Acupuncture for Chemotherapy-Induced Nausea and Vomiting: An Umbrella Review of Systematic Reviews

This umbrella systematic review aimed to evaluate the efficacy of invasive acupuncture for chemotherapy-induced nausea and vomiting (CINV) by synthesizing existing systematic reviews and meta-analyses and conducting a renewed meta-analysis of primary randomized controlled trials (RCTs).

We systematically searched the Cochrane Library, Embase, PubMed, Web of Science, China Biology Medicine (CBM), VIP Chinese Scientific Journals Database (VIP), China National Knowledge Infrastructure (CNKI), and Wanfang Data Knowledge Service Platform from inception to November 9, 2025, for SRs/MAs evaluating invasive acupuncture for CINV. The methodological quality, reporting quality, and risk of bias of the included SRs/MAs were assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, and Risk of Bias in Systematic Reviews (ROBIS), respectively. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the certainty of evidence for the outcomes reported in the included SRs/MAs. A renewed meta-analysis of the primary RCTs identified from these SRs/MAs was subsequently conducted to evaluate the efficacy of invasive acupuncture for CINV. Statistical heterogeneity, sensitivity, and publication bias were also assessed.

Eight SRs/MAs were included. Their methodological quality was generally low, and the GRADE assessment indicated low or very low certainty of evidence for most reported outcomes. The renewed meta-analysis included 41 primary RCTs involving 3,843 patients. Invasive acupuncture showed significant benefits for delayed CINV, improving the effective rate (18 RCTs, P < 0.001, RR = 1.26, 95% CI: 1.17-1.34, I² = 49%) and complete response rate (11 RCTs, P = 0.002, RR = 1.32, 95% CI: 1.10-1.57, I² = 55%). It also improved Karnofsky Performance Status (KPS) scores (5 RCTs, P < 0.001, MD = 5.16, 95% CI: 3.15-7.16, I² = 52%) and Functional Living Index-Emesis (FLIE) scores after chemotherapy completion (3 RCTs, P < 0.001, MD = 5.50, 95% CI: 2.64-8.35, I² = 68%) and reduced serum 5-HT levels (4 RCTs, P < 0.001, MD = -27.65, 95% CI: -39.24 to -16.06, I² = 0%).

Invasive acupuncture may be beneficial for delayed CINV. However, the certainty of the current evidence is limited by the methodological limitations of the available studies. Further large-scale, rigorously designed RCTs with adequate sample sizes are needed to confirm its efficacy for CINV.