Author: Brandi Lemessy

Authors: Janet Liu, MA, C-IAYT, SIO Project Coordinator; Xiaotong Li, PhD, LAc, IMAGINE Lead Acupuncturist IMAGINE Project Team

The Growing Role of Acupuncture in Cancer Care

As cancer care increasingly incorporates integrative approaches, acupuncture has emerged as an important therapy for managing cancer- and treatment-related symptoms and improving quality of life.¹  Oncology acupuncture refers to the evidence-based application of acupuncture and related techniques within the context of cancer care. Oncology guidelines from the Society for Integrative Oncology and the National Comprehensive Cancer Network now recommend acupuncture for several cancer-related symptoms such as pain, fatigue, and chemotherapy-induced peripheral neuropathy.^2-3

What Makes Oncology Acupuncture Different

Patients with cancer present with clinical complexity that requires scientific knowledge of cancer and its many treatments. Many patients undergo multiple therapies, such as chemotherapy, radiation, endocrine therapy, or immunotherapy, either concurrently or sequentially. Symptoms for which patients seek acupuncture may be treatment-induced, disease-related, or both. Pain, fatigue, neuropathy, hot flashes, insomnia, and cognitive changes often stem from specific therapies, and lab values and medical status can shift rapidly.^4-5 In addition, oncology care involves critical safety considerations, including neutropenia, thrombocytopenia, lymphedema risk, bone metastases, implanted devices, treatment timing, and significant emotional distress. This environment requires acupuncturists to have biomedical literacy and to conduct ongoing risk assessment. To practice safely and effectively in oncology, acupuncturists must expand beyond traditional frameworks to include oncology-specific considerations.

Core Competencies for Oncology Acupuncturists

Foundational Oncology Knowledge

Understanding cancer biology, treatment modalities, and mechanisms of action helps acupuncturists anticipate symptom patterns, recognize potential complications, and identify potential red flags that warrant medical referral.

Risk Assessment

Acupuncturists should perform comprehensive local risk assessments to minimize potential adverse events in cancer patients. These assessments should include the evaluation of various factors such as laboratory values (e.g., absolute neutrophil and platelet counts), hematologic status, and risks related to the lymphatic and vascular systems. 

A critical component of the assessment is the timing of active cancer treatments, as certain treatments may impact acupuncture safety. Key risks to be aware of include increased bleeding or bruising due to treatment side effects, thrombocytopenia, and impaired clotting.

Oncology-related concerns such as lymphoedema, immunosuppression, deep vein thrombosis, cachexia, anorexia, and low body mass index (BMI) must also be carefully considered.¹ Additionally, practitioners should assess skeletal integrity, nutritional status, the presence of infections or medical devices, and psychosocial distress. 

Clinical Decision-Making

Following a thorough risk assessment, acupuncture treatment should be tailored to the individual needs of each patient, with strict adherence to contraindications.¹ Practitioners must maintain a dynamic approach, continuously reassessing the patient’s condition and adjusting treatment as necessary. This includes modifying or deferring acupuncture when conditions warrant, ensuring patient safety and optimal care throughout the course of treatment.¹

Symptom Science in Oncology

Cancer-related symptoms rarely occur in isolation; patients often present with clusters of fatigue, pain, insomnia, anxiety, neuropathy, comorbidities, and psychosocial stressors. Integrating biomedical understanding with familiarity with the current evidence base for acupuncture in specific symptoms supports more precise and effective treatment. 

Interdisciplinary Communication and Collaboration

Practitioners must communicate clearly with oncology providers, understand medical terminology, document appropriately within healthcare systems, and build trust within multidisciplinary teams.

Psychosocial Sensitivity and Trauma-Informed Care

The patient experience of cancer encompasses body and mind. Fear of recurrence, altered body image, existential distress, and survivorship challenges impact how the patient presents clinically. Acupuncturists must recognize these evolving concerns at different stages of the cancer journey and provide care that supports patients both physically and psychologically within a high-stakes medical environment.

Why General Acupuncture Training May Not Be Enough

Traditional acupuncture education provides strong foundations in theory, diagnosis, and needling technique. However, patients with cancer often have compromised immunity, rapidly changing laboratory values, complex treatment regimens, and significant psychosocial stressors that require advanced clinical judgment and coordination within oncology settings.¹ Because structured oncology training is not consistently included in acupuncture curricula, variability in practitioner preparation may contribute to concerns about competency within medical settings.⁶ In a survey sent to over 2,000 SIO members, when asked about barriers to referring someone to an acupuncturist, the second most common reported barrier was concern about competency and training.⁶ 

Oncology acupuncture is not about changing the practice of acupuncture—it’s about applying it safely and responsibly within a medically complex and emotionally charged environment that demands additional expertise.

