Week_5_Research_Summary_Remy Kotchi
docx
keyboard_arrow_up
School
Chamberlain College of Nursing *
*We aren’t endorsed by this school
Course
503
Subject
Medicine
Date
Apr 3, 2024
Type
docx
Pages
20
Uploaded by PrivateHeatGiraffe25
LITERATURE SUMMARY TABLE
PICOT QUESTION (
sentence format)
:
In cancer patients, how effective is acupuncture compared to no acupuncture on pain relief over
120 days? QUANTITATIVE STUDY #1:
Author/Title/Year (APA format): Hershman, D., Unger, J. M., Greenlee, H., Capodice, J. L., Lew, D. L., Darke, A. K., Kengla, A. T., Melnik, M.
K., Jorgensen, C. W., Kreisle, W. H., Minasian, L. M., Fisch, M. J., Henry, N. L., & Crew, K. D. (2018). Effect of Acupuncture vs Sham Acupuncture or Waitlist Control on Joint Pain Related to Aromatase Inhibitors Among Women With Early-Stage Breast Cancer: A Randomized Clinical Trial.
JAMA : the Journal of the American Medical Association
,
320
(2), 167–176. https://doi.org/10.1001/jama.2018.8907
Problem related to PICOT: Many breast cancer patients are given aromatase inhibitors for treatment and experience joint pain as a result. Unfortunately, this unpleasant side effect can result in the discontinuation of the aromatase inhibitors by the patient due to intolerance. If acupuncture is successful in relieving pain for these patients, it may result in better adherence and patient outcomes. Purpose: This study was performed to evaluate the effectiveness of true acupuncture, sham acupuncture,
and no acupuncture on early-stage breast cancer patients’ joint pain due to the use of aromatase inhibitors.
LITERATURE SUMMARY TABLE
Sample/Population: The participants of the study were pre or post-menopausal women with confirmed breast cancer in early stages (I-III) and are using an aromatase inhibitor 30 days prior to the study and plan to continue use for at least another year (Hershman et al., 2018). There was a total of 226 participants that were randomized into three groups: 110 received true acupuncture, 59 received sham acupuncture, and
57 received no acupuncture (Hershman et al., 2018). The participants in the true and sham acupuncture groups received two 30-45-minute acupuncture sessions for the first six weeks followed by one session per week for six weeks (Hershman et al., 2018). This randomized clinical trial took place at 11 different academic centers in the United States from March 2012 to February 2017 (Hershman et al., 2018).
Data Collection Method:
The BPI Worst Pain (BPI-WP) scale was utilized to assess patient’s pain in all three groups comparatively to determine if acupuncture is beneficial for pain relief. A two-point reduction on the BPI-
WP scale indicates a clinically significant reduction in pain and was conducted at six weeks from the start
of acupuncture treatment (Hershman et al., 2018). The data was analyzed using a multivariable linear regression and accounted for any variables, adjusted for baseline score, and indicator variable for study sites and intervention group (Hershman et al., 2018).
Major Findings/Conclusions:
After analysis of the data from all three groups, it was found that the mean observed BPI-WP score for the patients in the true acupuncture group was 2.05 points lower at the six-week mark, indicating a successful reduction in pain, whereas the sham acupuncture group, the BPI-WP score was 1.07 points lower and the waitlist control group was 0.99 points lower on average. (Hershman et al., 2018). Specifically, 58% of true acupuncture patients had at least a two-point reduction in the BPI-WP scale at six weeks compared to 33.3% for sham acupuncture and 31.4% of the waitlist control group
LITERATURE SUMMARY TABLE
(Hershman et al., 2018). Although the true acupuncture group yielded a reduction of BPI-WP of over 2 points, the differences in the six-week adjust mean were 0.92 of true versus sham acupuncture and 0.96 in true acupuncture versus the waitlist control group. While true acupuncture was successful in reducing
pain, some may argue that it was not more than two points on the BPI-WP scale and, therefore, not as clinically significant as we may have thought. After initiating acupuncture therapy, it may have been beneficial to assess the patient’s pain level more often than solely at six weeks to yield more data and to
assess whether or not acupuncture is more effective if the duration of therapy is prolonged. Contribution to Review of the Literature:
Overall, the study was able to demonstrate that acupuncture reduced pain for breast cancer patients over a period of six weeks. In comparison to no acupuncture, the results were less significant but still showed some benefit. Symptoms experienced by cancer patients can decrease treatment adherence and quality of life, but utilizing acupuncture to reduce pain may help alleviate symptoms for and yield better overall outcomes. Perhaps conducting a study over a longer period of time may yield stronger evidence to the true benefit of acupuncture. QUANTITATIVE STUDY #2:
Author/Title/Year (APA format):
Miller, K., Patel, J. N., Symanowski, J. T., Edelen, C. A., & Walsh, D. (2019). Acupuncture for Cancer Pain and Symptom Management in a Palliative Medicine Clinic.
