Effects of Acupuncture and Acupressure on Cancer-Related Fatigue: A Systematic Review

Wai-man Ling

Liza Y. Y. Lui

Winnie K. W. So

Kuen Chan

fatigue, cancer, acupuncture, acupressure, systematic review
ONF 2014, 41(6), 581-592. DOI: 10.1188/14.ONF.581-592

Purpose/Objectives: To critically examine the evidence for acupuncture and acupressure in the management of cancer-related fatigue (CRF) in adult patients with cancer.

Data Sources: 18 databases were searched for randomized, controlled trials published in English and Chinese through April 2014.

Data Synthesis: Given the heterogeneity of data, meta-analysis was not conducted. A six-step thematic analysis method was used to synthesize the results.

Conclusions: Although results are inconclusive, acupuncture and acupressure tend to be effective in relieving CRF, with the former producing a greater improvement. Future research is recommended to contribute further evidence.

Implications for Nursing: Nurses should know about the relative effectiveness of acupuncture and acupressure in the management of CRF to educate and support their patients.

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    Andrykowski, M. A., Donovan, K. A., Laronga, C., & Jacobsen, P. B. (2010). Prevalence, predictors, and characteristics of off-treatment fatigue in breast cancer survivors. Cancer, 116, 5740-5748.
    Aveyard, H. (2010). Doing a literature review in health and social care: A practical guide (2nd ed.). Maidenhead, United Kingdom: Open University Press.
    Azad, A., & John, T. (2013). Do randomized acupuncture studies in patients with cancer need a sham acupuncture control arm? Journal of Clinical Oncology, 31, 2057-2058. doi:10.1200/jco.2012.47.8750
    Balk, J., Day, R., Rosenzweig, M., & Beriwal, S. (2009). Pilot, randomized, modified, double-blind, placebo-controlled trial of acupuncture for cancer-related fatigue. Journal of the Society for Integrative Oncology, 7, 4-11. doi:10.2310/7200.2009.0004
    Beck, S., Dudley, W. N., & Barsevick, A. (2005). Pain, sleep disturbance, and fatigue in patients with cancer: Using a mediation model to test a symptom cluster [Online exclusive]. Oncology Nursing Forum, 32, E48-E55. doi:10.1188/05.ONF.E48-E55
    Bower, J. E., Ganz, P. A., Desmond, K. A., Bernaards, C., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2006). Fatigue in long-term breast carcinoma survivors: A longitudinal investigation. Cancer, 106, 751-758. doi:10.1002/cncr.21671
    Campos, M. P., Hassan, B. J., Riechelmann, R., & Del Giglio, A. (2011). Cancer-related fatigue: A practical review. Annals of Oncology, 22, 1273-1279. doi:10.1093/annonc/mdq458
    Capodice, J. L. (2010). Acupuncture in the oncology setting: Clinical trial update. Current Treatment Options in Oncology, 11, 87-94.
    Chan, C. W., Chair, S. Y., & Chui, Y. Y. (2009). End of life experience of symptom cluster and their management in Hong Kong Chinese patients with lung cancer who receive palliative radiotherapy. Chinese Journal of Lung Cancer, 12, 361-368.
    Chan, C. W., & Molassiotis, A. (2000). The impact of fatigue on Chinese cancer patients in Hong Kong. Supportive Care in Cancer, 9, 18-24. doi:10.1007/s005200000192
    Chen, F. R., Wang, M., Xue, J., & Xu, J. (2011). Study on influence of ginger separated moxibustion on quality of life of elderly patients with advanced cancer. Chinese Nursing Research, 25, 2951-2952.
