Imagine battling cancer, facing not only the disease itself but also a relentless barrage of side effects: debilitating pain, crushing fatigue, and sleepless nights. What if there was a simple, drug-free way to find relief? Auricular acupoint therapy, a traditional Chinese medicine technique, is emerging as a promising approach to manage these symptoms and improve the quality of life for cancer patients. But here's where it gets controversial: Is this ancient practice truly effective, and how does it stack up against conventional treatments? Let's delve into the research and explore the potential of this fascinating therapy.
Introduction: The Growing Burden of Cancer and the Need for Effective Symptom Management
The International Agency for Research on Cancer (IARC) paints a stark picture in its Global Cancer Report: cancer is now the second leading cause of death worldwide. In 2022 alone, nearly 20 million new cancer cases were diagnosed, and almost 10 million people lost their lives to the disease. Projections estimate a staggering increase to 35 million new cases by 2050. As medical advancements extend survival rates, a growing number of individuals are living with cancer as a chronic condition. This increased longevity, however, often comes at a cost. Cancer patients frequently grapple with a multitude of physical and emotional challenges throughout their treatment journey, significantly impacting their overall well-being and chances of successful recovery.
Symptom management is about proactively addressing these challenges. It encompasses the comprehensive assessment, intervention, and coordination of care aimed at preventing, alleviating, or treating the various symptoms that arise during the course of the disease and its treatment. This includes not just the physical symptoms, but also the psychological, social, and even spiritual burdens that patients may carry. The ultimate goal is to enhance the patient's quality of life and promote overall health.
Currently, symptom management strategies typically fall into two broad categories: pharmacologic (medication-based) and non-pharmacologic. While medications can be effective, they often come with their own set of drawbacks, such as toxic side effects, the emergence of new symptoms, or the exacerbation of existing ones. For example, strong pain medications can cause constipation, and some chemotherapy drugs can lead to nerve damage. Therefore, there's a growing need for non-pharmacologic therapies that are not only effective but also easy to administer and have minimal side effects.
Auricular acupoint therapy offers a compelling alternative. This purely "green" external treatment, rooted in traditional Chinese medicine, involves applying small pills or magnetic beads to specific acupoints on the ear using adhesive tape. By gently pressing on these points, the auricular vagus nerve is stimulated. And this is the part most people miss: This stimulation triggers a cascade of neurological events. The signals generated are transmitted to the nucleus tractus solitarius in the brainstem, which then directly or indirectly projects to numerous brain regions, including the hippocampus (involved in memory), amygdala (emotional processing), thalamus (sensory relay), striatum (motor control and reward), and prefrontal cortex (executive functions). This intricate process helps regulate the autonomic nervous system, potentially alleviating a wide range of symptoms.
Characterized by its simplicity, affordability, and broad applicability, auricular acupoint therapy has become a popular complementary and alternative therapy for managing cancer-related symptoms. It’s used clinically to help manage conditions such as pain, nausea, anxiety, and sleep disturbances. However, despite its growing popularity, there remains a need for systematic reviews and comprehensive assessments of its effectiveness across different cancer types and symptom presentations.
Therefore, this study employs a scope review methodology to analyze the current state of knowledge and identify existing gaps in the application of auricular acupoint therapy for cancer symptom management. The aim is to provide valuable insights and guidance for clinical practice.
Materials and Methods: A Systematic Approach to Evaluating the Evidence
To ensure a rigorous and well-defined research process, the study adhered to established guidelines and principles.
Defining the Research Question
Following the "PCC" (Population, Concept, Context) framework published by the Joanna Briggs Institute (JBI) in Australia, the research questions were carefully formulated. The Population is cancer patients. The Concept is the application of auricular acupoint therapy. The Context is symptom management for these patients.
Based on this framework, the primary research questions were:
- What are the fundamental components and intervention methods involved in applying auricular acupoint therapy for symptom management in cancer patients?
- How effective is auricular acupoint therapy in alleviating symptoms experienced by cancer patients?
Search Strategy
A comprehensive search strategy was implemented to identify relevant studies from a wide range of databases. The following databases were systematically searched:
- PubMed
- Web of Science
- Cochrane Library
- Embase
- CINAHL
- Sinomed
- CNKI (China National Knowledge Infrastructure)
- Wanfang Database
- VIP Database
The search timeframe spanned from the inception of each database up to April 20, 2025. Both Chinese and English search terms were used to capture a broader range of literature. The Chinese search terms were based on the 13 symptoms listed within the MD Anderson Symptom Inventory (MDASI), a widely used tool for assessing symptom distress in cancer patients. Free-text keywords included terms like "cancer," "tumor," and "neoplasm," as well as various terms related to auricular therapy, such as "auricular plaster therapy," "auricular acupoint pressing with beans," and "magnetic beads."
