Weidong Lu

Symptom burden continues to be a significant challenge throughout the cancer care continuum, frequently persisting even when guideline-directed pharmacologic treatments are used. Acupuncture has emerged as a nonpharmacologic supportive care option with growing evidence of benefit in selected cancer-related symptoms and has been incorporated into multiple professional oncology guidelines. However, uncertainty about proper indications, safety issues, referral processes, and reimbursement structures has hindered its adoption into standard oncology practice. This review provides practical guidance for oncology clinicians about the roles of acupuncture in cancer care. We summarize clinical indications supported by guidelines, outline oncology-specific safety and risk stratification principles, and discuss implementation strategies within cancer centers, which include referral workflows, use of patient-reported outcomes, staffing and training considerations, and financial sustainability. When administered by oncology-trained practitioners and coordinated within multidisciplinary care teams, acupuncture is typically safe, provided that clinicians consider the patient's treatment phase, relevant laboratory and imaging results, presence of implanted devices, surgical scheduling, and extent of metastatic disease. Although insurance coverages for acupuncture in cancer care remains heterogenous in the United States, experience from mixed-payer environments demonstrates that services can be implemented using flexible delivery and staffing models, although financial sustainability remains influenced by payer mix and institutional support. For oncology professionals, familiarity with acupuncture referral criteria and available evidence can help broaden care options and support patient-centered symptom management.

Background: Visceral diseases often lead to referred pain, but clinical management is challenging due to poor understanding of the underlying mechanisms. Prior preclinical studies have shown that experimental induction of visceral diseases in animal models can cause cutaneous neurogenic inflammation, as assessed by Evans Blue dye extravasation. Neurogenic inflammation is associated with increased pain sensitivity. Thus, these preclinical findings may provide important mechanistic insights into the relationship between visceral diseases and referred somatic pain. Objective: The objective of this systematic review is to synthesize evidence on cutaneous neurogenic inflammation and corresponding somatic pain sensitivity in preclinical animal models of visceral diseases, to lay out the current state of knowledge, and to identify any gaps or limitations to be addressed in future research on this topic. Methods: This systematic review will be conducted, following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol) guidelines. The literature search will be conducted in MEDLINE (Ovid), Embase, and Web of Science, using search terms related to cutaneous neurogenic inflammation and animal models of visceral diseases. Two investigators will independently screen and select studies meeting the eligibility criteria. For each included study, a predefined template will be used to extract relevant information, including the details of animal species and strains, visceral disease models, outcomes related to the distribution and extent of Evans Blue dye extravasation, and other pertinent findings and methodologies. Quality assessments will be independently performed by two investigators using the Risk of Bias tool from the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE). A qualitative summary of the findings will be provided for outcomes related to the extent and distribution of Evans Blue dye extravasation. Results: As of August 2025, a total of 536 records were identified from database search, and 13 studies met the eligibility criteria to be included in the review. Results from data extraction and quality assessments are expected to be published in fall 2026. Conclusions: Prior preclinical animal studies have investigated cutaneous neurogenic inflammation as a potential mechanistic outcome of referred visceral pain. The proposed review will be the first to summarize research findings and study quality on this topic. This will be an important step toward gaining insights into one of the potential mechanisms underlying referred visceral pain and informing future research in this area. International Registered Report Identifier (IRRID): DERR1-10.2196/67852

Alice Feng, Mingxiao Yang, Weidong Lu, Wanqing Iris Zhi, Ting Bao. Journal of Acupuncture Research 2025;42:286-94. https://doi.org/10.13045/jar.25.0002

