Rédacteurs : Johan Nguyen, Henri Truong

Lung Cancer

Cancer du poumon : évaluation de l'acupuncture

Articles connexes : - évaluation du taiji-qigong - évaluation de la pharmacopée chinoise -

1. Systematic Reviews and Meta-Analysis

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

1.1. Bian 2020 (Lung Cancer Pain) ☆

Bian Shuanglin. [Meta-analysis of Acupuncture Combined with Three-step Analgesic in The Treatment of Lung Cancer Pain]. Chinese Journal of Basic Medicine in TCM. 2020. [212902].

Objective To systematically evaluate the clinical efficacy and safety of acupuncture combined with three-step analgesics in the treatment of lung cancer pain.
Method The clinical randomized controlled study of acupuncture combined with three-step analgesics in the treatment of lung cancer pain was retrieved by computer from China Journal Full-text Database (CNKI), VIP Journal Database (VIP), Wanfang Data Resources, PubMed, and Cochrane Library Database (since beginning to May 2018), and the meta-analysis was performed with Revman 5. 3 software.
Results 9 articles including 531 patients were included. Meta-analysis showed that acupuncture combined with three-step analgesics was more effective in analgesia than single-step analgesics alone, the degree of pain improvement was greater. It can also reduce the incidence of nausea and vomiting, reduce the occurrence of constipation reaction.
ConclusionAcupuncture combined with three-step analgesic is effective and safe in the treatment of lung cancer pain, but it still needs more and higher quality literature to verificate and support.

1.2. Chen 2013 ~

Chen HY, Li SG, Cho WC, Zhang ZJ. the role of acupoint stimulation as an adjunct therapy for lung cancer: a systematic review and meta-analysis. BMC Complement Altern Med. 2013. [170203].

Background Lung cancer is the leading cause of death in cancer patients. Clinical studies showed that a variety of acupoint stimulations have been extensively used for lung cancer patients, including needle insertion, injection with herbal extraction, plaster application, and moxibustion. However, the role of acupoint stimulation in lung cancer treatment was not fully reviewed.
Methods In the present study, we conducted a systematic review and meta-analysis on the role of acupoint stimulation in lung cancer treatment by electronic and manual searching in seven databases, including Ovid (Ovid MEDLINE, AMED, CAB Abstracts, EMBASE), EBSCOhost research databases (Academic Search premier, MEDLINE, CIHAHL Plus), PreQuest (British Nursing Index, ProQuest Medical Library, ProQuest Dissertations & Theses A&I, PsycINFO), and ISI web of knowledge (Web of Science, BIOSIS Citation Index, Biological Abstracts, Chinese Science Citation Database), CNKI, Wanfang Data, and CQVIP.
Results Our study showed that acupoint stimulation has strong immunomodulatory effect for lung cancer patients as demonstrated by the significant increase of IL-2, T cell subtypes (CD3+ and CD4+, but not CD8+ cells), and natural killer cells. Further analysis revealed that acupoint stimulation remarkably alleviates the conventional therapy-induced bone marrow suppression (hemoglobin, platelet, and WBC reduction) in lung cancer patients, as well as decreases nausea and vomiting. The pooled studies also showed that acupoint stimulation can improve Karnofsky performance status, immediate tumor response, quality of life (EORCT-QLQ-C30), and pain control of cancer patients.
Conclusions Acupoint stimulation is found to be effective in lung cancer treatment, further confirmatory evaluation via large scale randomized trials is warranted.

1.3. Kelley 2003 Ø

Kelley MJ, McCrory DC. Prevention of lung cancer: summary of published evidence. Chest. 2003;123(1 Suppl): 50S-59S. [146321].

Study objectivesTo describe empiric research related to lung cancer prevention strategies, including chemoprevention aimed at reducing lung cancer incidence and various smoking avoidance and cessation interventions aimed at reducing smoking rates.
Design, setting, and participants Systematic searches of MEDLINE, HealthStar, and Cochrane Library databases to July 2001 and print bibliographies. For chemoprevention studies, we considered only randomized controlled trials (RCTs) with lung cancer incidence as an end point. For studies of smoking avoidance or cessation, we selected systematic reviews and meta-analyses, and searched for individual RCTs only where high-quality and current reviews and meta-analyses were not available.
Measurement and resultsChemoprevention of lung cancer has been studied in five RCTs of primary prevention, no RCTs of secondary prevention, and five RCTs of tertiary prevention. None of these trials has shown evidence for efficacy of any agents tested, including retinol (vitamin A), beta-carotene, N-acetylcysteine, and selenium. There is a great deal of evidence about a wide variety of clinician-based and community-based efforts at smoking avoidance or cessation. Certain approaches have been shown to be effective (eg, mass media public education campaigns, direct restrictions on smoking, clinician-based approaches ranging from brief clinician advice to more in-depth sessions, and “life-skills training” in schools). Some approaches have intermediate or short-term effectiveness (ie, youth access restrictions and school-based interventions), and others have been shown to be ineffective (ie, acupuncture and provider education) or have been insufficiently studied (ie, provider feedback).
ConclusionsThere are no agents that have been proven to be effective for preventing lung cancer. Several clinician-based and community-based interventions show promise for reducing lung cancer incidence through smoking avoidance and prevention.

2. Clinical Practice Guidelines

⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation, (or lack of evidence)

2.1. American College of Chest Physicians (ACCP, USA) 2013 ⊕

Deng GE, Rausch SM, JoneS LW, Gulati A, Kumar NB, GreenleE H, Pietanza MC, Cassileth BR. Complementary therapies and integrative medicine in lung cancer: diagnosis and management of lung cancer, 3rd ed: American College Of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2013;143(5 Suppl):420-36. [159371].

Recommendation 2.5.3.1. In patients having nausea and vomiting from either chemotherapy or radiation therapy, acupuncture or related techniques is suggested as an adjunct treatment option (Grade 2B).
Recommendation 2.5.3.2. In patients with cancer related pain and peripheral neuropathy, acupuncture is suggested as an adjunct treatment in patients with inadequate control of symptoms (Grade 2C ).

2.2. American College of Chest Physicians (ACCP, USA) 2007 ⊕

Cassileth BR, Deng GE, Gomez JE, Johnstone PA, Kumar N, Vickers AJ; American College of Chest Physicians. Complementary therapies and integrative oncology in lung cancer: Accp Evidence-Based Clinical Practice Guidelines (2nd Edition). Chest. 2007;132(3sup:340s-54s. [146961]

Recommendation 7. Acupuncture is recommended as a complementary therapy when pain is poorly controlled or when side effects such as neuropathy or xerostomia from other modalities are clinically significant. Grade of recommendation, 1A
Recommendation 8. Acupuncture is recommended as a complementary therapy when nausea and vomiting associated with chemotherapy are poorly controlled. Grade of recommendation, 1B
Recommendation 9. Electrostimulation wristbands are not recommended for managing chemotherapy-induced nausea and vomiting. Grade of recommendation, 1B
Recommendation 10. When the patient with lung cancer does not stop smoking despite use of other options, a trial of acupuncture is recommended to assist in smoking cessation. Grade of recommendation, 2C
Recommendation 11. In patients with lung cancer with symptoms such as dyspnea, fatigue, chemotherapyinduced neuropathy, or postthoracotomy pain, a trial of acupuncture is recommended. Grade of recommendation, 2C
Recommendation 12. In patients with a bleeding tendency, it is recommended that acupuncture be performed by qualified practitioners and used cautiously. Grade of recommendation, 1C