Abstract
Objectives: To explore the effectiveness of somatic acupoint stimulation (SAS) for cancer patients with anxiety and depression. Methods: Thirteen electronic databases were searched systematically until August 2022. Randomized controlled trials (RCTs) investigating SAS for anxiety and/or depression in cancer patients were retrieved. Methodological quality of the included studies was assessed by utilizing the Cochrane Back Review Group Risk of Bias Assessment Criteria. Evidence level was assessed by using the approach of Grading of Recommendations, Assessment, Development and Evaluations (GRADE). Both meta-analysis and descriptive analysis were conducted for outcome assessment. Results: Twenty-eight records were finally included including 22 journal articles and six ongoing registered clinical trials. The overall methodological quality and level of evidence of the included studies were suboptimal, with no high-quality evidence identified. Moderate evidence showed that SAS could significantly decrease the anxiety of cancer patients (Acupuncture: [random effect model, SMD = −0.52, 95% CI = −0.79 to −0.24, p = 0.0002] and Acupressure: [random effect model, SMD = −0.89, 95% CI = −1.25 to −0.52, p < 0.00001]. While for depression, although the data analysis indicated that SAS can decrease depression significantly (Acupuncture: [random effect model, SMD = −1.26, 95% CI = −2.08 to −0.44, p = 0.003] and Acupressure: [random effect model, SMD = −1.42, 95% CI = −2.41 to −0.42, p = 0.005]), relevant evidence was rated as low. No statistically significant difference was identified between true and sham acupoints stimulation for both anxiety and depression. Conclusions: This systematic review provides the latest research evidence to support SAS as a promising intervention for alleviating anxiety and depression in cancer patients. However, the research evidence should be interpreted prudently as methodological concerns were identified in some included studies, and some sub-group analyses were performed with a relatively small sample size. More rigorously designed large-scale RCTs with placebo-controlled comparisons are warranted to generate high-quality evidence. Registration: The systematic review protocol has been registered with PROSPERO (CRD42019133070).
| Original language | English |
|---|---|
| Article number | 101735 |
| Journal | Complementary Therapies in Clinical Practice |
| Volume | 51 |
| DOIs | |
| Publication status | Published - May 2023 |
Bibliographical note
Funding Information:Pharmacological treatment for cancer-related anxiety and depression can lead to considerable chemical burden and additional adverse events [16]. As a result, the use of complementary therapies in addition to standard cancer therapies to improve survivors’ emotional well-being has been recommended [17]. Among which, somatic acupoints stimulation (SAS), including manual acupuncture and manual acupressure, is a commonly used method for cancer symptom management. This technique is supported by traditional meridian theory and is frequently utilised in practice for the prophylaxis and treatment of various health problems [18]. Many clinical trials and systematic reviews have been conducted to assess the effects of SAS for managing mental distress in non-cancer patients, including anxiety and depression [19]. While cancer patients usually experience a higher risk of anxiety and depression (nearly twice) than the general population [20]. A number of randomized control trials (RCTs) have been performed to explore the effectiveness of SAS for managing anxiety and depression in cancer. In 2015, a systematic review conducted by our group provided preliminary but inconclusive evidence on the promising role of SAS in reducing anxiety and depression in cancer patients [21]. Since the publication of the systematic review in 2016, a few RCTs have been conducted afterwards to further explore the effects of SAS on anxiety and depression among cancer patients. It is therefore important to include the recent clinical trials in an updated systematic review to identify the latest evidence of using SAS for anxiety and depression management in patients with cancer. The current systematic review was conducted to update the evidence from our previous work and provide updated implications for future research and practice.Previously published clinical trials and systematic reviews [21, 57–59] have proved that true acupoints stimulation was more effective than the sham comparisons in improving patient outcomes, which supported the specific therapeutic effects of true SAS. However, sub-group comparisons in this review did not reveal statistically significant difference between the true and sham SAS. Design of the sham comparisons might partially contribute to the insignificant between-group difference. To distinguish the specific therapeutic effects of SAS from its non-specific effects, ten studies included in this review [28,29, 35–39, 43–45]explored the placebo effect of SAS by using a sham comparison, which indicated faked acupoints stimulation [57]. All the nine studies located the sham acupoints (the “non-acupoints”) away from the true acupoints used in the true SAS group. However, it was difficult to ensure that all the selected non-acupoints are properly identified given only two studies clearly stated that the sham points were located away from meridians.This study was supported by the IAS Rainmaker Readiness Grant at Charles Darwin University.
Funding Information:
This study was supported by the IAS Rainmaker Readiness Grant at Charles Darwin University .
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