Electro-acupuncture for quality of life during adjuvant chemotherapy in gastric cancer: a randomized trial

Background Patients with locally advanced gastric cancer who undergo curative intent gastrectomy experience a decline in health-related quality of life (HRQOL) during adjuvant chemotherapy. The Electro-Acupuncture in Gastric Cancer (EAGER) trial sought to evaluate the ability of electro-acupuncture to preserve HRQOL in these patients. Methods In this open-label, multicenter, parallel controlled trial, patients with stage II-III gastric cancer across 11 hospitals in China who were undergoing chemotherapy following gastrectomy were randomly assigned to receive high-frequency electro-acupuncture, low-frequency electro-acupuncture, or no electro-acupuncture during the first 3 cycles of chemotherapy. The Functional Assessment of Cancer Therapy-Gastric was reported by patients at baseline and once weekly during the therapy. The primary outcome was the difference among groups in the Functional Assessment of Cancer Therapy-Gastric Trial Outcome Index trajectory during the study duration by the standardized area under the curve. Results Of 222 patients randomly assigned and analyzed, electro-acupuncture was associated with higher HRQOL measured by Trial Outcome Index–area under the curve (mean ± SD = 5678 ± 1229 [high-frequency electro-acupuncture], 5558 ± 1226 [low-frequency electro-acupuncture], and 4735 ± 1233 [usual care]; P < .001). No difference was seen based on acupuncture dosing (P = .557). Participants in the electro-acupuncture groups also showed a statistically significant improvement in disease-free survival (high-frequency electro-acupuncture vs usual care: hazard ratio [HR] = 0.47, 95% confidence interval [CI] =0.24 to 0.93; P = .026; low-frequency electro-acupuncture vs usual care: HR = 0.51, 95% CI = 0.28 to 0.95; P = .030), fewer grade 3-4 adverse events (20.7% vs 39.0%, P = .004), and decreased peripheral myeloid-derived suppressor cells (P = .038) compared with the usual care group. Conclusions Use of electro-acupuncture resulted in higher HRQOL in gastric cancer patients undergoing adjuvant chemotherapy, irrespective of dosing. Electro-acupuncture was also associated with prolonged disease-free survival and lower treatment-associated toxicities, which warrants further confirmative research. Trial Registration ClinicalTrials.gov NCT04360577.