The document discusses the current scientific evidence for acupuncture in oncology patients. It provides an introduction to acupuncture and scientific evidence. It then reviews the scientific evidence for acupuncture in cancer treatment from systematic reviews and meta-analyses published between 2009-2014. The evidence is analyzed for effects on nausea/vomiting, pain, fatigue, hot flashes, psychological effects, xerostomia (dry mouth), and hiccups. Overall, the reviews found some evidence that acupuncture may help manage certain side effects of cancer treatment.

1. Evidència científica actual de l'acupuntura en el pacient oncològic
Carles Fernández i Jané
BSc in TCM – Wales University-ISMET

2. ÍNDEX
•Introducció sobre l’acupuntura
•Introducció sobre l’evidència científica
•Evidència científica de l’acupuntura en el tractament del càncer

3. INTRODUCCIÓ SOBRE L’ACUPUNTURA
•Acupuntura:
Intervenció terapèutica originaria de la Medicina Tradicional Xinesa que es basa en l’estimulació de zones concretes de la superfície corporal (punts d’acupuntura) mitjançant diferents estímuls com ara la inserció d’agulles d’acupuntura, la pressió, l’aplicació de calor o fins i tot, corrent elèctric.
Vickers A, Zollman C. ABC of complementary medicine. Acupuncture. BMJ. 1999;319(7215):973-6.

5. •Altres modalitats d’acupuntura

6. Preferències del pacient
Coneixements professionals
Evidencia científica disponible
Bonfill X, Rev Esp Cardiol 1997
INTRODUCCIÓ SOBRE L’EVIDÈNCIA CIENTÍFICA

7. Evidence based practice Pràctica basada en PROVES

9. ¿Què és una revisió sistemàtica?
•Treballs de síntesis sobre una temàtica concreta.
•Les seves unitats d’anàlisi són estudis originals primaris.
•Sintetitzen i avaluen tots els articles publicats sobre una temàtica concreta.
•Permeten obtenir un major grau d’evidència i identifiquen àrees de desconeixement

10. ¿Què és un metanàlisis?
•Anàlisis estadístic dels resultats de diversos estudis
•Permeten obtenir una major potència estadística
•Permeten obtenir resultats més precisos i fiables
•S’acostumen a representar mitjançant “forest plots”

11. Ried K, Stuart K. Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: A systematic review. Complementary Therapies in Medicine. diciembre de 2011;19(6):319-31.

12. EVIDÈNCIA CIENTÍFICA DE L’ACUPUNTURA EN EL TRACTAMENT DEL CÀNCER
Pregunta d’investigació
Cerca d'evidència científica
Lectura crítica y avaluació dels resultats
Conclusions

13. Pregunta d’investigació
•Pot la acupuntura ser un complement en el tractament de pacients amb càncer?

14. Cerca d’evidència
•Estudis: Revisions sistemàtiques i metanàlisis
•Bases de dades:
▫Pubmed
▫Cochrane
▫PEDro
•Límits: Últims 5 anys (2009)

15. 27 articles rellevants
1. "acupuncture"[MeSH Terms] OR "acupuncture"[All Fields] 2. "acupuncture therapy"[MeSH Terms] OR ("acupuncture"[All Fields] and "therapy"[All Fields]) OR "acupuncture therapy"[All Fields]) 3. 1 OR 2 4. "neoplasms"[MeSH Terms] OR "neoplasms"[All Fields] OR "cancer"[All Fields] 5. (Meta-Analysis[ptyp] OR systematic[sb]) AND "2009/08/04"[PDat] : "2014/08/02"[PDat]) 6. 3 AND 4 AND 5

