Acupuncture in cancer care: recommendations for safe practice (peer-reviewed expert opinion)

Acupuncture has become established as a valuable intervention in the multidisciplinary care of people living with cancer, offering relief for various side effects of cancer treatments. This landmark document represents the first international update of safety guidelines for acupuncture in oncology in 17 years, since the pioneering guidance by Filshie and Hester in 2006. The development of these recommendations arose from the urgent need for updated guidance, given the emergence of new cancer treatments such as immunotherapy and targeted therapies, in addition to the growing number of cancer survivors living with late effects of the disease. During 2022 and 2023, an international panel of 15 experts, including senior acupuncturists, oncologists, physicians, and nurses trained in integrative oncology, researchers, and representatives of professional bodies, collaborated in developing these guidelines.

The core team, composed of three integrative oncology professionals, extensively updated the preexisting unpublished recommendations, which were then reviewed by invited experts across multiple iterations until final ratification. The panel represents national and international integrative oncology associations and major cancer treatment centers in Europe, the US, Australia, and the Middle East, ensuring broad global applicability. The recommendations systematically address contraindications, precautions, and risks for patients in active treatment or off treatment, including surgery, systemic anticancer therapies (SACT), and radiation therapy. An innovative 'Red and Amber Flags' system was developed to highlight situations where urgent medical referral is essential, providing clear guidance on when to treat and when not to treat with acupuncture.

The guidelines are intentionally comprehensive, intended for any acupuncture practitioner using any form of acupuncture and working in any setting, from integrative oncology centers to private community clinics. They cover special considerations for different patient populations, including those with immune compromise, neutropenia, thrombocytopenia, lymphedema, and other cancer-related conditions. The document emphasizes that acupuncture is a flexible modality that can be adapted to circumstances where needling should be avoided, offering nonpenetrative alternatives such as acupressure, moxa, and auricular seeds. The recommendations also address related techniques and specific considerations for different cancer treatments, including detailed guidance on when to modify approaches for specific cancer-related conditions.

Research shows that acupuncture is as safe in cancer patients as in the general population, with adverse events being rare when performed by qualified practitioners. The most common adverse events are transient bleeding and pain at the needle site, occurring in fewer than two in 1,000 treatments. The document addresses specific concerns such as pneumothorax, vasovagal reactions, and bleeding in patients at increased risk. An important section is dedicated to immunotherapy-related autoimmune reactions, recognizing this relatively new form of anticancer treatment and its unique implications for the practice of acupuncture.

The guidelines also provide practical recommendations for modifying acupuncture approaches during and after specific cancer treatments, including considerations for surgery, chemotherapy, radiation therapy, and hormonal therapies. This work represents a significant milestone in integrative oncology, providing a solid scientific basis for the safe practice of acupuncture in cancer care. The recommendations aim to empower practitioners, protect patients, and encourage policymakers and health care providers to consider acupuncture as a safe and effective part of routine cancer care at any stage of the cancer survivorship journey.