    Cho, Y. C., & Tsay, S. L. (2004). The effect of acupressure with massage on fatigue and depression in patients with end-stage renal disease. Journal of Nursing Research, 12, 51-59.
    Cleeland, C. S. (2007). Symptom burden: Multiple symptoms and their impact as patient-reported outcomes. Journal of the National Cancer Institute. Monographs, 37, 16-21.
    Cleeland, C. S., Mendoza, T. R., Wang, X. S., Chou, C., Harle, M. T., Morrissey, M., & Engstrom, M. C. (2000). Assessing symptom distress in cancer patients: The MD Anderson Symptom Inventory. Cancer, 89, 1634-1646.
    Crom, D. B., Hinds, P. S., Gattuso, J. S., Tyc, V., & Hudson, M. M. (2005). Creating the basis for a breast health program for female survivors of Hodgkin disease using a participatory research approach. Oncology Nursing Forum, 32, 1131-1141. doi:10.1188/05.ONF.1131-1141
    Curt, G. A., Breitbart, W., Cella, D., Groopman, J. E., Horning, S. J., Itri, L. M., … Vogelzang, N. J. (2000). Impact of cancer-related fatigue on the lives of patients: New findings from the Fatigue Coalition. Oncologist, 5, 353-360. doi:10.1634/theoncologist.5-5-353
    Dean-Clower, E., Doherty-Gilman, A. M., Keshaviah, A., Baker, F., Kaw, C., Lu, W., … Rosenthal, D. S. (2010). Acupuncture as palliative therapy for physical symptoms and quality of life for advanced cancer patients. Integrative Cancer Therapies, 9, 158-167.
    Deng, G., Chan, Y., Sjoberg, D., Vickers, A., Yeung, K. S., Kris, M., … Cassileth, B. (2013). Acupuncture for the treatment of post-chemotherapy chronic fatigue: A randomized, blinded, sham-controlled trial. Supportive Care in Cancer, 21, 1735-1741.
    Dodd, M. J., Miaskowski, C., & Paul, S. M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncology Nursing Forum, 28, 465-470.
    Dundee, J. W., & Yang, J. (1990). Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy. Journal of the Royal Society of Medicine, 83, 360-362.
    Ernst, E. (2009). Acupuncture: What does the most reliable evidence tell us? Journal of Pain and Symptom Management, 37, 709-714.
    Ernst, E., & Canter, P. H. (2005). Limitations of "pragmatic" trials. PostGraduate Medical Journal, 81(954), 203. doi:10.1136/pgmj.2004.026807
    Escalante, C. P., & Manzullo, E. F. (2009). Cancer-related fatigue: The approach and treatment. Journal of General Internal Medicine, 24(Suppl.), S412-S416. doi:10.1007/s11606-009-1056-z
    Ezzo, J., Vickers, A., Richardson, M. A., Allen, C., Dibble, S. L., Issell, B., … Zhang, G. (2005). Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting. Journal of Clinical Oncology, 23, 7188-7198. doi:10.1002/14651858.CD002285.pub2
    Finnegan-John, J., Molassiotis, A., Richardson, A., & Ream, E. (2013). A systematic review of complementary and alternative medicine interventions for the management of cancer-related fatigue. Integrative Cancer Therapies, 12, 276-290. doi:10.1177/1534735413485816
    Fox, S. W., Lyon, D., & Farace, E. (2007). Symptom clusters in patients with high-grade glioma. Journal of Nursing Scholarship, 39, 61-67.
    Garcia, M. K., McQuade, J., Haddad, R., Patel, S., Lee, R., Yang, P., … Cohen, L. (2013). Systematic review of acupuncture in cancer care: A synthesis of the evidence. Journal of Clinical Oncology, 31, 952-960. doi:10.1200/jco.2012.43.5818
    Given, B. (2008). Cancer-related fatigue: A brief overview of current nursing perspectives and experiences. Clinical Journal of Oncology Nursing, 12(Suppl.), 7-9. doi:10.1188/08.CJON.S2.7-9
