Acupuncture is a panacea, we are often told.
But is it true?
Of course not!
This study was aimed at evaluating the effect of acupuncture on myelosuppression and quality of life in women with breast cancer during treatment with anthracyclines (ANT).
Women with an indication for ANT chemotherapy were randomized into two groups:
- the acupuncture group (AG) was submitted to an acupuncture intervention, starting before the first chemotherapy infusion, and continuing throughout the treatment;
- the control group (CG) received no acupuncture.
A quality of life questionnaire (FACT-G) and peripheral blood levels of the participants were evaluated before and at the end of treatment.
A total of 26 women were randomized into 2 groups: AG (10) and CG (16). Of these, 26.9% had a dense dose indication according to the service’s protocol for the administration of granulocyte-stimulating factor (G-CSF) from the first cycle, not participating in the analysis. The need for secondary prophylaxis with G-CSF occurred in 72.7% in the control group versus 12% in the acupuncture group. Regarding quality of life (QoL), it was observed that the groups did not initially differ from each other. At the end of the treatment, there was a significant difference in the AG for the physical (GP) (p-value=0.011), social/family (GS) (p-value=0.018), and functional (GF) (p-value=0.010) domains, regarding the initial and final FACT-G showed a difference between the groups, where the GA average at the end rose from 80.68 to 90.12 (p-value = 0.004) and in the CG the average dropped from 81.95 to 70.59 (p-value=0.003).
The authors concluded that acupuncture was efficient in the secondary prophylaxis of myelosuppression during chemotherapy and the quality of life of women during treatment has increased.
My interpretation of these results is quite different from that of the authors.
Please let me explain.
The improvement of the quality of life can easily be explained via a placebo effect; acupuncture itself has not necessarily any part in it. But what about the effect on the bone marrow? Might it too be due to a placebo response, or the additional attention? Probably not.
Does that mean that this study proves a definite positive effect of acupuncture?
No!
Why not?
Because firstly the study was far too small for allowing such a far-reaching conclusion, and secondly one would need independent confirmation before accepting such a far-reaching conclusion.
4 Responses to The effect of acupuncture on myelosuppression and quality of life in women with breast cancer
Leave a Reply to Jörg Leopoldseder Cancel reply
This site uses Akismet to reduce spam. Learn how your comment data is processed.
What’s the matter, that patients with a primary prophylaxis are excluded from the Statistik?
Only 23.9% with primary prophylaxis have a febrile neutropenia (FN)👆
What a doctor’s botch!
https://link.springer.com/article/10.1007/s00280-019-03948-6
The only remarkable result of this failed exercise is that it got published. To draw conclusions from putting the data from an N=26 pilot study through Student’s T-test and Chi-square analysis should be considered a punishable offense.
This is a nonsense study. It is clear that the authors have no feel for the behaviour of numbers and no training in statistics. Why on earth are they reporting results as percentages when there are only 10 patients in one group and 16 patients in the other? Why are they giving these percentages to three significant figures, an absurd degree of precision? When it comes to quality of life measurements, why are they reporting averages? Average is a vague term used by non-statisticians to refer to several different ways of expressing central tendency and has no place in a medical paper; they should specify whether they are using the median or the mean.
It is not clear whether the patients judged to require primary G-CSF prophylaxis were taken out of the analysis before randomisation or after it, nor how many were whittled from each group. If it was after randomisation, this might explain the discrepancy between the sizes of the control and the acupuncture groups, and explain part of the difference between the numbers requiring secondary prophylaxis in each group; I would have thought that most of the difference was due to chance, given the small size of the groups.
G-CSF (or filgrastim, to give it it’s generic name) is a drug given by subcutaneous injection and used to treat neutropenia, or to prevent it. Neutropenia in this context refers to a drop in neutrophil polymorphs, a type of white blood cell, as a result of bone marrow suppression by chemotherapy. Following administration of a single anthrocycline dose the neutrophils start to fall, reaching a nadir somewhere between 7 and 14 days later before returning to baseline. If the level goes below a critical threshold it is called neutropenia and there is a substantially increased risk of a serious and potentially life-threatening bacterial infection (often referred to as febrile neutropenia). Febrile neutropenia is a medical emergency and requires admission to hospital. Neutropenia without fever is nevertheless often symptomatic, with fatigue, malaise, mouth ulcers and sometimes perianal soreness.
Although not explicitly stated, I am assuming that primary prophylaxis was used in patients thought to be at high risk of neutropenia, and secondary prophylaxis (the end point of the study) for those who became neutropenic during their first cycle of chemotherapy.
Given the symptoms of neutropenia, it is hardly surprising that the quality of life was correlated with the need for secondary prophylaxis with G-CSF and there is no need to invoke the placebo effect of acupuncture as an explanation, though it may have contributed.
Talking of neutropenia…
NEVER STICK ACUPUNCTURE NEEDLES IN SOMEONE WHO HAS, OR IS SUSPECTED TO HAVE, NEUTROPENIA.