---
title: "Acupuncture in cancer care"
url: "https://acuiq.com/wiki/safety/acupuncture-in-cancer-care"
updated: 2026-10-13
last_verified: 2026-10-13
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "safety"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-13"
reading_minutes: 8
sources: 10
---

# Acupuncture in cancer care

_What cancer guidelines, an international safe-practice panel, trials in arms at risk of lymphoedema and a meta-analysis of 65 trials say about needling people with cancer: blood counts, lymphoedema, implants and ports, irradiated skin and tumour sites._

Cancer and its treatment change the body that a needle goes into. Chemotherapy can lower the white cells that fight infection and the platelets that stop bleeding; removing or irradiating lymph nodes leaves a limb prone to swelling, called lymphoedema; ports, implants and expanders put foreign material under the skin; and radiotherapy leaves skin fragile. Cancer guidelines recommend acupuncture for some symptoms, and the guidance written for practitioners sets out where and when to leave the needles out. This page reports that guidance, the trials that tested needling in an arm at risk of lymphoedema, and what reviews of adverse events in people with cancer found. Whether acupuncture helps pain in cancer is on [Cancer pain](/wiki/evidence/cancer-pain).

## What cancer guidelines say about safety

The [2022 guideline on integrative medicine for pain in oncology](https://pubmed.ncbi.nlm.nih.gov/36122322/), issued jointly by the Society for Integrative Oncology (SIO) and the American Society of Clinical Oncology (ASCO), recommends acupuncture for joint pain caused by aromatase inhibitors and says it may be offered for general cancer pain, musculoskeletal pain and chemotherapy-induced neuropathy, each time judging that benefits outweigh harms. Its panel notes that people with cancer often have neutropenia, a low count of neutrophils (the commonest white blood cell), low platelets, a tumour or a surgical wound, which community acupuncturists may not have the knowledge to manage safely, and that most of the trials it reviewed did not report adverse events at all.

A [2026 review for oncology clinicians](https://pubmed.ncbi.nlm.nih.gov/42407001/) by Lu, Bao and colleagues says acupuncture given by oncology-trained practitioners within the cancer team is typically safe, provided the clinician considers the patient’s phase of treatment, blood tests and scans, implanted devices, planned surgery and the extent of metastatic disease. The detailed rules come from [recommendations for safe acupuncture in cancer care](https://pmc.ncbi.nlm.nih.gov/articles/PMC10940387/) published in 2024 by Beverley de Valois and an international panel that included staff of Memorial Sloan Kettering, the British Acupuncture Council and the British Medical Acupuncture Society. They update guidance published by Filshie and Hester in 2006, and the sections below report what they say.

## Is acupuncture safe when blood counts are low?

The 2024 panel ties needling to the neutrophil count. When the practitioner can see current blood results, it says acupuncture can be given throughout a chemotherapy cycle if neutrophils do not fall below 900 per microlitre at the lowest point of the cycle, called the nadir, and platelets do not fall below 20,000. It advises no acupuncture while neutrophils are below 500 or platelets below 20,000, and none without the haematology or oncology team’s consent for patients whose neutrophils stay below 100 during intensive treatment, such as after a bone marrow or stem cell transplant. A practitioner with no blood results is advised to treat on the day of chemotherapy or within a few days after it, before the nadir.

The panel states that there is a lack of evidence that acupuncture given during treatment raises the risk of infection, that many large cancer centres offer it alongside chemotherapy, and that some oncologists still prefer patients to avoid it at the nadir or until chemotherapy ends. In a [2009 pilot trial](https://pmc.ncbi.nlm.nih.gov/articles/PMC2875080/) by Lu and colleagues, 21 women with ovarian cancer had real or sham acupuncture during chemotherapy that suppresses the bone marrow; entry required more than 1,000 neutrophils and 100,000 platelets per microlitre. The authors report two adverse events: a sham needle left in place, which distressed the patient without physical harm, and an infection of a chemotherapy port that they judged unrelated to acupuncture. Bruising made up 21.8% of the 55 side effects recorded. What the studies counted at low platelet counts is on [Bleeding and anticoagulants](/wiki/safety/bleeding-and-anticoagulants), and clean needle technique is on [Infection and clean needles](/wiki/safety/infection-and-clean-needles).