16. 2+ 11 = 13 articles

17. 27 articles

18. Resultats
Pubmed
27
Cochrane 13
PEDro 27
Total
36
Articles finals 31
Descartats
5

19. Total: 31 RS
•Lovelace TL, Fox NF, Sood AJ, Nguyen SA, Day TA. Management of radiotherapy-induced salivary hypofunction and consequent xerostomia in patients with oral or head and neck cancer: meta-analysis and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol. mayo de 2014;117(5):595-607.
•Lee S, Jerng UM, Liu Y, Kang JW, Nam D, Lee J. The effectiveness and safety of moxibustion for treating cancer-related fatigue: a systematic review and meta-analyses. Supportive Care in Cancer. mayo de 2014;22(5):1429-40.
•Frisk JW, Hammar ML, Ingvar M, Spetz Holm A-CE. How long do the effects of acupuncture on hot flashes persist in cancer patients? Support Care Cancer. mayo de 2014;22(5):1409-15.
•Haddad NE, Palesh O. Acupuncture in the Treatment of Cancer-Related Psychological Symptoms. Integr Cancer Ther. 4 de febrero de 2014;
•Lian W-L, Pan M, Zhou D, Zhang Z. Effectiveness of acupuncture for palliative care in cancer patients: a systematic review. Chin J Integr Med. febrero de 2014;20(2):136-47.
•Bao Y, Kong X, Yang L, Liu R, Shi Z, Li W, et al. Complementary and Alternative Medicine for Cancer Pain: An Overview of Systematic Reviews. Evidence-Based Complementary and Alternative Medicine. 2014;2014:1-9.
•Zeng Y, Luo T, Finnegan-John J, Cheng ASK. Meta-Analysis of Randomized Controlled Trials of Acupuncture for Cancer- Related Fatigue. Integr Cancer Ther. 25 de noviembre de 2013;13(3):193-200.
•Towler P, Molassiotis A, Brearley SG. What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews. Support Care Cancer. octubre de 2013;21(10):2913-23.

20. •Posadzki P, Moon T-W, Choi T-Y, Park T-Y, Lee MS, Ernst E. Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials. Support Care Cancer. julio de 2013;21(7):2067-73.
•He X-R, Wang Q, Li P-P. Acupuncture and Moxibustion for Cancer-related Fatigue: a Systematic Review and Meta-analysis. Asian Pacific Journal of Cancer Prevention. 30 de mayo de 2013;14(5):3067-74.
•Zhuang L, Yang Z, Zeng X, Zhua X, Chen Z, Liu L, et al. The preventive and therapeutic effect of acupuncture for radiation- induced xerostomia in patients with head and neck cancer: a systematic review. Integr Cancer Ther. mayo de 2013;12(3):197-205.
•Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Yang P, et al. Systematic Review of Acupuncture in Cancer Care: A Synthesis of the Evidence. Journal of Clinical Oncology. 1 de marzo de 2013;31(7):952-60.
•Franconi G, Manni L, Schröder S, Marchetti P, Robinson N. A Systematic Review of Experimental and Clinical Acupuncture in Chemotherapy-Induced Peripheral Neuropathy. Evidence-Based Complementary and Alternative Medicine. 2013;2013:1- 7.
•Deng GE, Rausch SM, Jones LW, Gulati A, Kumar NB, Heather Greenlee ND, et al. CHEST Supplement. Chest. 2013;143(5):e420S-e436S.
•Chen H-Y, Li S-G, Cho WC, Zhang Z-J. The role of acupoint stimulation as an adjunct therapy for lung cancer: a systematic review and meta-analysis. BMC complementary and alternative medicine. 2013;13(1):362.
•Choi T-Y, Lee MS, Ernst E. Acupuncture for cancer patients suffering from hiccups: a systematic review and meta-analysis. Complement Ther Med. diciembre de 2012;20(6):447-55.

21. • Choi T-Y, Lee MS, Kim T-H, Zaslawski C, Ernst E. Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials. Support Care Cancer. junio de 2012;20(6):1147-58.
•Paley CA, Johnson MI, Tashani OA, Bagnall A-M. Acupuncture for cancer pain in adults. Cochrane Database Syst Rev. 2011;(1):CD007753.
•O’Sullivan EM, Higginson IJ. Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review. Acupunct Med. diciembre de 2010;28(4):191-9.
•Hopkins Hollis AS. Acupuncture as a treatment modality for the management of cancer pain: the state of the science. Oncol Nurs Forum. septiembre de 2010;37(5):E344-348.
•Jensen SB, Pedersen AML, Vissink A, Andersen E, Brown CG, Davies AN, et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer. agosto de 2010;18(8):1061-79.
•Ernst E, Lee MS. Acupuncture for palliative and supportive cancer care: a systematic review of systematic reviews. J Pain Symptom Manage. julio de 2010;40(1):e3-5.
•Peng H, Peng H-D, Xu L, Lao L-X. [Efficacy of acupuncture in treatment of cancer pain: a systematic review]. Zhong Xi Yi Jie He Xue Bao. junio de 2010;8(6):501-9.
•Dos Santos S, Hill N, Morgan A, Smith J, Thai C, Cheifetz O. Acupuncture for Treating Common Side Effects Associated With Breast Cancer Treatment: A Systematic Review. Medical Acupuncture. junio de 2010;22(2):81-97.
•Frisk J. Managing hot flushes in men after prostate cancer—A systematic review. Maturitas. enero de 2010;65(1):15-22.

