Research Highlights: May 2026
Compiled by the SIO Research Committee, May 2026
Each month, the SIO Research Committee reviews recently published integrative oncology literature and shares highlights with the broader membership. This month, we reviewed articles and highlighted two studies selected by member vote: one examining electroacupuncture for cognitive function and neuropsychiatric symptoms in breast cancer survivors, and one evaluating Panax ginseng extract for cancer-related fatigue in gastrointestinal cancer survivors.
Integrative Oncology Research: Two Studies Worth Knowing
The SIO Research Committee selected two papers this month for research highlights. A randomized controlled pilot trial compared electroacupuncture at neuropsychiatric-specific acupoints versus non-neuropsychiatric acupoints in breast cancer survivors, finding improvements in both groups but limited between-group differences — best interpreted as hypothesis-generating evidence for precision acupuncture (see full review below). A randomized double-blind placebo-controlled trial of standardized Panax ginseng extract in 70 gastrointestinal cancer survivors demonstrated a large effect size in reducing cancer-related fatigue over four weeks, though product characterization and follow-up limitations temper the conclusions (see full review below).
We provide in-depth reviews of both articles below.
Electroacupuncture for Cognitive Function and Neuropsychiatric Symptoms in Breast Cancer Survivors
Journal: Reviewed in May 2026 · Reviewed by Yin Ting Cheung
Study Type
| Design | Randomized controlled pilot trial; patient- and assessor-blinded |
| Population | Breast cancer survivors, outpatient setting |
| Sample Size | N = 35 (18 intervention, 17 control) |
| Intervention | Electroacupuncture (EA) at neuropsychiatric-specific acupoints (EA1) for 4 weeks |
| Comparator | Electroacupuncture at non-neuropsychiatric acupoints (EA2) — active comparator, not a true inert sham |
| Outcomes | Cognitive function (objective + subjective), fatigue, psychological distress, quality of life; biomarkers (inflammatory markers, BDNF) and neuroimaging measures |
Background
There is a recognized lack of evidence-based pharmacological interventions for neuropsychiatric symptoms in cancer survivors, particularly cognitive impairment. Safe and effective non-pharmacological strategies are needed. This pilot trial aimed to evaluate the preliminary efficacy and safety of two electroacupuncture regimens targeting different acupoint sets, using a novel biobehavioral framework that integrates clinical, biomarker, and neuroimaging outcomes.
Key Results
- Both EA1 and EA2 groups showed improvements in subjective cognition, fatigue, and quality of life from baseline to end of treatment and at 4-week follow-up.
- Psychological distress improved in the EA1 (neuropsychiatric) group but not in the EA2 group.
- Between-group differentiation was limited: only two cognitive domains — response speed and attention — favored EA1 over EA2.
- Biomarker and neuroimaging analyses found correlations between cognitive/fatigue domains and inflammatory markers, BDNF, gray matter volume, and brain connectivity — however, effects were present in both groups.
Strengths & Caveats
Strengths
- Novel biobehavioral framework combining validated cognitive testing (objective and subjective), patient-reported outcomes, biomarkers, and neuroimaging to explore mechanistic pathways.
- Addresses a clinically meaningful gap: cognitive impairment in breast cancer survivorship with limited pharmacological options.
- Rigorous outcome assessment methodology.
Caveats
- Active comparator, not a true sham: EA2 used clinically active acupoints — the committee agreed this is better framed as a comparative effectiveness or point-specificity study, not an active-vs.-sham design. Linda Carlson recommended the study avoid the term “sham” entirely.
- Small sample size with multiple endpoints and potentially correlated outcomes (neuroimaging, biomarkers) makes interpretation difficult; findings should be treated as hypothesis-generating.
- No placebo acupuncture devices were used, limiting full blinding of acupuncturists and patients.
- Conclusion overreach: The published conclusion — that EA targeting neuropsychiatric acupoints improves cognition and distress — was judged too strong given the pilot scale and limited between-group separation.
- Acupoint specificity is inherently difficult to establish: electroacupuncture at any site stimulates nerve pathways, making clean compartmentalization of neurological effects across acupoints uncertain.
