Volume 11, Number 2 | Summer 2016

Japanese Acupuncture - Current Research
Japanese Traditional Medicine Text (20) Palliative Care
Masanori Takashi

Cancer is the number one cause of death inJapan since 1981. With the addition of the rapid
aging of society as another major factor, these aretimes when one in every two people has cancer
and one in every three people dies of cancer inJapan.
Given that cancer has become a serious issue
to people’s lives and health, the Japanese
government established the Cancer Control Act
in June 2006 and put it into force in April 2007.
Article 16 of the Act, titled “Maintenance andImprovement of the Quality of Recuperation byCancer Patients,” stipulates that “medical care torelieve pain and other suffering should be
implemented early and appropriately.” Thus,
education to develop dedicated cancer specialists
is now being promoted among healthcare
professionals in various fields.
1. Definition of Palliative Care
Palliative care refers to specialized medicalcare given to cancer patients, from the point they
are told they have cancer and begin treatment,
through to their receiving terminal care. WHOdefines palliative care as “an approach thatimproves the quality of life of patients and theirfamilies facing the problem associated with lifethreatening illness, through the prevention andrelief of suffering by means of early identificationand impeccable assessment and treatment ofpain and other problems, physical, psychosocialand spiritual.” Cancer patients face various typesof pain and distress that disrupt their ability tolive humanly. Based on this understanding, it isimportant for health workers to actively help
cancer patients live their one and only precious
life as a unique human being by relieving them of
their pain and distress while respecting their will,

8values and dignity to the greatest extent. The
meaning of cancer treatment is thus to prolong
life, provide cure, alleviate symptoms, andimprove QOL. Providing treatment may have theeffect of prolonging life, but it causes QOL todecline in many cases. Palliative care, on theother hand, neither hastens nor delays death, but
improves QOL by alleviating the patient’s
various pains and distress. Therefore, palliative
care and cancer treatment are not contradictory,
but rather supplement each other, and the twocombined could perhaps deliver “ideal cancertreatment” that aims to both improve QOL andprolong life.
The role of acupuncture therapy in palliative
care must be considered not from a onedirectional approach to treatment, but from amulti-dimensional perspective of the situation athand. It could be classified into therapy for (1)prevention of recurrence after Western medicaltreatment, (2) management of the physicalcondition of patients, (3) alleviation of symptoms
among cancer patients, (4) mitigation of sideeffects produced by Western medical treatment,and (5) terminal care.
2. Overview of Studies in Japan and Overseas
Below is an introduction of publications on
symptoms of cancer patients that are expected tobenefit
fromacupuncture,basedon“Acupuncture guidelines based on palliative
evidence of cancer treatment using acupuncture”
presented in a study report published byShimoyama1).
a. Publication search conditions and evaluation(Table 20)
Publications (study designs) were classified
into systematic reviews (SR) and meta-analyses(MA), randomised controlled trials (RCT), nonrandomised controlled trials, studies with nocontrol group, and others.
A total of 261 publications were adopted fromThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 11, Number 2 | Summer 2016

among a list of 1,757 English publications
composed of database search results and otherrelated publications, obtained after eliminating
all duplications. They included 15 systematic
reviews and meta-analyses, 30 randomisedcontrolled trials, 5 non-randomised controlledtrials, 140 studies with no control group, and 71
others.
To evaluate research quality, systematic
reviews were evaluated according to 11 items of theQuality of Reporting of Meta-Analyses (QUOROM)
Checklist. Those that satisfied 7 or more items
were considered to be high in quality, and thosethat satisfied 6 or less items were considered to below. Randomised controlled trials were evaluatedusing the van Tulder scale (11 items). Those thatsatisfied 7 or more items were considered to be highin quality, and those that satisfied 6 or less items
were considered to be low.
Table 20 Publication search conditions
November 2006 & October 2007
Search Engine
Englishpublications

PubMedJapanesepublications

Ichushi-Web (service
provided by the JapanMedical Abstracts
Society)

Condition
Publications on
acupuncture andcancer.
Publications on
acupuncture andcancer.

January 2008 & January 2009
Search Engine
EnglishpublicationsJapanesepublications

MEDLINE, EMBASE,AMED, COCHRANELIBRARY, PubMed
Ichushi-Web (service
provided by the Japan
Medical Abstracts
Society)

