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Journal of Traditional Chinese Medicine >

2023 , Vol. 43 >Issue 3: 441 - 456

DOI: https://doi.org/10.19852/j.cnki.jtcm.20230313.001

Meta-analysises

Acupuncture and moxibustion for malignant tumor patients with psychological symptoms of insomnia, anxiety and depression: a systematic review and Meta-analysis

  • Fangfang MA ,
  • Hewei ZHANG ,
  • Bingxue LI ,
  • Peiyu CHENG ,
  • Mingwei YU ,
  • Xiaomin WANG
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  • 1 Department of Acupuncture-Moxibustion, Tuina and Rehabilitation, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, China
    2 Traditional Chinese Medicine Department, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
    3 Department of General Surgery, Pancreatic Disease Center, Research Institute of Pancreatic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
    4 Oncology Department, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China

Received date: 2021-12-12

  Accepted date: 2022-04-27

  Online published: 2023-03-13

Supported by

Demonstration and Popularization of Traditional Chinese Medicine Standardized Diagnosis and Treatment of Common Complications of Malignant Tumors(Z191100008319006);Clinical Study of Five Elements Acupuncture and Moxibustion in Treatment of Tumor-Related Insomnia(EE2019-22);Rehabilitation of Traditional Chinese Medicine(Szxk201822)

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Abstract

OBJECTIVE: To evaluate the efficacy and safety of acupuncture and moxibustion therapy (AMT) for cancer-related psychological symptoms (CRPS) of insomnia, depression and anxiety.

METHODS: Seven databases were searched for randomized controlled trials (RCT) comparing AMT to routine care or conventional drug for alleviating CRPS of insomnia, depression, and anxiety before April 2020. Two independent reviewers performed the data extraction and assessed the risk of bias.

RESULTS: A total of 30 RCTs involving 2483 cancer patients were enrolled. The pooled analysis indicated that the treatment group was significantly better than the control group in improving the depression effective rate [RR= 1.29, 95% CI(1.12, 1.49), P =0.0004], the quality of life (QOL) [MD =1.11, 95% CI(0.80, 1.42), P < 0.000 01], and reducing Self-rating Anxiety Scale (SAS) [MD =﹣7.75, 95% CI(﹣10.44, ﹣5.05), P < 0.000 01]. But there was no statistically significant difference between two groups in improving the insomnia effective rate [RR= 1.18, 95% CI(0.93, 1.51), P =0.18]. The subgroup analysis showed the effectiveness of different intervention on CRPS. Compared with routine care, AMT helps relieve CRPS better evaluated by Pittsburgh Sleep Quality Index (PSQI), Hamilton Depression Scale (HAMD), and Self-rating Depression Scale (SDS), and depression effective rate. Compared with conventional drug, AMT performs better evaluated by SDS, depression effective rate and QOL. Moreover, the conventional drug showed higher treatment efficacy on improving insomnia effective rate compared with AMT. Compared to conventional drug, AMT plus conventional drug resulted in a significant reduction on CRPS such as PSQI, HAMD, SDS, and SAS, and also had a meaningful improvement on insomnia effective rate, depression effective rate and QOL. Fewer published reports were found on the adverse events of AMT than the conventional drug.

CONCLUSION: The results suggested that AMT might be effective in improving CPRI; however, a definite conclusion could not be drawn because the quality of trials are low. Further large-scale and high-quality RCTs to verify the efficacy and safety of AMT on CRPS are still warranted.

Key words： acupuncture; moxibustion; neoplasms; sleep initiation and maintenance disorders; depression; anxiety; review

Cite this article

Fangfang MA , Hewei ZHANG , Bingxue LI , Peiyu CHENG , Mingwei YU , Xiaomin WANG . Acupuncture and moxibustion for malignant tumor patients with psychological symptoms of insomnia, anxiety and depression: a systematic review and Meta-analysis[J]. Journal of Traditional Chinese Medicine, 2023 , 43(3) : 441 -456 . DOI: 10.19852/j.cnki.jtcm.20230313.001

