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The use of acupuncture in women undergoing endocrine therapy for hormone receptor (HR)-positive breast cancer resulted in significant improvements in hot flashes and other endocrine symptoms, according to a pooled analysis of randomized trials.

Across the trials conducted in the U.S., China, and South Korea, patients randomized to receive immediate acupuncture reported statistically significant improvements in the Functional Assessment of Cancer Therapy (FACT) endocrine symptom subscale score compared with those in the delayed acupuncture arm (mean change 5.1 vs 0.2, P=0.0003), reported Weidong Lu, MB, MPH, PhD, of the Dana-Farber Cancer Institute in Boston, and colleagues.

Other significant improvements were observed in the hot flash score, calculated by multiplying the frequency and severity of hot flashes recorded in a daily hot flash diary (mean change -5.3 vs -1.4, P<0.003), and the FACT-Breast total score measuring breast cancer-related quality of life (mean change 8.0 vs -0.01, P=0.0005), they wrote in .

In addition, 64% of participants in the immediate acupuncture arm reported a reduction of ≥50% in the hot flash score compared with 18% of women in the delayed acupuncture group.

"Our results further suggest that the effects of acupuncture persisted for at least 10 weeks after the intervention in enrolled patients," Lu and colleagues wrote.

In a , Lu pointed out that "by managing side effects, our approach makes it easier for patients to continue their prescribed medication, which has the potential to reduce the risk of cancer recurrence and improve long-term outcomes for breast cancer survivors."

"In practice, patients interested in using acupuncture for this purpose might begin with a short trial period to assess their response to the treatment, particularly in terms of reduction in hot flashes and other symptoms," he added. "If the trial period yields positive results, patients may then engage in a long-term program, receiving regular acupuncture sessions throughout the duration of their anti-hormonal medication regimen."

For this analysis, a total of 158 women with stage 0-III breast cancer from three randomized trials were included: 78 in the U.S., 40 in China, and 40 in South Korea. Of these women, 81 were randomized to immediate acupuncture (20 acupuncture sessions over 10 weeks), and 77 to delayed acupuncture (usual care followed by acupuncture with reduced intensity).

Median age was 48 years, 53% were Asian, and 40% were white. Nearly all patients (95%) had confirmed HR‐positive disease, and 61.4% were HER2-negative.

Tamoxifen was the most used endocrine therapy (61.4%); 32.9% were treated with an aromatase inhibitor and 15% received ovarian suppression. The average number of hot flashes daily at baseline was 6.3, and almost two-thirds of patients had two to six episodes of hot flashes daily at baseline.

The primary endpoint was change in score on the FACT endocrine symptom subscale from baseline to week 10. At baseline, the average score was 50.3 in the immediate acupuncture arm and 51.6 in the delayed acupuncture arm (on a scale of 0-76).

The effect of the acupuncture intervention differed by site, with the most significant benefit of acupuncture on the FACT endocrine symptom subscale observed in South Korea.

Lu and colleagues acknowledged limitations to their study, including the fact that the trials included in the analysis did not apply sham acupuncture as a control. However, they noted that systematic reviews have suggested that the use of sham acupuncture should be reconsidered because these sham devices "are not adequate inert controls."

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