    Gooneratne, N. S. (2008). Complementary and alternative medicine for sleep disturbances in older adults. Clinics in Geriatric Medicine, 24, 121-138. doi:10.1016/j.cger.2007.08.002
    Haghighat, S., Akbari, M. E., Holakouei, K., Rahimi, A., & Montazeri, A. (2003). Factors predicting fatigue in breast cancer patients. Supportive Care in Cancer, 11, 533-538.
    He, X. R., Wang, Q., & Li, P. P. (2013). Acupuncture and moxibustion for cancer-related fatigue: A systematic review and meta-analysis. Asian Pacific Journal of Cancer Prevention, 14, 3067-3074.
    Johnston, M. F., Hays, R. D., Subramanian, S K., Elashoff, R. M., Axe, E. K., Li, J. J., … Hui, K. K. (2011). Patient education integrated with acupuncture for relief of cancer-related fatigue randomized controlled feasibility study. BMC Complementary and Alternative Medicine, 11, 49. doi:10.1186/1472-6882-11-49
    Kaptchuk, T. J., Kelley, J. M., Conboy, L. A., Davis, R. B., Kerr, C. E., Jacobson, E. E., … Lembo, A. J. (2008). Components of placebo effect: Randomised controlled trial in patients with irritable bowel syndrome. BMJ, 336, 999-1003. doi:10.1136/bmj.39524.439618.25
    Kirshbaum, M. (2010). Cancer-related fatigue: A review of nursing interventions. British Journal of Community Nursing, 15, 214-219.
    Kohara, H., Miyauchi, T., Suehiro, Y., Ueoka, H., Takeyama, H., & Morita, T. (2004). Combined modality treatment of aromatherapy, footsoak, and reflexology relieves fatigue in patients with cancer. Journal of Palliative Medicine, 7, 791-796. doi:10.1089/jpm.2004.7.791
    Lee, E. J., & Frazier, S. K. (2011). The efficacy of acupressure for symptom management: A systematic review. Journal of Pain and Symptom Management, 42, 589-603.
    Lim, J. T., Wong, E. T., & Aung, S. K. (2011). Is there a role for acupuncture in the symptom management of patients receiving palliative care for cancer? A pilot study of 20 patients comparing acupuncture with nurse-led supportive care. Acupuncture in Medicine, 29, 173-179. doi:10.1136/aim.2011.004044
    Liu, Q., Liu, X., & Tu, M. (2013). Effect of aerobic exercises and auricular acupoint pressing on cancer-related fatigue among oophoroma patients during intermittent chemotherapy. Journal of Nursing Science, 28, 44-45. doi:10.3870/hlxzz.2013.15.044
    Liu, Z. W., Liu, L., Fan, W., & Zhang, S. (2009). Essentials of chinese medicine (vol. 2). London, England: Springer.
    Lun, X. (2012). Dian xue liao fa [Therapy of acupressure]. Hong Kong: Wan Li Book Co.
    Maliski, S. L., Kwan, L., Elashoff, D., & Litwin, M. S. (2008). Symptom clusters related to treatment for prostate cancer. Oncology Nursing Forum, 35, 786-793. doi:10.1188/08.ONF.786-793
    Mao, J. J., Styles, T., Cheville, A., Wolf, J., Fernandes, S., & Farrar, J. T. (2009). Acupuncture for nonpalliative radiation therapy-related fatigue: Feasibility study. Journal of the Society for Integrative Oncology, 7, 52-58.
    Mitchell, S. A., Beck, S. L., Hood, L. E., Moore, K., & Tanner, E. R. (2007). Putting Evidence Into Practice: Evidence-based interventions for fatigue during and following cancer and its treatment. Clinical Journal of Oncology Nursing, 11, 99-113. doi:10.1188/07.CJON.99-113
    Moher, D., Hopewell, S., Schulz, K. F., Montori, V., Gøtzsche, P. C., Devereaux, P. J., … Altman, D. G. (2012). CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials. International Journal of Surgery, 10, 28-55.