American Journal of Hospice & Palliative Medicine
,
36
(4), 326–332. https://doi.org/10.1177/1049909118804464
Problem related to PICOT:
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
LITERATURE SUMMARY TABLE
Current and former cancer patients often face long-term symptoms due to the extensive therapies in hopes to cure their cancer. One of the most common symptoms experienced is pain, but providing non-pharmacological therapies like acupuncture may help relieve some of these adverse effects when used in conjunction with traditional therapy. Purpose:
The purpose of the study was to evaluate whether or not acupuncture showed any differences in pain improvement in conjunction with standard treatment for patients who currently have caner or have a history of cancer.
Sample:
Sixty- eight patients, age 18 or older, were studied from the Levine Cancer Institute Section of Palliative Medicine from May 1, 2013- December 31, 2015, for a total of 170 treatments (Miller et al., 2019).
Data Collection Method:
Data collection, including ESAS scores, was performed retrospectively for patients receiving acupuncture between May 1, 2013-December 31, 2015 at the Levine Cancer Institute via chart review (Miller et al., 2019). For initial treatments, paired t tests were used for comparison of pre and post-
treatment scores while a variance component model was utilized to evaluate and collect ESAS score differences across all acupuncture treatments (Miller et al., 2019). Univariate and multivariate logistic regression analyses of all of the data from, from the first acupuncture treatment to the last, was used to highlight any clinical meaningfulness in pain improvement this patient population (Miller et al., 2019).
LITERATURE SUMMARY TABLE
Major Findings/Conclusions:
Through data analysis, pain was a common symptom experienced by the population group, affecting 92% of the 68 patients (Miller et al., 2019). Specifically, 51% of patients reported a reduction in pain after the first acupuncture treatment and 45% after all completed treatments (Miller et al., 2019). Univariate analysis displayed that the more progressive the disease stage was, the higher the clinical significance, while patients with no current disease or who were in a less advanced disease state experienced less pain relief (Miller et al., 2019). Overall, there was significant evidence in reduction of pain, but a relatively small population of patients was utilized to evaluate the effectiveness of acupuncture. Smaller sample sizes may make it difficult to determine the strength of the data. Utilizing a
larger population may yield more information related to pain and acupuncture treatment to help develop stronger practice guidelines. Contribution to Review of the Literature:
While cancer patients in general likely experience pain, those in more advanced stages had enhanced pain relief with acupuncture therapy, potentially because they also experience more pain. But, overall almost half of the patients in the study experienced a reduction in pain which is essential in guiding future practice guidelines. We often prescribe pain relief medications, which are not always effective so it may be worth utilizing the same mindset when implementing non-pharmacological therapies such as acupuncture. QUANTITATIVE STUDY #3:
Author/Title/Year (APA format):
LITERATURE SUMMARY TABLE
Stringer, Ryder, W. D., Mackereth, P. A., Misra, V., & Wardley, A. M. (2022). A randomised, pragmatic clinical trial of ACUpuncture plus standard care versus standard care alone FOr Chemotherapy Induced peripheral Neuropathy (ACUFOCIN).