References

[1] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca Cancer J Clin 2021: 1-41.
[2] de Moor MJ, Mariotto AB, Parry C, et al. Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomarkers Prev 2013; 22: 561-70.
[3] Feng RM, Zong YN, Cao SM, Xu RH. Current cancer situation in China: good or bad news from the 2018 Global Cancer Statistics? Cancer Commun (Lond) 2019; 39: 22.
[4] Wei WQ, Zeng HM, Zheng RS, Zhang SW, He J. Cancer registration in China and its role in cancer prevention and control. Lancet Oncol 2020; 21: e342-9.
[5] Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It's not over when it's over: long-term symptoms in cancer survivors-a systematic review. Int J Clin Exp Med 2010; 40: 163-81.
[6] Yusufov M, Zhou ES, Recklitis CJ. Psychometric properties of the insomnia severity index in cancer survivors. Psychooncology 2019; 28: 540-6.
[7] Salo P, Sivertsen B, Oksanen T, et al. Insomnia symptoms as a predictor of incident treatment for depression: prospective cohort study of 40 791 men and women. Sleep Med 2012; 13: 278-84.
[8] Baglioni C, Spiegelhalder K, Nissen C, Riemann D. Clinical implications of the causal relationship between insomnia and depression: how individually tailored treatment of sleeping difficulties could prevent the onset of depression. Epma J 2011; 2: 287-93.
[9] Torre LA, Bray F, Siegel RL, Ferlay J, Tieulent J L, Jemal A. Global cancer statistics, 2012. CA: Cancer J Clin 2015; 65: 87-108.
[10] Qadire AM, Shamieh O, Abdullah S, Albadainah F. Symptom clusters' content, stability and correlation with the quality of life in a heterogeneous group of cancer patients: a large-scale longitudinal study. Clin Nurs Res 2020: 32525398.
[11] Omran S, Mcmillan S. Symptom severity, anxiety, depression, self- efficacy and quality of life in patients with cancer. Asian Pac J Cancer Prev 2018; 19: 365-74.
[12] Wedret JJ, Tu TG, Paul D, Rousseau C, Bota RG. Interactions between antidepressants, sleep aids and selected breast cancer therapy. Mental Ill 2019; 11: 36-8.
[13] Irwin MR. Depression and insomnia in cancer: prevalence, risk factors, and effects on cancer outcomes. CuRR Psychiatry Rep 2013; 15: 404.
[14] Marina GS, Machado CSP, Donato SCT, Silva AMD. Prevalence of symptoms and quality of life of cancer patients. Rev Gaucha Enferm 2020; 73: 1-7.
[15] Fatiregun OA, Olagunju AT, Erinfolami AR, Arogunmati OA, Fatiregun OA, Adeyemi JD. Relationship between anxiety disorders and domains of health related quality of life among nigerians with breast cancer. Breast 2017; 31: 150-6.
[16] Cha KM, Chung YKK, Lim Y, et al. Depression and insomnia as mediators of the relationship between distress and quality of life in cancer patients. J Affect Disord 2017; 217: 260-5.
[17] Dengs KE, Andersen EW, Thomsen T, Hansen CP, Dalton SO. Increased psychological symptom burden in patients with pancreatic cancer: a population-based cohort study. Pancreatology 2020; 20: 511-21.
[18] Asnis GM, Thomas M, Henderson MA. Pharmacotherapy treatment options for insomnia: a primer for clinicians. Int J Molecul 2016; 17: 26729104.
[19] Walsh JK, Roehrs T, Roth T. Pharmacologic treatment of primary insomnia, principles and practice of sleep medicine. PA: Elsevier Saunders, Philadelphia 2005; 63: 749-60.
[20] Delgado MG, Ferrer J, Rieber AG, Rhondali W, Bruera E. Financial distress and its associations with physical and emotional symptoms and quality of life among advanced cancer patients. Oncologist 2015; 20: 1092-8.
[21] Cho WC. Chinese versus Western medicine. 2nd ed. Schwab M, editor. Springer (NY): Encyclopedia of Cancer, 2011: 652-4.
