Efficacy and Safety of Acupuncture and Related Techniques in the Management of Oncological Children and Adolescent Patients: A Systematic Review

Acupuncture in pediatric oncology has gained increasing interest as a complementary treatment to relieve symptoms related to cancer and the side effects of conventional treatments. Childhood cancer and its treatments frequently cause nausea, vomiting, fatigue, and pain, significantly impacting children's quality of life. As a simple, low-cost procedure without drug interactions and with a high safety profile, acupuncture has been implemented in major oncology centers worldwide. The World Health Organization has recognized its efficacy and safety since 1979, and guidelines from the American Society of Clinical Oncology suggest acupuncture for the management of cancer pain in adults.

However, there are important knowledge gaps regarding its application in children and adolescents with cancer.

This systematic study was developed to evaluate the efficacy and safety of acupuncture and related techniques in the treatment of symptoms in pediatric oncology patients. The researchers conducted a comprehensive search in nine databases, including publications in English and Chinese, through June 2024. Randomized and quasi-randomized clinical trials involving children from 0 to 18 years of age with any type and stage of cancer were included. The interventions studied included needle acupuncture, electroacupuncture, moxibustion, acupressure, auricular acupuncture, and laser acupuncture, compared with control groups that received sham treatment, usual care, or no treatment.

The outcomes analyzed included nausea, vomiting, use of rescue antiemetic medication, fatigue, and adverse events.

The analysis identified eleven studies conducted in different countries between 2008 and 2024, involving 747 participants with ages between 4.75 and 13.6 years. The studies covered various types of cancer, including leukemia, sarcomas, lymphomas, and solid tumors. The most commonly used acupuncture techniques were acupressure (five studies) and auricular acupuncture (three studies), with PC-6 and ST-36 being the most frequently applied points. The methodological quality of the studies was considered low to moderate, with important limitations in study design and outcome reporting.

Heterogeneity among studies was significant, limiting the possibility of performing comprehensive meta-analyses.

The main results indicate that acupuncture may offer benefits in the control of chemotherapy-induced nausea when compared with sham interventions. The meta-analysis of four studies with 244 participants demonstrated a statistically significant reduction in nausea severity after treatment. However, there was no convincing evidence of a reduction in the number of vomiting episodes. Some individual studies reported improvements in fatigue intensity one hour after treatment, but these benefits were not maintained at 12 hours.

With regard to the use of rescue antiemetic medication, the results were inconsistent across studies. Regarding safety, only minor and transient adverse events were reported, including mild local pain, discomfort from overly tight bands, and auricular itching, with no serious adverse events.

For patients and families, these findings suggest that acupuncture may be a safe and potentially useful option as complementary treatment to help control nausea during chemotherapy. It is important to emphasize that acupuncture does not replace conventional treatments, but can be used together with antiemetic medications to improve the child's comfort. For healthcare professionals, the results indicate that acupuncture can be considered as part of an integrated approach in pediatric oncologic care, especially for the management of nausea. However, it is essential that it be performed by trained and experienced professionals, considering the vulnerability of this population.

The study has important limitations that should be considered in the interpretation of the results. The small number of participants in some studies, the heterogeneity in methodologies used, and the limited methodological quality of the trials restrict the strength of the conclusions. Many studies did not provide sufficient data for robust statistical analyses, and the diversity of assessment instruments hindered direct comparisons between results. In addition, it was not possible to assess publication bias due to the insufficient number of included studies.

Despite these limitations, the review used rigorous systematic methodology and a comprehensive search, including Chinese databases, which strengthens the reliability of the findings. The results are consistent with other systematic reviews in the area, reinforcing the evidence of potential benefit of acupuncture in the control of nausea in pediatric oncology patients.

In conclusion, although the results are promising, additional high-quality studies with larger samples and standardized methodologies are necessary to definitively establish the role of acupuncture in pediatric oncologic care and to guide its clinical application more precisely and safely.