Research Article

Acupoints Stimulation for Anxiety and Depression in Cancer Patients: A Quantitative Synthesis of Randomized Controlled Trials

Table 1

Characteristics of included trials.

Study & settingTypes of cancerSample size Acupoints stimulation interventionControlPrimary and/or secondary outcomes
Types of acupoints stimulationSelected acupoints

S1: Bao et al., 2014 [26]
Two cancer
centers, USA
Breast cancerRandomized = 51 Completed = 47
Intervention group: 23, age (yr) = median 61 (45–85)
Control group: 24, age (yr) = Median 61 (44–82)
Intervention: manual acupuncture
Practitioner: acupuncturist
Frequency: weekly treatment
Total duration: 8 weeks
Guanyuan (CV4), Qihai (CV6), Zhongwan (CV12), Hegu (LI4)
Master of Heart 6 (MH6), Yanglingquan (GB34), Zusanli (ST36), Taixi (KI3), and Shugu (BL65)
Sham acupuncture:
nonpenetrating retractable needles at 14 sham acupoints located at the midpoint of the line connecting 2 real acupoints
(i) Depression: Center for Epidemiologic Studies Depression Scale (CESD)
(ii) Anxiety: Hospital Anxiety and Depression Scale (HADS-A)
(iii) Sleep quality: Pittsburgh Sleep Quality Index (PSQI)  
(iv) Adverse events

S2: Deng et al., 2013 [27]
A cancer center, USA
Various types of cancerRandomized = 101 Completed = 74
Intervention group: 47, age (yr) = median 54 (IRQ 46, 58)
Control group: 50, age (yr) = median 53 (IRQ 45, 59)
Intervention: manual acupuncture
Practitioner: acupuncturist
Frequency: weekly treatment
Total duration: 6 weeks
Qihai (CV6), Guanyuan (CV4), Taixi (KI3), Zusanli (ST36), Sanyinjiao (SP6), Quchi (LI11), Yinxi (HT6), and auricular point for antidepressionSham acupuncture:
Blunt-tipped needles used at a few millimeters off the meridians and away from the points used in true acupuncture
(i) Anxiety and Depression: Hospital Anxiety and Depression Scale (HADS)
(ii) Adverse events

S3: Feng et al., 2011 [28]
Department of TCM, General Hospital of PLA, China
Various types of cancerRandomized = 80 Completed = 80
Intervention group: 40, age (yr) = 63.80 ± 5.47
Control group: 40, age (yr) = 63.60 ± 4.26
Intervention: manual acupuncture
Practitioner: acupuncturist
Frequency: daily treatment
Total duration: 30 days
Fenglong (ST40); Yinlingquan (SP9); Xuehai (SP10); Sanyinjiao (SP6); Yintang (EX-HN3); Baihui (DU20); Sishencong (EX-HN1); Neiguan (PC6); and Shenmen (TF4)Standard methods of treatment/care: standard medication using antidepressant(i) Depression: Self-Rating Depression Scale (SDS) and Hamilton Depression Scale (HAMD)
(ii) Sleep quality: Pittsburgh Sleep Quality Index (PSQI)

S4: Mao et al., 2014 [29]
A cancer center, USA
Breast cancerRandomized = 67 Completed = 59
Intervention group: 22, age (yr) = 57.5 ± 10.1
Control group 1: 22
age (yr) = 60.9 ± 6.5
Control group 2: 23
age (yr) = 60.6 ± 8.2
Intervention: electroacupuncture
Practitioner: acupuncturist
Frequency: twice per week for 2 weeks and weekly treatment for the following 6 weeks
Total duration: 8 weeks
At least 4 local points around the joint with the most pain and at least 4 distant points to address nonpain symptoms commonly observed in conjunction with painSham electroacupuncture (control 1):
nonpenetrating needles at nonacupuncture, nontrigger points at least 5 cm from the joint where pain was perceived to be maximal
Wait-list control (control 2)
(i) Anxiety and depression: Hospital Anxiety and Depression Scale (HADS)
(ii) Sleep quality: Pittsburgh Sleep Quality Index (PSQI)

S5: Tang et al., 2014 [30]
A medical center, Taiwan
Lung cancerRandomized = 57 Completed = 45
Group 1: 17, age (yr) = 53.9 ± 9.8
Group 2: 24, age (yr) = 54.8 ± 9.5
Group 3: 16, age (yr) = 66.1 ± 8.0
Intervention: acupressure
Practitioner: research assistant with acupressure training
Frequency: daily treatment
Total duration: 5 months
Hegu (LI4); Zusanli (ST36); Sanyinjiao (SP6) Sham acupressure:
sham acupressure at sham acupoints located at first metacarpal head, patella, and inner ankle
(i) Anxiety and depression: Hospital Anxiety and Depression Scale (HADS)
(ii) Sleep Quality: Pittsburgh Sleep Quality Index (PSQI)

