A randomized, controlled trial of acupuncture self-needling as maintenance therapy for cancer-related fatigue after therapist-delivered acupuncture

This pioneering study investigated whether maintenance acupuncture treatments — whether by professional therapists or self-administered by the patient — could maintain the benefits obtained after an initial course of acupuncture for cancer-related fatigue. The phase III randomized controlled trial included 197 women with breast cancer who had successfully completed an initial 6-week acupuncture treatment. Participants were re-randomized into three groups: maintenance acupuncture with a therapist (65 patients), self-acupuncture (67 patients), or no maintenance treatment (65 patients). The self-acupuncture group received training to apply needling at the SP-6 and ST-36 points, selected for being safe, easily located, and traditionally used for fatigue.

The main results were measured using the Multidimensional Fatigue Inventory, with assessments at weeks 10 and 18. The study demonstrated that self-acupuncture was equivalent in efficacy to professional therapist treatment, with fatigue scores practically identical between the groups (P > 0.05). This is a significant finding that suggests patients can be trained to perform acupuncture effectively and safely. There was a non-significant trend toward improvement when the two acupuncture groups were combined versus the control group (P = 0.07), but this difference did not reach clinical significance.

Surprisingly, even without maintenance treatment, the benefits of the initial acupuncture course remained stable over the 18 months of follow-up. This suggests that frequent maintenance sessions may not be necessary for cancer-related fatigue, differing from other conditions such as vasomotor symptoms where maintenance has proven beneficial. The safety of self-acupuncture was excellent, with only minor adverse events such as minor bleeding and minimal discomfort. All patients in the self-acupuncture group were able to perform the procedure adequately after training.

The clinical implications are substantial, as self-acupuncture can significantly reduce treatment costs and allow more patients to access therapy. Adequate training by a qualified acupuncturist is fundamental, as is careful selection of safe points. This study contrasts with the common practice of frequent maintenance sessions, suggesting they may be unnecessary for fatigue or applied only when symptoms return. Limitations include a considerable missing data rate (23-30%) and possible selection bias in patients who completed the protocol.

Future studies should investigate the cost-effectiveness of self-acupuncture and its application in other chronic cancer-related symptoms.