Advancing the Field: The IMAGINE Project

As evidence supporting integrative oncology grows, there is increasing need for specialized acupuncture training and broader access to evidence-informed cancer care. Funded by the Patient-Centered Outcomes Research Institute (PCORI), the IMAGINE Project was developed to address these needs by supporting the integration of acupuncture into oncology settings through clinician education and implementation strategies.

Building on findings from the PCORI-funded IMPACT study, IMAGINE prepares licensed acupuncturists and massage therapists to deliver evidence-informed care for cancer-related pain within multidisciplinary oncology teams.⁷ The program focuses on translating research into practice by strengthening knowledge of integrative oncology, standardized treatment protocols, patient-provider communication, and clinical decision-making in oncology settings.

Central to the initiative is the self-paced online course, IMAGINE: Addressing Cancer-Related Pain Through Acupuncture, approved for 8 continuing education units (CEUs) by the National Certification Board for Acupuncture and Herbal Medicine (NCBAHM). The curriculum covers oncology fundamentals, psycho-oncology, pain and palliative care, integrative oncology, communication strategies, acupuncture safety, mechanisms of pain management, evidence-based research, the IMPACT acupuncture protocol, and interactive clinical case studies.

Beyond education, IMAGINE applies implementation science principles to identify barriers and facilitators to integrating oncology acupuncture into practice. By developing practical, scalable strategies for adoption across healthcare settings, the project aims to support sustainable delivery of evidence-based acupuncture care for people living with cancer.

Moving Toward a Gold Standard

As integrative oncology continues to mature, establishing rigorous education and competency standards for oncology acupuncture will be essential. Expanding specialized training opportunities, strengthening clinician competencies, and fostering interdisciplinary collaboration can help ensure acupuncture is delivered safely, consistently, and in accordance with the best available evidence.

The IMAGINE Project represents an important step toward that vision. By combining evidence-based education with implementation science, the project aims to bridge the gap between research and clinical practice while increasing access to high-quality supportive care. With appropriate training and collaboration, acupuncture has the potential to become an increasingly integrated component of comprehensive cancer care—helping patients manage pain and other treatment-related symptoms, maintain physical function, and improve quality of life throughout the cancer continuum.

References

1. de Valois B, Young T, Zollman C, Appleyard I, Ben-Arye E, Cummings M, Green R, Hoffman C, Lacey J, Moir F, Peckham R, Stringer J, Veleber S, Weitzman M, Wode K. Acupuncture in cancer care: recommendations for safe practice (peer-reviewed expert opinion). Support Care Cancer. 2024;32(4):229. doi:10.1007/s00520-024-08386-6
2. Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Cohen L, Deng G, Fouladbakhsh JM, Greenlee H, Herrera A, Hershman DL, Lopez AM, Marcom PK, Mustian KM, Peppone LJ, Rosenzweig M, Smith ML. Integrative medicine for pain management in oncology: Society for Integrative Oncology–ASCO guideline. J Clin Oncol. 2022;40(34):3998-4024. doi:10.1200/JCO.22.01357
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Supportive Care. Version 1.2024. National Comprehensive Cancer Network; 2024. Accessed March 2026. https://www.nccn.org
4. Lyman GH, Greenlee H, Bohlke K, Bao T, DeMichele AM, Deng GE, Fouladbakhsh JM, Gil B, Hershman DL, Mansfield S, Mussallem DM, Mustian KM, Peppone LJ, Pirl WF, Rosenzweig M, Wagner LI, Van Poznak CH, Cohen L. Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. J Clin Oncol. 2018;36(25):2647-2654. doi:10.1200/JCO.2018.79.2721
5. Bao T, Seidman AD, Piulson L, Vertosick E, Chen X, DeRosa A, Vickers AJ, Mao JJ. A phase IIA trial of acupuncture to reduce chemotherapy-induced peripheral neuropathy severity during treatment. Oncologist. 2020;25(4):310-318. doi:10.1634/theoncologist.2019-0489
6. Veleber S, Cohen MR, Weitzman M, et al. Characteristics and Challenges of Providing Acupuncture and Chinese Herbal Medicine in Oncology Treatment: Report of Survey Data and Experience of Five Unique Clinical Settings. Integr Cancer Ther. 2024;23. doi:10.1177/15347354241226640
7. Epstein AS, Liou KT, Romero SAD, Baser RE, Wong G, Xiao H, Mo Z, Walker D, MacLeod J, Li Q, Barton-Burke M, Deng GE, Panageas KS, Farrar JT, Mao JJ. Acupuncture vs massage for pain in patients living with advanced cancer: The IMPACT randomized clinical trial. JAMA Netw Open. 2023;6(11):e2342482. doi:10.1001/jamanetworkopen.2023.42482.