    Molassiotis, A. (2013a). Evidence is in the eye of the beholder. Supportive Care in Cancer, 21, 3259-3260.
    Molassiotis, A. (2013b). Managing cancer-related fatigue with acupuncture: Is it all good news for patients? Acupuncture in Medicine, 31, 3-4. doi:10.1136/acupmed-2012-010292
    Molassiotis, A., Bardy, J., Finnegan-John, J., Mackereth, P., Ryder, D. W., Filshie, J., … Richardson, A. (2012). Acupuncture for cancer-related fatigue in patients with breast cancer: A pragmatic randomized controlled trial. Journal of Clinical Oncology, 30, 4470-4476.
    Molassiotis, A., Bardy, J., Finnegan-John, J., Mackereth, P., Ryder, W. D., Filshie, J., … Richardson, A. (2013). A randomized, controlled trial of acupuncture self-needling as maintenance therapy for cancer-related fatigue after therapist-delivered acupuncture. Annals of Oncology, 24, 1645-1652. doi:10.1093/annonc/mdt034
    Molassiotis, A., & Richardson, A. (2013). Reply to A. Azad et al. Journal of Clinical Oncology, 31, 2058-2059. doi:10.1200/jco.2013.49.2470
    Molassiotis, A., Sylt, P., & Diggins, H. (2007). The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: A randomised controlled trial. Complementary Therapies in Medicine, 15, 228-237. doi:10.1016/j.ctim.2006.09.009
    Morrow, G. R. (2007). Cancer-related fatigue: Causes, consequences, and management. Oncologist, 12(Suppl. 1), 1-3.
    National Cancer Institute. (2012). Fatigue (PDQ®). Retrieved from
    National Comprehensive Cancer Network. (2014). NCCN clinical practice guidelines in oncology: Cancer-related fatigue [v.1.2014]. Retrieved from
    Newton, S., Hickey, M., & Marrs, J. (2009). Mosby's oncology nursing advisor: A comprehensive guide to clinical practice. St. Louis, MO: Mosby Elsevier.
    Oh, D. (2009). The pilot study on the effect of SAAM acupuncture treatment for patients with cancer-related fatigue: Randomized, a single-blind, controlled trial (Unpublished master's thesis). Kyung-Hee University, South Korea.
    O'Regan, D., & Filshie, J. (2010). Acupuncture and cancer. Autonomic Neuroscience, 157, 96-100. doi:10.1016/j.autneu.2010.05.001
    Payne, C., Wiffen, P. J., & Martin, S. (2012). Interventions for fatigue and weight loss in adults with advanced progressive illness. Cochrane Database of Systematic Reviews, 18, CD008427.
    Posadzki, P., Moon, T. W., Choi, T. Y., Park, T. Y., Lee, M. S., & Ernst, E. (2013). Acupuncture for cancer-related fatigue: A systematic review of randomized clinical trials. Supportive Care in Cancer, 21, 2067-2073. doi:10.1007/s00520-013-1765-z
    Prue, G., Rankin, J., Allen, J., Gracey, J., & Cramp, F. (2006). Cancer-related fatigue: A critical appraisal. European Journal of Cancer, 42, 846-863. doi:10.1016/j.ejca.2005.11.026
    Qin, X. Y., & Liu, Z. H. (2012). Clinical observation of wen moxibustion therapy of cancer-related fatigue of advanced cancer. China Journal of Chinese Medicine, 27, 273-274.
    Reza, H., Kian, N., Pouresmail, Z., Masood, K., Sadat Seyed Bagher, M., & Cheraghi, M. A. (2010). The effect of acupressure on quality of sleep in Iranian elderly nursing home residents. Complementary Therapies in Clinical Practice, 16, 81-85.
    Ryan, J. L., Carroll, J. K., Ryan, E. P., Mustian, K. M., Fiscella, K., & Morrow, G. R. (2007). Mechanisms of cancer-related fatigue. Oncologist, 12(Suppl. 1), 22-34. doi:10.1634/theoncologist.12-S1-22
    Sagar, S. M. (2008). Acupuncture as an evidence-based option for symptom control in cancer patients. Current Treatment Options in Oncology, 9, 117-126. doi:10.1007/s11864-008-0063-3
