A silent transformation is happening in oncology rooms around the world. Physicians, pharmacists, and nurses specialized in cancer are increasingly incorporating integrative practices into the care plan of their patients — and acupuncture leads this movement. A global survey published in BMC Complementary Medicine and Therapies in November 2025 by the team of the University of California, Irvine (UC Irvine) quantifies this phenomenon with rigor: 344 oncology professionals from eight regions of the world, affiliated with the Multinational Association of Supportive Care in Cancer (MASCC) and the Society for Integrative Oncology (SIO), responded about their recommendation habits, perceived barriers, and views on the current state of integrative oncology.
The study was led by Prof. Alexandre Chan, chair of the Department of Clinical Pharmacy Practice at UC Irvine, with contribution from Reem Nasr, candidate for the Pharm.D. degree. It is a cross-sectional analysis by structured questionnaire, distributed among members of the two main international societies of supportive cancer care — which ensures that the sample represents professionals engaged with research and therapeutic innovation in oncology, not a convenience sample. The eight regions included cover North America, Europe, Latin America, Middle East, Asia, sub-Saharan Africa, South Asia, and Oceania.
GLOBAL SURVEY: INTEGRATIVE ONCOLOGY AND ACUPUNCTURE (BMC, NOVEMBER 2025)
Acupuncture at the Top: the Most Recommended Modality
Among all integrative modalities evaluated, acupuncture was the most recommended globally, cited by 48% of respondents. Following came exercise classes (39%), nutrition (38%), breathing/yoga (38%), and personalized exercise (38%). The leadership of acupuncture reflects the growing volume of high-quality evidence — clinical trials in cancer pain, fatigue, insomnia, chemotherapy-induced nausea, and peripheral neuropathy — as well as the familiarity of leading oncologists with these publications. In high-income countries (North America, Europe, Oceania), acupuncture shares first place with therapeutic massage and individualized exercise. In low- and middle-income countries (LMIC), the most accessible practices lead: nutritional counseling and group exercise — but acupuncture still appears frequently, especially in contexts with a tradition of Eastern medicine.
The Evidence-Practice Gap: Why Do 79% Say It Is Underutilized?
If 70% of oncologists already recommend integrative practices and the evidence is robust, why do 79% still perceive underutilization? The survey identifies concrete structural barriers: cost and insurance coverage are the largest obstacles. Payment data reveal high regional heterogeneity — in some regions, between 20% and 67% of patients pay out of pocket, which creates inequity of access. Coverage by private insurance varies from 0% to 26% by region; government coverage ranges between 7% and 40%. In high-income countries, the barriers are more about infrastructure and integration (lack of trained professionals within hospitals, difficulty of formal referral). In LMICs, cost is the central impediment.
Professional training also emerges as a critical factor: the availability of continuing education in integrative oncology is highest in North America (69% of professionals report access to courses) and lowest in South Asia and sub-Saharan Africa — where, incidentally, local traditional practices have historical roots but lack evidence-based systematization. The data is a call to action for medical societies and universities: the demand exists, the evidence exists, but training and coverage have not followed.
Frequently Asked Questions
According to available evidence, acupuncture has no described pharmacologic interactions with chemotherapy, radiotherapy, immunotherapy, or hormone therapy when practiced by a medical acupuncturist with oncologic knowledge. Specific care includes: avoiding acupuncture in irradiated areas until healing, awaiting platelet recovery before sessions (severe thrombocytopenia requires protocol adaptation), and using ultrafine disposable needles in neutropenic patients. Direct communication between the medical acupuncturist and the responsible oncologist is indispensable for adjustment of the protocol to the patient’s hematologic conditions.
Coverage varies by country and program. In many jurisdictions, acupuncture is included in integrative-medicine programs at the national or hospital level since the mid-2000s. Access varies according to region and service: some primary-care units and reference hospitals offer care by a medical acupuncturist or other qualified professional. For oncologic patients specifically, the ideal is for care to be provided by a medical acupuncturist with experience in oncology, within or linked to the oncology service. It is recommended to check with the referring oncology service for local availability.
In patients receiving chemotherapy, the most studied and safe protocols include acupuncture for nausea/vomiting (PC-6 — Neiguan — is the most documented in Cochrane, with high-quality evidence), acupuncture for fatigue (ST-36 — Zusanli — and BL-23 are consolidated clinical references), and acupuncture for peripheral neuropathy induced by taxanes or platinums (protocols with distal limb points). Auricular acupuncture with semi-permanent needles is especially practical for patients in intensive chemotherapy cycles, as it can be maintained between sessions. The medical acupuncturist will define the protocol after detailed clinical assessment of the chemotherapy regimen and the patient’s general condition.
Founded 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).