Introduction
Acupuncture has become increasingly incorporated into integrative oncology as a supplemental method of managing symptoms refractory to conventional treatments. 1 - 3 As such, many comprehensive cancer centers and supportive care programs have embraced acupuncture as a nonpharmacologic intervention with favorable safety. 1 - 3 This integration reflects the growing understanding of the complex symptom burden that cancer patients endure and the necessity of multifaceted approaches to address physical, emotional, and psychological ailments. 4 , 5 The wide range of symptoms, including pain, exhaustion, nausea, sleep disturbances, peripheral neuropathy, and psychological distress, are frequently experienced by cancer patients as a result of the disease and its treatment. 6 , 7 These symptoms frequently affect daily functioning and quality of life, first-appearing during active therapy and continuing throughout survivorship. 7 , 8 Pharmacologic treatments, while essential for symptom management, may result in bothersome side effects allowing for the complementary use of integrative therapies such as acupuncture. 2 , 9
The potential benefits of acupuncture for certain cancer-related symptoms are increasingly studied with meta-analyses among breast cancer populations demonstrating reductions in pain, fatigue, and hot flashes compared with the standard of care. 10 , 11 Additional studies indicate that acupuncture may alleviate chemotherapy-induced nausea and vomiting, improve sleep quality, reduce fatigue, address xerostomia, and reduce musculoskeletal discomfort among cancer survivors. 12 - 14 Individualized patient-reported outcome measures, such as the Measure Yourself Concerns and Wellbeing (MYCaW) questionnaire, have been validated in the oncologic population to capture symptom changes pertinent to such patients. 15 , 16 However, prior research often aggregates symptoms into broad clusters/categories, making it difficult to determine which specific symptoms may preferentially respond to acupuncture. By refining response categories and changes, this study seeks to examine improvement of specific malignancy and treatment-related symptoms by patients receiving acupuncture.
Methods
Patient Inclusion Characteristics
The Emory IRB deemed this project part of quality improvement, thus no IRB approval was required. Patients treated by the Integrative Oncology and Survivorship (IOS) Program at the Winship Cancer Institute from March 2023 to November 2025 were retrospectively enrolled in this study. Eligibility criteria were defined as being 18 years of age, having a primary cancer diagnosis, completing the acupuncture regimen and having completed pre- and post-treatment MyCaW questionnaires. Completion of the acupuncture regimen was defined as attending a minimum of 8 weekly acupuncture sessions. Patients with incomplete treatment regimens and missing data were otherwise excluded. General breakdown of study enrollment is included in Supplemental Figure 1 . Numbers are reported in accordance with STROBE guidelines for observational studies. Baseline demographic and clinical information were collected through chart reviews. Variables included age, gender, race, body mass index (BMI, kg/m2), smoking history, cancer status, and Eastern Cooperative Oncology Group (ECOG) performance status. All protected health information was gathered and de-identified in compliance with standard clinical protocols prior to data extraction.
Treatment Protocol and Outcomes
Established patients were referred to the Integrative Oncology Program by their respective medical oncology providers at the NCI-designated Winship Cancer Institute. Acupuncture sessions were scheduled at one-week intervals, with each session lasting 30 minutes. The number of acupuncture sessions attended ranged from a minimum of 8 to a maximum of 12. Treatments were performed by a licensed acupuncturist in a reduced group setting. Patients were instructed to list up to 3 of their most bothersome symptoms to be targeted by acupuncture at each session. Acupuncture points were selected for each patient based on pre-established institutional protocols ( Supplemental Table 1 ). There were no acupuncture-related adverse events reported by patients.
The Measure Your Concerns and Well-Being (MyCaW) is an assessment tool commonly utilized to collect health outcomes data in medical settings, including the benefit of complementary therapies such as acupuncture. 15 This questionnaire has been validated in the oncology setting and in clinical trials sampling heterogeneous patient populations with various symptomatology and primary diagnoses. 17 , 18 Patients were asked to self-identify and rate their two greatest symptoms on a Likert scale of 0 ( No bother at all ) to 6 ( Bothers me greatly ). Responses were collected during baseline and subsequent follow-up sessions. Patient-reported symptoms were then categorized into one of 20 categories ( Supplemental Table 2 ) due to their heterogenous nature.
These categories were internally determined through a three-tiered review process that included primary researchers, physicians, and the acupuncturist. The two primary researchers independently reviewed responses and categorized them into one of 20 domains given the broad range of initial reported symptoms. They were blinded to pre- and post-acupuncture MyCaW scores throughout this process. Disagreements in inter-rater categorization were resolved through consensus by a naturopathic physician and the lead acupuncturist. Nonetheless, formal inter-rater reliability was not assessed. Additionally, because the MyCaW instrument allows patients to identify more than one concern, individual patients could contribute data to different symptom categories. As such, the symptom domains may not be independent categories.
