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A Randomized Controlled Trial

Joannie Shen, MD, MPH; Neil Wenger, MD, MPH; John Glaspy, MD, MPH; Ron D. Hays, PhD; Paul S. Albert, PhD; Christina Choi, OMD; Paul G. Shekelle, MD, PhD

JAMA. 2000;284:2755-2761.

Context  High-dose chemotherapy poses considerable challenges to emesis management. Although prior studies suggest that acupuncture may reduce nausea and emesis, it is unclear whether such benefit comes from the nonspecific effects of attention and clinician-patient interaction.

Objective  To compare the effectiveness of electroacupuncture vs minimal needling and mock electrical stimulation or antiemetic medications alone in controlling emesis among patients undergoing a highly emetogenic chemotherapy regimen.

Design  Three-arm, parallel-group, randomized controlled trial conducted from March 1996 to December 1997, with a 5-day study period and a 9-day follow-up.

Setting  Oncology center at a university medical center.

Patients  One hundred four women (mean age, 46 years) with high-risk breast cancer.

Interventions  Patients were randomly assigned to receive low-frequency electroacupuncture at classic antiemetic acupuncture points once daily for 5 days (n = 37); minimal needling at control points with mock electrostimulation on the same schedule (n = 33); or no adjunct needling (n = 34). All patients received concurrent triple antiemetic pharmacotherapy and high-dose chemotherapy (cyclophosphamide, cisplatin, and carmustine).

Main Outcome Measures  Total number of emesis episodes occurring during the 5-day study period and the proportion of emesis-free days, compared among the 3 groups.

Results  The number of emesis episodes occurring during the 5 days was lower for patients receiving electroacupuncture compared with those receiving minimal needling or pharmacotherapy alone (median number of episodes, 5, 10, and 15, respectively; P<.001). The electroacupuncture group had fewer episodes of emesis than the minimal needling group (P<.001), whereas the minimal needling group had fewer episodes of emesis than the antiemetic pharmacotherapy alone group (P = .01). The differences among groups were not significant during the 9-day follow-up period (P = .18).

Conclusions  In this study of patients with breast cancer receiving high-dose chemotherapy, adjunct electroacupuncture was more effective in controlling emesis than minimal needling or antiemetic pharmacotherapy alone, although the observed effect had limited duration.

Author Affiliations: Laboratory of Clinical Studies, Brain Electrophysiology and Imaging Section, National Institute of Alcoholism and Alcohol Abuse, National Institutes of Health, Bethesda, Md (Dr Shen); Department of Medicine, Division of General Internal Medicine and Health Services Research (Drs Wenger and Hays) and Department of Medicine, Division of Hematology and Oncology (Dr Glaspy), UCLA School of Medicine, Los Angeles, Calif; RAND, Santa Monica, Calif (Drs Hays and Shekelle); Biometric Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md (Dr Albert); and Department of Medicine, West-L.A. VAMC, Veterans Affairs Health Services Research and Development Service, Los Angeles, Calif (Dr Shekelle). Dr Choi is in private practice in Santa Monica, Calif.

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