European Journal of Oncology Nursing : the Official Journal of European Oncology Nursing Society
,
60
, 102171–102171. https://doi.org/10.1016/j.ejon.2022.102171
Problem related to PICOT:
Cancer patients receive therapy that can become burdensome and debilitating with little to no relief of symptoms from medications to relieve pain. Because of this, adherence to cancer treatment regimens becomes difficult when symptoms are intolerable, but the use of acupuncture may help keep symptoms manageable resulting in better patient outcomes. Purpose:
Treatments for cancer introduce a variety of undesirable symptoms including Chemotherapy-
induced peripheral neuropathy (CIPN). The study was conducted to evaluate the safety, feasibility, acceptability, and effectiveness of acupuncture for these patients (Stringer et al., 2022). Sample:
Participants were recruited from April 2015- November 2018 and were at least 18 years old with
breast cancer, multiple myeloma, gastrointestinal cancer or gynecological cancer, received neurotoxic chemotherapy, and had a CIPN of more than two (Stringer et al., 2022). The sample size consisted of a total size of 120 participants that were randomized into two groups: the control group (n=59) that received only standard treatment, and the acupuncture group (n=61) that received both standard treatment and acupuncture (Stringer et al., 2022). The study was conducted over a 10-week period in
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
LITERATURE SUMMARY TABLE
which the acupuncture group received one weekly acupuncture treatment for 40 minutes and the control group participated in telephone or in-person assessments at baseline, six and ten weeks (Stringer et al., 2022). The acupuncture group was given the MYMOP 2 (Measure Yourself Medical Outcome Profile) to measure improvement in neuropathy pain (Stringer et al., 2022).
Data Collection Method:
The efficacy of acupuncture was measured by the MYMOP2 which was collected at baseline, six, and ten weeks and considered successful if there was a two point or more improvement in scores (Stringer et al., 2022).
Major Findings/Conclusions:
Overall, data was available for 108 of the 120 participants and the acupuncture group yielded a 68% success rate compared to 33% in the control group in relieving CIPN symptoms including pain (Stringer et al., 2022). The study suggests that acupuncture may be a beneficial treatment for peripheral neuropathy, especially since the data shows almost double the amount of success in the acupuncture group compare to control. While the data is promising, the study does not show how effective acupuncture is as a long-term therapy. Contribution to Review of the Literature:
Overall the study was able to demonstrate the effectiveness of acupuncture therapy for CIPN symptoms, including pain, in comparison to standard care for cancer. While pain is a symptom of CIPN, there are several other symptoms that benefit from acupuncture including numbness, tingling, mobility, dexterity, and cramps. This study, like others, shows improvement for patients that results in a better quality of life and an increased tolerability in cancer treatments. QUANTITATIVE STUDY #4:
LITERATURE SUMMARY TABLE
Author/Title/Year (APA format): Deng, G. (2020). Acupuncture As a Potential Opioid-Sparing Pain Management Intervention for Patients Undergoing Cancer Treatment.
Medical Acupuncture
,
32
(6), 394–395. https://doi.org/10.1089/acu.2020.1494
Problem related to PICOT: Opioids are often prescribed to cancer patients experiencing pain, but the use of acupuncture may lessen the use of these drug by effectively reducing pain. Purpose:
The study was conducted to evaluate the effectiveness of acupuncture on pain experienced by cancer patients and if this can potentially decrease the use of opioids. Sample:
A randomized sham-controlled study was conducted on sixty patients at an academic cancer center with multiple myeloma receiving autologous hematopoietic stem cell transplants (Deng, 2020). These patients were randomized into two groups: true acupuncture (TA) and sham acupuncture (SA) and acupuncture therapy was initiated the day after chemotherapy and continued daily for five days (Deng, 2020).
Data Collection Method:
The M.D. Anderson Symptom Inventory (MDASI) was utilized to assess pain scores and evaluate the use of pain medications on days five, fifteen, and thirty (Deng, 2020).
Major Findings/Conclusion:
LITERATURE SUMMARY TABLE
Patients in the SA group were five times more likely to utilize pain medications at baseline in comparison to the TA group (Deng, 2020). Fifteen patients identified in the TA group used opioids prior to acupuncture therapy but remained opioid free by the end of the study, compared to 20% of SA patients continued with opioids by day five and 40% by day 3 (Deng, 2020). Although opioid use was reduced in the TA group, no significant differences were found in pain scores between the two groups potentially due to the limited sample size and the short period of time studied. Contribution to Review of the Literature:
Based on the results of the study, using TA may reduce the use of opioids and may be an effective alternative to alleviate pain symptoms in these patients. Further studies with a larger sample size and timeline would be useful in solidifying data. QUANTITATIVE STUDY #5:
Author/Title/Year (APA format): Behzadmehr, R., Dastyar, N., Moghadam, M. P., Abavisani, M., & Moradi, M. (2020). Effect of complementary and alternative medicine interventions on cancer related pain among breast cancer patients: A systematic review.
