Wound Healing In Oncology: The Acupuncture Advantage
Overview
In this meta-analysis, researchers aimed to evaluate the effectiveness of acupuncture in improving wound healing in patients experiencing leukopenia following chemotherapy for malignant tumors. They conducted a thorough search for randomized controlled trials and observational studies focusing on post-chemotherapy leukopenia in cancer patients. Data analysis was conducted using Revman 5.3 software, incorporating eleven articles with a total of 957 patients.
The meta-analysis findings indicated that patients receiving acupuncture exhibited a significantly higher total effectiveness rate compared to control groups (p < 0.05). Subgroup analysis further revealed that groups receiving acupuncture combined with moxibustion or acupuncture combined with Western medicine demonstrated superior outcomes (p < 0.05), with acupuncture-moxibustion combination therapy showing greater efficacy.
Significantly, acupuncture was observed to enhance white blood cell (WBC) counts on days 3, 7, 14, 21, and 28 post-treatment, with notable differences compared to control groups. These improvements were time-dependent and more substantial than those in control groups, underscoring acupuncture’s potential in enhancing wound healing in leukopenia following chemotherapy for malignant tumors.
Overall, the study underscores acupuncture as a promising complementary therapy for managing chemotherapy-induced leukopenia, contributing positively to the wound healing process in cancer patients.
Introduction
Chemotherapy, a cornerstone in treating malignant tumors, often leads to adverse effects like leukopenia, characterized by a decrease in white blood cells. This condition not only hampers wound healing but also weakens the immune system, leaving patients vulnerable to infections and other complications. Effective wound healing is crucial for cancer patients as it impacts treatment success and overall quality of life.
Within the domain of complementary and alternative medicine (CAM), acupuncture has garnered considerable attention as a potentially effective therapeutic intervention. Originating from traditional Chinese medicine, acupuncture is renowned for its therapeutic benefits, particularly in oncological care, where it helps manage pain and alleviate various symptoms associated with cancer and its treatment.
Recent research and a growing interest suggest that acupuncture may have the potential to significantly improve wound recovery in patients undergoing chemotherapy for malignant tumors. One potential mechanism by which acupuncture could aid in wound healing is through the mitigation of leukopenia-related side effects, such as decreased white blood cell counts.
The primary objective of this scholarly article is to conduct a meta-analysis regarding the effectiveness of acupuncture in promoting wound healing when chemotherapy-induced leukopenia is present. By examining data derived from a variety of observational and randomized controlled trials, this research endeavors to determine the degree to which acupuncture can promote wound healing through the mitigation of leukopenia. Through this analysis, the study aims to contribute to our understanding of acupuncture’s role in cancer care and its potential as a complementary therapy to conventional treatments like chemotherapy.
Methods
Inclusion Criteria
- Study Type: Randomized controlled trials (RCTs) investigating the efficacy of acupuncture in managing post-chemotherapy leukopenia in patients with malignant tumors.
- Study Subjects: Patients diagnosed with malignancy who developed leukopenia following chemotherapy.
- Observation Group: Studies where patients received either general acupuncture combined with Western medicine or moxibustion. The selection of acupuncture points, duration of treatment, and retention time were not restricted.
- Control Group: Studies where patients received recombinant human granulocyte colony-stimulating factor (rhG-CSF) or other Western medicine treatments such as lisinopril combined with shark’s glycol. Dosage and treatment regimens were in accordance with standard guidelines for leukopenia management.
- Outcome Indicators:
– Total effective rate
– Total effective rate of acupuncture combined with Western medicine
– Total effective rate of acupuncture combined with moxibustion
– White blood cell count on days 3, 7, 14, 21, and 28 post-treatment
– Safety evaluation
Exclusion Criteria
- Non-clinical studies.
- Literature not written in Chinese or English.
- Literature with inaccessible full text or data extraction.
- Duplicate studies.
- Case reports.
- Review-type or commentary studies.
- Studies not focused on chemotherapy-induced leukopenia.
Literature Screening and Data Extraction
- Two researchers independently screened the literature, cross-checked their findings, and resolved any disagreements through discussion or negotiation with a third researcher.
- Data extraction followed the Cochrane systematic evaluation handbook, including general information (e.g., literature title, first author, year), item information (e.g., number of patient cases, age, medication regimen), and outcome indicators (e.g., number of events, total number, mean, standard deviation).
Quality Evaluation
The Cochrane 5.1.0 bias assessment method was utilized to evaluate the methodological quality of the included studies. This included assessing biases such as random sequence generation, allocation concealment, blinding, incomplete outcome data, and selective reporting. Each bias was categorized as high risk, low risk, or ambiguous.