The English search terms included "neoplasms," "tumors," "cancer," and "carcinoma," along with terms like "auricular acupressure," "auricular acupoint pressing," "auricular point therapy," "Wang Buliuxing seeds," and "transcutaneous auricular Vagus Nerve Stimulation (taVNS)."
The search strategy combined subject headings and free-text keywords. In addition, manual searches were conducted, snowballing through the reference lists of included articles to identify any potentially relevant studies that may have been missed in the initial database searches.
Literature Inclusion and Exclusion Criteria
To ensure that only relevant and high-quality studies were included in the review, specific inclusion and exclusion criteria were established.
Inclusion Criteria:
- Study participants were adult cancer patients (aged 18 years or older).
- The intervention involved auricular acupoint therapy, with no restrictions on the specific method or approach used.
- The study was an original research article, including randomized controlled trials, quasi-experimental studies, mixed-methods studies, and qualitative studies.
- The study was published in either Chinese or English.
Exclusion Criteria:
- Duplicate publications (studies published more than once).
- Studies for which the full text was not accessible.
Literature Screening and Data Extraction
The retrieved articles were imported into NoteExpress software to remove any duplicates. Two independent researchers then screened the titles and abstracts of the remaining articles based on the inclusion and exclusion criteria. Articles that appeared to meet the criteria were then subjected to full-text review. Any disagreements between the two researchers were resolved through discussion or by consulting with a third researcher.
A standardized data extraction form was developed to collect relevant information from the included studies, including details about the study design, participants, intervention, and outcomes. Two researchers independently extracted the data, and any discrepancies were resolved through discussion with a third researcher. The extracted data included the first author, country of publication, publication year, sample size, stage of implementation, implementer, target group, mode of implementation, and effect of implementation.
Results: A Synthesis of the Existing Evidence
Results of Literature Search and Screening
The initial search yielded a total of 3160 documents. After removing duplicates, 1940 documents remained. Following a thorough review of titles, abstracts, and full texts, 42 studies met the inclusion criteria and were included in the review. Of these, 26 were published in Chinese and 16 in English. A flowchart illustrating the literature screening process is shown in Figure 1 (in the original article). The key characteristics of the included studies are summarized in Table 1 (in the original article).
Basic Characteristics of Included Literature
The 42 included studies were published between 1984 and 2025. The majority of the studies (33) were conducted in China, followed by the United States (3), Brazil (3), Korea (2), and France (1). The study designs varied, with 32 randomized controlled trials, 4 quasi-experimental studies, 5 cross-sectional studies, and 1 case-control study.
Research Subjects of Included Literature
All of the included studies focused on cancer patients. The studies covered a range of cancer types, including gastrointestinal cancer (11 studies), breast cancer (7 studies), lung cancer (6 studies), head and neck cancer (2 studies), esophageal cancer (1 study), pancreatic cancer (1 study), liver cancer (1 study), hematological malignancy (1 study), cervical cancer (1 study), prostate cancer (1 study), and studies without specified cancer types (10 studies).
Application Features of Auricular Therapy in Symptom Management of Cancer Patients
Implementation Personnel:
Auricular therapy can be administered either directly by healthcare professionals or researchers, or by patients themselves after being instructed on proper acupoint location and stimulation techniques by healthcare professionals. In 16 of the 42 included studies, it was explicitly stated that the operators were either required to possess certain qualifications or have undergone specific training. This training typically includes theoretical knowledge and practical skills, such as identifying positive points, mastering intervention techniques, understanding safety protocols, and providing health guidance to patients.
Intervention Phase:
Auricular therapy plays a multifaceted role in symptom management for cancer patients, encompassing prevention, diagnosis, and adjunctive treatment. In the diagnostic phase, five studies suggested that ear acupuncture points in cancer patients exhibit changes in color, shape, and low resistance responses, which may have auxiliary diagnostic significance. In the perioperative period, auricular therapy is considered a safe and effective intervention. Preoperative application of ear acupuncture point pressure may achieve preemptive analgesia, assist with anesthesia, and alleviate anxiety symptoms. During surgery, it may enhance analgesic effects and stabilize vital signs. Postoperatively, it may promote gastrointestinal function recovery, enhance patient immunity, shorten anesthesia recovery time, and reduce the incidence of adverse reactions. During the comprehensive treatment period or treatment interval period, 28 studies indicated that auricular therapy can effectively prevent the occurrence of adverse reactions during chemotherapy, alleviate symptoms caused by adjuvant chemotherapy and radiotherapy, and improve patients’ quality of life.
