Acupuncture to Alleviate Chemotherapy-induced Nausea and Vomiting in Pediatric Oncology – A Randomized Multicenter Crossover Pilot Trial

Abstract

Background: We investigated whether acupuncture as a supportive antiemetic approach reduces the need for antiemetic rescue medication during highly emetogenic chemotherapy in pediatric oncology. We report on a multicenter crossover study at 5 tertiary hospitals in Germany.

Procedure: Twenty-three children (13.6 y,+/− 2.9) receiving highly emetogenic chemotherapy for treatment of solid malignant tumors were included. Patients were randomly allocated to receive acupuncture treatment during either the second or third identical chemotherapy course together with standard antiemetic medication. The main outcome measure was the amount of additional antiemetic medication during chemotherapy. Secondary outcome measure was the number of episodes of vomiting per course.

Results: Fourty-six chemotherapy courses with or without acupuncture were compared. The need for rescue antiemetic medication was significantly lower in acupuncture courses compared to control courses (p=0.001) Episodes of vomiting per course were also significantly lower in courses with acupuncture (p=0.01). Except for pain from needling (4/23) no side effects occurred. Patients acceptance of acupuncture was high.

Conclusions: Acupuncture as applied here seems to be effective in preventing nausea and vomiting in pediatric cancer patients.

Zusammenfassung

Wir untersuchten im Rahmen einer multizentrischen Crossover-Studie an 5 pädiatrisch onkologischen Zentren in Deutschland, ob klassische chinesische Nadelakupunktur als zusätzliche Therapie den Bedarf an antiemetischer Bedarfsmedikation und die Erbrechenshäufigkeit bei Kindern unter Chemotherapie reduzieren kann. 23 Kinder (13,6 Jahre,+/− 2,9), die hochemetogene Chemotherapie zur Behandlung ihrer malignen soliden Tumoren erhielten, wurden in die Studie eingeschlossen. Die Patienten wurden randomisiert und erhielten entweder während des zweiten oder dritten wirkstoffgleichen Chemotherapiezyklus Akupunktur zusätzlich zur Standardantiemetikatherapie. Hauptstudienzielvariable war die Menge an zusätzlich benötigten Antiemetika. Nebenzielvariable war die Anzahl der Erbrechensepisoden pro Block.

Ergebnisse:46 Chemotherapieblöcke mit und ohne Akupunktur wurden verglichen. Der Bedarf an additiver antiemetischer Medikation war in den Akupunkturzyklen signifikant geringer (p=0,001). Erbrechensepisoden pro Block waren ebenfalls signifikant seltener während der Akupunkturzyklen (p=0,01). Abgesehen von Schmerzen durch die Nadelungen (4/23) traten keine Nebenwirkungen der Akupunkturbehandlung auf. Die Akzeptanz der Akupunktur war bei den Patienten hoch.

Schlussfolgerung: Akupunktur scheint hinsichtlich der Prävention von Übelkeit und Erbrechen bei Kindern unter hochemetogener Chemotherapie wirksam zu sein.

Key words

acupuncture - pediatric oncology - supportive care - nausea and vomiting - complementary and alternative medicine (CAM)

Schlüsselwörter

Akupunktur - pädiatrische Onkologie - Supportivtherapie - Übelkeit und Erbrechen - complementary and alternative medicine (CAM)

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1 The authors contributed equally to the work.

Correspondence