Authors: Janet Liu, MA, C-IAYT, SIO Project Coordinator; Ting Bao, MD, MS, SIO Past President, SIO Fellow; IMAGINE Project Team

Pain is one of the most common and challenging symptoms affecting up to 45% of people with cancer.(1) Cancer-related musculoskeletal pain may stem from the disease itself or emerge as a side effect of standard cancer treatments. Musculoskeletal pain affects bones, joints, ligaments, tendons, or muscles, and can become chronic. Chronic pain is often accompanied by other symptoms, such as fatigue and insomnia, leading to impaired overall quality of life.(2) 

While medications remain the first-line approach, a large body of research shows that integrative therapies such as acupuncture and massage therapy are effective non-medication options for safely and effectively reducing cancer-related musculoskeletal pain and related symptoms. At Memorial Sloan Kettering Cancer Center (MSK), the Patient-Centered Outcomes Research Institute- (PCORI) funded Integrative Medicine for Pain in Patients with Advanced Cancer Trial (IMPACT) found that both therapies were equally effective in improving pain and co-occurring symptoms such as fatigue and sleep disturbance.(12) The SIO–ASCO (Society for Integrative Oncology and American Society of Clinical Oncology) guideline on pain recommends acupuncture and oncology massage as evidence-based options.(3) Many cancer centers now include these therapies as part of standard cancer care. 

“For general cancer or musculoskeletal pain, therapies like acupuncture, reflexology or acupressure, and massage have evidence showing benefits outweigh harms. These approaches can be safely integrated with  conventional medications or physical therapy.” 

— Jun J. Mao, MD, MSCE, Chief, Integrative Medicine & Wellness Service, Memorial Sloan Kettering Cancer Center (MSK); Principal Investigator, IMPACT study and the IMAGINE Project(4) 

Acupuncture: Evidence for Pain Relief 

Acupuncture is part of an ancient traditional medicine system that research has demonstrated to be an effective treatment for musculoskeletal pain.(3) The procedure involves the use of very thin, sterile needles placed at specific points on the body. Research shows that acupuncture stimulates peripheral nerves, releases endorphins and serotonin, and modulates brain regions involved in pain perception.(5) 

Studies have shown that acupuncture can: 

• Reduce the amount of pain medication needed (6, 12)
• Ease side effects from pain medications (3)
• Improve pain related symptoms such as fatigue, sleep problems, and anxiety (7, 8, 9, 12) 
• Improve overall quality of life during and after cancer treatment (3, 10, 12)

When provided by trained practitioners, acupuncture is considered safe for most people with cancer. 

Massage Therapy: Evidence for Symptom Reduction 

Oncology massage adapts therapeutic massage techniques to ensure safe, appropriate care for people with cancer. Evidence suggests massage can reduce pain, tension, and stress by modulating the nervous system.(11, 12) 

Research shows that massage can:

• Improve pain and mood in people with cancer(12)
• Reduce anxiety(11, 12)
• Improve sleep and reduce fatigue(12)
• Support overall quality of life during and after treatment(11, 12, 13)

Massage is generally safe when delivered by an oncology-trained therapist. 

Patient Voices: Real Experiences with Acupuncture and Massage 

People with cancer describe acupuncture and massage as providing meaningful relief—helping ease discomfort, reduce stress, improve sleep, and enhance mobility. Many turn to these therapies to lessen reliance on pain medications and manage difficult side effects. In doing so, they often feel more in control of their symptoms and more supported throughout the treatment journey. 

“As I had radiation therapy and chemo, I was achy, had fatigue, balance issues, and fractured my shoulder. I used acupuncture and massage regularly, and I felt better. I believe acupuncture can boost the immune system, aiding recovery.” – Joan Rodman Smoller, PhD 

“Mom is 96 years old with severe lumbar stenosis, chronic low back pain, peripheral neuropathy, and osteoarthritic knee pain. Her age precluded opioids or surgery. Acupuncture has been magical—relieving her back pain, pins & needles, and knee pain—and may be causing endorphins to release, resulting in pain relief and nimbleness.” – Pearl Leung 

“I am in active treatment and started acupuncture to help my body adapt and treat issues like sciatica. My sciatica has cleared up, and my overall health has been stable. Acupuncture has helped me overcome symptoms and has been a huge help with my mental health.” – Burt Rosen

Implementing Evidence-Based Therapies in Clinical Programs 

Integrating evidence-based therapies like acupuncture and massage into standard cancer care can provide relief from pain and improve quality of life for patients. As more people with cancer seek non-drug options for pain, expanding access to trained, oncology-certified practitioners will be essential. By combining these therapies with standard medical treatment, clinical programs can offer more holistic care. 