Furthermore, the meta-analysis accounted for the diverse acupuncture techniques employed across studies and the variability in control interventions. Subgroup analyses were conducted to mitigate the impact of methodological differences on treatment efficacy outcomes.
Analysis
The systematic evaluation utilized Rev Man 5.3 software. Heterogeneity among trials was assessed using the Cochrane χ2 test with a significance level of p=0.1, and the degree of heterogeneity was determined by I2. If p> 0.1 and I2
If p> 0.1 and I2 < 50%, it suggests no statistical heterogeneity among RCTs, employing a fixed-effects model. Conversely, a random-effects model was chosen in cases of significant heterogeneity. The weighted mean difference (WMD) was employed for continuous variables sharing the same unit of measure, while standardized mean difference (SMD) was used for different units. Each effect measure was presented with a 95% confidence interval (95% CI), with p≤0.05 indicating statistical significance.
Results
Among the initial pool of 70 randomized controlled trials (RCTs) scrutinized through keyword searches, 45 were deemed unfit for further consideration following an evaluation of their titles and abstracts. After a thorough examination of the full texts of the remaining 14 studies, three duplicates were identified and subsequently removed from the pool, leaving behind 11 RCTs that adhered to the predetermined inclusion criteria.
In evaluating the methodological quality of these studies, the Cochrane risk of bias assessment revealed some deficiencies, particularly regarding the lack of clarity on randomization methods and allocation concealment in most cases. This suggests the potential for bias in the reported outcomes, highlighting the importance of rigorous study design and execution in acupuncture research.
The collective data from these trials encompassed a total of 957 patients diagnosed with malignant tumors who experienced leukopenia subsequent to chemotherapy. Meta-analysis of the gathered data unveiled considerable heterogeneity among the studies concerning the total effective rate, indicating variations in treatment responses across different intervention modalities.
Notably, the observation group, which received acupuncture treatment, demonstrated superior efficacy compared to the control groups, suggesting a beneficial effect of acupuncture in managing leukopenia post-chemotherapy. Furthermore, subgroup analyses delineated significant improvements in white blood cell counts at various intervals following treatment initiation, underscoring the potential time-dependent efficacy of acupuncture in this context.
Interestingly, when considering different intervention approaches, acupuncture combined with moxibustion exhibited the highest effectiveness, surpassing other treatment modalities. This finding underscores the potential synergistic effects of combining acupuncture with adjunctive therapies, such as moxibustion, in enhancing treatment outcomes for chemotherapy-induced leukopenia.
Despite the promising efficacy of acupuncture, safety remains a paramount concern in clinical practice. Adverse reactions associated with acupuncture, such as insomnia, anorexia, and dizziness, were reported across the included studies. However, these adverse events were predominantly minor in nature, highlighting the overall safety profile of acupuncture as an adjunctive therapy in the management of chemotherapy-induced leukopenia.
Moreover, sensitivity analysis conducted to assess the robustness of the meta-analysis results revealed consistent outcomes across all included studies, suggesting the stability and reliability of the findings.
The findings of this meta-analysis suggest that acupuncture holds promise as a viable therapeutic intervention for improving leukopenia after chemotherapy in patients with malignant tumors. However, further research employing rigorous study designs and larger sample sizes is warranted to corroborate these findings and elucidate the underlying mechanisms of acupuncture’s therapeutic effects in this context.
Conclusion
This study underscores the efficacy and safety of acupuncture, particularly when combined with moxibustion, in the treatment of leukopenia following chemotherapy in patients with malignant tumors. Notably, acupuncture demonstrates a dual benefit by not only effectively managing leukopenia but also playing a crucial role in enhancing wound healing, which is often compromised in cancer patients with impaired immune function.
The temporal aspect of acupuncture’s effectiveness is highlighted, with repeated sessions showing increasingly pronounced improvements in leukopenia. This suggests that acupuncture may contribute progressively to wound healing by addressing the underlying leukopenia, a key impediment to the healing process in cancer patients.
While the findings provide substantial evidence supporting the role of acupuncture in improving leukopenia post-chemotherapy and its indirect impact on wound healing, the study acknowledges limitations. These include the relatively small number of randomized controlled trials (RCTs) included and the variability in study quality. Future research should focus on conducting more comprehensive, high-quality RCTs with larger sample sizes to further validate these findings and fully exploit acupuncture’s potential in enhancing wound healing in oncological care.
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