[22] Zia FZ, Olaku O, Bao T, et al. The national cancer institute's conference on acupuncture for symptom management in oncology: state of the science, evidence, and research gaps. J Natl Cancer Inst Monogr 2017; 52: 68-73.
[23] He YH, Guo XF, May BH, et al. Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and Meta-analysis. JAMA Oncology 2020; 6: 271-8.
[24] Kim TH, Kang JW, Lee TH. Therapeutic options for aromatase inhibitor-associated arthralgia in breast cancer survivors: a systematic review, evidence mapping, and network Meta-analysis. Maturitas 2018; 118: 29-37.
[25] Chien TJ, Liu CY, Fang CJ, Kuo CY. The efficacy of acupuncture in chemotherapy-induced peripheral neuropathy: systematic review and Meta-analysis. Integr Cancer Ther 2019; 18: 31833790.
[26] Zhang HW, Lin ZX, Cheung F, Cho CS, Tang JL. Moxibustion for alleviating side effects of chemotherapy or radiotherapy in cancer patients. Cochrane Database Syst Rev 2018; 11: CD010559.
[27] Posadzki P, Moon WT, Choi YT, Park TY, Lee MS, Ernst E. Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials. Support Care in Cancer 2013; 21: 2067-73.
[28] Liu YH, Dong GT, Ye Y, et al. Effectiveness of acupuncture for early recovery of bowel function in cancer: a systematic review and Meta-analysis. Evid-based Complement Altern Med 2017; 29422935.
[29] Jin HM, Feng YQ, Xiang YY, et al. Efficacy and safety of acupuncture-moxibustion therapy on chemotherapy-induced leukopenia: a systematic review and Meta-analysis. Evid-based Complement Altern Med 2020; 33178318.
[30] Choi TY, Kim JI, Lim HJ, Lee MS. Acupuncture for managing cancer-related insomnia: a systematic review of randomized clinical trials. Integr Cancer Ther 2017; 16: 135-46.
[31] Haddad NE, Palesh O. Acupuncture in the treatment of cancer-related psychological symptoms. Integr Cancer Ther 2014; 13: 371-85.
[32] Smith CA, Armour M, Lee MS, et al. Acupuncture for depression. Cochrane Database Syst Rev 2018; 3: CD004046.
[33] Chen YH, Cao Y. Effect of acupoint moxibustion on anxiety, depression and quality of life in patients with advanced gastric cancer pain. Hu Li Xue Bao Chin Nurs Res 2013; 20: 63-5.
[34] Chen J. Effect of acupuncture on post-tumor depression. Lin Chuang Yi Yao Wen Xian Dian Zi Za Zhi 2018; 5: 50-1.
[35] Dan ZJ. Clinical randomized controlled study of acupuncture intervention on insomnia in cancer patients. Chengdu: Chengdu University of Traditional Chinese medicine, 2013: 1-80.
[36] Deng XY, Xu TS. Clinical study on acupuncture treatment of 60 patients with tumor accompanied by anxiety and depression. Zhejiang Zhong Yi Yao Da Xue Xue Bao 2018; 42: 748-51 + 768.
[37] Deng XY, Xu TS. Treatment of tumor-related depression with acupuncture combined with sertraline hydrochloride. Zhong Guo Zhen Jiu 2019; 39: 379-83.
[38] Feng Y, Wang XY, Li SD, et al. Clinical research of acupuncture on malignant tumor patients for improving depression and sleep quality. J Trad Chin Med 2011; 31: 199-202.
[39] Feng XT, Jiao YW, Jia YQ, Cui JY, Zhang YY. Therapeutic effect of integrated Chinese and Western medicine on anxiety and depression of liver cancer. Hebei Zhong Yi Yao Xue Bao 2019; 34: 22-3+36.
[40] Liao LL. Effect of intradermal acupuncture combined with moxibustion on sleep quality tumor chemotherapy patients. Lin Chuang Yi Yao Wen Xian Dian Zi Za Zhi 2019; 6: 29+32.
[41] Liu YL. Clinical study of heat-sensitive moxibustion on tumor-associated depression. Guangzhou: Guangzhou University of Chinese medicine, 2017: 1-50.
