Chemotherapy-induced nausea and vomiting (CINV) are among the most distressing side effects experienced by cancer patients undergoing treatment. Despite advancements in pharmacological antiemetic therapies, these symptoms persist for a significant number of patients, impacting their quality of life and potentially disrupting their treatment schedules. In recent years, oncology acupuncture has emerged as a promising complementary therapy to manage multiple side effects resulting from cancer treatments (Capodice 2010; Mayer 2000). This article explores the compelling evidence supporting the efficacy of acupuncture in managing chemotherapy-induced nausea and vomiting, drawing from key studies.
Understanding Chemotherapy-Induced Nausea and Vomiting
CINV is triggered by chemotherapeutic agents that cause the release of serotonin from the gastrointestinal wall (MacDougall & Sharma 2023; Navari & Rapoort 2016). This serotonin stimulates the 5-HT3 receptors in the chemoreceptor trigger zone (CTZ) and activates the vomiting center (VC). The CTZ detects emetic agents in the blood and relays this information to the VC, which coordinates vomiting by integrating signals from various parts of the body. Several neurotransmitters, including serotonin, dopamine, and substance P, interact with their respective receptors in the CTZ and VC (National Cancer Institute 2023). Once activated, the VC sends signals to other brain regions to trigger responses such as increased saliva production, changes in breathing, and muscle contractions in the esophagus, stomach, and diaphragm, resulting in vomiting. Therefore, many antiemetics work by blocking these receptors, inhibiting stimulation at the CTZ and VC.
How Acupuncture Works
Acupuncture involves inserting thin needles into specific points on the body to balance the body's energy and improve health. Electroacupuncture, a modern version, uses a small electric current passing through the needles to enhance the treatment's effects.
A major research study focused on patients with breast cancer receiving intense chemotherapy (Shen et al. 2000). Participants were divided into three groups: one received electroacupuncture with antiemetics, another received sham acupuncture with antiemetics, and the third received antiemetic medication alone. The results were promising: the electroacupuncture group had significantly fewer episodes of vomiting compared to the other groups. The study proposed mechanisms by which acupuncture exerts its antiemetic effects, including modulation of neurotransmitters such as serotonin and substance P, as well as endogenous opioids in the central nervous system. These mechanisms suggest that acupuncture may provide a multifaceted approach to managing emesis by addressing various pathways involved in the emetic response.
Additionally, a well-design randomized clinical trial published on Gynecologic Oncology found that acupuncture on PC 6 with prophylactic antiemetics is more effective in preventing delayed CINV—nausea and vomiting occurring more than 24 hours after chemotherapy administration—comparing to the prophylactic medications along (Rithirangsriroj, Manchana & Akkayagorn 2015).
A systematic review and meta-analysis that included 38 studies with a total of 2,503 patients showed that acupuncture combined with usual care (antiemetics) may offer a higher chance of complete control of CINV compared to usual care alone (Yan et al. 2023). The study categorized the most frequently used acupoints:
PC6 (Pericardium 6, Nei Guan): Commonly used for its antiemetic properties.
ST36 (Stomach 36, Zusanli): Plays a key role in gastrointestinal health and overall immune support.
CV12 (Conception Vessel 12, Zhongwan): Alleviates digestive tract discomfort and improves digestive functions.
A review of systematic reviews on acupuncture for gynecologic conditions noted that evidence supports its efficacy in managing CINV (Kang et al. 2011). While research in this area is still growing, existing studies indicate that acupuncture can significantly improve these symptoms, offering much-needed relief.
Conclusion
Overall, the evidence supports the potential efficacy of acupuncture in reducing nausea and vomiting in cancer patients undergoing chemotherapy. As oncology care continues to evolve, the integration of acupuncture represents a valuable option for the holistic management of cancer patients, improving their quality of life and treatment adherence.
Reference
Capodice, J.L. 2010, 'Acupuncture in the Oncology Setting: Clinical Trial Update', Current Treatment Options in Oncology, vol. 11, no. 3, pp. 87-94.
Kang, H.-S., Jeong, D., Kim, D.-I. & Lee, M.S. 2011, 'The use of acupuncture for managing gynaecologic conditions: An overview of systematic reviews', Maturitas, vol. 68, no. 4, pp. 346-54.
MacDougall, M.R. & Sharma, S. 2023, Physiology, Chemoreceptor Trigger Zone, StatPearls Publishing, viewed 27/06/2024 2024, <https://www.ncbi.nlm.nih.gov/books/NBK537133/>.
Mayer, D.J. 2000, 'Acupuncture: An Evidence-Based Review of the Clinical Literature', Annual Review of Medicine, vol. 51, no. Volume 51, 2000, pp. 49-63.
National Cancer Institute 2023, Nausea and Vomiting Related to Cancer Treatment (PDQ®)–Health Professional Version, viewed 25/06/2024, <https://www.cancer.gov/about-cancer/treatment/side-effects/nausea/nausea-hp-pdq#section_3.9>.
Navari, R.M. & Rapoort, B.L. 2016, Fast Facts : Chemotherapy-Induced Nausea & Vomiting, Health Press, Oxford.
Rithirangsriroj, K., Manchana, T. & Akkayagorn, L. 2015, 'Efficacy of acupuncture in prevention of delayed chemotherapy induced nausea and vomiting in gynecologic cancer patients', Gynecologic oncology, vol. 136, no. 1, pp. 82-6.
Shen, J., Wenger, N., Glaspy, J., Hays, R.D., Albert, P.S., Choi, C. & Shekelle, P.G. 2000, 'Electroacupuncture for Control of Myeloablative Chemotherapy–Induced Emesis: A Randomized Controlled Trial', JAMA : the journal of the American Medical Association, vol. 284, no. 21, pp. 2755-61.
Yan, Y., López-Alcalde, J., Zhang, L., Siebenhüner, A.R., Witt, C.M. & Barth, J. 2023, 'Acupuncture for the prevention of chemotherapy-induced nausea and vomiting in cancer patients: A systematic review and meta-analysis', Cancer Medicine, vol. 12, no. 11, pp. 12504-17.
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