Rédacteur : Johan Nguyen

Pallative Care

Soins palliatifs : évaluation de l'acupuncture

1. Systematic Reviews and Meta-Analysis

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

1.1. Zeng 2019

Zeng YS , Wang C , Ward KE , Hume AL. Complementary and Alternative Medicine in Hospice and Palliative Care: A Systematic Review. J Pain Symptom Manage. 2018;56(5):781-794. [202692].

ContextThe aim of palliative care is to improve quality of life for patients with serious illnesses by treating their symptoms and adverse effects. Hospice care also aims for this for patients with a life expectancy of six months or less. When conventional therapies do not provide adequate symptom management or produce their own adverse effects, patients, families, and caregivers may prefer complementary or alternative approaches in their care.
Objectives The objectives of this study were to evaluate the available evidence on the use of complementary or alternative medicine (CAM) in hospice and palliative care and to summarize their potential benefits.
MethodsA defined search strategy was used in reviewing literature from major databases. Searches were conducted using base terms and the symptom in question. Symptoms included anxiety, pain, dyspnea, cough, fatigue, insomnia, nausea, and vomiting. Studies were selected for further evaluation based on relevancy and study type. References of systematic reviews were also assessed. After evaluation using quality assessment tools, findings were summarized and the review was structured based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results Out of 4682 studies, 17 were identified for further evaluation. Therapies included acupressure, acupuncture, aromatherapy massage, breathing, hypnotherapy, massage, meditation, music therapy, reflexology, and reiki. Many studies demonstrated a short-term benefit in symptom improvement from baseline with CAM, although a significant benefit was not found between groups.
Conclusion CAM may provide a limited short-term benefit in patients with symptom burden. Additional studies are needed to clarify the potential value of CAM in the hospice or palliative setting.

1.2. Lian 2014

Lian WL, Pan MQ, Zhou DH, Zhang ZJ. Effectiveness of acupuncture for palliative care in cancer patients: a systematic review. Chinese Journal of Integrative Medicine. 2014;20(2):136-47. [214400]. doi

ObjectiveTo critically evaluate the currently available randomized clinical trials regarding the effectiveness of acupuncture in palliative care for cancer patients, hence, to provide sufficient evidences for the widespread use of acupuncture in cancer treatment.
MethodsTwo independent reviewers extracted data from all of the randomized clinical trials (RCTs) that assessed the efficacy of acupuncture in palliative care for cancer patients. Seven databases were searched from their respective inception to December 2010. All eligible trials identified were evaluated by two independent reviewers using the Jadad scale, and data from the articles were validated and extracted.
Results In total, 33 RCTs met the inclusion criteria. The effects of acupuncture on different cancer-related aspects were shown, including chemotherapy or radiotherapy-induced side effects (13/33, 39.4%), cancer pain (6/33, 18.2%), post-operative urinary retention (4/33, 12.1%), quality of life (2/33, 6.1%), vasomotor syndrome (2/33, 6.1%), post-operative gastrointestinal dysfunction (2/33, 6.1%), prevention of prolonged postoperative ileus (2/33, 6.1%), joint symptoms (1/33, 3.0%), and immunomodulation (1/33, 3.0%).
ConclusionsThe result of our systematic review suggested that the effectiveness of acupuncture in palliative care for cancer patients is promising, especially in reducing chemotherapy or radiotherapy-induced side effects and cancer pain. Acupuncture may be an appropriate adjunctive treatment for palliative care.

2. Clinical Practice Guidelines

⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation, (or lack of evidence)

2.1. Health Care for the Homeless Clinicians’ Network ((HCH, USA) 2018 ⊕

Adapting Your Practice Recommendations for End-of-Life Care for People Experiencing Homelessnes. Health Care for the Homeless (HCH ) Clinicians’ Network. 2018;:90p. [198223].

Many patients are interested ICAM, either for belief in cure or for management of terminal illness. There is evidence that a variety of ICAM modalities can be helpful as an adjunct in terminal illness, including but not limited to Traditional Chinese Medicine, acupuncture, massage, meditation, prayer, guided imagery, laughter therapy, yoga, healing touch, Reike, aromatherapy, nutrition, and supplements. These modalities can serve as useful adjuncts for alleviating symptoms. Many patients are using ICAM and not discussing it with providers. It can be helpful to identify if your patients are using or interested in any ICAM modalities and helping with referral if needed. There are often free or low cost resources that may be located and accessed in many communities. If your patient is using ICAM modalities in belief of cure for a terminal illness, particularly instead of Western modalities, it is important to avoid alienating them or endorsing a cure that doesn’t have evidence, while also avoiding instilling false hope for treatments whose efficacy is not substantiated by available.