    Scottish Intercollegiate Guidelines Network. (2014). Critical appraisal: Notes and checklists. Retrieved from
    Smith, C., Carmady, B., Thornton, C., Perz, J., & Ussher, J. M. (2013). The effect of acupuncture on post-cancer fatigue and well-being for women recovering from breast cancer: A pilot randomised controlled trial. Acupuncture in Medicine, 31, 9-15.
    So, W. K., Marsh, G., Ling, W. M., Leung, F. Y., Lo, J. C., Yeung, M., & Li, G. K. (2009). The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: A multicenter study [Online exclusive]. Oncology Nursing Forum, 36, E205-E214.
    Stone, P. C., & Minton, O. (2008). Cancer-related fatigue. European Journal of Cancer, 44, 1097-1104. doi:10.1016/j.ejca.2008.02.037
    Stricker, C. T., Drake, D., Hoyer, K. A., & Mock, V. (2004). Evidence-based practice for fatigue management in adults with cancer: Exercise as an intervention. Oncology Nursing Forum, 31, 963-976.
    Sun, J. L., Sung, M. S., Huang, M. Y., Cheng, G. C., & Lin, C. C. (2010). Effectiveness of acupressure for residents of long-term care facilities with insomnia: A randomized controlled trial. International Journal of Nursing Studies, 47, 798-805. doi:10.1016/j.ijnurstu.2009.12.003
    Tsay, S. L. (2004). Acupressure and fatigue in patients with end-stage renal disease-A randomized controlled trial. International Journal of Nursing Studies, 41, 99-106. doi:10.1016/S0020-7489(03)00079-8
    Tsay, S. L., Cho, Y. C., & Chen, M. L. (2004). Acupressure and transcutaneous electrical acupoint stimulation in improving fatigue, sleep quality and depression in hemodialysis patients. American Journal of Chinese Medicine, 32, 407-416. doi:10.1142/S0192415X04002065
    Tsay, S. L., Rong, J. R., & Lin, P. F. (2003). Acupoints massage in improving the quality of sleep and quality of life in patients with end-stage renal disease. Journal of Advanced Nursing, 42, 134-142.
    Vickers, A. J., Straus, D. J., Fearon, B., & Cassileth, B. R. (2004). Acupuncture for postchemotherapy fatigue: A phase II study. Journal of Clinical Oncology, 22, 1731-1735. doi:10.1200/JCO.2004.04.102
    Wang, X. S. (2008). Pathophysiology of cancer-related fatigue. Clinical Journal of Oncology Nursing, 12(Suppl.), 11-20.
    Wu, C. Z., & Gao, S. W. (2010). Shu xue ding wei su cha [Quick reference for locating the acupoints]. Beijing, China: People's Military Medical Press.
    Wu, H. S., Wu, S. C., Lin, J. G., & Lin, L. C. (2004). Effectiveness of acupressure in improving dyspnoea in chronic obstructive pulmonary disease. Journal of Advanced Nursing, 45, 252-259. doi:10.1046/j.1365-2648.2003.02886.x
    Xu, J. J., Gu, L. X., & Qiao, H. (2010). Effect of traditional Chinese and western medicine joint exercise therapy on cancer-related fatigue after operation of mammary cancer. Chinese General Practice, 13, 3225-3226.
    Yang, J. L., Yu, L., Xu, L., Wang, J., & Jing, N. C. (2012). The effect observation of moxibustion for cancer-related fatigue in elderly patients suffered from advanced cancer. Chinese Journal of Gerontology, 32, 4408-4410. doi:10.3969/j.issn.1005-9202.2012.20.025
    Zick, S. M., Alrawi, S., Merel, G., Burris, B., Sen, A., Litzinger, A., & Harris, R. E. (2011). Relaxation acupressure reduces persistent cancer-related fatigue. Evidence-Based Complementary and Alternative Medicine, 8, 1-10. doi:10.1155/2011/142913