Acupuncture as treatment of cancer-therapy induced fatigue: a critical systematic review with a focus on the methodological assessment of blinding

Abstract Background Acupuncture is a method of traditional Chinese medicine that has been adapted in the Western world. The objective of this study was to critically assess the evidence presented in randomized controlled trials (RCTs) about the effectiveness of acupuncture on fatigue in cancer patients. Method In April 2024 a systematic search was conducted searching five electronic databases to find studies concerning the use, effectiveness and potential harm of acupuncture therapy on cancer patients. Results From all (1599) search results, 15 studies with 1346 patients were included. Acupuncture methods varied (e.g., traditional-, electro-, mind-regulating and ATAS-acupuncture) and were compared to sham acupuncture, usual care, or other controls. Studies comparing acupuncture to sham acupuncture reported mixed results: while some found significant effects on cancer-related fatigue, others found no advantages. Studies comparing acupuncture to usual care or waitlist controls often reported positive effects. However, the reliability of these findings is limited, as 14 of 15 studies were rated as “high risk of bias” by the RoB-2 tool due to issues like insufficient blinding and incomplete data analysis. Only one study, with low risk of bias, showed a significant reduction in fatigue with acupuncture compared to sham acupuncture ( p < 0.001). GRADE evaluation also showed very low certainty of evidence. Conclusion The heterogenous results and methodological limitations of the existing studies prevent us from drawing definitive conclusions about the effectiveness of acupuncture in the treatment of cancer-related fatigue. Despite the inclusion of 15 studies, the overall evidence remains insufficient due to widespread problems in study design and inconsistent results. This analysis highlights the need to use more rigorous designs and more comprehensive assessment tools in future studies to better understand the role of acupuncture in the management of fatigue after cancer treatment.