[42] Liu XF, Zhang X, Kong J. Effect of warm acupuncture and moxibustion on postoperative upper limb edema and anxiety and depression in breast cancer patients. Shi Jie Zhong Yi Yao 2019; 14: 1856-60.
[43] Liu YP, Wang Y, Fu L, Xiao Q, Liu X. Clinical study of acupuncture in the treatment of depression in cancer patients. Shanghai Zhen Jiu Za Zhi 2019; 38: 417-20.
[44] Mo ZY, Pang YH, Mo QG, et al. Effect of ginger-separated moxibustion on anxiety and depression of patients after modified radical mastectomy. Hu Li Yan Jiu 2017; 31: 3418-20.
[45] Pei Y, Yang J, Zhang J, Chen J. Effect of acupuncture on depression and anxiety in breast cancer. Zhong Guo Zhong Yi Yao Xin Xi Za Zhi 2010; 17: 62-3.
[46] Peng XH, Zhang JL, Song JR, et al. Clinical observation on the treatment of insomnia by acupuncture and moxibustion. Zhong Hua Zhong Yi Yao Za Zhi 2016; 31: 2409-11.
[47] Shen LP, Chen WY, Lv XD, et al. Effect of electroacupuncture on improving sleep quality in patients with lung cancer pain. Yi Xue Yan Jiu Za Zhi 2016; 45: 87-90.
[48] Shi Y, Wang ZX, Li R. Clinical Observation on the treatment of sleep disorder in patients with cancer chemotherapy with scalp flower needle therapy. Zhong Guo Yi Yao Zhi Nan 2014; 12: 286-8.
[49] Song JR, Zhao YL, Peng XH, Hu YP. Clinical randomized controlled study of acupuncture and moxibustion for insomnia in cancer patients. Sichuan Zhong Yi 2015; 33: 163-5.
[50] Wang Y. Analysis of the related factors of anxiety and depression in patients with advanced breast cancer treated with chemotherapy and evaluation of intervention effect of five elements acupuncture. Zhengzhou: Henan University of Chinese medicine, 2015: 1-52.
[51] Wang BN, An P, Wang L, et al. Clinical application of needle embedding in skin for insomnia of heart and spleen deficiency in breast cancer. Zhong Guo Shi Yong Hu Li Za Zhi 2019; 29: 2280-4.
[52] Wang WG, Liu JY, Zhu LJ, Zhang RX. Effect of Xingnao Kaiqiao acupuncture combined with emotional nursing on post-operative depression and quality of life of brain tumor patients. Xin Zhong Yi 2020; 52: 167-70.
[53] Wei S. Application of fire moxibustion combined with alprazolam in patients with gynecological malignant tumor chemotherapy and sleep disorder. Nanning: Guangxi University of Chinese medicine, 2019: 1-77.
[54] Xia Q, Li L. Clinical observation of scalp acupuncture on tumor-associated depression. Xian Dai Zhong Liu Yi Xue 2017; 25: 3506-8.
[55] Xia WM, Lin WQ, Chen CC, Zhou YX. Effect of Baihui acupoint moxibustion on postoperative negative emotion and sleep quality of thyroid cancer patients. Hu Li Yan Jiu 2019; 33: 2239-42.
[56] Zeng XL. Clinical study on the treatment of tumor-associated depression with “Jin Sanjing” toning acupuncture. Guangzhou: Guangzhou University of Chinese medicine, 2015: 1-47.
[57] Zhang YT. Clinical study of heat-sensitive moxibustion in treatment of insomnia related to heart-spleen and two-deficiency tumor. Guangzhou: Guangzhou University of Chinese medicine, 2017: 1-53.
[58] Zhang CH, Chen X, Sun LJ, Wang YH, Li L, Xu JX. Clinical study of Jianpi Tiaogan decoction combined with acupuncture and moxibustion on tumor-associated depression. The International Society of Digital Medicine. Proceedings of the Digital Traditional Chinese Medicine Branch of the International Digital Medicine Association in 2017, International Digital Medical Association: Hunan University of Traditional Chinese Medicine Journal Magazine, 2017: 1004-5.