Statistical Analysis
The main objective for the current study was to evaluate the pre-to-post changes in patient-reported symptoms after the completion of a group acupuncture regimen. Categorical variables were reported as total count with percentages, while continuous variables were documented as median values with interquartile ranges (IQR). Pre-to-post changes in MyCaW scores were calculated. In prior outcomes studies validating this instrument, researchers established a 0.5-point threshold for clinical significance, recognizing the questionnaire is sensitive enough to track changes in patient-reported concerns at this level. 15 , 16 This parameter was utilized for the purposes of this study. Wilcoxon signed-rank tests were administered to analyze change in categorized symptoms from baseline to post-acupuncture completion. Non-parametric tests were utilized given the small sample size for eight symptom categories; additionally, those with larger sample sizes had non-normal distribution. To mitigate the use of multiple comparisons in the analysis, adjusted p-values were employed using the Bonferroni correction method. A significance threshold of p < 0.0025 and two-sided p-values were used for the purposes of this study. Analyses were conducted using STATA, version 18.5 (StataCorp LLC, College Station, TX).
Results
Cohort Characteristics
723 patients met inclusion criteria, of whom 570 (78.8%) were female. Patients’ median (IQR) age was 60 (IQR 51-69) years, and median (IQR) cohort BMI was 26.78 (23.11-31.6) kg/m 2 . A total of 260 patients were Black/African American (35.96%). Regarding cancer status, 240 (47.0%) patients had active disease and 483 (53.0%) were survivors. The most represented primary cancer diagnoses were breast (382; 52.84%), multiple myeloma (54; 7.47%), head and neck (44; 6.09%), colorectal (44; 6.09%), and prostate (37; 5.12%) with no other group representing more than 5% of the cohort. Total cohort characteristics are demonstrated in Table 1 , and Table 2 depicts cohort primary cancer diagnosis distributions.
Table 1.
Total Cohort Demographics and Clinical Features
Abbreviations: Eastern Cooperative Oncology Group (ECOG); Body Mass Index (BMI); Interquartile range (IQR).
| Covariate | Subgroup | Total (N = 723) |
| Age | Median (IQR) | 60 (51-69) |
| Gender | Female | 570 (78.8%) |
| Male | 153 (21.2%) | |
| Race | Asian | 28 (3.9%) |
| Black or African American | 260 (35.9%) | |
| Native Hawaiian or Other Pacific Islander | 3 (0.4%) | |
| Other | 14 (1.9%) | |
| Unknown | 5 (0.7%) | |
| White | 413 (57.1%) | |
| BMI (kg/m2) | Non-obese (<30) | 228 (31.5%) |
| Obese (≥30) | 495 (68.5%) | |
| Median (IQR) | 26.78 (23.11-31.60) | |
| Smoking History | Current | 9 (1.2%) |
| Former | 170 (23.5%) | |
| None | 544 (75.2%) | |
| Cancer Status | Survivorship | 483 (53.0%) |
| Active | 240 (47.0%) | |
| ECOG Performance Status | ECOG 0 | 449 (62.1%) |
| ECOG 1+ | 257 (35.6%) | |
| Not Reported | 17 (2.3%) |
Table 2.
