---
title: "Cancer-related fatigue"
url: "https://acuiq.com/wiki/evidence/cancer-related-fatigue"
updated: 2026-10-10
last_verified: 2026-10-10
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-10"
reading_minutes: 9
sources: 12
---

# Cancer-related fatigue

_What four systematic reviews, trials of acupuncture and self-acupressure in the UK and the United States, and the 2024 ASCO–SIO guideline report on acupuncture and acupressure for fatigue during and after cancer treatment._

Cancer-related fatigue is tiredness that is out of proportion to effort and is not relieved by rest or sleep, as a [2020 review](https://doi.org/10.1177/1534735420949679) by Jang and colleagues at Royal North Shore Hospital in New South Wales describes it. It can start at diagnosis, build during chemotherapy or radiotherapy, and persist for years after treatment ends. Cochrane has not published a review of acupuncture or acupressure for cancer-related fatigue, so the evidence on this page comes from reviews in other journals, a small number of trials in the UK and the United States, and one guideline. Acupressure is pressure on acupuncture points with a finger or a device instead of a needle, and in the trials below people applied it to themselves.

## Reviews

Most trials score fatigue on a questionnaire such as the Brief Fatigue Inventory (BFI), on which a score under 4 counts as a normal fatigue level in the [2016 acupressure trial](https://doi.org/10.1001/jamaoncol.2016.1867) described below. Reviews that pool trials on different questionnaires report a standardised mean difference (SMD), the gap between groups expressed in units of the spread of scores. Sham acupuncture is a control procedure made to look like acupuncture, such as needles that retract into the handle; [Sham acupuncture](/wiki/research/sham-acupuncture) covers the kinds in use. The four reviews below kept the comparisons with sham, usual care and a waiting list separate.

| Review | Trials and people | Against sham | Against usual care or waiting list | Certainty (GRADE) |
| --- | --- | --- | --- | --- |
| [Jang 2020](https://doi.org/10.1177/1534735420949679), English-language trials only | 9 trials, 809 people | BFI 0.93 points lower | BFI 2.12 points lower against usual care | Not graded |
| [Choi 2022](https://doi.org/10.3390/cancers14184419), breast cancer, searched to June 2022 | 12 trials, 1,084 people | SMD 0.26 lower (5 trials, 256 people) | SMD 0.39 lower against usual care (4 trials, 238 people); 0.85 lower against a waiting list (2 trials, 62 people) | Low for each |
| [Voigtländer 2026](https://doi.org/10.1007/s00432-025-06395-4), searched April 2024 | 15 trials, 1,346 people | Mixed results; one trial at low risk of bias | Often positive | Very low |
| [Zhang 2026](https://doi.org/10.3389/fonc.2026.1790238), searched to April 2025 | 28 trials, 2,168 people | No significant difference on the Piper Fatigue Scale (mean difference 0.34 lower, 95% CI 0.76 lower to 0.08 higher) | Lower Piper scores against usual care and a waiting list | Low against sham; very low for most outcomes against usual care |

Choi and colleagues, at the Korea Institute of Oriental Medicine, judged 3 of their 12 trials at low risk of bias in every domain, and wrote that small samples and low methodological quality limited what could be concluded. Voigtländer and colleagues in Germany rated 14 of their 15 trials at high risk of bias, mostly for insufficient blinding and incomplete data analysis, and concluded that the evidence was insufficient to say whether acupuncture reduces fatigue. Zhang and colleagues, at Guangzhou University of Chinese Medicine, rated no trial at low risk of bias. In their 10 trials using the Piper Fatigue Scale, with 804 people, acupuncture against all controls together was associated with scores 0.56 points lower; the difference held against usual care and a waiting list but not against sham. They suggested that sham needles which pierce the skin may have effects of their own, and called for trials with non-penetrating shams.

## Trials of needle acupuncture

A [2012 pragmatic trial](https://doi.org/10.1200/jco.2012.41.6222) by Alex Molassiotis and colleagues in the UK randomised 302 outpatients with breast cancer: 227 to weekly acupuncture for 6 weeks on top of usual care, and 75 to usual care with a booklet on managing fatigue. A pragmatic trial tests a treatment as it would be given in practice, here against no extra treatment and with no sham. Acupuncturists needled three pairs of points, which Jang’s review lists as [`LI04`](/points/LI04) (Hegu), [`SP06`](/points/SP06) (Sanyinjiao) and [`ST36`](/points/ST36) (Zusanli). At 6 weeks the general fatigue score on the Multidimensional Fatigue Inventory was 3.11 points lower in the acupuncture group, and anxiety, depression and quality of life scores were also better; 246 of the 302 provided complete data. In a [follow-on trial](https://doi.org/10.1093/annonc/mdt034), 197 of the same women were randomised again to four more weekly sessions from an acupuncturist, four sessions of needling themselves, or no further acupuncture. The extra sessions did not improve fatigue, mood or quality of life beyond the gains of the first course.