Complementary Therapies in Medicine
,
49
, 102318–
102318. https://doi.org/10.1016/j.ctim.2020.102318
Problem related to PICOT: Since this study was a systematic review, it is useful in evaluating data from numerous studies performed to effectively evaluate how successful acupuncture is for the treatment of cancer-related pain for patients. Purpose:
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
LITERATURE SUMMARY TABLE
This study was a systematic review to evaluate the effectiveness of using CAM interventions to treat pain in breast cancer patients. Sample: The 47 identified studies in the trial included clinical trials, quasi-experiments, pilot studies, cohort, and feasibility studies (
Behzadmehr et al., 2020)
. The target population was breast cancer patients experiencing cancer-related pain. Data Collection Method:
The systematic review was conducted by searching PubMed, Scopus, Web of Science, and EMBASE from January 1, 2000- April 31, 2019 (
Behzadmehr et al., 2020)
.
Major Findings/Conclusion:
Although several different CAM interventions were included, acupuncture specifically was the focus of twelve of the 47 total studies. In these twelve studies, most of them showed an improvement in
different types of pain experienced by cancer patients including: aromatase-inhibitor pain, postoperative pain, and chronic cancer-related pain (
Behzadmehr et al., 2020)
.
Contribution to Review of the Literature:
This systematic review of 47 studies effectively showed how effective acupuncture can be for different types of cancer-related pain. This is essential in addressing that the effects of acupuncture are not discriminatory to what kind of pain the patient experiences. QUANTITATIVE STUDY #6:
Author/Title/Year (APA format):
LITERATURE SUMMARY TABLE
Yang, M., Liou, K. T., Garland, S. N., Bao, T., Hung, T. K. W., Li, S. Q., Li, Y., & Mao, J. J. (2021). Acupuncture versus cognitive behavioral therapy for pain among cancer survivors with insomnia: an exploratory analysis of a randomized clinical trial.
NPJ Breast Cancer
,
7
(1), 148–
148. https://doi.org/10.1038/s41523-021-00355-0
Problem related to PICOT:
While the PICOT question is focused on treating pain for cancer patients, this study was done to evaluate the effectiveness of acupuncture versus CBT-I on pain and insomnia co-occurring for cancer survivors. Cancer patients often face symptoms long after treatment has ended, highlighting the importance of treating pain in survivors as well. The study intersects by evaluating how effective acupuncture can be for pain and inadvertently for insomnia as well. Purpose: This studied was conducted to evaluate the effect of acupuncture versus cognitive behavioral therapy (CBT-I) for insomnia and pain severity amongst cancer survivors. Sample/Population:
Eligible participants were 18 years or older with a previous diagnosis of cancer, completed active
therapy, scored at least an eight on the Insomnia Severity Index (ISI), and met the criteria for a diagnosis of insomnia by the Diagnostic and Statistical Manual of Mental disorders 5
th
edition (Yang et al., 2021). Participants were then placed into two groups: CBT-I group who received one session per week for five weeks and then one week of two sessions or the acupuncture group who received treatment twice a week for two weeks and then weekly treatments for six weeks (Yang et al., 2021). Data Collection Method:
LITERATURE SUMMARY TABLE
To collect relevant data, the BPI pain assessment tool was utilized at baseline, week four, and week eight to measure pain intensity and the interference of pain in one’s life (Yang et al., 2021). Additionally, the Insomnia Severity Index (ISI) was used at baseline, week four, and week eight to assess insomnia and associated symptoms (Yang et al., 2021). Two measurement tools were utilized for pain in insomnia because they often occur simultaneously in cancer patients. Major Findings/Conclusions:
Analysis of the data showed that patients who received acupuncture was successful in reducing pain severity by week eight compared to CBT-I (Yang et al., 2021). Additionally, patients with insomnia had a higher rate of pain reduction when utilizing acupuncture compared to patients without insomnia (Yang et al., 2021). Overall, the findings suggest that acupuncture was successful in rapidly reducing pain
which indirectly led to a decrease in insomnia. Contribution to Review of the Literature: The study addressed the use of acupuncture on pain in patients experiencing pain an insomnia collectively. Specifically, pain can lead to other unpleasant symptoms, it is essential to acknowledge that if pain can be treated and improved, it may improve other associated symptoms. QUANTITATIVE STUDY #7:
Author/Title/Year (APA format):
Kim, K., & Lee, S. (2018). Intradermal Acupuncture Along with Analgesics for Pain Control in Advanced Cancer Cases: A Pilot, Randomized, Patient-Assessor-Blinded, Controlled Trial.