Distribution of Cohort Primary Cancer Diagnoses
| Primary diagnosis | Total (N = 723) |
| Anal Cancer | 6 (0.8%) |
| Bladder Cancer | 5 (0.7%) |
| Brain and Spine Tumors | 10 (1.4%) |
| Breast Cancer | 382 (52.8%) |
| Cervical Cancer | 3 (0.4%) |
| Colorectal Cancer | 44 (6.1%) |
| Esophageal Cancer | 2 (0.3%) |
| Head and Neck Cancer | 44 (6.1%) |
| Kidney Cancer | 9 (1.2%) |
| Leukemia | 6 (0.8%) |
| Liver Cancer | 2 (0.3%) |
| Lung Cancer | 16 (2.2%) |
| Lymphoma | 10 (1.4%) |
| Melanoma | 6 (0.8%) |
| Multiple Myeloma | 54 (7.5%) |
| Neuroendocrine Tumors | 2 (0.3%) |
| Other | 11 (1.5%) |
| Ovarian Cancer | 26 (3.5%) |
| Pancreatic Cancer | 12 (1.7%) |
| Prostate Cancer | 37 (5.1%) |
| Sarcoma | 6 (0.8%) |
| Skin Cancer | 1 (0.1%) |
| Stomach Cancer | 6 (0.8%) |
| Testicular Cancer | 2 (0.3%) |
| Thyroid Cancer | 1 (0.1%) |
| Uterine Cancer | 20 (2.8%) |
Improvement of Categorized Patient-Reported Symptoms
Table 3 depicts baseline and post-treatment symptom prevalence and respective severities. The most prevalent symptom domains included peripheral neuropathy (n=293), general pain (n=245), fatigue–low energy (n=120), hot flashes (n=96), insomnia (n=83), and cancer-related pain (n=78). Median baseline symptom severity scores were uniformly elevated across domains, generally ranging from 4 to 5 on the assessment scale. Results from Wilcoxon signed-rank tests evaluating change in categorized symptoms after acupuncture are also reported in Table 3 . Medium-to-large effect sizes ( |r| ≥0.6) were observed in most symptom categories. Notable improvements included upper gastrointestinal symptoms ( Mdn : 5 vs 3; r = −0.86, p<0.001), radiation-related changes (5 vs 3; r = −0.80, p<0.001), lower gastrointestinal symptoms (5 vs 3; r = −0.79, p<0.001), oral–salivary gland symptoms (5 vs 3; r = −0.79, p<0.001), and anxiety–stress (5 vs 3; r = −0.78, p<0.001). Common high-prevalence symptoms also demonstrated clinically meaningful improvement, including peripheral neuropathy (5 vs 4; r = −0.74, p<0.001), general pain (5 vs 3; r = −0.73, p<0.001), fatigue–low energy (5 vs 3; r = −0.77, p<0.001), hot flashes (5 vs 3; r = −0.78, p<0.001), insomnia (5 vs 4; r = −0.77, p<0.001), and cancer-related pain (5 vs 4; r = −0.77, p<0.001). Even less prevalent symptoms, such as brain fog (5 vs 3; r = −0.77, p=0.0021), demonstrated statistically significant and substantial magnitude improvements. Depression (5 vs 4; r = −0.85, p = 0.057),urinary incontinence (4 vs 3; r = −0.85, p = 0.057), cough–shortness of breath (5 vs 4, r = −0.88, p = 0.031), ear, nose, and throat concerns (5 vs 3, r = −0.87, p = 0.022), and headaches–migraines (4 vs 3, r = −0.67, p = 0.012) were the only nonsignificant symptoms. Spider plot visualization of pre-to-post-acupuncture changes are included for all categorized patient-reported symptoms in Figure 1a -b [insert here].
Table 3.
Pre-to-post-acupuncture changes in categorized patient-reported symptoms
Bolded values indicate statistical significance.
| Categorized symptoms | n | Median baseline score | Median follow-up score | Adjusted p-value α = (0.05/20) = 0.0025 | Z | Effect size ( r ) |
| Anxiety–Stress | 63 | 5 (4-5) | 3 (2-4) | <0.001 | -5.41 | -0.78 |
| Brain Fog | 21 | 5 (4-6) | 3 (2.5-5) | 0.0021 | -3.08 | -0.77 |
| Cancer-related Pain | 78 | 5 (4-6) | 4 (2-5) | <0.001 | -5.85 | -0.77 |
| Cough–SOB | 7 | 5 (4-6) | 4 (1-5) | 0.031 | -2.16 | -0.88 |
| Depression | 7 | 5 (4-6) | 4 (1-4) | 0.057 | -1.90 | -0.85 |
| Ear, Nose, and Throat | 9 | 5 (3.5-6) | 3 (1.5-3.5) | 0.022 | -2.29 | -0.87 |
| Fatigue–Low Energy | 120 | 5 (4-6) | 3 (2-4) | <0.001 | -7.50 | -0.77 |
| General Pain | 245 | 5 (4-6) | 3 (2-4) | <0.001 | -10.22 | -0.73 |
| Headaches–Migraine | 16 | 4 (3-5.5) | 3 (1-4) | 0.012 | -2.51 | -0.67 |
| Hot Flashes | 96 | 5 (4-6) | 3 (2-4.5) | <0.001 | -6.81 | -0.78 |
| Insomnia | 83 | 5 (4-6) | 4 (3-5) | <0.001 | -6.23 | -0.77 |
| Lower Gastrointestinal | 19 | 5 (4-5) | 3 (1-4) | <0.001 | -3.25 | -0.79 |
| Lymphedema | 36 | 5 (4-6) | 4 (2.5-5) | <0.001 | -4.23 | -0.81 |
| Oral–Salivary Gland | 29 | 5 (5-6) | 4 (4-5) | <0.001 | -3.43 | -0.79 |
| Other | 59 | 5 (4-6) | 4 (2-5) | <0.001 | -5.16 | -0.77 |
| Peripheral Neuropathy | 293 | 5 (4-6) | 4 (2-5) | <0.001 | -11.16 | -0.74 |
| Post-operative Pain | 59 | 5 (4-6) | 3 (2-5) | <0.001 | -4.77 | -0.70 |
| Radiation-related Changes | 65 | 5 (4-6) | 3 (2-5) | <0.001 | -5.75 | -0.80 |
| Upper Gastrointestinal | 44 | 5 (4-6) | 2.5 (1-3) | <0.001 | -5.60 | -0.86 |
| Urinary Incontinence | 5 | 4 (3.5-6) | 3 (2-3.5) | 0.057 | -1.91 | -0.85 |
Discussion
In this study, participation in a group acupuncture regimen was associated with statistically and clinically significant symptom improvement. Patients who received at least 8 acupuncture sessions reported lower symptom severity post-completion compared with baseline. These results suggest that acupuncture may be associated with improvement across a broad range of symptoms self-reported by patients, highlighting its potential use in cancer symptom management.
