Effectiveness of acupuncture for cancer-related fatigue: a systematic reviews and meta-analysis

Background/objectivesAcupuncture is recommended for the treatment of cancer-related fatigue (CRF), but the strength of evidence remains limited. This study aims to comprehensively update the evaluation of the effectiveness of acupuncture for CRF and clarify the latest strength of evidence.MethodsEight databases were searched from inception to April 2025 to identify eligible randomized controlled trials (RCTs). The quality of the study was assessed using the Cochrane risk of bias tool version 2.0(ROB 2.0). Meta-analyses were performed using R studio 4.4 software and RevMan software (version 5.4). Subgroup analyses by acupuncture type were conducted to explore sources of heterogeneity and further elucidate the efficacy of different acupuncture modalities. Publication bias was assessed when applicable. Finally, evidence quality was rated using the GRADE system.ResultsThis meta-analysis included 28 RCTs. Risk of bias assessment indicated low overall study quality. The meta-analysis of the primary outcome(Piper Fatigue Scale, PFS) revealed that acupuncture intervention significantly improved fatigue levels compared to the control group (MD = -0.56, 95% CI: -0.74 to -0.38, I2 = 45%, P < 0.01). Subgroup analyses showed that different acupuncture type had distinct advantages, suggesting distinct targeted advantages. Other factors showed significant differences. Sensitivity analyses for multiple outcome measures yielded unstable results, with indications of publication bias. According to GRADE criteria, the most outcomes were rated as low or very low quality.ConclusionsCurrent evidence suggests that acupuncture may alleviate CRF. However, conclusive evidence supporting its therapeutic efficacy remains limited. Given the methodological concerns and low certainty of the available evidence, further high-quality studies are needed to confirm these findings.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42024603184.