Supplementary Material for: Efficacy and safety of acupuncture-related interventions for fatigue, quality of life, and cancer-related indicators in cancer patients: a systematic review and network meta-analysis

ABSTRACT
Objective: Although studies have explored the analysis of acupuncture therapy in the treatment of cancer-related fatigue, there are still deficiencies in terms of the degree of fatigue, quality of life, and cancer-related indicators. The best option remains elusive regarding the degree of improvement in these aspects. This systematic review and network meta-analysis compared the efficacy of various acupuncture therapies on the degree of fatigue, quality of life, and cancer-related indicators (natural killer (NK) cells, CD3+ cells, CD4+ cells) among cancer survivors.
Methods: A comprehensive literature search was conducted across eight databases from their establishment to September. The methodological quality of the included randomized controlled trials (RCTs) was assessed using the Cochrane Collaboration’s Risk of Bias Tool. Pairwise meta-analysis was performed in Review Manager (version 5.3), while traditional meta-analysis for continuous outcomes was conducted using Stata 18.0 software with a random-effects model, reporting effect sizes as both standardized mean differences (SMDs) and weighted mean differences (WMDs). Network meta-analysis (NMA) was employed to synthesize the data, with network diagrams illustrating comparisons between interventions for different outcome measures. We evaluated the consistency of results, performed sensitivity analyses, and examined publication bias to assess its influence on individual studies. Additionally, subgroup and network meta-regression analyses were conducted to explore potential sources of heterogeneity.
Results: This study included 30 studies involving 2287 patients and 6 acupuncture-related interventions. Our results suggest that acupuncture methods have great advantages in improving fatigue, quality of life, and cancer-related indicators in cancer survivors. In particular, moxibustion may be the best acupuncture modality for improving CRF, quality of life, CD3+ cells, and CD4+ cells. In contrast, warm acupuncture contributes more to increasing natural killer (NK) cells. Sensitivity analysis validated the robustness of the research findings. Although there was publication bias, it did not affect the overall results of the network meta-analysis.
Conclusion: Our findings suggest that moxibustion has great potential in treating CRF. It may improve quality of life, CD3+ cells, and CD4+ cells. For natural killer (NK) cells, warm acupuncture may be the optimal regimen to personalize the treatment when clinical problems are encountered.