Integrative Cancer
Therapies
,
17
(4), 1137–1143. https://doi.org/10.1177/1534735418786797
Problem related to PICOT:
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
LITERATURE SUMMARY TABLE
The study intersecting with the PICOT question by evaluating what effect acupuncture has on cancer patients. Many cancer patients are prescribed analgesics for pain, so this was a realistic study to assess whether or not acupuncture is effective. Purpose:
This study was conducted to determine the feasibility along with the effects of acupuncture on cancer patients receiving analgesics for pain relief. Sample:
The study consisted of 30 patients and was performed at a single center as a patient-assessor-
blinded, randomized, sham-controlled clinical trial with two parallel arms (Kim & Lee, 2018). The two arms were acupuncture and sham acupuncture, with 15 participants in each group with each being age 18 or older, have a diagnosis of advanced cancer, and are taking analgesics for cancer-related pain (Kim & Lee, 2018).
Data Collection Method:
Three outcomes were measured to evaluate the effectiveness of acupuncture. The first outcome
was whether or not there was a change in grade and dosage of pain between baseline and one and three-weeks after acupuncture treatments (Kim & Lee, 2018). The second outcome was assessing pain by using the numerical rating scale (NRS) (Kim & Lee, 2018). Lastly, the third outcome was a measurement of QOL by using the European Organization for Research and Treatment of Cancer QOL questionnaire (EORTC QLQ-C30) (Kim & Lee, 2018). Key Findings/Themes:
For the acupuncture group, 64.3% of the patient had a reduction in the usage of analgesics, while 38.5% of the sham acupuncture group had reduction in analgesic use (Kim & Lee, 2018).
LITERATURE SUMMARY TABLE
Regarding the NRS, both acupuncture and sham acupuncture groups had a reduction in pain after treatment, at the first follow-up, and at the end of the follow-up visits (Kim & Lee, 2018). The QOL scores resulted by the EORTC QLC-C30 showed significant improvement after the first treatment, at the first follow-up, and at the end of follow-up visits (Kim & Lee, 2018). Overall, acupuncture treatments vs sham acupuncture did not yield any significant statistical evidence to support the use of acupuncture for
pain relief. One limitation of the study is the resistance of patients willing to admit the amount of analgesic use as well as the sample size. Contribution to Review of the Literature:
While the study did not show any significance between the two groups in relation to relieving pain, it does highlight the reduction in the use of analgesics. Due to this, acupuncture may be beneficial in relieving some patients pain and reducing the reliance on medications. This may also prompt patients to utilize acupuncture before resorting to pharmacological measures. QUALITATIVE STUDY #1:
Author/Title/Year (APA format):
Zayas, J., Ruddy, K. J., Olson, J. E., Couch, F. J., Bauer, B. A., Mallory, M. J., Yang, P., Zahrieh, D., Athreya, A. P., Loprinzi, C. L., & Cathcart-Rake, E. J. (2020). Real-world experiences with acupuncture among breast cancer survivors: a cross-sectional survey study.
Supportive Care in Cancer
,
28
(12),
5833–5838. https://doi.org/10.1007/s00520-020-05442-9
Problem related to PICOT:
Pain is subjective and the patient’s perspective is essential for understanding effective methods to help alleviate pain in cancer patients.
