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Dr. Jack West is a medical oncologist and thoracic oncology specialist, and Executive Director of Employer Services at the City of Hope Comprehensive Cancer Center in Duarte, CA.

Acupuncture for Treating Nausea & Vomiting
Sun, 11/25/2007 - 20:48
Howard (Jack) West, MD, Associate Clinical Professor, Medical Oncology, Executive Director, Employer Services, Founder, President and CEO of GRACE

I reviewed a few general principles of acupuncture in my last post on its use for pain control. In addition, acupuncture has also been studied as a potential treatment modality for other nausea/vomiting, with some evidence to support its use in addition to anti-nausea (also called antiemetic) medications. Current ACCP guidelines (abstract here, again) strongly recommended acupuncture as a treatment for nausea and vomiting associated with chemo if these symptoms are not well controlled or when side effects from other treatments are problematic. The data aren't overwhelming, but the recommendation is largely based on acupuncture having very minimal potential adverse effects, so even modest/inconsistent benefits would be felt to outweigh the very slight risk.

A study in the setting of breast cancer (abstract here) randomized patients to receive electroacupuncture to a couple of relevant points, minimal needling at non-acupuncture sites ("sham" acupuncture, a form of placebo control), or anti-nausea medications with no attempted acupuncture, real or otherwise. Electroacupuncture reduced total vomiting episodes from 15 to 5 (median), compared to medications alone, while minimal needling produced results between the full treatment and medications alone (median 10 vomiting episodes).

Studies combining acupuncture with newer generation anti-nausea medications like serotonin receptor blockers (current staples like zofran, kytril, and anzamet, all very similar to each other) have been inconclusive. In a study of patients without cancer but with a form of rheumatic disease that required the chemo medication methotrexate), the combination of acupuncture at the PC6 acupuncture point above the wrist and zofran worked better than zofran alone (full text here). On the other hand, another study that compared zofran and acupuncture at the PC6 point to zofran with sham acupuncture (without penetrating skin) showed no real contribution from acupuncture (abstract here). Other studies demonstrate that acupuncture can reduce nausea/vomiting associated with recent surgery (abstract here) motion sickness (abstract here), and pregnancy (abstract here).

There was a recent meta-analysis of over 1200 patients from 11 trials of various modalities that included acupuncture, acupressure, electroacupuncture, and non-invasive electrostimulation of overlying skin (abstract here). Although not especially dramatic, all of these modalities except non-invasive electrostimulation was associated with some improvement in acute, but not delayed, vomiting.

Overall, the benefits of acupuncture have been rather subtle, but it appears to be an approach that may provide some modest added benefit over medications alone. One interpretation of the negative results in the setting of a bone marrow transplant is that acupuncture may be helpful for more moderate nausea/vomiting challenges, but it may not be effective enough in the setting of very severe anticipated nausea/vomiting. Regardless, these results were enough to have the ACCP say that acupuncture merits consideration as a treatment strategy for nausea/vomiting.

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