Intervention Methods:
Various methods of auricular therapy were employed in the included studies:
- Ear acupuncture point application: Applying medicinal seeds, magnetic beads, etc., to ear acupuncture points, stimulating them through pressure.
- Ear acupuncture: Using needles to penetrate the acupoints.
- Ear vagus nerve stimulation: Stimulation through surface electrodes on the ear.
- Ear acupoint massage: Massaging ear acupoints.
- Ear acupoint injection: Injecting medication into the ear.
- Ear scraping: Scraping specific areas of the ear with a scraping board.
- Ear acupoint laser therapy: Using low-intensity laser irradiation on ear acupoints.
- Combined therapy: Combining ear acupuncture therapy with other treatment methods to enhance efficacy.
Types of Symptoms
The 42 included studies covered a wide range of symptoms, including sleep disorders (11 studies), pain (10 studies), fatigue (9 studies), anxiety (4 studies), chemotherapy-induced nausea, vomiting, and diarrhea (5 studies), constipation (2 studies), chemotherapy-induced neurotoxicity (4 studies), chemotherapy-induced intractable hiccups (1 study), chemotherapy-induced stomatitis (1 study), and other symptoms.
Effect Evaluation:
Pain:
Ten studies demonstrated that auricular therapy shows promising prospects and significant efficacy in the management of cancer pain and pain associated with cancer treatment. Barb Van de Castle et al noted that auricular pressure application can significantly reduce pain intensity in cancer pain patients and decrease the use of analgesic medications. Wu Qiaohong et al applied ear acupuncture patches to liver cancer patients undergoing radiofrequency ablation prior to the procedure. The results showed that patients experienced pain relief during surgery without significant adverse reactions. Jun J. Mao et al compared electroacupuncture and battlefield ear acupuncture in cancer pain patients. The results indicated that battlefield ear acupuncture was more effective in alleviating cancer pain, but had a higher discontinuation rate than electroacupuncture.
Cancer-Related Fatigue:
Nine studies have indicated that auricular therapy can improve fatigue symptoms in cancer patients. Lu Lin et al found that auricular pressure application can significantly alleviate cancer-related fatigue in lung cancer patients undergoing chemotherapy. Yeh et al analyzed breast cancer patients and found a high correlation between pain, fatigue, and sleep disorders, and that ear acupuncture can effectively manage the pain-fatigue-sleep disorder symptom cluster in breast cancer patients.
Sleep Disorders:
Nine studies have shown that auricular therapy can improve sleep quality in cancer patients. Wang et al found that auricular pressure application reduced the total score of the Pittsburgh Sleep Quality Index (PSQI), shortened the sleep latency period, prolonged total sleep time, and improved sleep efficiency. Lu Na et al used ear scraping combined with mindfulness therapy to treat cancer-related insomnia in advanced lung cancer patients, significantly improving their sleep quality and quality of life.
Gastrointestinal Reactions Caused by Chemotherapy:
Seven studies have shown that auricular therapy can significantly reduce the incidence, severity, and duration of gastrointestinal symptoms following chemotherapy. A randomized controlled trial targeting breast cancer patients showed that patients who received ear acupuncture had a significantly higher rate of complete remission of acute nausea and vomiting (CINV) compared to those who only received standard antiemetic treatment.
Peripheral Neuropathy by Chemotherapy:
A case series study of CIPN patients showed that 65% of patients with peripheral neuropathy were satisfied with auricular acupuncture treatment. Yang Yifan et al performed auricular vagus nerve stimulation on patients with chemotherapy-induced painful peripheral neuropathy. The results showed that auricular vagus nerve stimulation could alleviate chemotherapy-induced neuropathic pain in the short term, improve sleep quality and quality of life. However, it is important to note that Mi Sook Jung et al reported in their study that ear acupuncture can significantly alleviate subjective symptoms (such as pain and functional limitations) in patients with peripheral neuropathy, but its effect on improving objective neuropathy scores is limited.
Others:
Auricular therapy, as an adjunctive treatment, has shown promising results in alleviating symptoms such as anxiety, chemotherapy-induced nausea, and gastrointestinal dysfunction following cancer surgery.
Safety Evaluation:
22 studies reported that patients experienced high safety during treatment, Participants reported fewer adverse reactions, primarily mild ear pain, bruising, allergies, itching, dizziness, and nausea. However, these adverse reactions gradually subsided, and most were within the tolerable range for patients.