Background: In the United States, acupuncture education is divided into two primary pathways: medical acupuncture for licensed physicians and traditional acupuncture rooted in Traditional Chinese Medicine (TCM) for nonphysician practitioners. These pathways reflect the distinct educational needs and historical development of acupuncture in the United States. Objective: To compare medical and traditional acupuncture educational systems, highlighting their strengths, weaknesses, and the potential for integration to enhance patient care. Methods: This narrative review utilized comprehensive literature searches, analyzing peer-reviewed articles, institutional reports, and accreditation documents. The study focused on programs approved by the American Academy of Medical Acupuncture and accredited by the Accreditation Commission for Acupuncture and Herbal Medicine. Results: Medical acupuncture programs are shorter and emphasize evidence-based practice, allowing physicians to integrate acupuncture into conventional medical treatment. These programs focus on Western medical terminology and concepts but may lack depth in TCM principles. Traditional acupuncture programs offer extensive training in TCM principles and practices, including herbal medicine, with comprehensive clinical training but may lack emphasis on modern medical science and research-based evidence. There is a significant workforce disparity between licensed traditional acupuncturists and the much smaller number of medical acupuncturists in practice. Conclusions: Integrating both educational pathways can enhance patient care through comprehensive treatment approaches. Successful integration examples demonstrate improved patient outcomes. Future efforts should focus on developing joint training programs, promoting research collaboration, and increasing hospital-based internships to foster interdisciplinary learning and practice.

Molly Siegel, Sylvia Baedorf Kassis, Weidong Lu, Im Hee Shin, Ting Bao, Barbara E. Bierer. Journal of Acupuncture Research 2025;42:41-5. https://doi.org/10.13045/jar.24.0053

BACKGROUND Visceral diseases often lead to referred pain, but clinical management is challenging due to poor understanding of the underlying mechanisms. Prior preclinical studies have shown that experimental induction of visceral diseases in animal models can cause cutaneous neurogenic inflammation, as assessed by Evans Blue dye extravasation. Neurogenic inflammation is associated with increased pain sensitivity. Thus, these preclinical findings may provide important mechanistic insights into the relationship between visceral diseases and referred somatic pain. OBJECTIVE The objective of this systematic review is to synthesize evidence on cutaneous neurogenic inflammation and corresponding somatic pain sensitivity in preclinical animal models of visceral diseases, to lay out the current state of knowledge, and to identify any gaps or limitations to be addressed in future research on this topic. METHODS This systematic review will be conducted, following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol) guidelines. The literature search will be conducted in MEDLINE (Ovid), Embase, and Web of Science, using search terms related to cutaneous neurogenic inflammation and animal models of visceral diseases. Two investigators will independently screen and select studies meeting the eligibility criteria. For each included study, a predefined template will be used to extract relevant information, including the details of animal species and strains, visceral disease models, outcomes related to the distribution and extent of Evans Blue dye extravasation, and other pertinent findings and methodologies. Quality assessments will be independently performed by two investigators using the Risk of Bias tool from the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE). A qualitative summary of the findings will be provided for outcomes related to the extent and distribution of Evans Blue dye extravasation. RESULTS As of August 2025, a total of 536 records were identified from database search, and 13 studies met the eligibility criteria to be included in the review. Results from data extraction and quality assessments are expected to be published in fall 2026. CONCLUSIONS Prior preclinical animal studies have investigated cutaneous neurogenic inflammation as a potential mechanistic outcome of referred visceral pain. The proposed review will be the first to summarize research findings and study quality on this topic. This will be an important step toward gaining insights into one of the potential mechanisms underlying referred visceral pain and informing future research in this area. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/67852