LITERATURE SUMMARY TABLE
Purpose:
The study was conducted to assess patients and their perception of the effectiveness of acupuncture on unpleasant symptoms experienced including pain during treatment for breast cancer. Sample:
Eligible participants resulted in 241 total individuals identified through the Mayo Clinic Breast Disease Registry (MCBDR) as well as EHR records from Mayo Clinic who used acupuncture for cancer-
related symptoms between August 2018 and January 2019 (Zayas et al., 2020). Data Collection Method:
Surveys sent to eligible participants included questions related to whether or not acupuncture helped their symptoms by using a 5-point Likert scale that included responses ranging from “it did not provide any benefit” to “it totally resolved my symptoms” (Zayas et al., 2020). The symptoms evaluated before and after treatment included: arthralgias, myalgias, post-surgical pain, hot flashes, nausea/vomiting, fatigue, depression, anxiety, insomnia, lymphedema, headache, and neuropathy (Zayas et al., 2020).
Key Findings/Themes:
Cancer patients most commonly experience joint and muscle pain, hot flashes, fatigue, and neuropathy (Zayas et al., 2020). Overall, most patients reported symptomatic benefit from using acupuncture and symptoms like headache, constipation and pain yielded the highest number of patients
reporting improvement (Zayas et al., 2020). These findings are especially helpful for cancer patients to seek out if pharmacological options are ineffective, limited, costly, or not preferred. One identified limitation was that some identified participants received acupuncture close to a year prior to
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
LITERATURE SUMMARY TABLE
participating in the study. This may yield inaccurate results due to the inability to recall details and pain experienced from an extended period of time. Contribution to Review of the Literature:
The study was helpful in viewing the patient’s perspective in relation to pain. Overall, pain was one of the most commonly reported symptoms that decreased after acupuncture treatment. This study is relevant in showing that immediately after acupuncture therapy, pain was decreased for a significant number of patients. The almost immediate relief of pain demonstrates how acupuncture may be used as
an acute therapy for cancer patients experiencing pain. META-ANALYSIS STUDY #1:
Author/Title/Year (APA format):
Jang, S., Ko, Y., Sasaki, Y., Park, S., Jo, J., Kang, N.-H., Yoo, E.-S., Park, N.-C., Cho, S. H., Jang, H., Jang, B.-
H., Hwang, D.-S., & Ko, S.-G. (2020). Acupuncture as an Adjuvant Therapy for Management of Treatment-Related Symptoms in Breast Cancer Patients: Systematic Review and Meta-Analysis (PRISMA-Compliant).
Medicine (Baltimore)
,
99
(50), e21820–e21820. https://doi.org/10.1097/md.0000000000021820
Problem related to PICOT:
While there are numerous studies evaluating the effectiveness of acupuncture on symptom management for cancer patients, conducting a meta-analysis is useful in dissecting data and finding strengths and limitations that are commonly present. By doing so, it can guide further research to conduct more precise and accurate research on the topic to help guide clinical practice. Purpose:
LITERATURE SUMMARY TABLE
The purpose of this study was to explore current research trends in relation to the effectiveness of acupuncture on treating symptoms caused by breast cancer treatment.
Search selection method:
This systematic review and meta-analysis was performed on RCTs extracted from several databases including: MEDLINE, EMBASE, the Cochrane Library, AMED, CINAHL, OASIS, CNKI, and CiNii (Jang et al., 2020). 19 RCTs were utilized for this qualitative synthesis and eight explored climacteric synthesis, four explored pain, two explored lymphedemas, two explored nausea and vomiting, and three
investigated miscellaneous symptoms (Jang et al., 2020). To search for relevant data in these databases, several terms were utilized as search terms including: breast cancer, acupuncture, breast carcinoma, breast neoplasm, traditional medicine, complementary and alternative medicine, Chinese medicine, Korean medicine, and Kampo medicine (Jang et al., 2020). The data collected included comparisons of acupuncture groups to sham acupuncture, active control (i.e. conventional medicine and exercise), no treatment, and waitlist control groups (Jang et al., 2020).
Meta-Analysis Model:
This study is a fixed-effects model. Consistency/Variation of Studies:
Each of the included studies had some degree of variation and included some or all of the following: sham acupuncture, active control (conventional medicine and exercise), no treatment, and waitlist control groups. It was also mentioned that no restrictions were placed on the type of breast cancer, chemotherapy, surgery, or size of tumors deeming this as a limitation to the study (Jang et al., 2020).
