Open Access Open Badges Research article

Patient education integrated with acupuncture for relief of cancer-related fatigue randomized controlled feasibility study

Michael F Johnston123, Ron D Hays234, Saskia K Subramanian5, Robert M Elashoff67, Eleanor K Axe1, Jie-Jia Li1, Irene Kim1, Roberto B Vargas1234, Jihey Lee6, LuGe Yang1 and Ka-Kit Hui123*

Author Affiliations

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

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BMC Complementary and Alternative Medicine 2011, 11:49  doi:10.1186/1472-6882-11-49

Published: 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.

Trial registration