[59] Zhang YL, Yang SJ. Effect of warm acupuncture combined with comprehensive nursing on delayed diarrhea and anxiety and depression caused by irinotecan chemotherapy in rectal cancer patients. Lin Chuang Xin Shen Ji Bing Za Zhi 2017; 23: 99-102.
[60] Zhang B. Clinical study of Wuxing acupuncture on cancer-related depression. Zhengzhou: Henan University of Chinese medicine, 2017: 1-55.
[61] Zhao YL. Clinical randomized controlled trial of acupuncture for insomnia in cancer patients. Chengdu: Chengdu University of Traditional Chinese medicine, 2015: 1-77.
[62] Zhu JJ, Zhang L, Li Y. Clinical observation of Shenshi Dafu decoction combined with medicine-separated cake moxibustion on depression after interventional operation of liver cancer. Sichuan Zhong Yi 2017; 11: 118-21.
[63] Greenlee H, Dupont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA: Cancer J Clin 2017; 67: 194-232.
[64] Carmady B, Smith CA. Use of Chinese medicine by cancer patients: a review of surveys. Chin Med 2011; 6: 22.
[65] Su D, Li L, Trends in the use of complementary and alternative medicine in the united states: 2002-2007. J Health Care Poor Underserved 2011; 22: 296-310.
[66] Yun H, Sun L, Mao JJ. Growth of integrative medicine at leading cancer centers between 2009 and 2016: a systematic analysis of NCI-designated comprehensive cancer center websites. J Natl Cancer Inst Monog 2017; 52: 29-32.
[67] Thornton LM, Andersen BL, Blakely WP. The pain, depression, and fatigue symptom cluster in advanced breast cancer: covariation with the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Health Psychol Official J Divis Health Psychol Americ Psychol Associat 2010; 29: 333-7.
[68] Li HJ, Liu TT, Heinsberg LW, Lockwood MB, Doorenbos AZ. Systematic review of the kynurenine pathway and psychoneurological symptoms among adult cancer survivors. Biologic Res Nurs 2008; 22: 631-48.
[69] Calker DV, Biber K, Domschke K, Serchov T. The role of adenosine receptors in mood and anxiety disorders. J Neurochem 2019; 151: 11-27.
[70] Miller AH, Ancoli-Israel S, Bower JE, Capuron L, Irwin MR. Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol 2008; 26: 971-82.
[71] Capuron L, Miller AH. Immune system to brain signaling: neuropsychopharmacological implications. Pharm Ther 2011; 130: 226-38.
[72] Park HJ, Chae Y, Kim JW, Lee H, Chung JH. Effect of acupuncture on hypothalamic-pituitary-adrenal system in maternal separation rats. Cellul Molecul Neurobiol 2011; 31: 1123-7.
[73] Kim SK, Bae H. Acupuncture and immune modulation. Autonomic Neuroence Basic Clin 2010; 157: 38-41.
[74] Chae Y, Hong MS, Kim GH, Hahm DH, Lee H. Protein array analysis of cytokine levels on the action of acupuncture in carrageenan-induced inflammation. Neurol Res 2007; 29: S55-8.
[75] Hirsch D, Zukowska Z. Npy and stress 30 years later: the peripheral view. Cellul Molec Neurobiol 2012; 32: 645-59.
[76] Huang W, Kutner N, Bliwise DL. Autonomic activation in insomnia: the case for acupuncture. J Clin Sleep Med 2011; 7: 95-102.
[77] Stone JAM, Johnstone PAS. Mechanisms of action for acupuncture in the oncology setting. CuRR Treat Options Oncol 2010; 11: 118-27.
[78] Samuels N, Gropp C, Singer SR, Oberbaum M. Acupuncture for psychiatric illness: a literature review. Behav Med 2008; 34: 55-64.
[79] Yeung WF, Chung KF, Leung YK, Zhang SP, Andrew CKL. Traditional needle acupuncture treatment for insomnia: a systematic review of randomized controlled trials. Sleep Med 2009; 10: 694-704.
[80] Tu JH, Chung WC, Yang CY, Tzeng DS. A comparison between acupuncture versus zolpidem in the treatment of primary insomnia. Asian J Psychiat 2012; 5: 231-5.
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