Building on findings from the IMPACT study to achieve these goals, MSK and SIO are partnering on the Implementing Massage & Acupuncture to Achieve Better Pain Management in Oncology Care (IMAGINE) project, also funded by PCORI, to expand access to these evidence-based therapies by supporting their integration into routine cancer care across diverse clinical settings in the United States. IMAGINE aligns with SIO’s mission to advance evidence-based integrative healthcare for people affected by cancer. 

Through IMAGINE, MSK and SIO are working with 35 rural and urban academic and community cancer centers across the U.S. to implement evidence-based oncology acupuncture and massage protocols. This four-year project brings evidence from the IMPACT trial to real-world clinical settings, helping thousands of people with cancer find relief from musculoskeletal pain. (12)

You can learn more about IMAGINE here: https://integrativeonc.org/imagine-project/. 

References 

1. Snijders RAH, Brom L, Theunissen M, van den Beuken-van Everdingen MHJ. Update on prevalence of pain in patients with cancer 2022: A systematic literature review and meta-analysis. Cancers (Basel). 2023;15(3):591. 
2. Mao H, Bao T, Shen X, Li Q, Seluzicki C, Im EO, Mao JJ. Prevalence and risk factors for fatigue among breast cancer survivors on aromatase inhibitors. Eur J Cancer. 2018;101:47-54. 
3. Mao JJ, Ismaila N, Bao T, Barton D, Ben-Arye E, Garland EL, Greenlee H, Leblanc T, Lee RT, Lopez AM, Loprinzi C, Lyman GH, MacLeod J, Master VA, Ramchandran K, Wagner LI, Walker EM, Bruner DW, Witt CM, Bruera E. Integrative medicine for pain management in oncology: Society for Integrative Oncology–ASCO guideline. J Clin Oncol. 2022;40(34):3998-4024.
4. Harvey B, Mao J. Integrative medicine for pain management in oncology: SIO-ASCO guideline. ASCO Guidelines Podcast. September 19, 2022. 
5. Robinson CL, Berger A, Sottosanti E, Li M, Kaneb A, Keefe J, Kim E, Kaye AD, Viswanath O, Urits I. Acupuncture as part of multimodal analgesia for chronic pain. Orthop Rev. 2022;14:38321. 
6. Mao JJ, Liou KT, Baser RE, Bao T, Panageas KS, Romero SAD, Li QS, Gallagher RM, Kantoff PW. Effectiveness of electroacupuncture or auricular acupuncture vs usual care for chronic musculoskeletal pain among cancer survivors: The PEACE Randomized Clinical Trial. JAMA Oncol. 2021;7(5):720-727. 
7. Li X, Lampson K, Rosa WE, Li QS, Ramalingam MB, Epstein AS, Mao JJ. Effect of acupuncture on fatigue in cancer survivors with chronic pain: A secondary analysis. Support Care Cancer. 2025;34(1):31. doi:10.1007/s00520-025-10219-z. 
8. Höxtermann MD, Buner K, Haller H, Kohl W, Dobos G, Reinisch M, Kümmel S, Cramer H, Voiss P. Efficacy and safety of auricular acupuncture for the treatment of insomnia in breast cancer survivors: A randomized controlled trial. Cancers (Basel). 2021;13(16):4082. doi:10.3390/cancers13164082. 
9. Kwag E, Li X, Garland S, Bryl K, Taylor L, Li QS, Amann L, Mao JJ, McConnell KM. Acupuncture versus cognitive behavioral therapy for anxiety among cancer survivors with insomnia: An exploratory analysis of a randomized clinical trial. Integr Med Res. 2025;14(4):101213. doi:10.1016/j.imr.2025.101213. 
10. Sun L, Ramalingam MB, Baser R, Santos Teles M, Seluzicki C, Li QS, Mao JJ. Acupuncture improves functional limitations for cancer patients with chronic pain: A secondary analysis of PEACE randomized clinical trial. Curr Oncol. 2025;32(11):640. doi:10.3390/curroncol32110640. 
11. Win Myint O, Yoong SQ, Toh E, Lei F, Jiang Y. Effectiveness of massage therapy for cancer pain, quality of life and anxiety: A systematic review and meta-analysis. J Clin Nurs. 2025;34(1):49-87. 
12. Epstein AS, Liou KT, Romero SAD, Baser RE, Wong G, Xiao H, Mo Z, Walker D, MacLeod J, Li Q, Barton-Burke M, Deng GE, Panageas KS, Farrar JT, Mao JJ. Acupuncture vs massage for pain in patients living with advanced cancer: The IMPACT randomized clinical trial. JAMA Netw Open. 2023;6(11):e2342482. doi:10.1001/jamanetworkopen.2023.42482.
13. Izgu N, Metin ZG, Karadas C, Ozdemir L, Çetin N, Demirci U. Prevention of chemotherapy-induced peripheral neuropathy with classical massage in breast cancer patients receiving paclitaxel. Eur J Oncol Nurs. 2019;40:36-43.