22. •Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, et al. Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst Rev. 2010;(9):CD004923.
•Lee MS, Choi T-Y, Park J-E, Lee S-S, Ernst E. Moxibustion for cancer care: a systematic review and meta-analysis. BMC cancer. 2010;10(1):130.
•Chao L-F, Zhang AL, Liu H-E, Cheng M-H, Lam H-B, Lo SK. The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: a systematic review. Breast Cancer Res Treat. noviembre de 2009;118(2):255-67.
•Lee MS, Kim K-H, Shin B-C, Choi S-M, Ernst E. Acupuncture for treating hot flushes in men with prostate cancer: a systematic review. Support Care Cancer. julio de 2009;17(7):763-70.
•Lee MS, Kim K-H, Choi S-M, Ernst E. Acupuncture for treating hot flashes in breast cancer patients: a systematic review. Breast Cancer Res Treat. junio de 2009;115(3):497-503.
•Silva DRF, Reis PED dos, Gomes IP, Funghetto SS, Leon CGRMP de. Non pharmacological interventions for chemotherapy induced nauseas and vomits: integrative review. Online Brazilian Journal of Nursing [Internet]. 2009 [citado 4 de agosto de 2014];8(1). Recuperado a partir de: http://www.gnresearch.org/doi/10.5935/1676-4285.20092098

23. •General
•Nàusees y vòmits
•Dolor
•Fatiga
•Fogots
•Afectació psicològica
•Xerostomia
•Singlot
Lectura crítica dels resultats

24. General
•Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Yang P, et al. Systematic Review of Acupuncture in Cancer Care: A Synthesis of the Evidence. Journal of Clinical Oncology. 1 de marzo de 2013;31(7):952-60.
•Ernst E, Lee MS. Acupuncture for palliative and supportive cancer care: a systematic review of systematic reviews. J Pain Symptom Manage. julio de 2010;40(1):e3-5.
•Lian W-L, Pan M, Zhou D, Zhang Z. Effectiveness of acupuncture for palliative care in cancer patients: a systematic review. Chin J Integr Med. febrero de 2014;20(2):136-47.
•Towler P, Molassiotis A, Brearley SG. What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews. Support Care Cancer. octubre de 2013;21(10):2913-23.
•Deng GE, Rausch SM, Jones LW, Gulati A, Kumar NB, Heather Greenlee ND, et al. CHEST Supplement. Chest. 2013;143(5):e420S-e436S.
•Chen H-Y, Li S-G, Cho WC, Zhang Z-J. The role of acupoint stimulation as an adjunct therapy for lung cancer: a systematic review and meta-analysis. BMC complementary and alternative medicine. 2013;13(1):362.
•Dos Santos S, Hill N, Morgan A, Smith J, Thai C, Cheifetz O. Acupuncture for Treating Common Side Effects Associated With Breast Cancer Treatment: A Systematic Review. Medical Acupuncture. junio de 2010;22(2):81-97.
•Lee MS, Choi T-Y, Park J-E, Lee S-S, Ernst E. Moxibustion for cancer care: a systematic review and meta-analysis. BMC cancer. 2010;10(1):130.
•Chao L-F, Zhang AL, Liu H-E, Cheng M-H, Lam H-B, Lo SK. The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: a systematic review. Breast Cancer Res Treat. noviembre de 2009;118(2):255-67.
Revisió de revisions

25. Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Yang P, et al. Systematic Review of Acupuncture in Cancer Care: A Synthesis of the Evidence. Journal of Clinical Oncology. 1 de marzo de 2013;31(7):952-60.
17 Revisions

26. Ernst E, Lee MS. Acupuncture for palliative and supportive cancer care: a systematic review of systematic reviews. J Pain Symptom Manage. julio de 2010;40(1):e3-5.
7 RS

27. Lian W-L, Pan M, Zhou D, Zhang Z. Effectiveness of acupuncture for palliative care in cancer patients: a systematic review. Chin J Integr Med. febrero de 2014;20(2):136-47.
33 RCT

28. Towler P, Molassiotis A, Brearley SG. What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews. Support Care Cancer. octubre de 2013;21(10):2913-23.
17 RCT

29. Deng GE, Rausch SM, Jones LW, Gulati A, Kumar NB, Heather Greenlee ND, et al. CHEST Supplement. Chest. 2013;143(5):e420S-e436S.
15 RCT 1 RS
12 RCT, 6 SC 1 RCT, 4 Altres

30. The role of acupoint stimulation as an adjunct therapy for lung cancer: a systematic review and meta-analysis. BMC complementary and alternative medicine. 2013;13(1):362.
31 RCT o CT

31. Dos Santos S, Hill N, Morgan A, Smith J, Thai C, Cheifetz O. Acupuncture for Treating Common Side Effects Associated With Breast Cancer Treatment: A Systematic Review. Medical Acupuncture. junio de 2010;22(2):81-97.
12 RCT o hqCS

32. Chao L-F, Zhang AL, Liu H-E, Cheng M-H, Lam H-B, Lo SK. The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: a systematic review. Breast Cancer Res Treat. noviembre de 2009;118(2):255-67.
18 RCT 8 CCT

33. Lee MS, Choi T-Y, Park J-E, Lee S-S, Ernst E. Moxibustion for cancer care: a systematic review and meta-analysis. BMC cancer. 2010;10(1):130.
5 RCT

34. Dos Santos S, Hill N, Morgan A, Smith J, Thai C, Cheifetz O. Acupuncture for Treating Common Side Effects Associated With Breast Cancer Treatment: A Systematic Review. Medical Acupuncture. junio de 2010;22(2):81-97.

35. Nàusees i vòmits
•Silva DRF, Reis PED dos, Gomes IP, Funghetto SS, Leon CGRMP de. Non pharmacological interventions for chemotherapy induced nauseas and vomits: integrative review. Online Brazilian Journal of Nursing [Internet]. 2009 [citado 4 de agosto de 2014];8(1). Recuperado a partir de: http://www.gnresearch.org/doi/10.5935/1676-4285.20092098

36. •Los resultados sugieren que el uso de intervenciones no farmacológicas para las náuseas y vómitos inducidos por la quimioterapia debe ser considerada en pacientes con cáncer, especialmente aquellos que experimentan emesis recurrente en los ciclos posteriores. La muestra consistió principalmente en ensayos clínicos aleatorios, que cuenta con fuerte nivel de evidencia de los resultados, a pesar de que no fue posible realizar un metanálisis debido a las diferentes medidas de resultado evaluadas en relación con el perfil de los pacientes (tipo de cáncer, el sexo, el protocolo de quimioterapia, tipo de intervención), así como la caracterización de las náuseas y los vómitos. La estimulación del punto P6 demostró eficacia para potenciar el tratamiento antiemético, aunque no está claro cuál es la mejor técnica a emplear. Es de destacar que las estrategias de enseñanza deben adoptarse contribuir a la adherencia del paciente. Se considera crucial que se realizan estudios clínicos que evalúan la eficacia de las posibles alternativas al tratamiento y prevención de las náuseas y vómitos inducidos por la quimioterapia
Silva DRF, Reis PED dos, Gomes IP, Funghetto SS, Leon CGRMP de. Non pharmacological interventions for chemotherapy induced nauseas and vomits: integrative review. Online Brazilian Journal of Nursing [Internet]. 2009 [citado 4 de agosto de 2014];8(1). Recuperado a partir de: http://www.gnresearch.org/doi/10.5935/1676-4285.20092098
1RS, 4 RCT, 1 CCT, 2 Cohorts, 1 Descrip.

