Patient education integrated with acupuncture for relief of cancer-related fatigue randomized controlled feasibility study
1 UCLA Center for East-West Medicine, David Geffen School of Medicine at UCLA, LA, USA
2 Division of General Internal Medicine, David Geffen School of Medicine at UCLA, LA, USA
3 Department of Health Services, UCLA School of Public Health, LA, USA
4 RAND, Santa Monica, CA, USA
5 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, LA, USA
6 Department of Biostatistics, School of Public Health, UCLA, LA, USA
7 Department of Biomathematics, UCLA Graduate Division, LA, USA
BMC Complementary and Alternative Medicine 2011, 11:49 doi:10.1186/1472-6882-11-49Published: 25 June 2011
Cancer-related fatigue (CRF) is a prominent clinical problem. There are calls for multi-modal interventions.
We assessed the feasibility of delivering patient education integrated with acupuncture for relief of CRF in a pilot randomized controlled trial (RCT) with breast cancer survivors using usual care as control. Social cognitive and integrative medicine theories guided integration of patient education with acupuncture into a coherent treatment protocol. The intervention consisted of two parts. First, patients were taught to improve self-care by optimizing exercise routines, improving nutrition, implementing some additional evidence-based cognitive behavioral techniques such as stress management in four weekly 50-minute sessions. Second, patients received eight weekly 50-minute acupuncture sessions. The pre-specified primary outcome, CRF, was assessed with the Brief Fatigue Inventory (BFI). Secondary outcomes included three dimensions of cognitive impairment assessed with the FACT-COGv2.
Due to difficulties in recruitment, we tried several methods that led to the development of a tailored recruitment strategy: we enlisted oncologists into the core research team and recruited patients completing treatment from oncology waiting rooms. Compared to usual care control, the intervention was associated with a 2.38-point decline in fatigue as measured by the BFI (90% Confidence Interval from 0.586 to 5.014; p <0.10). Outcomes associated with cognitive dysfunction were not statistically significant.
Patient education integrated with acupuncture had a very promising effect that warrants conducting a larger RCT to confirm findings. An effective recruitment strategy will be essential for the successful execution of a larger-scale trial.