Supplementary Material for: Acupuncture relative to sham control in managing breast cancer-related hot flashes: a meta-analysis of randomized controlled trials

Introduction: Breast cancer is the leading cause of morbidity and mortality among female cancers globally. Hot flashes are among the most bothersome complications in women with breast cancer. Acupuncture is a common complementary approach for cancer worldwide. Here we aim to determine the differential effect between acupuncture and sham acupuncture on hot flashes among breast cancer patients. Methods: Eight English and Chinese databases through 10 October 2024, such as PubMed, Cochrane Library, ScienceDirect, Web of Science, etc. were searched to identify the randomized controlled trials (RCTs) about acupuncture relative to sham control treating breast cancer patients experiencing hot flashes. Outcomes included hot flash frequency per day, hot flash severity score, quality of life related to hot flashes, response rate. Continuous variables and categorical ones were expressed as standardized mean difference (SMD) or MD, and risk ratio (RR), with 95% confidence interval (CI), respectively, for meta-analysis. Sensitivity analysis and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) of evidence were conducted additionally. Results: Eight RCTs involving 493 participants were included. Relative to sham control, acupuncture was significantly more efficacious in improving the quality of life of breast cancer patients experiencing hot flashes (165 participants, SMD [95%CI]:-1.01 [-1.99, -0.03], I2=88%, P=0.04) at the end of treatment, as well as at follow-up of over three months (59 participants, MD [95%CI]: -3.38 [-4.83, -1.93]). With respect to response rate, acupuncture achieved a higher rate versus sham acupuncture (118 subjects, RR[95%CI]:2.66 [1.63, 4.36], I2=0, P＜0.0001). Sensitivity analysis solely supported the statistically significant difference between the two groups in terms of response rate (RR [95%CI]: 2.14 [1.03, 4.44]) or 3.20 [1.64, 6.23]). As for frequency and hot flash severity, no difference was noted between groups. GRADE of evidence showed low to very low quality.
Conclusions: Acupuncture reached a significantly higher response rate compared to sham control in breast cancer patients with hot flashes, whereas its efficacy on the quality of life showed inconsistency. Given significant heterogeneity and low quality of evidence, future large-sample-size and high-quality RCTs are warranted.