Acupuncture Abates Hot Flashes in Breast Cancer Survivors

Jun Mao, MD, MSCE

Jun Mao, MD, MSCE

Hot flashes are severe, daily nuisances for many breast cancer survivors, but a few needle pricks from acupuncture may be enough to cool the unpleasant episodes, according to a new study published in the Journal of Clinical Oncology.

Researchers at the Perelman School of Medicine at the University of Pennsylvania found that electroacupuncture—in which needles deliver a weak electrical current—produced larger placebo and smaller nocebo effects than did gabapentin for treating hot flashes among breast cancer survivors. Breast cancer survivors are restricted from taking FDA-approved treatment for hot flashes, such as hormone replacement therapies, because they include estrogen, but the Penn researchers concluded that electroacupuncture may be an effective management treatment.

“These latest results clearly show promise for managing hot flashes experienced by breast cancer survivors through the use of acupuncture, which in previous studies has also been proven to be an effective treatment for joint pain in this patient population,” lead author Jun J. Mao, MD, MSCE, associate professor of Family Medicine and Community Health, said in a statement.

This randomized controlled trial enrolled 120 breast cancer survivors who reported experiencing multiple hot flashes per day. Participants were randomly assigned to 1 of 4 groups, two involving active treatment and the other two placebo. The intervention was carried out over 8 weeks.

In the two treatment arms, participants received electroacupuncture twice per week for 2 weeks and then once weekly, or gabapentin (900 mg) daily. Survivors assigned to one of the placebo groups received either “sham” electroacupuncture, which involved no actual needle penetration or electrical current, or a daily placebo in place of the gabapentin.

Investigators used a hot flash composite score (HFCS) to measure hot flash frequency and severity. At the end of the 8 weeks, those in the electroacupuncture group showed the greatest reduction in HFCS (-7.4), followed by the sham acupuncture group, the gabapentin pill group, and the placebo pill group (-5.9 v -5.2 v -3.4, respectively).

The electroacupuncture group and the sham electroacupuncture group experienced 47.8% and 45% improvement in hot flashes, respectively. Improvement for the gabapentin group was 39.4% and 22.3% with placebo.

Both acupuncture groups reported fewer adverse side effects than the pill groups.

“We found that acupuncture elicited a greater placebo response than did pills, consistent with observations in studies of pain,” the authors wrote. “Although not completely understood, the enhanced placebo effect seen in acupuncture may be a combination of positive expectancy, patient—provider interaction, active patient engagement, relaxation, and light sensory stimulation by the sham needling.”

The groups were evaluated again 4 months after therapy ended to measure the durability of the treatment effects. Researchers found that survivors who received electroacupuncture had the best long-term effect (-8.5), followed by the sham acupuncture group (-6.1), placebo pill group (-4.6) and the gabapentin group (-2.8).

Electroacupuncture produced a 25% greater reduction in HFCS compared with the sham version, but the authors noted that their preliminary findings need to be confirmed in larger studies with long-term follow-up.

“Acupuncture is an exotic therapy, elicits the patient’s active participation, and involves a greater patient—provider interaction, compared with taking a pill,” explained Mao. “Importantly, the results of this trial show that even sham acupuncture—which is effectively a placebo—is more effective than medications. The placebo effect is often dismissed as noise, but these results suggest we should be taking a closer look at how we can best harness it.”

Mao JJ, Bowman MA, Xie SX, et al. Electroacupuncture versus gabapentin for hot flashes among breast cancer survivors: a randomized placebo-controlled trial [published online August 24, 2015]. J Clin Oncol.