37. Dolor
•Bao Y, Kong X, Yang L, Liu R, Shi Z, Li W, et al. Complementary and Alternative Medicine for Cancer Pain: An Overview of Systematic Reviews. Evidence-Based Complementary and Alternative Medicine. 2014;2014:1-9.
•Choi T-Y, Lee MS, Kim T-H, Zaslawski C, Ernst E. Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials. Support Care Cancer. junio de 2012;20(6):1147-58.
•Paley CA, Johnson MI, Tashani OA, Bagnall A-M. Acupuncture for cancer pain in adults. Cochrane Database Syst Rev. 2011;(1):CD007753.
•Hopkins Hollis AS. Acupuncture as a treatment modality for the management of cancer pain: the state of the science. Oncol Nurs Forum. septiembre de 2010;37(5):E344-348.
•Peng H, Peng H-D, Xu L, Lao L-X. [Efficacy of acupuncture in treatment of cancer pain: a systematic review]. Zhong Xi Yi Jie He Xue Bao. junio de 2010;8(6):501-9.
•Franconi G, Manni L, Schröder S, Marchetti P, Robinson N. A Systematic Review of Experimental and Clinical Acupuncture in Chemotherapy-Induced Peripheral Neuropathy. Evidence-Based Complementary and Alternative Medicine. 2013;2013:1- 7.
Revisió de revisions
Neuropatia perifèrica

38. Bao Y, Kong X, Yang L, Liu R, Shi Z, Li W, et al. Complementary and Alternative Medicine for Cancer Pain: An Overview of Systematic Reviews. Evidence-Based Complementary and Alternative Medicine. 2014;2014:1-9.
4 RS

39. Choi T-Y, Lee MS, Kim T-H, Zaslawski C, Ernst E. Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials. Support Care Cancer. junio de 2012;20(6):1147-58.

40. Choi T-Y, Lee MS, Kim T-H, Zaslawski C, Ernst E. Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials. Support Care Cancer. junio de 2012;20(6):1147-58.
15 (9) RCT

41. Paley CA, Johnson MI, Tashani OA, Bagnall A-M. Acupuncture for cancer pain in adults. Cochrane Database Syst Rev. 2011;(1):CD007753.
3 RCT

42. Peng H, Peng H-D, Xu L, Lao L-X. [Efficacy of acupuncture in treatment of cancer pain: a systematic review]. Zhong Xi Yi Jie He Xue Bao. junio de 2010;8(6):501-9.
7 RCT

43. Hopkins Hollis AS. Acupuncture as a treatment modality for the management of cancer pain: the state of the science. Oncol Nurs Forum. septiembre de 2010;37(5):E344-348.
1 MA, 3 RCT, 1 Pilot, 1 CC, 1 Cohorts

44. Franconi G, Manni L, Schröder S, Marchetti P, Robinson N. A Systematic Review of Experimental and Clinical Acupuncture in Chemotherapy- Induced Peripheral Neuropathy. Evidence-Based Complementary and Alternative Medicine. 2013;2013:1-7.
3 RCT, 4 Altres

45. Choi T-Y, Lee MS, Kim T-H, Zaslawski C, Ernst E. Acupuncture for the treatment of cancer pain: a systematic review of randomised clinical trials. Support Care Cancer. junio de 2012;20(6):1147-58.

46. Franconi G, Manni L, Schröder S, Marchetti P, Robinson N. A Systematic Review of Experimental and Clinical Acupuncture in Chemotherapy- Induced Peripheral Neuropathy. Evidence-Based Complementary and Alternative Medicine. 2013;2013:1-7.

47. Fatiga
•Lee S, Jerng UM, Liu Y, Kang JW, Nam D, Lee J. The effectiveness and safety of moxibustion for treating cancer-related fatigue: a systematic review and meta-analyses. Supportive Care in Cancer. mayo de 2014;22(5):1429-40.
•Zeng Y, Luo T, Finnegan-John J, Cheng ASK. Meta-Analysis of Randomized Controlled Trials of Acupuncture for Cancer- Related Fatigue. Integr Cancer Ther. 25 de noviembre de 2013;13(3):193-200.
•Posadzki P, Moon T-W, Choi T-Y, Park T-Y, Lee MS, Ernst E. Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials. Support Care Cancer. julio de 2013;21(7):2067-73.
•He X-R, Wang Q, Li P-P. Acupuncture and Moxibustion for Cancer-related Fatigue: a Systematic Review and Meta-analysis. Asian Pacific Journal of Cancer Prevention. 30 de mayo de 2013;14(5):3067-74.