S6: Walker et al., 2010 [31]
Oncology clinics, USA
Breast cancerRandomized = 50 Completed = 27, age (yr) = median 55 (35–77)
Intervention group: 25
Control group: 25
Intervention: manual acupuncture
Practitioner: not reported
Frequency: twice per week for the first 4 weeks and once per week for
the following 8 weeks
Total duration: 12 weeks for intervention and 1 year for follow-up
Kidney 3; Urinary bladder 23; Spleen 6; Gallbladder 20; Du 14; Du 20; Stomach 36; Liver 3; Heart 7; Pericardium 7; Ren 6; Lung 9 Standard methods of treatment/care: standard medication using antidepressant(i) Depression: Beck Depression Inventory-Primary Care (BDI-PC)
(ii) Adverse events

S7: Frisk et al., 2012 [32]
Three participating centers, Sweden
Breast cancerRandomized = 45 Completed = 18
Intervention group: 26
age (yr) = mean 54.1 (47–69)
Control group: 18
age (yr) = mean 53.4 (43–67)
Intervention: electroacupuncture
Practitioner: physiotherapist
Frequency: twice a week the first two weeks and then once a week for 10 weeks
Total duration: 12 weeks
Xinshu (BL15); Shenshu (BL23);
Ciliao (BL32); Baihui (GV20); Shenmen (HE7); Neiguan (PC6);
Taichong (LR3); Sanyinjiao (SP6);
Yinlingquan (SP9)
Standard methods of treatment/care: standard medication (sequential or continuous combined estrogen/progestagen therapy for hot flushes)(i) Depression/anxiety: Psychological and General Well-Being Index (PGWB) and Women’s Health Questionnaire (WHQ)
(ii) Sleep data: the numbers of times wake-up/night and hours of sleep
(iii) Adverse events

S8: Molassiotis et al., 2012 [33]
Two cancer hospitals, four cancer centers, and three treatment centers of a national voluntary breast cancer organization, United Kingdom
Breast cancerRandomized = 302 Completed = 246
Intervention group: 227, age (yr) = mean 52 (30–75)
Control group: 75, age (yr) = mean 53 (25–80)
Intervention: manual acupuncture
Practitioner: therapists with acupuncture training
Frequency: 6 sessions with each session lasting 20 min
Total duration: 6 weeks
Zusanli (ST36); Sanyinjiao (SP6); Hegu (LI4); and some alternative points [Yanglingquan (GB34) and Yinlingquan (SP9)]Standard methods of treatment/care: enhanced usual care with information booklet on how to cope with fatigue(i) Anxiety and depression: Hospital Anxiety and Depression Scale (HADS)
(ii) Adverse events

S9: Molassiotis et al., 2013 [34]
Two cancer hospitals, four cancer centers, and three treatment centers of a national voluntary breast cancer organization, United Kingdom
Breast cancerRandomized = 198 Completed = 151, age (yr) = mean: 53
Intervention group: 65
Control group 1: 67
Control group 2: 65
Intervention: manual acupuncture
Practitioner: acupuncturist
Frequency: weekly treatment
Total duration: 4 weeks
Zusanli (ST36); Sanyinjiao (SP6); Hegu (LI4)Self-acupuncture (control 1):
self-acupuncture at Zusanli (ST36) and Sanyinjiao (SP6)
No acupuncture (control 2)
(i) Anxiety and depression: Hospital Anxiety and Depression Scale (HADS)
(ii) Adverse events

S10: Xiang et al., 2006 [35]
A TCM hospital, Beijing, China
Various types of cancer (details not given)Randomized = 92 Completed = 92
Intervention group: 46, age (yr) = 41–82
Control group: 46, age (yr) = 37–89
Intervention: electroacupuncture + music therapy
Practitioner: doctor
Frequency: daily treatment
Total duration: 4 weeks
Neiguan (PC6); Zusanli (ST36); Sanyinjiao (SP6); Baihui (DU20); Taixi (KI3); Yintang (EX-HN3); and so forth.Music therapy + standard methods of treatment/care (usual care)Depression: Hamilton Depression Scale (HAMD) and Self-Rating Depression Scale (SDS)

S11: Shi et al., 2013 [36]
A hospital, Anhui, China
Gynecological cancerRandomized = 30 Completed = 30
Intervention group: 15, age (yr) = 43.3 ± 1.94
Control group: 15, age (yr) = 45.0 ± 1.49
Intervention: manual acupuncture
Practitioner: not reported
Frequency: twice per week
Total duration: 3 months
Neiguan (PC6); Zusanli (ST36); Sanyinjiao (SP6); Taichong (LR3); Hegu (LI4); Guanyuan (RN4); Qihai (RN6); Taixi (KI3); Shenshu (BL23); Ganshu (BL18); Pishu (BL20)Standard methods of treatment/care: usual careDepression: Hamilton Depression Scale (HAMD)

S = study, Primary and/or secondary outcomes which were determined by the systematic review.