Bottom line: An innovative biobehavioral framework that generates testable hypotheses about acupoint specificity and mechanisms of acupuncture on cognition and neuropsychiatric symptoms in breast cancer survivors. Results are preliminary and should be interpreted cautiously. A larger, adequately powered trial with true placebo control and pre-specified primary endpoints is warranted.
| Reviewer name | Yin Ting Cheung |
| Month / Year | May 2026 |
| Article title | Electroacupuncture improves cognitive function and neuropsychiatric symptoms in breast cancer survivors: a pilot randomized controlled trial |
| Authors | Ding Quan Ng, Matthew Heshmatipour, Julia Trudeau, Apeksha Sridhar, Brock Pluimer, Olivia G G Drayson, Sayeh M Lavasani, Ritesh Parajuli, Sanghoon Lee, Anshu Agrawal, Munjal M Acharya, Charles L Limoli, Richard E Harris, Lifang Xie, Shaista Malik, Alexandre Chan |
| Journal | Journal of the National Cancer Institute (impact factor 7.2) |
| DOI | doi:10.1093/jnci/djag096 |
| Study type | Randomized, patient and assessor-blinded pilot trial; breast cancer survivors; electroacupuncture on neuropsychiatric-specific acupoints vs electroacupuncture on non-neuropsychiatric-specific (non-disease-related specific) acupoints as comparator |
| COI disclosure | No COI to disclose |
| Background | • Breast cancer survivors may be affected by neuropsychiatric symptoms, including cognitive impairment, fatigue, distress, and insomnia, even years after treatment. With the lack of evidence-based pharmacological interventions (especially for cancer-related cognitive impairment), there is a need for effective, safe nonpharmacological strategies to manage neuropsychiatric symptoms in survivors.
• This study evaluated the preliminary efficacy and safety of 2 different electroacupuncture regimens administered at neuropsychiatric-specific acupoints (n=18 survivors; neuropsyEA) versus non-neuropsychiatric-specific acupoints (n=17 survivors; active-controlEA) on cognition, fatigue, distress, and insomnia. Survivors were assessed at baseline, at end-of-treatment, and at four weeks after. |
| Key results | (Figure 3 provides a succinct graphical summary of the results)
• Improvement observed in both neuropsyEA and active-controlEA groups: From baseline to end-of-treatment: both groups showed significant improvement in self-perceived cognition (neuropsyEA: Δ=0.685; active-controlEA: Δ = 0.730, both Padjusted<0.05) and fatigue (neuropsyEA: Δ=0.978; active-controlEA: Δ=0.853, both Padjusted<0.05). • Regimen-specific effects: The neuropsyEA group showed significant improvement in objective attention performance (Δ=0.562 at end-of-treatment; Δ=0.708 at four weeks after, both Padjusted<0.05) and distress (Δ=0.764 at end-of-treatment; Δ=0.711 at four weeks after, both Padjusted<0.05). The active-controlEA group did not show significant improvement in attention and distress at end-of-treatment, though improvements were observed in other outcomes. • Association with blood biomarkers and neuroimaging measures: Improvements in several cognitive domains and fatigue were associated with blood biomarkers (inflammatory markers and brain-derived neurotrophic factor) brain structural changes (total gray matter volume) and brain connectivity measures in the neuropsyEA group. |
| Strengths | • The active-controlEA group with electrical stimulation but varied needle placement may allow the isolation of the unique therapeutic effect of specific acupoints relevant to neuropsychiatric symptoms. This offers a novel perspective on the mapping of acupoints to symptomatology.
• Outcomes assessed using validated cognitive testing (both objective and subjective) and patient-reported outcome measures, corroborated with biomarkers and neuroimaging measures. • Specific acupuncture points linked to neurological and psychological function. The summary of evidence base presented in the Supplementary materials is particularly informative. |
| Caveats | • Placebo acupuncture devices were not used, limiting full blinding of acupuncturists and patients. This is a common problem in RCTs involving acupuncture.
