Cancer-related fatigue (CRF) is the most prevalent and debilitating symptom among patients in oncologic treatment and survivors — affecting 60% to 90% of patients undergoing chemotherapy and radiotherapy, and persisting for months or years after treatment ends. Unlike common physiologic fatigue, CRF is not relieved by rest and profoundly interferes with daily activities, quality of life, and adherence to oncologic treatment. There is no, to date, approved drug with robust efficacy for the specific management of CRF, making evidence-based non-pharmacologic interventions particularly relevant.
An integrative review published in February 2026 in Supportive Care in Cancer (Springer), conducted by Tan and colleagues, synthesizes a decade of evidence (2015–2025) from English- and Chinese-language databases, including 13 randomized clinical trials with 919 participants with various types of cancer. The work differs from previous reviews by proposing practical clinical recommendations organized into three distinct protocols — allowing the medical acupuncturist to select the most appropriate approach to the phase and context of each patient’s oncologic treatment.
A DECADE IN NUMBERS: REVIEW DATA
Methodology: integrating English and Chinese evidence
One of the distinctive methodologic contributions of this review is the inclusion of Chinese-language databases — in addition to the traditional English-language databases (PubMed, Cochrane, Embase, CINAHL, Scopus, Web of Science, and PsycINFO). This allowed capture of RCTs published in Chinese journals that frequently are not indexed in Western reviews, significantly expanding the body of evidence analyzed. The 13 included studies evaluated manual acupuncture, electroacupuncture, and moxibustion — alone or combined — in patients with breast, lung, colorectal, gastric, and other cancers during or after active oncologic treatment.
Most frequent acupoints: ST-36, CV-6, CV-4
Analysis of the 13 RCTs revealed convergence in the selection of acupoints. The point ST-36 (Zusanli) was the most used, appearing in most protocols of both acupuncture and moxibustion. In the tradition of Chinese medicine, ST-36 is considered the principal point of qi tonification and general strengthening — and modern research has demonstrated its effects on immune modulation, gastrointestinal function, and reduction of systemic inflammation. CV-6 (Qihai) and CV-4 (Guanyuan), both in the Ren Mai meridian (Conception Vessel) in the infraumbilical region, complete the core of acupoints with the highest frequency of use, especially in moxibustion protocols for tonification of yang and qi.
Needle retention time in the studies varied from 10 to 30 minutes per session. Session frequency depended on the protocol adopted, with models of two to five sessions per week in the acute phase and one to two sessions per week in maintenance.
Three recommended clinical protocols
The principal differentiator of this review compared with previous publications is the systematization of the evidence into three clinical protocol profiles, organized by duration and therapeutic context. This structure allows the medical acupuncturist to select the approach according to the phase of the patient’s oncologic treatment — something that generic reviews do not provide.
Frequently Asked Questions
Yes. The review demonstrates that acupuncture protocols synchronized with chemotherapy cycles are safe and effective. None of the 13 RCTs reported significant adverse events in patients on active treatment. The cycle-based protocol was specifically designed to reduce the fatigue peak in the days following chemotherapy infusion.
Acupuncture uses fine needles inserted at specific acupoints. Moxibustion applies localized heat (through combustion of Artemisia vulgaris) over the same points. The review shows that both are effective, but moxibustion has an especially relevant role in long-term protocols (up to 6 months), with focus on ST-36 and CV-4 for sustained tonification.
It depends on the protocol. The short-term protocol (up to 3 weeks) demonstrated reduction in fatigue scores by the first week. The cycle-based protocol synchronizes sessions with chemotherapy. The long-term protocol may extend up to 6 months. Frequency varies from 2 to 5 sessions per week in the acute phase to 1–2 in maintenance, with needle retention of 10 to 30 minutes.
The 13 RCTs included patients with various cancer types — breast, lung, colorectal, gastric, and others. The results were consistent across the different diagnoses. However, more specific evidence exists for breast and colorectal cancer in cycle-based chemotherapy protocols.
The review recommends acupuncture and moxibustion as part of an integrative approach, complemented by physical exercise, mind-body therapies, and cognitive behavioral therapy. Treatment of CRF is multimodal, and medical acupuncture integrates as one of the components with evidence of efficacy — not as an isolated intervention.
Fonte Original
Supportive Care in Cancer (Springer)(em inglês)Estudo Científico
DOI: 10.1007/s00520-026-10467-7Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).
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