Inspired by Chen et al 2026.[1]
EA – electroacupuncture
CINV – chemotherapy-induced nausea and vomiting
IF – impact factor
5-HT – 5-hydroxytryptamine (serotonin)
NK – neurokinin
GSRS – gastrointestinal symptom rating scale
IBS – irritable bowel syndrome
MCID – minimal clinically important difference
SD – standard deviation
CI – confidence interval (95% here)– key to acronyms
This trial in the Journal of the National Cancer Institute (IF 7.8) first came out in early August but has just come to the top of my queue. We don’t see many such trials of EA in CINV despite the fact that we have suspected its efficacy for over a quarter of a century – see EA for CINV 2024.[2]
This paper comes from Chengdu and is a multicentre study (6 centres). 230 patients with colon or high rectal cancer who had already been through at least one cycle of chemotherapy and suffered GI symptoms were randomised to one of 3 arms – EA, sham, or usual care. EA or sham were in addition to usual care.
EA was performed for 30 minutes daily for 3 days from the day of chemotherapy. EA was applied from LI11 to PC6 and ST36 to ST37 on both sides. The frequency used was 2Hz and we are told that the intensity was from 0.1mA to 10mA – of course 0.1mA is subthreshold for most nerves in most situations and 10mA is very strong stimulation and considerably above what most patients would tolerate. The sham was a non-penetrating off-point sham control without stimulation but with EA leads attached.
All groups received standard therapy for prophylaxis of CINV consisting of a 5-HT3 receptor antagonist and dexamethasone, with the addition of an NK1 receptor antagonist at the clinician’s discretion.
The primary outcome was the change in GSRS score from baseline to day 3. The GSRS is a 15-item questionnaire that was originally developed for IBS and peptic ulcer disease.[3]
It assesses 5 symptom domains, including abdominal pain, reflux, indigestion, diarrhoea, and constipation, with nausea/vomiting captured as an individual item. The research group used the validated Chinese version, which employs a modified 0-3 Likert scale and yields a total score of 0-45, with higher scores indicating more severe symptoms. Patients admitted to the trial had to have scored at least 2 on the GSRS during the previous cycle of chemotherapy.
The MCID for the GSRS is taken to be half of the baseline SD. The mean baseline GSRS score in this trial was between 8 and 9 with SDs of 4.1 to 4.5. This led to the team to adopting a 2.15 change as being the MCID.
The reduction in score by day 3 was 2.83 (CI 3.58 to 2.09) in the EA group, 1.04 in the sham group, and 1.38 in the usual care group (EA vs sham p < 0.001; EA vs usual care p = 0.001).
So, the mean change from baseline in the EA group was clinically relevant, but the lower CI was just less than the adopted MCID. I guess that about 90% of the EA group had a clinically relevant benefit from the addition of EA to usual care; however, the difference between EA and usual care was only 1.3 (CI 2.09 to 0.50). This led to the muted conclusion and reference to between group differences. Readers of this blog will have heard me comment many times about MCIDs and the irrelevance of applying them to between group mean differences.
The bottom line is that the EA group was highly significantly improved compared with both sham and usual care alone at day 3, and less than 5% of patients in the sham or usual care groups had a clinically relevant improvement whereas over 90% of the EA group achieve that improvement.
The groups all ended up in the same place on the GSRS at day 10, but that was after a week of no extra treatment, which is not really a surprise.
References
1 Chen Z, Xu T, Sun M, et al. Electroacupuncture for acute gastrointestinal symptoms during chemotherapy for colorectal cancer: a randomized clinical trial. J Natl Cancer Inst. 2026;djag265. doi: 10.1093/jnci/djag265
2 Shen G, Ren D, Zhao F, et al. Effect of Adding Electroacupuncture to Standard Triple Antiemetic Therapy on Chemotherapy-Induced Nausea and Vomiting: A Randomized Controlled Clinical Trial. J Clin Oncol. 2024;42:4051–9. doi: 10.1200/JCO.24.00099
3 Svedlund J, Sjödin I, Dotevall G. GSRS–a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci. 1988;33:129–34. doi: 10.1007/BF01535722
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