Effects of acupuncture on cancer-related fatigue and quality of life in breast cancer survivors: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Cancer-related fatigue (CRF) and impaired quality of life (QoL) are common consequences among breast cancer survivors. While acupuncture is increasingly applied as a complementary therapy, its efficacy remains unclear owing to inconsistent results across randomized controlled trials (RCTs) that have applied diverse outcome measures. This study aims to analyze how acupuncture affects CRF and both general and domain-specific QoL among breast cancer survivors. METHODS: Seven databases were comprehensively searched until May 1, 2025. We included RCTs comparing acupuncture with control interventions in breast cancer survivors reporting CRF or impaired QoL. Methodological quality and evidence certainty were assessed with the Grading of Recommendations, Assessment, Development, and Evaluation framework and the Cochrane Risk of Bias tool. RESULTS: Analysis of 13 RCTs (n = 963) showed acupuncture significantly reduced CRF severity on the Brief Fatigue Inventory (weighted mean difference [WMD]: -1.31, 95% confidence interval [CI] -2.04--0.59, P = .0004, I2 = 37%) and Cancer Fatigue Scale (WMD: -5.89, 95% CI -7.62--4.17, P < .00001, I2 = 0%), and improved clinical response rates (risk ratio: 1.46, 95% CI 1.14-1.87, P = .003, I2 = 44%). Significant benefits were also observed for the Pittsburgh Sleep Quality Index (WMD: -1.65, 95% CI -2.30--1.01, P < .00001, I2 = 0%) and the Hospital Anxiety and Depression Scale (standardized mean difference: -0.54, 95% CI -0.79--0.29, P < .0001, I2 = 0%). QoL improvement was significant when measured by the breast cancer-specific Functional Assessment of Cancer Therapy-Breast (standardized mean difference: 0.33, 95% CI 0.09-0.56, P = .007, I2 = 5%) but not with generic instruments. The evidence level was between moderate and very low. Acupuncture was found to be safe, with only minor adverse events reported. CONCLUSION: Acupuncture can effectively and safely alleviate CRF. Its benefits for QoL are best captured by disease-specific measures. Future high-quality RCTs with standard protocols and longer follow-up are warranted to confirm these benefits.