Condition
Publications on
acupuncture andcancer
Words related toacupuncture.
Words related tocancer

b. Symptoms that are expected to benefit fromacupuncture
Symptoms that emerged included aching pain,
hiccups, diarrhea, vasomotor disturbance,xerostomia, nausea, poor feeding, dysuria,leukopenia, fatigue and malaise, anxiety,insomnia,edema,abdominalfullness,constipation,numbness,
andacupuncture
anesthesia. Of these symptoms, five with thelargest number of references are discussed below.
1) Aching pain (including both cancerous pain
and pain unrelated to cancer)
The search yielded 47 English papers and 39
Japanese papers. They consisted of 4 systematicreviews, 9 randomised controlled trials, 51 casereports, and 11 studies with no control group.
Among these, “Acupuncture for the relief ofcancer – related pain – a systematic review” byLee, H. et al., a publication that discusses
acupuncture treatment, scored high on theQualityof
ReportingofMeta-Analyses(QUOROM) Checklist. The evaluation of “Efficacyof complementary and alternative medicine
therapies in relieving cancer pain: a systematicreview” by Bardia, A. was such that “acupuncturetreatment may be valid, but as there are too few
studies that have been carefully designed, itcannot be said to be useful to relieving pain.” TheJapanese papers were all case reports, andincluded a report by Kobayashi et al., which
discusses 7 cases of treatment that combined EAP
and an analgesic.
In terms of clinical applicability, evidence levelwas 1a, and recommendation level was C.
2) Nausea, vomiting, poor feeding
The search yielded 21 English publications and6 Japanese publications. They consisted of 6
systematic reviews, 7 randomised controlled trials,
6 studies with no control group, and 8 case reports.
“Cochrane systematic reviews examine P6
acupuncture ─ point stimulation for nausea andvomiting” by Ezzo, J., Streitberger, K. et al.
scored relatively high on the Quality of Reportingof Meta-Analyses (QUOROM) Checklist, and was
judged as a substantial systematic review. TheJapanese publications were all case reports, andincluded a report on the improvement of cancer
symptoms by Yoshikawa.

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9Volume 11, Number 2 | Summer 2016

In terms of clinical applicability, evidence levelwas 1a, and recommendation level was A(conditional).
The
conditionwas
thatelectroacupuncture is effective against vomiting
after chemotherapy.
All Japanese papers were case reports.
3) Vasomotor disturbance (hot flashes)
The search yielded 12 English papers and noJapanese papers. They consisted of 2 systematicreviews, 2 randomised controlled trials, 6 studies
with no control group, and 2 case reports. Most
literature was about breast cancer patients.
In terms of clinical applicability, evidence levelwas 1b, and recommendation level was B.
There were no relevant Japanese papers.
4) Fatigue and malaise
The search yielded 8 English papers and 11Japanese papers. They consisted of 1 systematicreview, 1 randomised controlled trial, 4 studies
without a control group, and 12 case reports.
“The management of cancer – related fatigue
after chemotherapy with acupuncture andacupressure: A randomised controlled trial” byMolassiotis, A., Sylt, P., and Diggins, H. scored ahigh 8/11 on the van Tulder scale. In it, thefeeling of fatigue and malaise is compared amongan acupuncture group, a shiatsu finger-pressure
therapy group and a sham shiatsu therapy group,with the result that all groups showed significant
improvement in general fatigue, physical fatigue,activity and motivation, and the acupuncturegroup showing particularly greater efficacy
compared to the other groups.
All case reports were Japanese papers, with 10
out of 12 papers showing a positive result.
In terms of clinical applicability, evidence levelwas 1b, and recommendation level was A, on thecondition that it is recommended only to cancer
patients who complain of fatigue after
chemotherapy.
The Japanese papers were all case reports,
with the exception of 2 studies without a control

10group. They were “Acupuncture and moxibustion
therapy for cancer patients” and “Cancer care –Pain relief provided to cancer patients – The
reality and efficacy of acupuncture andmoxibustion” by Yokokawa et al.
5) Edema
The search yielded 4 English papers and 4Japanese papers.
Evidence level was low, as they were all studies
without a control group. Acupuncture is notrecommended, due to scattered results.
Of the 8 papers, 4 showed a positive result.
In terms of clinical applicability, evidence level
was 5, and recommendation level was C(precaution needed). Due to the scattered resultspresented in the papers, no conclusion was able tobe reached at the present stage.
The Japanese papers included a study without
a control group titled “An experience inacupuncture and concoction combined treatment
against leg edema after radical hysterectomy orradiation therapy” by Takashi and a case reporton 40 cases by Yokokawa et al.
3. Summary
Judging by the numbers of Japanese papers
published in the last 10 years, there is increasing
interest in palliative care, but most papers arecase reports, and do not discuss the efficacy ofacupuncture treatment or present any evidence of
its scope of application. Recently, however, anincreasing trend has begun to be seen in papers on
moxibustion, such as “Leukokinetic analysis ofmoxibustion therapy applied in combination withchemotherapy forperitoneal cancer”
byNakamura, and papers on the mitigation of theside effects of Western medical treatment, such as“Acupuncture therapy against the side effects ofcancer treatment – The safety and efficacy ofacupuncture
therapyagainstperipheral
neuropathy caused by cancer chemotherapy” byFukuda et al. and “Cancer and integrative

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Volume 11, Number 2 | Summer 2016

medicine – Palliative care” by Kitsuya et al.
References1) Shimoyama, Naoto (research reporter). “Studyon the mechanism of endogenous analgesia,
including acupuncture and moxibustion, andits clinical applicability to palliative cancer
care: FY2009 General/shared research reportfunded by the Grants-in-Aid for Scientific
Research (research on region medical) of the
Ministry of Health, Labour and Welfare,”April 2010 (Material 1).

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