## Can needles go into an arm at risk of lymphoedema?

The 2024 panel says no, as a precaution. Lymphoedema follows surgery or radiotherapy to regional lymph nodes, and the panel regards the risk of it, and of the skin infection cellulitis, as probably lifelong. It reports that lymphology experts advise against any needle puncture in a limb with or at risk of lymphoedema, blood tests and acupuncture included, while acknowledging that the evidence behind that advice is weak. With no clear evidence of benefit or harm, it advises avoiding needling such limbs and using points elsewhere: distal points, the opposite side or the ear.

A [2016 review in The Lancet Oncology](https://pubmed.ncbi.nlm.nih.gov/27599144/) by Asdourian and colleagues looked for the evidence behind such precautions in 31 studies of air travel, blood pressure cuffs, skin puncture, heat and infection. Most gave low-level or inconclusive evidence of a link with lymphoedema after breast cancer; infection of the skin of that arm was among the best established risk factors.

Memorial Sloan Kettering tested needling in the affected arm directly. In a [2013 pilot study](https://pmc.ncbi.nlm.nih.gov/articles/PMC3738927/) by Cassileth and colleagues, 33 women with lymphoedema after breast cancer had eight sessions each, with four needles in the affected arm and four in the other. Over 255 sessions, 14 women reported minor complaints such as bruising, pain or tingling; follow-up calls for six months found no serious adverse events, no infections and no severe worsening. The study excluded women with metastatic cancer or on drugs that suppress the bone marrow. A [2018 randomised trial](https://pmc.ncbi.nlm.nih.gov/articles/PMC6159216/) by Bao and colleagues needled points on both arms in 82 women, twice a week for six weeks, against a waiting list. Across 837 treatments, bruising was reported for 58% of the 77 women treated and a haematoma for two, and one had a grade 2 (moderate) skin infection that the authors judged possibly related; no severe adverse event occurred. Acupuncture did not reduce the swelling more than the waiting list did, and the authors conclude that including the affected arm is safe and feasible but that their protocol should not be offered outside trials.

A [2023 pilot trial](https://pmc.ncbi.nlm.nih.gov/articles/PMC11708185/) by Friedman and colleagues needled only the unaffected arm in 10 women and reported no severe adverse events. A [2023 systematic review](https://doi.org/10.2458/lymph.5873) by Kim and colleagues counted 189 participants in 8 trials of acupuncture for this lymphoedema: 2,965 treatments, 1,390 of them in the affected limb, with no serious adverse event and a single grade 2 skin infection. AcuiQ lists the condition as [breast cancer-related lymphedema](/symptoms/breast-cancer-related-lymphedema).

## Ports, implants and other devices

The 2024 panel advises against needling into or close to prostheses, implants, ports, tissue expanders, pacemakers and the sites of current or recent intravenous lines, because foreign material raises the risk of infection, and against needling over a craniotomy flap, where the brain lies under skin with no bone. It asks for in-dwelling needles and metal beads to be removed before imaging, and for firm acupressure or cupping to be kept away from tumours, enlarged lymph nodes, radiation fields and devices. The searches behind this page found no published case of an acupuncture needle damaging a breast implant or port. Reports of infected joint replacements after needling, and the evidence on pacemakers and electroacupuncture, are on [Electrical stimulation and implants](/wiki/safety/electrical-stimulation-and-implants).

## Irradiated skin, tumours and recent surgery

The panel advises against needling skin that received radiotherapy in the previous month or that still shows redness, blistering, swelling, fragility or broken skin from it, and warns that chemotherapy and radiotherapy make skin burn more easily under moxibustion or heat lamps. It advises against needling into or next to a tumour or over metastases in the absence of clear evidence to the contrary, and in favour of distal points for advanced local tumours. Needling beside the spine for back pain in someone with spinal metastases is advised only after the oncology team has been consulted, with the patient told to report new numbness, weakness or bladder and bowel changes at once. After surgery the area is left until the wound has healed, and after keyhole surgery the whole abdomen or pelvis is avoided during the immediate recovery.