48. Lee S, Jerng UM, Liu Y, Kang JW, Nam D, Lee J. The effectiveness and safety of moxibustion for treating cancer-related fatigue: a systematic review and meta-analyses. Supportive Care in Cancer. mayo de 2014;22(5):1429-40.
4 RCT

49. Zeng Y, Luo T, Finnegan-John J, Cheng ASK. Meta-Analysis of Randomized Controlled Trials of Acupuncture for Cancer-Related Fatigue. Integr Cancer Ther. 25 de noviembre de 2013;13(3):193-200.
7 RCT

50. Posadzki P, Moon T-W, Choi T-Y, Park T-Y, Lee MS, Ernst E. Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials. Support Care Cancer. julio de 2013;21(7):2067-73.
7 RCT

51. He X-R, Wang Q, Li P-P. Acupuncture and Moxibustion for Cancer-related Fatigue: a Systematic Review and Meta-analysis. Asian Pacific Journal of Cancer Prevention. 30 de mayo de 2013;14(5):3067-74.
7 RCT

52. Fogots
•Frisk JW, Hammar ML, Ingvar M, Spetz Holm A-CE. How long do the effects of acupuncture on hot flashes persist in cancer patients? Support Care Cancer. mayo de 2014;22(5):1409-15.
•Frisk J. Managing hot flushes in men after prostate cancer—A systematic review. Maturitas. enero de 2010;65(1):15-22.
•Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, et al. Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst Rev. 2010;(9):CD004923.
•Lee MS, Kim K-H, Shin B-C, Choi S-M, Ernst E. Acupuncture for treating hot flushes in men with prostate cancer: a systematic review. Support Care Cancer. julio de 2009;17(7):763-70.
•Lee MS, Kim K-H, Choi S-M, Ernst E. Acupuncture for treating hot flashes in breast cancer patients: a systematic review. Breast Cancer Res Treat. junio de 2009;115(3):497-503.
Ca mama
Ca pròstata

53. Frisk JW, Hammar ML, Ingvar M, Spetz Holm A-CE. How long do the effects of acupuncture on hot flashes persist in cancer patients? Support Care Cancer. mayo de 2014;22(5):1409-15.
7 RCT Jada ≥3, 10 altres Jada< 3

54. Rada G, Capurro D, Pantoja T, Corbalán J, Moreno G, Letelier LM, et al. Non-hormonal interventions for hot flushes in women with a history of breast cancer. Cochrane Database Syst Rev. 2010;(9):CD004923.
1 RCT

55. Lee MS, Kim K-H, Choi S-M, Ernst E. Acupuncture for treating hot flashes in breast cancer patients: a systematic review. Breast Cancer Res Treat. junio de 2009;115(3):497-503.
6 RCT

56. Lee MS, Kim K-H, Choi S-M, Ernst E. Acupuncture for treating hot flashes in breast cancer patients: a systematic review. Breast Cancer Res Treat. junio de 2009;115(3):497-503.

57. Frisk J. Managing hot flushes in men after prostate cancer—A systematic review. Maturitas. enero de 2010;65(1):15-22.
0 RCT placebo

58. Lee MS, Kim K-H, Shin B-C, Choi S-M, Ernst E. Acupuncture for treating hot flushes in men with prostate cancer: a systematic review. Support Care Cancer. julio de 2009;17(7):763-70.
1 RCT, 5 No controlats

59. Lee MS, Kim K-H, Shin B-C, Choi S-M, Ernst E. Acupuncture for treating hot flushes in men with prostate cancer: a systematic review. Support Care Cancer. julio de 2009;17(7):763-70.