• Although this is acknowledged as a pilot study, the small sample size combined with multiple endpoints introduces challenges in interpreting the results. To note, some of these outcomes may be correlated (e.g., neuroimaging measures and biomarkers). It’s hard to draw firm conclusions about the overall effectiveness of the intervention from this pilot study. Some analyses should be interpreted with caution and considered as hypotheses generating. |
| Clinical takeaways OR Research implications | • Future work should adopt a three‑arm randomized design comparing electroacupuncture, traditional acupuncture, and a waitlist control. This structure would help isolate the specific therapeutic contribution of electrical stimulation while accounting for natural symptom progression.
• Building on pilot data, the next study should streamline its focus on the most pertinent neuropsychiatric symptoms and extend follow‑up duration to better capture the trajectory of symptom burden across groups. • The selection of biomarkers and neuroimaging measures should be guided by a specific hypothesis or linked to defined neuropathophysiological pathways. |
| Bottom line | • This study illustrates a novel bio-behavioral framework that could potentially generate rigorous evidence for electroacupuncture efficacy, while advancing the mapping of symptomatology and its underlying mechanisms. |
Panax Ginseng Extract for Cancer-Related Fatigue in Gastrointestinal Cancer Survivors
Journal: Reviewed in May 2026 · Reviewed by Sara Izadi-Najafabadi
Study Type
| Design | Randomized, double-blind, placebo-controlled trial; single center |
| Population | 70 cancer survivors with gastrointestinal malignancies |
| Sample Size | N = 70 (randomized 1:1) |
| Intervention | Standardized Panax ginseng extract capsules (250 mg) for 4 weeks |
| Comparator | Placebo capsules for 4 weeks |
| Outcomes | Primary: Brief Fatigue Inventory (BFI) total score. Secondary: BFI subscales (activity, walking, mood, enjoyment of life). Exercise minutes logged but not analyzed. |
Background
Cancer-related fatigue is one of the most prevalent and distressing symptoms in cancer survivors, with limited effective pharmacological options. Ginseng has been explored as a natural intervention, with Wisconsin ginseng (American ginseng) already integrated into fatigue management guidelines based on Mayo Clinic trial data. This study examines Panax (Asian) ginseng in GI cancer survivors — a different ginseng species with a distinct pharmacological profile.
Key Results
- Significantly reduced fatigue in the intervention vs. placebo group after 4 weeks (primary outcome met).
- Large effect size (d = 1.26); between-group difference in BFI change score approximately 1.38 points.
- BFI subscale improvements in the intervention group: general activity, walking ability, mood, and enjoyment of life (all patient-reported via BFI interference items).
- No follow-up data beyond the 4-week treatment period.
Strengths & Caveats
Strengths
- Placebo-controlled, double-blind design with a clinically relevant primary outcome.
- Large effect size is notable if confirmed in a more rigorous replication study.
- Authors acknowledged limitations transparently.
Caveats
- Critical product characterization gap (raised by Eran Ben-Arye): The paper reports use of a “standardized” Panax ginseng extract but does not specify the standardization compound (e.g., ginsenoside percentage or specific ginsenoside profile). Without this, the quality of the product cannot be assessed and results cannot be meaningfully compared to other trials.
- Ginseng species matters: Panax (Asian) ginseng has a substantially different drug-interaction profile from Wisconsin (American) ginseng used in prior guideline-informing trials (e.g., Mayo Clinic, 1,000 mg BID). These should not be conflated.
- Short 4-week observation window with no post-treatment follow-up; 4 weeks is also the period of peak placebo effect, which may inflate apparent benefits.
- Small single-center sample; results may not generalize.
- No objective measures (e.g., actigraphy, performance testing); all outcomes are patient-reported via a single instrument.
- Exercise data were collected but not reported — a missed opportunity.
- No MCID reported: The clinical significance of a 1.38-point BFI difference is unclear without a minimally clinically important difference benchmark for this instrument.
