| ObjectiveThe aim of this systemic review and Meta-analysis is to evaluate the effectiveness and safeness of using acupuncture for Cancer-related fatigue.MethodsFirst,inclusion criteria and exclusion criteria were needed to be set up.Inclusion criteria:1.Type of study:only randomized controlled trials were included,literature from journals and conferences were used.2.Subjects:Confirmed cancer patients,no matter age,sex,type of tumor,type of stage,whether or not receiving any kind of western medicine treatment(drugs,operation,chemotherapy,radiotherapy).The cancer patients all were confirmed that they had the symtpoms of cancer-related fatigue.3.Interventions:treatment simply applied acupuncture,while control group could be any treatment,such as sham acupuncture,self-help acupuncture,self-help acupressure,education,or no treatment(blank)at all.4.Outcome index:any invertory changes that could measure cancer-related fatigue.Exclusion criteria:1.Non-randomized controlled trial.2.Literature is not from aboard.3.Acupuncture is not used as a media in treating cancer-related fatigue.4.Repeated literature and published in a different database.5.Outcome data was not numerical.6.No related outcome index.5electronicdatabaseswereincluded:ChinaNationalKnowledge Infrastructure(CNKI),Wanfang Database,EMBASE(OVID),MEDLINE(OVID)and the Cochrane Library,mainly searched for the randomized controlled trials(RCT)of cancer-related fatigue.In addition,retrieve more studies through the references of the selected literature.We searched the literature when the five computer databases were built until October 2016.English keywords were cancer-related fatigue,acupuncture,quality of life,meridian points,randomized controlled trial,tumor,herbal medicine etc.and their Chinese equivalents.Studies involving cases of RCTs of acupuncture for the treatment of cancer-related fatigue were collected.NoteExpress,a piece of journal article management software,was then used to filter out repeated findings.According to the inclusion and exclusion criteria of this study,the selected studies were analyzed after going through the last selection procedure involving the examination of titles,abstracts,and full text.Retrieval and quality evaluation:Retrieved some basic information about the literature:like the author,time of the study,title.And also the information about the participants likes sex,age,cancer type,treatment received;as well as the risk bias and related outcome index.The selection process and retrieval of data were carried out independently by two individual researchers.Discrepancies were dealt with by a third researcher.Statistical analysis:The software Review Manager 5.3 was employed,which was developed by the Cochrane Collaboration Network.For the dichotomous trial,odds ratio(OR)analysis and 95%confidence interval were used;and for continuous trial,the standard mean difference(SMD)and 95%confidence interval were employed.The risk of bias tool to the methodology of the literature research was applied.The not onlyχ~2statistic test was used,but also heterogeneity I~2and its p-value test.If the p-value is≥0.1,heterogeneity did not exist and then fixed model would use.If the p-value is<0.1,then heterogeneity existed,the random model would have applied.After analysis of heterogeneity,Trail Sequential Analysis(TSA)would use.It was for further analysis in quantifying the statistical reliability of data in the Meta-analysis and adjusting significance levels for sparse data and repetitive testing on accumulating data.ResultsA total of 1873 titles and abstracts were collected in the retrieval process through the use of computers and manual work.After filtering out 24 repeated articles by using NoteExpress,1849 studies were selected in the initial selection process.According to the set criteria,11 studies were chosen and their full texts were then examined,after which two were excluded because of the absence of RCT,incomplete presentation of data and the nature of control groups.Finally,9 studies involving a total of 684 cancer cases were selected as the targets to undergoing further examination.Risk of bias evaluation was done according to Cochrane Handbook for Systematic Reviews of Interventions 5.1.Random sequence generation:9 studies were all used random sequence generation,7 of them described how it generated and used it properly;2 of them only mentioned about random generated,all belonged to low riskAllocation concealment:4 studiescarried outwithsailed and non-transparent envelopes,1 study was allocated by the center,low risk.?Blinding of participants and personnel:5 studies mentioned about double blinding and mentioned about how it was carried out,low risk.4 studies did not use blinding,high risk.Blinding of outcome:5 studies mentioned about it,low risk.4 studies did not use it,high risk.Incomplete outcome data:8 studies did not have this problem.?Selective reporting:8 studies did not have this problem.All the 9 studies mentioned the problem of the reduced number of cases caused by the quitting of and the loss of contact with the subjects.Results from Meta-analysis1.9 studies were included for comparing the effectiveness of Acupuncture group vs Control group,684 cases in total.There were 418 cases in the acupuncture group and 266 cases in the control group.Heterogeneity I~2=0%,P=0.47;≥0.1.Fixed models were used in Meta-analysis and it showed OR=0.92,95%CI(0.61,1.40),P=0.70;>0.05.2.For comparing Acupuncture vs Sham Acupuncture:3 studies were included,121 cases in total.There were 60 cases in Acupuncture group and 61 cases in Sham Acupuncture group.Heterogeneity I~2=83%,P=0.002<0.1.Random models were used in Meta-analysis and it showed SMD=-0.82,95%CI(-1.90,0.26),P=0.14>0.05.3.For comparing Acupuncture vs Self Help Treatment:2 studies were included,163 cases in total.There were 80 cases in Acupuncture group and 83 cases in the Self Help Treatment group.Heterogeneity I~2=94%,P<0.0001;<0.1.Random model was used in Meta-analysis and it showed SMD=-1.12,95%CI(-3.03,0.78),P=0.25;>0.05.4.For comparing Acupuncture+Education vs Education:2 studies were included,314 cases in total.There were 232 cases in Acupuncture+Education group and82 cases in Education group.Heterogeneity I~2=65%,P=0.09;<0.1.Random model was used in Meta-analysis and it showed SMD=-2.12,95%CI(-3.21,-1.03),P=0.0001;<0.05.5.For comparing Acupuncture vs No Treatment:2 studies were included,150cases in total.There were 75 cases in Acupuncture group and 75 cases in No Treatment group.Heterogeneity I~2=90%,P=0.001;<0.1.Random model was used in Meta-analysis and it showed SMD=-1.46,95%CI(-3.56,0.63),P=0.17;>0.05.6.For comparing BEI score before and after Acupuncture treatment:2 studies were included,138 cases in total.There were 69 cases in Acupuncture group and 69 cases in Control group.Heterogeneity I~2=77%,P=0.005;<0.1.The random model was used in Meta-analysis and it showed MD=2.33,95%CI(0.98,3.67),P=0.0007;<0.05.Conclusion1.It showed that Acupuncture group was not more effective than Control group and the result of Meta-analysis was not statistically significance.2.There was statistical significance in the comparison of Acupuncture+Education vs Education for the relief of cancer-related fatigue.However,whether acupuncture or education caused such a positive impact was not known.3.It is a good way in promoting acupuncture for relieving cancer-related fatigue as it is safe,less side effect and economical,worth for promoting in public health care system.4.If needs to do a systematic review on acupuncture for cancer-related fatigue again,there is an urge to make sure that the researchers are adopting the same kind of acupuncture technique,because there is the difference between traditional Chinese medicine method and Western one.5.Should combine the technology of Traditional Chinese Medicine and Western medicine in curing the tumor,further fulfilling the system of acupuncture for cancer-related fatigue,tailor-made treatment,in-advanced education,supporting for rehabilitation. |
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