Summary of Findings:
LITERATURE SUMMARY TABLE
Overall results of the studies showed improvement in symptoms including: climacteric symptoms were reduced including frequency and severity, significant improvements in pain, nausea and
vomiting, lymphedema, and chemotherapy-related cognitive impairment (Jang et al., 2020). The only symptoms that did not show any significant changes was Taxane-induced peripheral neuropathy. But, even with positive data to support the use of acupuncture for cancer patients, the authors suggest pursuing further confirmatory trials to gather more conclusive data since the studies had a low level of reporting quality and a high heterogeneity in methodical quality (Jang et al., 2020). CLINICAL PRACTICE GUIDELINE #1
Author/Title/Year (APA format):
Ge, L., Wang, Q., He, Y., Wu, D., Zhou, Q., Xu, N., Yang, K., Chen, Y., Zhang, A. L., Hua, H., Huang, J., Hui, K.-K., Liang, F., Wang, L., Xu, B., Yang, Y., Zhang, W., Zhao, B., Zhu, B., … Zhang, H. (2022). Acupuncture for cancer pain: an evidence-based clinical practice guideline.
Chinese Medicine
,
17
(1), 8–8. https://doi.org/10.1186/s13020-021-00558-4
Problem related to PICOT:
In relation to the PICOT question, this study was performed to assess past research to determine
the effectiveness of acupuncture on pain. Stakeholders represented:
This panel consisted of several stakeholders including U.S. providers, two patients, representatives of Chinese medicine/acupuncture, and experts in systematic review methodology. These individuals represented cancer patients experiencing pain symptoms. Systematic review of literature:
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
LITERATURE SUMMARY TABLE
To identify relevant studies, PubMed and Chinese National Infrastructure databases were searched and data synthesis was re-performed to confirm validity of evidence by using Review Manager software Ge et al., 2022). Clinical questions were drafted in conjunction with the systemic review in JAMA Oncology and the Patients, Intervention, Control and Outcomes (PICO) framework (Jang et al., 2020). Five clinical questions were created: (1) With regard to pain alleviation for cancer patients, what are the effects of acupuncture treatment? (2) For cancer patients using analgesics for pain control, what are the effect of acupuncture/acupressure when combined with analgesics? (3) What are the differences of different acupuncture methods in pain alleviation for cancer patients? (4) What are the acupoints selection, manipulation and course of acupuncture/acupressure treatment for cancer pain? (5) With regard to breast cancer patients with aromatase-inhibitor induced arthralgia, what are the effects of acupuncture treatment? (Jang et al., 2020)
Strength of recommendations used:
The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach
was used to formulate recommendations and place them into either strong or weak categories by considering benefits and harm, certainty of evidence, patient preferences and values, resources, and other factors (Jang et al., 2020). The first recommendation was utilizing acupuncture compared to no acupuncture to treat pain in patients with moderate to severe cancer (Jang et al., 2020). While it is a strong recommendation, the certainty of evidence is moderate. There was no significant difference in pain when comparing different forms of acupuncture but true acupuncture was effective in relieving pain when compared to sham acupuncture (Jang et al., 2020).
LITERATURE SUMMARY TABLE
The second recommendation was to use a combination of acupuncture and acupressure, decrease opioid use, and alleviate opioid-related side effects for patients who are using analgesics with moderate to severe cancer pain (Jang et al., 2020). Overall this is a weak recommendation with low certainty evidence. The RCTs addressed suggested that using analgesics with acupuncture can effectively
relieve pain and reduce the use of opioids, but, as previously mentioned, the certainty for evidence was low. The third recommendation was to use acupuncture to treat pain compared to no acupuncture for breast cancer patients with aromatase inhibitor-induced arthralgia (Jang et al., 2020). While this is a strong recommendation, it has low certainty evidence even though the RCTs related to this recommendation showed that acupuncture was effective in reducing the intensity of joint pain caused by aromatase inhibitors. Recommendations have been peer reviewed:
All three of the above recommendations were reviewed by a panel of experts and the Delphi
method was utilized to reach a consensus requiring at least a 70% score to determine the strength and relevancy of each recommendation (Jang et al., 2020).
Summary of findings as related to PICOT:
In relation to patients experiencing cancer pain, acupuncture is an effective method of reducing pain and enhancing quality of life. The hope of this study was to create guidelines to standardize the use
of acupuncture in clinical care, but more research is required to illicit high certainty evidence.