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Moxibustion for the treatment of chemotherapy-induced leukopenia: a systematic review of randomized clinical trials

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Abstract

Purpose

The purpose of this study is to assess the efficacy of moxibustion as a treatment of chemotherapy-induced leukopenia.

Methods

Twelve databases were searched from their inception through June 2014, without a language restriction. Randomized clinical trials (RCTs) were included if moxibustion was used as the sole treatment or as a part of a combination therapy with conventional drugs for leukopenia induced by chemotherapy. Cochrane criteria were used to assess the risk of bias.

Results

Six RCTs with a total of 681 patients met our inclusion criteria. All of the included RCTs were associated with a high risk of bias. The trials included patients with various types of cancer receiving ongoing chemotherapy or after chemotherapy. The results of two RCTs suggested the effectiveness of moxibustion combined with chemotherapy vs. chemotherapy alone. In four RCTs, moxibustion was more effective than conventional drug therapy. Six RCTs showed that moxibustion was more effective than various types of control interventions in increasing white blood cell counts.

Conclusions

There is low level of evidence based on these six trials that demonstrates the superiority of moxibustion over drug therapies in the treatment of chemotherapy-induced leukopenia. However, the number of trials, the total sample size, and the methodological quality are too low to draw firm conclusions. Future RCTs appear to be warranted.

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References

  1. World Health Organization (2014) Cancer. http://www.who.int/mediacentre/factsheets/fs297/en/ Accessed 10 June 2014

  2. Yamanaka T, Matsumoto S, Teramukai S, Ishiwata R, Nagai Y, Fukushima M (2007) Predictive value of chemotherapy-induced neutropenia for the efficacy of oral fluoropyrimidine S-1 in advanced gastric carcinoma. Br J Cancer 97:37–42

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Liu W, Zhang CC, Li K (2013) Prognostic value of chemotherapy-induced leukopenia in small-cell lung cancer. Cancer Biol Med 10:92–98

    PubMed Central  PubMed  Google Scholar 

  4. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad I, Rolston KV, Young JA, Wingard JR, Infectious Diseases Society of America (2011) Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis 52:56–93

    Article  Google Scholar 

  5. Clark OA, Lyman GH, Castro AA, Clark LG, Djulbegovic B (2005) Colony-stimulating factors for chemotherapy-induced febrile neutropenia: a meta-analysis of randomized controlled trials. J Clin Oncol 23:4198–4214

    Article  CAS  PubMed  Google Scholar 

  6. Dale DC (2009) Advances in the treatment of neutropenia. Curr Opin Support Palliat Care 3:207–212

    Article  PubMed Central  PubMed  Google Scholar 

  7. Aapro MS, Bohlius J, Cameron DA, Dal Lago L, Donnelly JP, Kearney N, Lyman GH, Pettengell R, Tjan-Heijnen VC, Walewski J, Weber DC, Zielinski C, European Organisation for Research and Treatment of Cancer (2011) 2010 update of EORTC guidelines for the use of granulocyte-colony stimulating factor to reduce the incidence of chemotherapy-induced febrile neutropenia in adult patients with lymphoproliferative disorders and solid tumours. Eur J Cancer 47:8–32

    Article  CAS  PubMed  Google Scholar 

  8. Patterson RE, Neuhouser ML, Hedderson MM, Schwartz SM, Standish LJ, Bowen DJ, Marshall LM (2002) Types of alternative medicine used by patients with breast, colon, or prostate cancer: predictors, motives, and costs. J Altern Complement Med 8:477–485

    Article  PubMed  Google Scholar 

  9. World Health Organization (2007) WHO international standard terminologies on traditional medicine in the western pacific region. World Health Organization, Western Pacific Region, Manila, Philippines

  10. World Health Organization Western Pacific Region (2007) WHO international standard terminologies on traditional medicine in the western pacific region. Manila

  11. Deng H, Shen X (2013) The mechanism of moxibustion: ancient theory and modern research. Evid Based Complement Alternat Med 2013:379291

    Article  PubMed Central  PubMed  Google Scholar 

  12. Yang HQ, Liu XG, Yang X, Chen T, Yu SG (2013) Effect of different types of moxibustion intervention on expression of inflammatory cytokines IL-1 and TNF-alpha in rabbits with rheumatoid arthritis. Zhen Ci Yan Jiu 38:134–139

    PubMed  Google Scholar 

  13. Zhang JL, Li SS, Luo WH, Zhang DF, Shu RG (2008) Research of moxibustion therapy for cancer: a review. Jiangxi J Tradit Chin Med 39:59–61

    Google Scholar 

  14. Lee MS, Choi TY, Park JE, Lee SS, Ernst E (2010) Moxibustion for cancer care: a systematic review and meta-analysis. BMC Cancer 10:130

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Pei J, Yu YM, Wei H, Fang ZQ, Guan DY, Yu QW (2007) Experimental research on moxibustion in modulating tumor immunosuppression. Shanghai J Tradit Chin Med 41:1–4

    Google Scholar 

  16. Cui J, Yan J (2007) Effect of moxibustion or acupuncture at Geshu acupoint on the granulocyte-macrophage colony stimulating factor of cyclophosphamide induced leukopenic rats. J Clin Rehabil Tissue Eng Res 11:5473–5476

    CAS  Google Scholar 

  17. Yang HY, Hu ZC (2010) Biophysical characteristics of moxibustion. World J Acupunct Moxibustion 20(27–31):37

    CAS  Google Scholar 

  18. Lu J, Zhang HL, Yin ZZ, Tu Y, Li ZG, Zhao BX, Guo JY (2012) Moxibustion attenuates inflammatory response to chronic exhaustive exercise in rats. Int J Sports Med 33:580–585

