IMPACT (cancer pain)
Trial question
What is the role of acupuncture in patients living with advanced cancer pain?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
67.0% female
33.0% male
N = 298
298 patients (200 female, 98 male).
Inclusion criteria: patients with advanced cancer with moderate-to-severe pain and clinician-estimated life expectancy of > 6 months.
Key exclusion criteria: platelet count < 15,000; cognitive impairment precluding response to study assessments; unwilling to commit to 26-week study period; non-musculoskeletal pain syndromes.
Interventions
N=150 acupuncture (weekly acupuncture for 10 weeks with monthly booster sessions up to 26 weeks).
N=148 massage (weekly massage for 10 weeks with monthly booster sessions up to 26 weeks).
Primary outcome
Reduction in worst pain intensity score at week 26
2.53 points
3.01 points
3.0 points
2.3 points
1.5 points
0.8 points
0.0 points
Acupuncture
Massage
No significant
difference ↔
No significant difference in reduction in worst pain intensity score at week 26 (2.53 points vs. 3.01 points; AD -0.48 points, 95% CI -0.98 to 0.03).
Secondary outcomes
No significant difference in reduction in Brief Fatigue Inventory score at week 26 (1.15 points vs. 1.37 points; AD -0.22 points, 95% CI -0.7 to 0.25).
No significant difference in reduction in Insomnia Severity Index score at week 26 (3.49 points vs. 3.46 points; AD 0.02 points, 95% CI -1.23 to 1.27).
No significant difference in improvement in Patient-Reported Outcomes Measurement Information System-Global Health Physical Health score at week 26 (3.76 points vs. 3.66 points; AD 0.1 points, 95% CI -1.19 to 1.39).
Conclusion
In patients with advanced cancer with moderate-to-severe pain and clinician-estimated life expectancy of > 6 months, acupuncture was not superior to massage with respect to reduction in worst pain intensity score at week 26.
Reference
Andrew S Epstein, Kevin T Liou, Sally A D Romero et al. Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer: The IMPACT Randomized Clinical Trial. JAMA Netw Open. 2023 Nov 1;6(11):e2342482.
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