Hot flashes are a common and often debilitating side effect for women undergoing endocrine therapy for hormone receptor-positive breast cancer. A 2024 study conducted across the United States, China, and South Korea published in Cancer evaluated the effectiveness of acupuncture in alleviating these symptoms and improving overall quality of life. The results are promising, indicating that acupuncture could be a valuable addition to cancer care for these patients.

Key Points:

• Acupuncture significantly reduces the frequency and severity of hot flashes in women receiving endocrine therapy for breast cancer.

• Immediate acupuncture improves quality-of-life scores more effectively than delayed acupuncture.

• Participants experienced a 50% or more reduction in hot flash scores, significantly improving their daily comfort.

• Acupuncture's holistic approach addresses multiple symptoms simultaneously, enhancing overall well-being.

• The study shows no serious adverse events, suggesting that acupuncture is a safe complementary treatment.

• Future research is needed to explore the impact of acupuncture on treatment adherence and its effects on diverse populations.

Acupuncture has long been recognized as a beneficial treatment for various ailments. This study, published in Cancer, investigates its specific effects on hot flashes in women undergoing endocrine therapy for hormone receptor-positive breast cancer. The study's multinational approach aims to provide consistent and reliable data across different cultural backgrounds.

Study Design and Methodology

The study enrolled 158 women diagnosed with stage 0–III hormone receptor-positive breast cancer from three countries: the United States, China, and South Korea. These participants, all undergoing endocrine therapy and experiencing frequent hot flashes, were randomly assigned to one of two groups: Immediate Acupuncture (IA) or Delayed Acupuncture Control (DAC). The IA group received 20 acupuncture sessions over a 10-week period, designed to assess the immediate effects of acupuncture on their symptoms. Meanwhile, the DAC group continued with their usual care for the first 10 weeks before switching to a reduced-intensity acupuncture regimen, thereby serving as a control to measure the difference in symptom relief timing.

The primary endpoint of the study was the change in the endocrine symptom subscale of the Functional Assessment of Cancer Therapy (FACT)-Endocrine Symptoms, which measures specific symptoms related to endocrine therapy. This endpoint was chosen to quantify the direct impact of acupuncture on endocrine-related symptoms. Secondary endpoints included hot flash scores, which track the frequency and severity of hot flashes, and the FACT-Breast score, which assesses the overall quality of life specific to breast cancer patients. By using these comprehensive measures, the researchers aimed to capture both the specific and broader impacts of acupuncture on the participants' well-being.

To ensure robust and reliable data, the study employed longitudinal mixed models for the pooled analysis of individual patient data. This statistical approach allowed the researchers to account for variations between the different sites and individual patient characteristics. The multi-national nature of the study also provided a diverse participant base, enhancing the generalizability of the findings. Despite some limitations, such as the potential for placebo effects and site-specific differences in acupuncture techniques, the study's design aimed to provide a thorough and nuanced understanding of acupuncture's efficacy in managing hot flashes and improving the quality of life for women undergoing endocrine therapy for breast cancer.

Results

The study's findings were quite clear and compelling. Women in the Immediate Acupuncture (IA) group experienced significant improvements in their endocrine symptom subscale scores compared to those in the Delayed Acupuncture Control (DAC) group. Specifically, the IA group reported a mean change of 5.1 ± 0.9, a substantial improvement over the DAC group's mean change of 0.2 ± 1.0 (p = .0003). This indicates that acupuncture provided a meaningful reduction in endocrine-related symptoms for the women receiving immediate treatment.

Moreover, hot flash scores, which measure the frequency and severity of hot flashes, also showed significant reductions in the IA group. Participants in this group reported a decrease of −5.3 ± 0.9, compared to a reduction of −1.4 ± 0.9 in the DAC group (p < .003). This highlights the effectiveness of acupuncture in mitigating one of the most distressing side effects of endocrine therapy. The significant reduction in hot flash scores suggests that immediate acupuncture can provide rapid relief, improving the quality of life for breast cancer patients undergoing endocrine therapy.

Additionally, the Functional Assessment of Cancer Therapy-Breast (FACT-Breast) total score, which assesses overall quality of life specific to breast cancer patients, showed a notable improvement in the IA group. The IA group experienced an increase of 8.0 ± 1.6, while the DAC group saw virtually no change, with a score of −0.01 ± 1.6 (p = .0005). These results underscore the holistic benefits of acupuncture, not only in reducing specific symptoms but also in enhancing overall well-being. The clear, statistically significant differences between the IA and DAC groups across multiple measures reinforce the potential of acupuncture as a valuable complementary treatment for managing hot flashes and improving the quality of life in women receiving endocrine therapy for breast cancer.