Bottom line: Promising findings in a placebo-controlled design, but the absence of product standardization details is a critical gap that limits interpretability and reproducibility. Future trials should fully characterize the investigational product, extend follow-up beyond active treatment, and incorporate objective outcome measures. Results should not be used to draw clinical practice conclusions at this stage.
| Reviewer name | Sara Izadi-Najafabadi |
| Month / Year | May 2026 |
| Article title | The effect of ginseng extract on fatigue in cancer survivors:
a randomized double-blind clinical trial |
| Authors | Rahmani et al. |
| Journal | Supportive Care in Cancer · 2026 · Impact factor: 2.698 |
| DOI | https://doi.org/10.1007/s00520-026-10398-3 |
| Study type | Single-center RCT (Randomized double-blind clinical trial), adults with GI Cancer receiving 250mg of ginseng extract daily for 4 weeks compared to placebo, |
| COI disclosure | None |
| Background | This research question matters because cancer-related fatigue is a highly prevalent and persistent symptom that significantly impairs quality of life among cancer survivors, yet effective and evidence-based treatment options remain limited. While integrative therapies such as Panax ginseng are widely used and recommended as complementary approaches, existing evidence is inconsistent and key uncertainties—particularly around optimal dosing—remain. This study addresses an important gap by evaluating the effectiveness of ginseng in a specific survivor population, contributing to the growing but still limited evidence base guiding integrative management of cancer-related fatigue. |
| Key results | · 70 participants randomized; 65 completed (intervention = 34, placebo = 31); no significant baseline differences between groups (all p > 0.05)
· Fatigue scores (4 weeks):
· Adjusted mean difference: −1.38 (95% CI: −1.90 to −0.86), p < 0.001 · Large effect size: Cohen’s d = −1.26 · ANCOVA: significant group effect on post-intervention fatigue (F(1,37) = 15.41, p < 0.001; R² = 0.79, adjusted R² = 0.70) · Pre-test fatigue also a significant predictor (F(1,37) = 12.80, p = 0.001); all other covariates non-significant (p > 0.05) · Significant improvements in general activity, walking, mood, and enjoyment of life in the intervention group only · No adverse events reported |
| Strengths | · Robust study design: Randomized, double-blind, placebo-controlled trial, minimizing selection, performance, and detection bias
· Allocation rigor: Block randomization with stratification (cancer type, sex, stage) ensured balanced groups on key prognostic variables |
| Caveats | · Small sample size
· Short intervention duration · Single-center design · Self-reported outcome measure only and lack of objective outcome measures (mood, physical activity), etc. · Narrow patient population: Included only gastric and colorectal cancer survivors who had completed treatment ≥4 months prior, limiting applicability to other cancer types or patients in active treatment · Insufficient detail regarding the composition and standardization of Panax ginseng preparations. |
| Clinical takeaways OR Research implications | · Panax ginseng (250 mg/day) demonstrated a significant and clinically meaningful reduction in cancer-related fatigue (CRF) over 4 weeks, with a large effect size (d = −1.26) and no reported adverse events
· Improvements extended beyond fatigue to functional and quality-of-life domains (activity, mood, walking, enjoyment of life), supporting a multidimensional benefit · The favorable safety profile suggests it may be a low-risk addition in survivorship care, though clinical judgment is needed given dosing uncertainties |
| Bottom line | In this small study of individuals who had finished treatment for stomach or colon cancer (GI Cancer), taking 250 mg of ginseng daily for 4 weeks led to a meaningful reduction in cancer-related fatigue compared with placebo, along with improvements in daily functioning and mood. No side effects were reported. However, because the study was small, short, and done at a single center, the results are promising but not yet strong enough to prove ginseng works broadly or to establish it as a standard treatment. More research is needed to confirm the benefit and determine the right dose and duration. |
A Note on Our Review Process
The SIO Research Committee identifies new RCTs and high-impact observational studies in integrative oncology each month via a systematic PubMed search. From the resulting monthly digest, members discuss and highlight articles for in-depth review. Two members volunteer as reviewers each month and prepare structured summaries covering study design, key results, strengths, and caveats. The committee discusses each paper collectively, and final summaries incorporate group feedback. We aim to share work that is methodologically sound and clinically meaningful — and to provide honest context when promising findings require further validation. We welcome article nominations from members for future monthly reviews.
References
- Ng et al. Electroacupuncture improves cognitive function and neuropsychiatric symptoms in breast cancer survivors: a pilot randomized controlled trial. J Natl Cancer Inst. 2026 Apr 2
- Rahmani et al. The effect of ginseng extract on fatigue in cancer survivors: a randomized double-blind clinical trial. Support Care Cancer. 2026 Mar 16;34(4):327.