Introduction Fatigue is a common symptom observed in post-cancer treatment, yet its underlying mechanisms remain poorly understood. Acupuncture has been employed to alleviate cancer-related fatigue (CRF); however, its effectiveness in addressing associated comorbidities that may influence fatigue is also poorly understood. This study represents the first investigation to use acupuncture as an intervention for fatigue in breast cancer survivors within a Norwegian cohort. The study will employ questionnaires to evaluate various facets of fatigue. As a pragmatic trial, it statistically assesses its clinical relevance, documents adverse events and evaluates the cost-effectiveness of the acupuncture treatment. Methods and analysis This assessor-blinded, pragmatic, randomised, mixed method, controlled trial with two parallel arms aims to evaluate the effectiveness, safety and cost-effectiveness of acupuncture. It will recruit 250 participants presented with CRF for 6 months or longer. Patients will be randomly allocated either to acupuncture and usual care (n=125) or to usual care alone (n=125). Acupuncture treatments (12 in total) are to be given within 12 weeks. The statistician who will analyse the data will be blinded to group allocation. The primary outcome will be changes in CRF measured by the Chalder fatigue scale. Measurements will be taken 12 weeks and 6 months after randomisation. The secondary outcomes include patient-reported outcomes of pain, anxiety, depression, hot flashes, insomnia and sleepiness. Health-related quality of life and economic evaluation will also be conducted 12 weeks and 6 months after randomisation. Nested within this randomised controlled trial are two qualitative studies and one sub-study measuring biomarkers (C-reactive protein, interleukin (IL)-1, IL-6, tumour necrosis factor alpha (TNF-α) and aPL in addition to the current genotype genes TNF-308 and IL-6–174) from blood samples (n=80). Such biomarkers can potentially address changes in CRF. Ethics and dissemination Ethical approval of this study has been granted by the Regional Committees for Medical and Health Research Ethics (REC southeast ID number: 112285). Written informed consent will be obtained from all participants. The outcomes of the trial will be disseminated through peer-reviewed publications. Trial registration number NCT04418115.

Background: Hot flashes are a common side effect of endocrine therapy (ET) that contribute to poor quality of life and decreased treatment adherence.Methods: Patients with breast cancer wo were receiving ET and experiencing hot flashes were enrolled through three parallel, randomized trials conducted in the United States, China, and South Korea. Participants were randomized to either immediate acupuncture (IA) or delayed acupuncture control (DAC). IA participants received 20 acupuncture sessions over 10 weeks, whereas DAC participants received usual care, then crossed over to acupuncture with a reduced intensity. The primary end point was a change in score on the endocrine symptom subscale of the Functional Assessment of Cancer Therapy (FACT)‐Endocrine Symptoms between baseline and week 10. Secondary end points included the hot flash score and the FACT‐Breast score. A planned pooled analysis of individual patient data was performed using longitudinal mixed models.Results: In total, 158 women with stage 0–III breast cancer were randomized (United States, n = 78; China, n = 40; South Korea, n = 40). At week 10, IA participants reported statistically significant improvements in the endocrine symptom subscale score (mean change ± standard error: 5.1 ± 0.9 vs. 0.2 ± 1.0; p = .0003), the hot flash score (−5.3 ± 0.9 vs. −1.4 ± 0.9; p < .003), and the FACT‐Breast total score (8.0 ± 1.6 vs. −0.01 ± 1.6; p = .0005) compared with DAC participants. The effect of the acupuncture intervention differed by site (p = .005).Conclusions: Acupuncture led to statistically and clinically meaningful improvements in hot flashes, endocrine symptoms, and breast cancer‐specific quality of life in women undergoing ET for breast cancer in the United States, China, and South Korea.

Purpose of Review Over the last 2 decades, integrative oncology (IO) has seen exponential growth within cancer care. It aims to combine evidence-based complementary therapies with conventional treatments to improve the well-being and quality of life for individuals dealing with cancer. The proliferation of integrative medicine programs in major cancer centers globally reflects varying approaches shaped by cultural, demographic, and resource-based factors. Recent Findings Drawing upon the expertise of leaders in IO from the Society for Integrative Oncology (SIO) Clinical Practice Committee, this manuscript serves as a practical guide for establishing an IO practice. Collating insights from diverse professionals, including oncologists, integrative oncologists, supportive care physicians, researchers, and clinicians, the paper aims to provide a comprehensive roadmap for initiating and advancing IO services. The primary objective is to bridge the gap between conventional cancer care and complementary therapies, fostering a patient-centric approach to address the multifaceted challenges encountered by individuals with cancer. Summary This paper delineates several key sections elucidating different aspects of IO practice. It delves into the core components necessary for an IO service’s foundation, outlines the initial medical consultation process, and presents crucial tools essential for successful consultations. By consolidating insights and expertise, this manuscript seeks to facilitate the integration of IO into mainstream cancer care, ultimately enhancing patient outcomes and experiences.