Hot Flashes and Quality of Life

Hot flashes are more than just a nuisance; they significantly impact quality of life, especially for women undergoing cancer treatment. This study showed that 64% of women in the immediate acupuncture group experienced a 50% or more reduction in the frequency and severity of hot flashes, compared to just 18% in the control group. This improvement was not only statistically significant but also clinically meaningful, offering a better quality of life for these patients.

Implications for Breast Cancer Treatment

The findings from this study underscore the potential of acupuncture as an effective complementary therapy in the comprehensive treatment of breast cancer, particularly for managing the side effects of endocrine therapy. Acupuncture offers a non-pharmaceutical approach to alleviating hot flashes, reducing endocrine symptoms, and improving overall quality of life for patients undergoing treatment. The significant improvements observed in the immediate acupuncture group highlight its ability to provide relief where conventional treatments might fall short, offering a holistic approach to patient care.

The robust research supporting acupuncture's role in breast cancer treatment is growing, with this study adding to a body of evidence that validates its efficacy. Acupuncture addresses multiple symptoms simultaneously, unlike many medications that target single symptoms, making it a versatile and valuable tool in cancer care. The study's results, which showed significant reductions in hot flash scores and improvements in quality of life, suggest that integrating acupuncture into standard oncology care could enhance patient outcomes and adherence to endocrine therapy.

Moreover, the holistic nature of acupuncture aligns well with the goals of comprehensive cancer treatment, which aims to address not only the physical but also the emotional and psychological well-being of patients. By managing debilitating side effects, acupuncture can help patients maintain a better quality of life, allowing them to continue with their prescribed treatments and improve their overall prognosis. As more research continues to validate these findings, acupuncture is likely to become a standard component of breast cancer treatment protocols, offering patients a more integrated and supportive care experience.

Study Limitations

While the results of the study are promising, there are several limitations that should be acknowledged. One significant limitation is the use of delayed acupuncture as a control, which may introduce a placebo effect. This design choice means that participants in the DAC group might have experienced some psychological benefit simply from the expectation of receiving acupuncture later, which could influence their reported outcomes. Additionally, the lack of an active control group makes it difficult to ascertain the specific effects of acupuncture compared to other potential interventions.

Another notable limitation is the lack of diversity within the study cohort. The participants were predominantly from the United States, China, and South Korea, which may not fully represent the global population of women with hormone receptor-positive breast cancer. This lack of diversity could limit the generalizability of the findings, as different racial and ethnic groups may respond differently to acupuncture. Furthermore, the study was conducted across multiple sites, which introduced variability in needle sizes and device selection. Such inconsistencies can affect the standardization of the treatment and potentially influence the outcomes, making it challenging to draw uniform conclusions from the data.

Future Research

Given these limitations, future research should aim to address several critical areas to build on the findings of this study. One important avenue for future research is to explore how acupuncture impacts adherence to endocrine therapy. Since hot flashes and other side effects often lead to discontinuation of treatment, understanding whether acupuncture can help patients stay on their prescribed therapy longer could have significant implications for long-term breast cancer outcomes.

Moreover, future studies should strive to include a more diverse participant pool to better understand how acupuncture affects different racial and ethnic groups. This would help ensure that the findings are applicable to a broader population. Research should also delve into the underlying mechanisms that make acupuncture effective. Investigating the physiological and neurological pathways influenced by acupuncture could provide a deeper understanding of how this treatment alleviates symptoms and improves quality of life. Additionally, more rigorous studies with active control groups and standardized protocols across sites would help validate acupuncture's efficacy and establish it as a reliable complementary therapy for managing the side effects of endocrine therapy in breast cancer patients.

Conclusion

This study demonstrates that acupuncture can significantly reduce hot flashes and improve the quality of life for women undergoing endocrine therapy for breast cancer. It highlights the potential of acupuncture as a complementary treatment in oncology, aiming to enhance patient well-being and treatment outcomes. As further evidence accumulates, integrating acupuncture into standard oncology care could become an important step in providing holistic cancer treatment.

Over to you

If you liked this article, please share with friends and family who may want to learn more about acupuncture for hot flashes and breast cancer patients.

Sources:

• Lu, W., Giobbie-Hurder, A., Tanasijevic, A., Kassis, S. B., Park, S. H., Jeong, Y. J., Shin, I. H., Yao, C., Jung, H. J., Zhu, Z., Bao, C., Bao, T., Yang, E., Bierer, B. E., & Ligibel, J. A. (2024). Acupuncture for hot flashes in hormone receptor-positive breast cancer: A pooled analysis of individual patient data from parallel randomized trials. Cancer, 10.1002/cncr.35374. Advance online publication. https://doi.org/10.1002/cncr.35374

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