Acupuncture for breathlessness in advanced diseases: A systematic review and meta-analysis

Abstract Context Non-pharmacological approaches are effective strategies for difficult to palliate breathlessness. Whilst acupuncture is effective for dyspnoea in early-stage COPD, little is known about its effects in patients with advanced (non-)malignant diseases. Objectives To identify and examine the evidence of acupuncture on breathlessness in advanced malignant and non-malignant diseases. Methods Systematic literature review of randomised controlled trials of acupuncture and acupressure searched in five databases. Included were adult participants with at least 25% having advanced diseases such as cancer or COPD with severe breathlessness. Primary outcome was severity of dyspnoea on visual analogue or Borg scale. Secondary outcomes included quality of life, function and acceptability. Data were pooled using a random effects model of standardised mean differences. Results 12 studies with 597 patients (347 COPD, 190 advanced cancer) were included. For breathlessness severity significant differences were obtained in a meta-analysis (10 studies with 480 patients; SMD=-1.77 (95% CI -3.05,-0.49; p=0.007; I2= 90%)) and in a subgroup analysis of using sham acupuncture control groups and a treatment duration of at least three weeks (6 studies with 302 patients; SMD=-2.53 (95% CI -4.07,-0.99; p=0.001; I2 =91%)). Exercise tolerance (6MWT) improved significantly in the acupuncture group (6 studies with 287 patients; SMD=0.93 (95% CI 0.27,1.59; p=0.006; I2= 85%)). In four of six studies quality of life improved in the acupuncture group. Conclusion Acupuncture improved breathlessness severity in patients with advanced diseases. The methodological heterogeneity, low power and potential morphine-sparing effects of acupuncture as add-on should be further addressed in future trials.