Discussion: Unpacking the Findings and Exploring the Mechanisms
Chinese scholars have conducted extensive research on auricular acupoint therapy for alleviating cancer-related symptoms. Auricular acupoint therapy can be applied in multiple stages of cancer patients’ journey, including diagnosis, treatment, and post-treatment rehabilitation. It exerts positive effects on various symptoms such as cancer pain, cancer-related fatigue, sleep disorders, anxiety, and chemotherapy-induced symptoms. Among these symptoms, pain, fatigue, and sleep disorders are the most common and interrelated symptom clusters in cancer symptom management, and auricular acupoint application is the most frequently used intervention method.
The Mechanism of Auricular Acupoint Therapy
Auricular therapy is simple to perform and highly safe, making it an important branch of acupuncture. Having been practiced for thousands of years, it integrates traditional Chinese medical theory with modern medicine and is widely applied in symptom management for cancer patients. According to traditional Chinese medical theory, “The ear is where the meridians converge.” The auricle, as the convergence point of meridians, has a small surface area with concentrated reaction points. When there are pathological changes in the internal organs or meridians, the corresponding areas of the ear may exhibit symptoms such as tenderness, deformation, or discoloration. By stimulating these reaction points, one can unblock meridians, promote the circulation of qi and blood, alleviate patients’ discomfort, and improve their quality of life. In 1956, French scholars proposed the “inverted embryo theory,” noting that the shape of the auricle resembles that of an inverted fetus. The distribution of ear acupoints on the auricle corresponds to the internal organs and structures within the fetus, aligning with traditional Chinese medicine’s theory of internal organs. Modern medicine posits that the auricle and surrounding areas are rich in nerves, and stimulating the auricle can directly act on the vagus nerve of the body, regulating the function of the autonomic nervous system. Additionally, studies have found that stimulating the vagus nerve in the ear can effectively regulate the hypothalamic-pituitary-adrenal axis (HPA axis), optimize the functions of the neuroendocrine and immune systems, and promote the body’s recovery.
The Application of Auricular Therapy in Symptom Management for Cancer Patients Is Gradually Shifting From Treating Individual Symptoms to Comprehensive Assessment of Symptom Clusters
Cancer patients often experience a range of physical and psychological symptoms, which typically do not occur in isolation but rather present as “symptom clusters,” interacting and influencing one another synergistically. This synergistic effect not only reduces patients’ quality of life but may also shorten their survival period. Auricular therapy can simultaneously improve multiple symptoms in cancer patients, with good therapeutic efficacy and minimal risk of inducing new symptoms or exacerbating existing ones. In recent years, researchers have shifted their focus in symptom management for cancer patients from addressing single symptoms or individual dimensions within a syndrome cluster to comprehensive management of symptom clusters. However, current research on symptom clusters in cancer patients primarily focuses on the identification and intervention of specific symptom clusters (pain-fatigue-sleep disorders), neglecting the dynamic changes in symptoms across different treatment stages and lacking comprehensive studies on the identification of core symptom clusters and the overall progression of cancer across different stages.
Heterogeneity in Interventions
(1) Qualifications of practitioners are not yet clearly defined: Auricular therapy requires precise selection of acupoints based on the patient’s syndrome pattern and symptoms. Therefore, practitioners need to have a certain level of training. Additionally, some procedures involve invasive techniques, which require professional skills and standardized protocols to ensure the safety and efficacy of treatment. Although specialized nursing training programs have been established in some regions, the qualifications and certification standards for practitioners have not yet been clearly defined or standardized. (2) Lack of standardized operating procedures: there remains a lack of completely unified standardized operational procedures for key aspects of ear acupuncture therapy, including intervention processes, method selection, material selection, intervention timing, acupoint localization, stimulation methods, and stimulation intensity.
Perspective: The Future of Auricular Therapy in Cancer Care
Auricular acupoint therapy has demonstrated significant value in the symptom management of cancer patients, leveraging its unique advantages such as simple operation, high cost-effectiveness, good safety, and few side effects. Currently, the research focus in this field has shifted from interventions targeting single symptoms to the comprehensive management of symptom clusters. Future studies should improve the research design process, conduct multi-center, large-sample randomized controlled trials to enhance the reliability and generalizability of research results. In addition, researchers need to deepen the research on dynamic interventions for core symptom clusters, identify core symptom clusters at different stages through systematic evaluation or symptom network analysis, and develop personalized auricular acupoint therapy schemes to improve intervention effects, thereby continuously enhancing the clinical application value and scientificity of auricular acupoint therapy in cancer symptom management.
Now, it's your turn. Have you or someone you know tried auricular acupoint therapy? What were the results? Do you believe in the potential of traditional medicine to complement modern cancer treatments? Share your thoughts and experiences in the comments below! Let's discuss the possibilities and the challenges of integrating this ancient practice into contemporary cancer care.
