Acupuncture for Xerostomia in Patients with Cancer: An Update

Background: Xerostomia (dry mouth) is a common side-effect of cancer treatment following radiotherapy, especially in patients with head-and-neck (HN) cancer. Objective: The purpose of this review was to evaluate evidence related to acupuncture for xerostomia in patients with HN cancer.

Materials and Methods: Embase, Medline, Cochrane (all databases), PubMed, and Scopus were searched from inception through December 2014 for studies published in English that were randomized controlled trials (RCTs) evaluating acupuncture to treat and/or prevent xerostomia in patients with cancer. A usual-care and/or placebo comparison group was required for inclusion. Risk of bias (ROB) was rated as low, high, or unclear according to Cochrane criteria. Outcomes and treatment parameters were summarized.

Results: Of 184 articles identified, 136 duplicates were omitted, leaving 48 publications that were screened. Thirty-nine studies were excluded because they were not prospective RCTs of acupuncture in patients with cancer, and three studies did not involve needle insertion into acupuncture points. Six studies met all inclusion criteria. Four investigated acupuncture to treat xerostomia, and two investigated acupuncture to prevent xerostomia. Of the six included trials, four reported significant between-group differences in favor of real acupuncture, and two reported significant within-group differences only. No studies were rated as low ROB, either because of low statistical power or a lack of blinding.

Conclusions: Acupuncture may be a helpful adjunct to cancer care for treatment and/or prevention of xerostomia in patients with HN cancer, but studies to date have been limited by small sample size and/or lack of blinding. Large phase III trials are currently underway.

Comments: 

The Acupuncture points used and the number of sessions  varied considerably in studies. Some studies combined common acupuncture points with ear points. The retention period was fairly consistent across studies with minimum 20 minutes and maximum 30 minutes. Some studies had 3 sessions a week during radiotherapy and others only 1. There are promising results across these studies that prove acupuncture can help increase salivary flow rate and relieving symptoms of dry mouth as well as improving QoL for patients. However the results are inconsistent due to differences in trial design and measurements used. Never the less the review  is a positive outcome for acupuncture as a beneficial adjunct treatment for dry mouth.

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