Systematic Review And Meta-analysis Of Acupuncture And Moxibustion Combined With Medicine In The Treatment Of Cancer-related Fatigue

Objective:To evaluate the clinical efficacy and safety of acupuncture combined with drugs in the treatment of cancer-related fatigue by using the Meta analysis method of evidence-based medicine,so as to discuss the advantages of acupuncture in the future cancer relief treatMent and the need for its application in clinical practice.Methods:1.Database selection:Chinese journal full-text databaseCN-KI),Wanfang Database,VIP Database,Chinese Biomedical Literature Database(CBMD),PubMed Database,Ovid Database,Embase Database,and Cochrane Library Database.The retrieval time is limited to December 2020.2.Search terms:"Acupuncture combined with drugs","cancer-related fatigue","immune","CRF","Immunity","Randomized control trial" are keywords or subject words.The search time is up to 2020/123.Inclusion criteria:①.Study type:Open Randomized Control Trial(RCT)at home and abroad.(2).Subjects:The patient was diagnosed as cancer regardless of the nature or stage of the cancer,regardless of the gender,age and origin of the cases.It also met the diagnostic criteria of cancer-induced fatigue.(3).Intervention measures:the experimental group was the control group plus acupuncture and moxibustion treatment,acupuncture,moxibustion(thunder fire moxibustion,wheat moxibustion,ginger moxibustion,etc.),the choice of acupoints,implementation techniques,needle retention time and course of treatment is unlimited.(4).Outcome indicators:1.)Brief Fatigue Inventory(BFI),Karnofsky score,KPS,Piper fatigue scale(including RPFS revised scale),cancer fatigue scale(CFS),multidimensional fatigue scale(MFI);2.)Cancer quality of life assessment:Functional Assessment of Cancer Therapy(FACT),Functional Assessment of Anorexia/Cachexia Therapy(FAACT),The European O-rganization for Reasearch and Treatment of Cancer/Quality of Life Questionnare-Core 30(EORTC QLQ-C30,QLQ-C30),Pittsburgh sleep quality index(PSQI),hospital anxiety and depression scale(HADS),Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS);3.)TCM syndrome scores;4.Blood routine and biochemical indexes,etc.4.Exclusion criteria:①.Non-randomized controlled trials,including trial design,review,and case analysis.(2).Comparison between the treatment group and the control group for the intervention of cancer-induced fatigue and different acupuncture and moxibustion techniques or different acupoint selection prescription.(3).Repeated publications or earlier reports of the same outcome events in the same study.(4).Literature on unusable outcome indicators:including clinical trials with inconsistent observation criteria,non-data results,and self-designed evaluation protocols.5.Data extraction:study number,title,author information,documents and publication time,published magazines and general information(including gender distribution,the average age,the type of cancer),sample size,design method,intervention/exposures,inspection index,experiment data extraction:grouping data,the number of trials,the number of samples,the experimental data.6.Risk assessment and quality assessment:①.Cochrane Risk Bias Assessment Tool;(2).The Jadad scale.7.Statistical analysis:Review Manager5.4 software of Cochrane Collaborative Network was used to summarize and analyze the included literatures.Relative risk(RR)was calculated when the outcome variable was dichotomous data,and mean difference(MD)was calculated when the outcome variable was continuous,and 95%confidence intervals(CI)of the statistical results were reported.Forest plots were used to display the results of the meta-analysis.Analysis process:A.Analysis model selection B.Heterogeneity test(homogeneity test),c.Combined statistics,D.Sensitivity analysis,e.Bias estimation.Results:The curative effect of acupuncture and moxibustion in the treatment of cancer-induced fatigue was superior to that in the control group(MD=-2.56,95%CL[-3.57,-1.55])(P<0.00001,statistically significant));Acupuncture(Z=6.17(P<0.00001));In the moxibustion group Z=5.85(P<0.00001)can improve the efficiency.Acupuncture and moxibustion therapy can improve TCM syndrome score(Z=8.51(P<0.00001)).Acupuncture improved KPS fatigue score(Z=8.69(P<0.00001),acupuncture(P<0.0001)),moxibustion(P<0.00001).Acupuncture could improve the BFI scale(Z=5.46(P<0.00001));Piper scale(Z=6.36(P<0.00001));The acupuncture group was not significant(Z=3.36(P=0.0008)),and the moxibustion group Z=4.31(P<0.0001),significant;Similarly,acupuncture and moxibustion had no significant changes in CFS and MFI scales(Z=3.76(P=0.0002);Acupuncture increased KPS effectiveness(Z=4.43,P<0.00001)).Acupuncture did not significantly improve anxiety(P=0.01,meaningless),but moxibustion could effectively improve anxiety(P<0.0001,meaningful);There was no significant effect on depression scores(Z=3.05(P=0.002,meaningless),but in chemotherapy patients,acupuncture significantly improved depression status(MD=-1.96,95%CI[-4.74,0.82],P<0.0001,meaningful);There was no significant change in the Pittsburgh Sleep Quality Index(PSQI)(Z=1.74(P=0.08)).The improvement in cancer function evaluation was significant(Z=7.50(P<0.00001),in which acupuncture performed better(Z=7.19(P<0.00001),the moxibustion rule was not significant(Z=1.98(P=0.05));Chemotherapy had a significant effect on the efficacy of acupuncture and moxibustion(MD=5.22,95%CI[-1.05,11.49](P=0.10,meaningless)).In terms of immune cells,the changes of white blood cells in 5 groups were not significant(Z=0.41(P=0.68)),and the changes of CD3+T cells in 10 groups were not significant(Z=2.45(P=0.01)),but CD4+T cell values were significantly improved by acupuncture(Z=4.42(P<0.00001),the improvement of acupuncture was not significant(Z=1.87(P=0.06),but the improvement of moxibustion was significant(Z=4.03(P<0.0001);There was no significant improvement in CD8+T cell value(Z=0.36(P=0.72)),nor in NK value(Z=3.16(P=0.002)).Conclusion:1.Compared with conventional drug treatment,acupuncture and moxibustion combined with drugs have more advantages in improving patients’ subjective fatigue feeling,among which moxibustion has a better performance.2.Acupuncture combined with drugs has little influence on the scores of anxiety and depression,while moxibustion combined with drugs can improve the scores of anxiety and depression more than the control group.Similarly,there was no significant statistical evidence that acupuncture combined with drugs improved sleep over drugs.3.There is no obvious evidence to support acupuncture and moxibustion combined with drugs in improving the WBC value.There was no obvious evidence to prove that acupuncture combined with drugs improved lymphocyte subsets in patients compared with drugs alone.Compared with the combination of moxibustion and drugs,single use of drugs can significantly improve the lymphocyte subsets of patients,indicating that moxibustion can better regulate the immune function of patients.