Improvement of Categorized Patient-Reported Symptoms
Improvements were observed across multiple physical and psychosocial domains, reflecting the complex symptom burden commonly experienced by patients with cancer. The largest median reductions were noted in upper and lower gastrointestinal symptoms, depression, ENT-related concerns, and urinary incontinence, with additional improvements in pain, fatigue, insomnia, anxiety–stress, peripheral neuropathy, hot flashes, and radiation-related changes (e.g., trismus). These findings are consistent with contemporary literature indicating that acupuncture is frequently used to address multiple co-occurring symptoms rather than a single isolated concern. 2 , 9 , 12 Additionally, these findings align with real-world clinical observations, as patients seeking acupuncture in oncology settings often report high baseline symptom severity across pain, fatigue, sleep, and emotional domains. 19 The holistic framework of acupuncture may therefore be well suited to addressing overlapping symptom clusters common in supportive cancer care. 4 , 6 , 7
Improvements in pain-related symptoms align with existing evidence supporting acupuncture for cancer-related pain management. 3 , 9 , 10 Similarly, observed improvements in fatigue, sleep disturbance, anxiety, depressive symptoms, and peripheral neuropathy are consistent with prior studies reporting favorable outcomes in patients receiving acupuncture and acupoint-based interventions for both physical and psychological symptoms in oncology populations. 12 , 13 , 20 The use of an individualized patient-reported outcome measure allowed patients to identify symptoms most relevant to their experience. The MYCaW instrument has demonstrated responsiveness and validity in heterogeneous oncology populations and complementary therapy settings. 15 By organizing patient-identified concerns into standardized symptom domains, this study extends prior MYCaW-based research by enabling domain-specific analysis while maintaining a patient-centered approach, offering greater specificity than studies focused solely on global wellbeing or composite outcomes. 14 , 16
Limitations
These findings should be contextualized within certain limitations. The absence of a control group and unmeasured confounders limit causal inference as improvements may reflect concurrent treatment effects such as supportive medical care, natural symptom fluctuation over time, and placebo effects. Different clinical factors could also influence utility and completion rates of acupuncture, and integrative care in general. These may include patients’ cancer type and stage, which treatment therapies they have received, and general disease burden. The possibility of selection bias should also be considered, as only patients who had completed 8 visits and the MyCaW data at baseline and post-acupuncture were included. Those with incomplete regimens and missing data may have reported different outcomes. Symptom categories were internally developed and have not been externally validated, introducing potential misclassification. Although researchers were blinded to symptom severity scores throughout the process, inter-rater reliability when categorizing patient-reported concerns was not assessed either. However, acupuncture treatment often involves overlapping point selection for multiple symptoms, and observed improvements may still reflect meaningful clinical improvement even when symptom boundaries are not discrete. Future studies should focus on external validation of symptom categorization frameworks and further exploration of whether symptom response varies by cancer diagnosis, treatment modality, or baseline symptom burden. Comparative evaluation of group-based and individual acupuncture delivery models may also inform scalable implementation within integrative oncology programs. 21 Overall, these findings support continued investigation of acupuncture as a component of comprehensive, patient-centered symptom management in oncology care.
Conclusions
In this retrospective study of patients with more than 24 various types of cancer receiving acupuncture, improvements were observed across all symptom domains using the MyCaW tool. While several key limitations, including the potential for unmeasured confounders, limit causal inference, this analysis represents a general first step in determining the association between acupuncture and symptom improvement among patients with cancer. Further research accounting for prognostic confounders is warranted to validate our results and establish the role of acupuncture in the treatment of such symptoms.