    Article  PubMed  Google Scholar 

  19. Zhao XX, Hang XM, Wang HP, Lu M, Yu TK (2011) Effect of acupuncture-moxibustion on bone marrow suppression and leukocytes after chemotherapy. J Acupunct Tuina Sci 9:331–335

    Article  Google Scholar 

  20. Li Y, Li P (2010) The research progress of acupuncture in the treatment of leukopenia after radiotherapy and chemotherapy. Gansu J Tradit Chin Med 23:71–73

    CAS  Google Scholar 

  21. Lee MS, Kim T-H, Ernst E (2012) Is acupuncture or moxibustion better than a sham or placebo-treatment? In: Cho WCS (ed) Acupuncture and moxibustion as an evidence-based therapy for cancer. Springer Netherlands, pp. 249-264

  22. Choi T-Y, Lee M, Ernst E (2012) An overview of acupuncture and moxibustion for cancer care. In: Cho WCS (ed) Acupuncture and Moxibustion as an evidence-based therapy for cancer. Springer Netherlands, pp. 1-18

  23. Zhang HW, Lin ZX, Cheung F, Cho WCS, Tang JL (2013) Moxibustion for alleviating side effects of chemotherapy or radiotherapy in cancer patients (Protocol). Cochrane Database Syst Rev. doi:10.1002/14651858.CD010559

    Google Scholar 

  24. Lu W, Hu D, Dean-Clower E, Doherty-Gilman A, Legedza AT, Lee H, Matulonis U, Rosenthal DS (2007) Acupuncture for chemotherapy-induced leukopenia: exploratory meta-analysis of randomized controlled trials. J Soc Integr Oncol 5:1–10

    Article  PubMed  Google Scholar 

  25. Higgins JPT, Altman DG, Sterne JAC (2011) Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 510. The Cochrane Collaboration,http://www.cochrane-handbook.org, Accessed 28 May 2014

  26. Wu YT, Wu JY, Yue HP (2013) Observation on thermal moxibustion on myelosuppression induced by chemotherapy in patients with malignant tumor. Liaoning J Tradit Chin Med 40:2120–2121

    Google Scholar 

  27. Shao KW, Kong YM (2012) Clinical study on herbs-partitioned moxibustion treatment of after chemotherapy with leukopenia in 82 cases. Hunan J Tradit Chin Med 28:86–87

    Google Scholar 

  28. Li PH (2012) Clinical study on ginger moxibustion for the treatment of leukopenia after chemotherapy of cancer. China J Chin Med 27:1244–1245

    Google Scholar 

  29. Zhao XX, Lu M, Zhu X, Gao P, Li YL, Wang XM, Ma DY, Guo XH, Tong BY, Yang XL, Du WW, Zhou SF, Liu HM, Ran PF, Lu XR (2007) Multi-central clinical evaluation of ginger-partitioned moxibustion for treatment of leukopenia induced by chemotherapy. Chin Acupunct Moxibustion 27:715–720

    CAS  Google Scholar 

  30. Zhang Y, Luo YX, Caui XP, Hu H (2013) Clinical observation on the treatment of leukocytopenia after chemotherapy in 45 patients with malignant tumor receiving herbs-partitioned moxibustion. Pharm Clin Chin Mater Medica 4:42–43

    CAS  Google Scholar 

  31. Liang JJ, Luo GY, Du ZP (2012) Clinical observation on herbs-partitioned moxibustion prevention for gastrointestinal cancer with cause chemotherapy of bone marrow suppression. J Emerg Tradit Chin Med 21:1330–1331

    Google Scholar 

  32. Vickers A, Goyal N, Harland R, Rees R (1998) Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials 19:159–166

    Article  CAS  PubMed  Google Scholar 

  33. Schulz KF (2001) Assessing allocation concealment and blinding in randomised controlled trials: why bother? Evid Based Nurs 4:4–6

    Article  CAS  PubMed  Google Scholar 

  34. Zhao B, Wang X, Lin Z, Liu R, Lao L (2006) A novel sham moxibustion device: a randomized, placebo-controlled trial. Complement Ther Med 14:53–60

    Article  PubMed  Google Scholar 

  35. Park JE, Lee SS, Lee MS, Choi SM, Ernst E (2010) Adverse events of moxibustion: a systematic review. Complement Ther Med 18:215–223

    Article  PubMed  Google Scholar 

  36. Moor A, McQuay H (2006) Bandolier’s little book of making sense of the medical evidence. Oxford University Press, Oxford

    Book  Google Scholar 

  37. Schulz KF, Altman DG, Moher D, CONSORT Group (2011) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Int J Surg 9:672–677

    Article  PubMed  Google Scholar 

  38. MacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, Moher D, STRICTA Revision Group (2010) Revised STandards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement. J Evid Based Med 3:140–155

    Article  PubMed  Google Scholar 

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Conflict of interest

None

Accessing the primary data

Our manuscript had no primary data, and all of the data came from primary research.

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Authors and Affiliations

  1. Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, 305-811, South Korea

    Tae-Young Choi & Myeong Soo Lee

  2. Complementary Medicine, Peninsula Medical School, University of Exeter, Exeter, UK

    Edzard Ernst

Authors
  1. Tae-Young Choi
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  2. Myeong Soo Lee
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  3. Edzard Ernst
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Corresponding author

Correspondence to Myeong Soo Lee.

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PROSPERO registration number: CRD42014009739

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Choi, TY., Lee, M.S. & Ernst, E. Moxibustion for the treatment of chemotherapy-induced leukopenia: a systematic review of randomized clinical trials. Support Care Cancer 23, 1819–1826 (2015). https://doi.org/10.1007/s00520-014-2530-7

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