Meta-analysis of 28 RCTs suggests acupuncture may improve cancer-related fatigue levels

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Frontiers in Medicine Published May 5, 2026 Medically reviewed May 5, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Note that while acupuncture showed improvement in fatigue, evidence quality remains low or very low.

This meta-analysis synthesized data from 28 RCTs to assess the impact of acupuncture on cancer-related fatigue. The primary focus was the Piper Fatigue Scale (PFS) as a measure of fatigue levels in comparison to control groups.

The results showed that acupuncture intervention significantly improved fatigue levels compared to the control group, with a mean difference of -0.56 (95% CI: -0.74 to -0.38, P < 0.01). While these data suggest a potential benefit, the authors noted several significant limitations regarding the certainty of the findings.

Key limitations include low overall study quality, with most outcomes rated as low or very low quality according to GRADE criteria. The authors also identified indications of publication bias and noted that sensitivity analyses for multiple outcome measures yielded unstable results. Safety data and specific follow-up durations were not reported.

Clinically, the current evidence suggests that acupuncture may alleviate cancer-related fatigue, but conclusive evidence remains limited. Further high-quality studies are required to confirm these findings and establish definitive therapeutic efficacy.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

Background/objectivesAcupuncture is recommended for the treatment of cancer-related fatigue (CRF), but the strength of evidence remains limited. This study aims to comprehensively update the evaluation of the effectiveness of acupuncture for CRF and clarify the latest strength of evidence.MethodsEight databases were searched from inception to April 2025 to identify eligible randomized controlled trials (RCTs). The quality of the study was assessed using the Cochrane risk of bias tool version 2.0(ROB 2.0). Meta-analyses were performed using R studio 4.4 software and RevMan software (version 5.4). Subgroup analyses by acupuncture type were conducted to explore sources of heterogeneity and further elucidate the efficacy of different acupuncture modalities. Publication bias was assessed when applicable. Finally, evidence quality was rated using the GRADE system.ResultsThis meta-analysis included 28 RCTs. Risk of bias assessment indicated low overall study quality. The meta-analysis of the primary outcome(Piper Fatigue Scale, PFS) revealed that acupuncture intervention significantly improved fatigue levels compared to the control group (MD = -0.56, 95% CI: -0.74 to -0.38, I2 = 45%, P < 0.01). Subgroup analyses showed that different acupuncture type had distinct advantages, suggesting distinct targeted advantages. Other factors showed significant differences. Sensitivity analyses for multiple outcome measures yielded unstable results, with indications of publication bias. According to GRADE criteria, the most outcomes were rated as low or very low quality.ConclusionsCurrent evidence suggests that acupuncture may alleviate CRF. However, conclusive evidence supporting its therapeutic efficacy remains limited. Given the methodological concerns and low certainty of the available evidence, further high-quality studies are needed to confirm these findings.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024603184.