Supplemental Material
Supplemental Material - A Retrospective Assessment of Symptom Reduction With Group Acupuncture at an NCI-Designated Comprehensive Cancer Center
Supplemental Material for A Retrospective Assessment of Symptom Reduction With Group Acupuncture at an NCI-Designated Comprehensive Cancer Center by Maria Grosso Zelaya, Moshelle Borjigin, Reza Lahiji, Gloria Fung, Anna Bausum, Margarite Melikian, Almira Catic, Ryan Suk, Kevin Kalinsky, Viraj A. Master in Integrative Cancer Therapies.
Supplemental Material - A Retrospective Assessment of Symptom Reduction With Group Acupuncture at an NCI-Designated Comprehensive Cancer Center
Supplemental Material for A Retrospective Assessment of Symptom Reduction With Group Acupuncture at an NCI-Designated Comprehensive Cancer Center by Maria Grosso Zelaya, Moshelle Borjigin, Reza Lahiji, Gloria Fung, Anna Bausum, Margarite Melikian, Almira Catic, Ryan Suk, Kevin Kalinsky, Viraj A. Master in Integrative Cancer Therapies.
Supplemental Material - A Retrospective Assessment of Symptom Reduction With Group Acupuncture at an NCI-Designated Comprehensive Cancer Center
Supplemental Material for A Retrospective Assessment of Symptom Reduction With Group Acupuncture at an NCI-Designated Comprehensive Cancer Center by Maria Grosso Zelaya, Moshelle Borjigin, Reza Lahiji, Gloria Fung, Anna Bausum, Margarite Melikian, Almira Catic, Ryan Suk, Kevin Kalinsky, Viraj A. Master in Integrative Cancer Therapies.
Acknowledgements
The authors have no acknowledgements to declare.
Author Contributions: All authors were responsible for the conception and design of the project. Authors MB, AB, and MM participated in the initial data collection. Author MGZ was responsible for primary data analysis, executing interpretation of results, and preparing tables and figures. Authors MB and RL collaborated in manuscript writing. All authors participated in editing and revising the final manuscript for publication. Author VAM was responsible for the senior leadership and securing funding.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Generative AI Use: No generative AI was used for the production of this manuscript or content therein.
Supplemental Material: Supplemental material for this article is available online.
ORCID iD
Maria Grosso Zelaya https://orcid.org/0009-0006-7809-5427
Ethical Considerations
The Emory IRB deemed this project part of quality improvement, and no full IRB approval was required. All research was performed in line with the declaration of Helsinki.
Data Availability Statement
Data and statistical methodology underlying the results reported in this article can be made available upon reasonable request by investigators following publication. *
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Associated Data
Supplementary Materials
Supplemental Material - A Retrospective Assessment of Symptom Reduction With Group Acupuncture at an NCI-Designated Comprehensive Cancer Center
Supplemental Material for A Retrospective Assessment of Symptom Reduction With Group Acupuncture at an NCI-Designated Comprehensive Cancer Center by Maria Grosso Zelaya, Moshelle Borjigin, Reza Lahiji, Gloria Fung, Anna Bausum, Margarite Melikian, Almira Catic, Ryan Suk, Kevin Kalinsky, Viraj A. Master in Integrative Cancer Therapies.
Supplemental Material - A Retrospective Assessment of Symptom Reduction With Group Acupuncture at an NCI-Designated Comprehensive Cancer Center
Supplemental Material for A Retrospective Assessment of Symptom Reduction With Group Acupuncture at an NCI-Designated Comprehensive Cancer Center by Maria Grosso Zelaya, Moshelle Borjigin, Reza Lahiji, Gloria Fung, Anna Bausum, Margarite Melikian, Almira Catic, Ryan Suk, Kevin Kalinsky, Viraj A. Master in Integrative Cancer Therapies.
Supplemental Material - A Retrospective Assessment of Symptom Reduction With Group Acupuncture at an NCI-Designated Comprehensive Cancer Center
Supplemental Material for A Retrospective Assessment of Symptom Reduction With Group Acupuncture at an NCI-Designated Comprehensive Cancer Center by Maria Grosso Zelaya, Moshelle Borjigin, Reza Lahiji, Gloria Fung, Anna Bausum, Margarite Melikian, Almira Catic, Ryan Suk, Kevin Kalinsky, Viraj A. Master in Integrative Cancer Therapies.
Data Availability Statement
Data and statistical methodology underlying the results reported in this article can be made available upon reasonable request by investigators following publication. *