis showed that the acupuncture-treated BCA patients had a greater reduction in the degree of upper arm lymphoedema than the patients not receiving acupuncture. Further research to optimise acupuncture point selection is needed.
  • The authors suggest that acupuncture intervention is clinically safe and that adverse event rarely occur.
  • There were some limitations associated with this study. First, we found that the duration of lymphoedema in patients differed, although studies suggest that the duration of lymphoedema is not necessarily related to the severity of the disease. The duration of the intervention also differed between trials.