A [2013 trial](https://doi.org/10.1007/s00520-013-1720-z) by Gary Deng and colleagues at Memorial Sloan Kettering Cancer Center in New York compared real with sham acupuncture, once a week for 6 weeks, in 101 people whose fatigue had lasted at least 2 months after chemotherapy ended. The sham needles were blunt and slid up into the handle instead of piercing the skin, placed a few millimetres from the real points. BFI scores fell by about one point in both groups, with no significant difference between them, and no lasting reduction was seen at 6 months. Only 74 people were evaluated for the primary outcome, which the authors gave as a limitation, and they could not exclude that more frequent treatment would work differently.

The one trial Voigtländer’s review rated at low risk of bias is a [2017 pilot trial](https://doi.org/10.1007/s00520-017-3812-7) by Cheng and colleagues in Shanghai, in 28 people with lung cancer. It needled LI-4, Ren-6, St-36, KI-3 and Sp-6, twice a week for 4 weeks, against a placebo procedure, and reported lower fatigue scores with real acupuncture at 2 and 6 weeks. The review noted that the trial had no power calculation, and the authors called for larger trials.

## Self-acupressure

The [2016 trial in JAMA Oncology](https://doi.org/10.1001/jamaoncol.2016.1867) by Suzanna Zick and colleagues at the University of Michigan randomised 288 women who had finished treatment for breast cancer at least 12 months earlier and still had fatigue. They were taught to give themselves either relaxing or stimulating acupressure daily for 6 weeks, or had usual care. At week 6, 66.2% of the relaxing group, 60.9% of the stimulating group and 31.3% of the usual care group had normal fatigue levels, and the two acupressure groups did not differ from each other. Only relaxing acupressure improved sleep and quality of life. One woman withdrew because of bruising at the points.

A [2026 trial in JAMA Network Open](https://doi.org/10.1001/jamanetworkopen.2025.56357) from the same group added a sham arm. It randomised 171 women who had survived ovarian cancer and had a BFI score of 4 or more; 160 were allocated to true self-acupressure, sham self-acupressure or usual care, taught through a mobile app. True self-acupressure used Yintang ([`XH03`](/points/XH03)), Anmian, heart 7 ([`HT07`](/points/HT07), Shenmen), spleen 6 (`SP06`) and liver 3 ([`LV03`](/points/LV03), Taichong); the sham used points in the same areas of the body that the authors called nontherapeutic. At 6 weeks, BFI change was 1.23 points better than usual care with true acupressure and 0.91 better with sham, the latter not statistically significant, and the true and sham groups did not differ from each other. Both groups still scored better than usual care at 24 weeks, and neither had an adverse event. The authors suggested the sham points may have stimulated the same nerves as the true ones.

## What guidelines say

The [2024 guideline](https://doi.org/10.1200/jco.24.00541) from the American Society of Clinical Oncology (ASCO) and the Society for Integrative Oncology (SIO), led by Julienne Bower, reviewed 113 randomised trials published from 2013 to 2023. For adults who have completed cancer treatment it states that clinicians may recommend acupressure, a conditional recommendation on low-certainty evidence that rests on the 2016 trial alone, and the same for moxibustion, heat applied to points, which in the trials it drew on was delivered by machine with no plant material. For adults still in treatment it found insufficient evidence for or against acupressure. It made no recommendation for or against acupuncture after treatment, citing one positive and one negative trial, the 2012 Molassiotis and 2013 Deng trials, and asked for larger trials to settle the difference. The Multinational Association of Supportive Care in Cancer (MASCC) [endorsed the guideline](https://pubmed.ncbi.nlm.nih.gov/42268440/) in June 2026. [Clinical guidelines](/wiki/evidence/clinical-guidelines) compares other bodies’ positions on acupuncture.

