TABLE 3.

Treatment Parameters for Included Studies

Study	Study Design/ Participants	Acupuncture Points	Type of Stimulation/ Retention	No. of Acupuncture Treatments	Treatment Frequency/ Follow-Up	Primary Outcome(s)	Results/Conclusions	Limitations
Nedstrand 200624	RCT of women with breast cancer; EA (n = 19) vs applied relaxation (n = 19)	EA: bilaterally from B23 to B32 + GV20 and bilateral B15, H7, Sp6, Sp9, Lv3, and P6	Electrostimulation; retained 30 min	14	Twice per wk for 2 wk, then once per wk for 10 wk Weekly 60-min applied-relaxation sessions for 12 wk Follow-up for 6 mo	No. of HFs/24 h (per daily logbook) KI	No sig differences were seen between groups, but a sig decrease was seen in No. of HFs/24 h from the baseline in both groups. No. of HFs decreased from 8.4 (95% CI, 6.6– 10.2) to 4.1 (95% CI, 3.0– 5.2) after 12 wk and to 3.5 (95% CI, 1.7–5.3) after 6 mo in the EA group (n = 17; P <.0001) and from 9.2 (95% CI, 6.6–11.9) to 4.5 (95% CI, 3.2–5.8) after 12 wk and to 3.9 (95% CI, 1.8–6.0) after 6 mo in the applied-relaxation group (n = 14; P < .001).	Small sample size/ low statistical power; no patient blinding; no usual-care comparison group
							Similarly for KI, a sig within- group improvement (P < .001 for both) was seen, but no sig between-group differences were found.
							Conclusion: There were within-group improve- ments from the baseline only.
Deng 200725	Crossover RCT of women with breast cancer and 3 or more HFs/d; TA (n = 39 at 6 wk; n = 33 at 6 mo) vs SA (n = 28 at 6 wk; n = 17 at 6 mo); after 6 wk, 17 SA patients crossed over to TA.	TA: GV14, bilateral Gb20, B13, P7, H6, K7, St36, and Sp6 + ear Shenmen and ear Sympathetic SA: nonpenetrating needles applied a few centimeters from TA points	Manual; retained 20 min	8	Twice per wk for 4 wk Follow-up for 6 mo	No. of HFs/24 h (per daily diary	Mean No. of HFs/24 h was reduced from 8.7 (SD, 3.9) to 6.2 (SD, 4.2) in the TA group and from 10.0 (SD, 6.1) to 7.6 (SD, 5.7) in the SA group. TA was associ- ated with 0.8 fewer HFs/d than SA at 6 wk, but no sig between-group differ- ences were found (95% CI, −0.7 to 2.4; P = .3). When participants in the SA group crossed over to TA, a further reduction in HFs was seen, and it per- sisted for up to 6 mo after the completion of treatment.	Crossover design with small sam- ple; short treat- ment and washout period
							Conclusion: No sig between- group differences were seen, but additional improvement was seen af- ter SA patients crossed over to TA.
Frisk 200826 and Frisk 201231 (same data)	RCT of women with breast cancer; EA (n = 27) for 12 wk vs HT (n = 18) for 24 mo	EA bilaterally from B23 to B32 + GV20 and bilateral B15, H7, Sp6, Sp9, Lv3, and P6	Electrostimulation; retained 30 min	14	Twice per wk for 2 wk followed by 10 weekly sessions HT given for 2 y and then stopped Follow-up for 24 mo	No. of HFs/d and No. of HFs/night for 24 h (per daily logbook); HF distress KI	At 12 wk, median No. of HFs/24 h decreased from 9.6 (IQR, 6.6–9.9) to 4.3 (IQR, 1.0–7.1; P < .001) for EA (n = 19) vs 6.6 (IQR, 4.0–8.9) to 0.0 (IQR, 0.0– 1.6; P = .001) for HT (n = 18).	Small sample size; no patient blinding
							For KI, a sig improvement was found over time within groups and in favor of HT for between-group com- parisons (at 12 mo, P = .002; at 24 mo, P = .039).
							Conclusion: Both EA and HT had a persistent sig effect over time, with differences between groups in favor of HT (P < .001) 12 mo after the start of treatment. EA is a possible treatment for HFs in this population.
Hervik & Mjaland 200927	Women with breast cancer; TA (n = 30) vs SA (n = 29)	TA: Lv3, Gb20, Lu7, K3, Sp6, CV4, P7, and Lv8 SA: superficial nee- dling at 4 bilateral points located 5, 10, and 15 cm proximal to the upper border of the patella and 1 point over the highest point of the trape- zius muscle	Manual; retained 30 min	15	Twice per wk for 5 wk followed by 5 weekly sessions Follow-up for 12 wk	No. of HFs/d and No. of HFs/night (recorded on the same day each wk for 4 wk before treat- ment, during 10-wk treatment period, and 12 wk after treatment) KI	A sig between-group differ- ence was found for day- time HFs in favor of TA during treatment and at 12 wk (P < .001 for both), with similar findings for nighttime HFs (P = .009 during treatment; P < .001 at 12 wk). For KI, a sig difference was found in favor of TA after treatment (P = .004) and at 12 wk (P = .001).	Small sample size; both groups treated by 1 acupuncturist (unblinded)