60. Afectació psicològica
•Haddad NE, Palesh O. Acupuncture in the Treatment of Cancer-Related Psychological Symptoms. Integr Cancer Ther. 4 de febrero de 2014;

61. Haddad NE, Palesh O. Acupuncture in the Treatment of Cancer-Related Psychological Symptoms. Integr Cancer Ther. 4 de febrero de 2014;
7 RCT, 5 altres

62. Haddad NE, Palesh O. Acupuncture in the Treatment of Cancer-Related Psychological Symptoms. Integr Cancer Ther. 4 de febrero de 2014;

63. Xerostomia
•Lovelace TL, Fox NF, Sood AJ, Nguyen SA, Day TA. Management of radiotherapy-induced salivary hypofunction and consequent xerostomia in patients with oral or head and neck cancer: meta-analysis and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol. mayo de 2014;117(5):595-607.
•Zhuang L, Yang Z, Zeng X, Zhua X, Chen Z, Liu L, et al. The preventive and therapeutic effect of acupuncture for radiation- induced xerostomia in patients with head and neck cancer: a systematic review. Integr Cancer Ther. mayo de 2013;12(3):197-205.
•O’Sullivan EM, Higginson IJ. Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review. Acupunct Med. diciembre de 2010;28(4):191-9.
•Jensen SB, Pedersen AML, Vissink A, Andersen E, Brown CG, Davies AN, et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer. agosto de 2010;18(8):1061-79.

64. Lovelace TL, Fox NF, Sood AJ, Nguyen SA, Day TA. Management of radiotherapy-induced salivary hypofunction and consequent xerostomia in patients with oral or head and neck cancer: meta-analysis and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol. mayo de 2014;117(5):595-607.
2 RCT

65. Zhuang L, Yang Z, Zeng X, Zhua X, Chen Z, Liu L, et al. The preventive and therapeutic effect of acupuncture for radiation-induced xerostomia in patients with head and neck cancer: a systematic review. Integr Cancer Ther. mayo de 2013;12(3):197-205.
4 RCT

66. O’Sullivan EM, Higginson IJ. Clinical effectiveness and safety of acupuncture in the treatment of irradiation-induced xerostomia in patients with head and neck cancer: a systematic review. Acupunct Med. diciembre de 2010;28(4):191-9.
3 RCT

67. Jensen SB, Pedersen AML, Vissink A, Andersen E, Brown CG, Davies AN, et al. A systematic review of salivary gland hypofunction and xerostomia induced by cancer therapies: management strategies and economic impact. Support Care Cancer. agosto de 2010;18(8):1061-79.
2 RCT, altres

68. Zhuang L, Yang Z, Zeng X, Zhua X, Chen Z, Liu L, et al. The preventive and therapeutic effect of acupuncture for radiation-induced xerostomia in patients with head and neck cancer: a systematic review. Integr Cancer Ther. mayo de 2013;12(3):197-205.

69. Singlot
•Choi T-Y, Lee MS, Ernst E. Acupuncture for cancer patients suffering from hiccups: a systematic review and meta-analysis. Complement Ther Med. diciembre de 2012;20(6):447-55.

70. 20. Choi T-Y, Lee MS, Ernst E. Acupuncture for cancer patients suffering from hiccups: a systematic review and meta-analysis. Complement Ther Med. diciembre de 2012;20(6):447-55.
5 (3) RCT

71. 20. Choi T-Y, Lee MS, Ernst E. Acupuncture for cancer patients suffering from hiccups: a systematic review and meta-analysis. Complement Ther Med. diciembre de 2012;20(6):447-55.

72. CONCLUSIONS
•Tractament segur i ben tolerat.
•Només el tractament de nàusees i vòmits té un grau d’evidència alta.
•Existeixen estudis més o menys adequats que apunten a la seva possible efectivitat en diverses situacions.
•Les principals limitacions de l’evidència actual són degudes a:
▫Falta d’estudis de qualitat (RCT)
▫Falta d’una correcta metodologia (aleatorització, cegament...)
▫Desconeixement (tractament més efectiu?, grup control adequat?)

73. CAL GENERAR NOVES INVESTIGACIONS!

74. ALGUNA PREGUNTA?

75. MOLTES GRÀCIES PER LA VOSTRA ATENCIÓ
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