True acupuncture is more effective than placebo and standard care in reducing the number and severity of radiation-induced xerostomia (dry mouth) symptoms at 1 year following treatment in patients with head and neck cancer, study results published in JAMA Network Open suggest.

In a phase 3 clinical trial, researchers enrolled patients with oropharyngeal or nasopharyngeal carcinoma from the United States and China who were scheduled to undergo radiation therapy (mean age, 51.3±11.7 years. Patients were randomly assigned to either a true acupuncture treatment (n=112), sham acupuncture (n=115), or standard care control (n=112). Acupuncture and sham acupuncture treatments were performed a total of 3 times per week during a 6- to 7-week radiation treatment course. Radiation-induced xerostomia was assessed at 1 year after radiation therapy using the Xerostomia Questionnaire. Secondary outcomes of the study were the incidence of clinically significant xerostomia, quality of life, salivary flow, and salivary constituents.

Patients who received true acupuncture had a lower adjusted least square mean xerostomia score than patients who received standard care (26.6 vs 34.8, respectively; effect size = −0.44; P =.001). True acupuncture was also associated with a lower xerostomia score than sham acupuncture, but this was not statistically significant (26.6 vs 31.3, respectively; effect size = −0.26; P =.06). A significantly lower percentage of patients in the true acupuncture group experienced clinically significant xerostomia 1 year following the end of radiation therapy compared with patients in the sham acupuncture and standard care control groups (34.6% vs 47.8% vs 55.1%, respectively; P =.009).

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True acupuncture was significantly different from standard care control (estimated difference [SE], −9.9 [2.5]; P <.001) and sham acupuncture (estimated difference, −8.2 [2.5]; P =.001) only at Fudan University Cancer Center in Shanghai. At the University of Texas MD Anderson Cancer Center in Houston, only sham acupuncture was different from standard care control (estimated difference, −10.5 [3.3]; P =.002). True acupuncture was also different from standard care control in Houston (estimated difference, −8.1 [3.4]; P =.016).


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Researchers note that patients in China and the United States were treated as inpatients and outpatients, respectively, which may limit the findings. Another limitation was the possibility that patients in China may have become unblinded during treatment, which could have influenced the results.

While further studies are needed, the researchers suggest “acupuncture may be considered an adjunct to standard care for patients who are interested in receiving acupuncture and at risk of developing radiation-induced xerostomia.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Garcia MK, Meng Z, Rosenthal DI, et al. Effect of True and Sham Acupuncture on Radiation-Induced Xerostomia Among Patients With Head and Neck Cancer: A Randomized Clinical Trial. JAMA Netw Open. 2019;2(12):e1916910.