## What the reviews could not settle

The trials that found the largest differences compared acupuncture with usual care or a waiting list, where everyone knew who was treated and fatigue was self-reported. Against sham, the 2026 pooled estimate is compatible with a small benefit and with none, and the largest sham-controlled needle trial evaluated 74 people. In the 2016 acupressure trial the two sets of points did not differ, and in the 2026 trial true and sham points did not differ from each other, so neither trial shows that the choice of points matters. Voigtländer’s review found the acupuncture methods and points varied from trial to trial and called for more rigorous designs. Trials of acupuncture for symptoms that often come with fatigue are covered in [Nausea from chemotherapy](/wiki/evidence/nausea-from-chemotherapy), [Hot flushes](/wiki/evidence/hot-flushes) and [Insomnia](/wiki/evidence/insomnia), trials for nerve damage from the same drugs in [Chemotherapy-induced neuropathy](/wiki/evidence/chemotherapy-induced-neuropathy), and trials for pain in people with cancer in [Cancer pain](/wiki/evidence/cancer-pain). Trials in chronic fatigue syndrome, where fatigue is the condition itself rather than an effect of cancer or its treatment, are in [Chronic fatigue syndrome](/wiki/evidence/chronic-fatigue-syndrome).

AcuiQ’s [cancer-related fatigue](/symptoms/fatigue-cancer-related) and [chemotherapy-induced fatigue](/symptoms/fatigue-chemotherapy-induced) pages list the protocols individual studies prescribed, each with its citation.

### Sources

1. Jang A, Brown C, Lamoury G, et al., The effects of acupuncture on cancer-related fatigue: updated systematic review and meta-analysis, Integrative Cancer Therapies 2020 — https://doi.org/10.1177/1534735420949679
2. Choi TY, Ang L, Jun JH, Alraek T, Birch S, Lu W, Lee MS, Acupuncture for managing cancer-related fatigue in breast cancer patients: a systematic review and meta-analysis, Cancers 2022 — https://doi.org/10.3390/cancers14184419
3. Voigtländer S, Dörfler J, Hübner J, Acupuncture as treatment of cancer-therapy induced fatigue: a critical systematic review with a focus on the methodological assessment of blinding, Journal of Cancer Research and Clinical Oncology 2026 — https://doi.org/10.1007/s00432-025-06395-4
4. Zhang H, Pan Z, Huang Y, et al., Effectiveness of acupuncture for cancer-related fatigue: a systematic review and meta-analysis, Frontiers in Oncology 2026 — https://doi.org/10.3389/fonc.2026.1790238
5. Molassiotis A, Bardy J, Finnegan-John J, et al., Acupuncture for cancer-related fatigue in patients with breast cancer: a pragmatic randomized controlled trial, Journal of Clinical Oncology 2012 — https://doi.org/10.1200/jco.2012.41.6222
6. Molassiotis A, Bardy J, Finnegan-John J, et al., A randomized, controlled trial of acupuncture self-needling as maintenance therapy for cancer-related fatigue after therapist-delivered acupuncture, Annals of Oncology 2013 — https://doi.org/10.1093/annonc/mdt034
7. Deng G, Chan Y, Sjoberg D, et al., Acupuncture for the treatment of post-chemotherapy chronic fatigue: a randomized, blinded, sham-controlled trial, Supportive Care in Cancer 2013 — https://doi.org/10.1007/s00520-013-1720-z
8. Cheng CS, Chen LY, Ning ZY, et al., Acupuncture for cancer-related fatigue in lung cancer patients: a randomized, double blind, placebo-controlled pilot trial, Supportive Care in Cancer 2017 — https://doi.org/10.1007/s00520-017-3812-7
9. Zick SM, Sen A, Wyatt GK, Murphy SL, Arnedt JT, Harris RE, Investigation of 2 types of self-administered acupressure for persistent cancer-related fatigue in breast cancer survivors: a randomized clinical trial, JAMA Oncology 2016 — https://doi.org/10.1001/jamaoncol.2016.1867
10. Zick SM, Chen D, Harris RE, et al., Self-acupressure for fatigue in patients surviving ovarian cancer: a randomized clinical trial, JAMA Network Open 2026 — https://doi.org/10.1001/jamanetworkopen.2025.56357
11. Bower JE, Lacchetti C, Alici Y, et al., Management of fatigue in adult survivors of cancer: ASCO-Society for Integrative Oncology guideline update, Journal of Clinical Oncology 2024 — https://doi.org/10.1200/jco.24.00541
12. Kleckner AS, Agbejule OA, Al-Harrasi A, et al., Multinational Association of Supportive Care in Cancer (MASCC) endorsement and global perspectives on implementation of the ASCO-SIO fatigue in adult cancer survivors guideline, Supportive Care in Cancer 2026 — https://pubmed.ncbi.nlm.nih.gov/42268440/