## How often do people with cancer have adverse events?

A [2022 meta-analysis](https://pubmed.ncbi.nlm.nih.gov/35262912/) by Höxtermann and colleagues pooled adverse events from 65 randomised trials of needle acupuncture in people with cancer. Compared with sham acupuncture or another active treatment, acupuncture did not raise the risk of treatment-related, non-serious or serious adverse events, or of dropping out because of one. Compared with usual care alone it raised the odds of non-serious events about fourfold, a result the authors found was not robust to selection bias. They note that the trials reported adverse events poorly and ask future trials to follow the CONSORT extension for reporting harms.

## What the sources cannot tell you

The blood count thresholds, the lymphoedema precaution and the advice on implants, irradiated skin and tumours are expert opinion; the 2024 panel says so for lymphoedema and tumour sites, and the sources found for this page include no trial comparing infections at different neutrophil counts. The two largest lymphoedema studies come from one cancer centre and enrolled women who had lived with lymphoedema for at least six months, and the trials in the 2023 review total 189 people, too few to detect a rare infection. The meta-analysis rests on trials that mostly did not report harms. AcuiQ’s entries record what a study prescribed, not participants’ blood counts, lymph node surgery or implanted devices. People having cancer treatment can ask their oncology team about their own counts and nadir timing; AcuiQ cannot answer for an individual. Neutropenia itself is listed as [neutropenia](/symptoms/neutropenia).

### Sources

1. Mao JJ, Ismaila N, Bao T, et al., Integrative medicine for pain management in oncology: Society for Integrative Oncology-ASCO guideline, Journal of Clinical Oncology 2022 — https://pubmed.ncbi.nlm.nih.gov/36122322/
2. Lu W, Kwag E, Martyniuk I, Bao T, Acupuncture in cancer care: evidence, safety, and implementation in oncology practice, JCO Oncology Practice 2026 — https://pubmed.ncbi.nlm.nih.gov/42407001/
3. de Valois B, Young T, Zollman C, et al., Acupuncture in cancer care: recommendations for safe practice (peer-reviewed expert opinion), Supportive Care in Cancer 2024 — https://pmc.ncbi.nlm.nih.gov/articles/PMC10940387/
4. Lu W, Matulonis UA, Doherty-Gilman A, et al., Acupuncture for chemotherapy-induced neutropenia in patients with gynecologic malignancies: a pilot randomized, sham-controlled clinical trial, Journal of Alternative and Complementary Medicine 2009 — https://pmc.ncbi.nlm.nih.gov/articles/PMC2875080/
5. Asdourian MS, Skolny MN, Brunelle C, et al., Precautions for breast cancer-related lymphoedema: risk from air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and cellulitis, Lancet Oncology 2016 — https://pubmed.ncbi.nlm.nih.gov/27599144/
6. Cassileth BR, Van Zee KJ, Yeung KS, et al., Acupuncture in the treatment of upper-limb lymphedema: results of a pilot study, Cancer 2013 — https://pmc.ncbi.nlm.nih.gov/articles/PMC3738927/
7. Bao T, Zhi WI, Vertosick EA, et al., Acupuncture for breast cancer-related lymphedema: a randomized controlled trial, Breast Cancer Research and Treatment 2018 — https://pmc.ncbi.nlm.nih.gov/articles/PMC6159216/
8. Friedman R, Johnson AR, Shillue K, et al., Acupuncture treatment for breast cancer-related lymphedema: a randomized pilot study, Lymphatic Research and Biology 2023 — https://pmc.ncbi.nlm.nih.gov/articles/PMC11708185/
9. Kim JK, Loo C, Kim JS, Pranskevich C, Gordon OK, Can acupuncture be a part of the treatment for breast cancer-related lymphedema? A systematic review of the safety and proposed model for care, Lymphology 2023 — https://doi.org/10.2458/lymph.5873
10. Höxtermann MD, Haller H, Aboudamaah S, et al., Safety of acupuncture in oncology: a systematic review and meta-analysis of randomized controlled trials, Cancer 2022 — https://pubmed.ncbi.nlm.nih.gov/35262912/