Effect of eight different acupuncture and moxibustion therapies on breast cancer-related lymphedema: a Bayesian network meta-analysis.

backgroundBreast cancer is the most prevalent cancer worldwide, and nearly 30% of affected patients experience breast cancer-related lymphedema (BCRL). Some evidence suggests that acupuncture and moxibustion therapies are safe and effective in the treatment of BCRL. Nevertheless, there is controversy regarding the optimal acupuncture and moxibustion therapy for BCRL.

objectiveThe aim of this study was to compare and rank the efficacy of different acupuncture and moxibustion therapies for BCRL, to identify the best acupuncture and moxibustion therapy for BCRL, and to provide a reference for clinicians to choose the treatment modality.

methodsWe searched PubMed, Embase, Cochrane Library, Web of Science, Google Scholar, China National Knowledge Infrastructure, CQVIP, Wanfang Data, and SINOMED Databases for randomized controlled trials (RCTs) of acupuncture and moxibustion therapy for BCRL from inception to March 30, 2023. The quality of the included literature was assessed using the Cochrane risk of bias assessment, and data were analyzed and plotted using R4.3.2 and Stata 15.1 software.

resultsWe included 27 RCTs including 8 acupuncture interventions with a sample size of 1976 cases. The results of the network meta-analysis showed that acupuncture + moxibustion, moxibustion, blood-letting puncture and cupping, and electroacupuncture combined with conventional rehabilitation were superior to conventional rehabilitation alone in reducing arm circumference. Moxibustion combined with conventional rehabilitation was superior to conventional rehabilitation alone in reducing the degree of edema. Electroacupuncture and acupoint massage combined with conventional rehabilitation were superior to conventional rehabilitation alone in reducing the visual analogue scale (VAS) scores. And in terms of improving the mobility of the shoulder joint, moxibustion and electroacupuncture combined with conventional rehabilitation were better than conventional rehabilitation alone.

conclusionThe combination of acupuncture and moxibustion therapy with conventional rehabilitation can improve the efficacy of BCRL. Acupuncture + moxibustion was the best treatment modality to reduce arm circumference, acupuncture was the best modality to reduce edema, and electroacupuncture was the most effective modality for relieving BCRL pain symptoms and was the best choice to improve abduction range of motion (ROM). Due to the limitations of this study, this conclusion remains to be validated by further high-quality clinical studies.