							Conclusion: A sig decrease in daytime and nighttime HFs in favor of TA over SA was seen.
Liljegren 201228	Women with breast cancer; TA (n = 38) vs SA (n = 36)	TA: LI4, H6, Lv3, and St36 unilaterally and Sp6 and K7 bilaterally SA: nonpenetrating needle on same meridian 1 cm from TA points	Manual; retained 20 min	10	Twice per wk for 5 wk Follow-up for 1 wk	No. of HFs/d and No. of HFs/ night (recorded at the baseline and 1, 3, and 18 wk after EOT)	Both groups reported improvement from the baseline in the severity and frequency of HFs (42% [16/38] at 6 wk [ie, 1 wk after EOT] for TA vs 47% [17/36] for SA [95% CI, −28% to 18%]). A sig improvement was also found in favor of TA for nighttime HF severity (P = .03), but no other sig between-group differences were found.	Both TA and SA participants able to accu- rately guess group assign- ment at EOS (69.4% and 63.9%, respectively); almost all treatments given by same (unblinded) acupuncturist
							CONCLUSION: Sig between- group differences in favor of TA were observed for nighttime HFs only
Walker 20107	Women with breast cancer; TA (n = 25) vs venlafaxine (n = 25)	Bilateral core points: B23, K3, and Sp6 Secondary points based on TCM di- agnosis: GV14, GV20, Gb20, Lu9, Lv3, St36, CV6, P7, and H7	Manual; retained 30 min	16	Twice per wk for 4 wk, then 8 weekly sessions Venlafaxine at 37.5 mg PO HS for 1 wk followed by 75 mg HS for 11 wk Follow-up for 1 y	No. of HFs/24 h (per HFD)	Sig decreases (50%) in HFs were observed between the baseline and EOT for both groups with no sig between-group differen- ces; this indicated that TA was as effective as venla- faxine. By 2 wk after treat- ment, the venlafaxine group experienced sig increases in HFs, whereas HFs in the TA group remained low. The venla- faxine group experienced 18 occurrences of adverse effects (eg, nausea, dry mouth, dizziness, and anx- iety), whereas there were no adverse effects in the TA group.	Small sample size; no blinding
							CONCLUSION: TA was as effective as drug therapy with fewer adverse events.
Bao 201410	Women with stage 0- III breast cancer; TA (n = 23) vs SA (n = 24)	TA: CV4, CV6, CV12, bilateral LI4, SJ6, Gb34, St36, K3, and B65 SA: nonpenetrating device in 14 nona- cupuncture points	Manual; retained 20 min	8	Weekly Follow-up for 24 wk	Severity; No. of HFs/24 h (per HFD) HFRDI	For TA, sig improvements at 8 wk were found for HF severity (P = .006), HF fre- quency (P = .011), and HFRDI (P = .014), whereas for SA, improvement was found only for HFRDI (P = .043). African American patients (n = 9) benefited more from TA than SA in comparison with non-Afri- can American patients (n = 38) in reducing HF se- verity (P <.001) and fre- quency (P <.001).	Small sample size; study powered to detect improvements in AIMSS, not sig differences between TA and SA
							CONCLUSION: Within-group improvements were found for both TA and SA with no sig between-group differences.
Bokmand & Flyger 201329	Women with breast cancer; TA (n = 31) vs SA (n = 29) vs NA (n = 34)	TA: bilateral H6, K3, Sp6, and Lv3 SA: bilateral nonacu- puncture points (4) with superficial insertion	Manual; retained 15–20 min	5	Weekly Follow-up for 12 wk	HF distress (0–10 on VAS per logbook)	Sig less distress was found in favor of TA vs SA (P < 0.01) or NA (P < .001), with effects occurring after the second acupuncture session and lasting at least 12 wk. CONCLUSION: TA was more effective than either SA or NA for HF distress in this population.	Unclear how patient-reported HF distress per VAS compares with measures used in other studies (eg, No. of HFs/24 h)

Abbreviations: AIMSS, aromatase inhibitor musculoskeletal symptoms; B, bladder; CI, confidence interval; GV, governing vessel; EA, electroacupuncture; EOS, end of study; EOT, end of treatment; Gb, gallbladder; H, heart; HF, hot flash; HFD, hot flash diary; HFRDI, Hot Flash-Related Daily Interference Scale; HS, at bedtime; HT, hormone replacement therapy; IQR, interquartile range; K, kidney; KI, Kupperman index; LI, large intestine; Lu, lung; Lv, liver; NA. no acupuncture; R pericardium; PO, by mouth; RCT, randomized controlled trial; CV, conception vessel; SA, sham acupuncture; SD, standard deviation; sig, statistically significant; SJ, san jiao (triple burner); Sp, spleen; St, stomach; TA, true acupuncture; TCM, traditional Chinese medicine; VAS, visual analogue scale.