Acupuncture for Cancer Symptoms: Clinical Application and Longitudinal Impact — A Retrospective Observational Real-World Data Study

This retrospective study represents the largest real-world data analysis of acupuncture in oncology ever conducted, evaluating 2,239 consecutive cancer patients who received traditional Chinese acupuncture (TCA) in an outpatient setting between 2015 and 2022. The study was conducted at the Department of Supportive Oncology at Atrium Health Levine Cancer, where an Integrative Medicine Section was established in 2013 to integrate complementary practices into conventional cancer care. The study population was predominantly female (83%) with a mean age of 57 years, with 57% of cases related to breast cancer. The most common symptoms included pain (61%), sleep problems (50%), fatigue (45%), hot flashes (42%), anxiety (40%), and neuropathy (40%).

Most patients (68%) presented with multiple symptoms, with baseline severity between 5 and 6 on a 0-10 numerical scale. The intervention consisted of group acupuncture sessions, accommodating up to four patients simultaneously in recliner chairs similar to those used for chemotherapy. Licensed acupuncturists with more than 10 years of experience applied approximately 18 needles per session, with number and depth tailored to symptoms and prior patient response. Sessions lasted 30-45 minutes, with a recommendation of one session per week for four weeks.

The results demonstrated significant effectiveness of TCA for all evaluated symptoms. By session 2, all symptoms showed statistically significant improvement, with anxiety and hot flashes also showing clinically significant improvement (≥1 point on the scale). By session 3, all improvements were both statistically and clinically significant. Clinical response rates ranged from 57% for hot flashes to 42% for pain when all patients were included, and from 70% for hot flashes to 56% for pain among those who completed at least two sessions.

An important finding was that the benefits of TCA appeared to be sustained between sessions, suggesting lasting treatment effects. In addition, a dose-response relationship was observed, with multiple sessions needed for optimal benefit, especially for symptoms such as pain and fatigue. For symptoms of more acute nature, such as anxiety and hot flashes, the therapeutic effect was more pronounced and immediate. Treatment adherence was high, with 83% of patients returning for a second session.

Adherent patients tended to be older and with greater symptom burden. The study revealed important disparities in TCA use. Women and younger patients used the services more, while men and older adults had lower utilization, despite experiencing similar benefits when they participated in treatment. Women showed greater symptom burden (3 ± 2 vs.

2 ± 2 symptoms) and more severe symptoms in several categories. No significant differences in clinical response rates were observed between genders or age groups. Clinical implications are substantial. The study demonstrated that integration of TCA into conventional outpatient oncology settings is feasible and sustainable.

The group TCA model proved to be cost-efficient, allowing greater access to services. The weekly session frequency proved to be both acceptable and effective, contrasting with clinical trials that often use multiple sessions per week. The study identified significant gaps in the current evidence base, including the need for research on gender and age disparities, benefits in diverse populations, prescribing practices, cost-effectiveness analyses, and standardization of criteria for minimal clinically important difference. The findings support expanding insurance coverage for TCA services as a way to improve access and reduce disparities in cancer supportive care.