1 Introduction

Cancer is a major public health problem worldwide and one of the major causes of increased mortality worldwide^[1]. In recent years, novel anti-tumor therapies have been constantly updated^[2,3], but chemotherapy is still the primary treatment. Although chemotherapy helps to prolong the survival of patients, a series of adverse reactions (fatigue, pain, nausea, vomiting, anxiety, depression, insomnia, constipation, hot flashes, peripheral neuropathy, etc.) inevitably occur, seriously affecting the quality of life of patients and interfering with the treatment of cancer^[4]. Therefore, it is necessary to actively develop new therapies or complementary therapies that can effectively alleviate the side effects of cancer.

Traditional acupuncture (AC) involves inserting needles into specific points on the body to treat various diseases by regulating the Qi mechanism^[5]. Since 1869, the use of acupuncture in the treatment of cancer has gradually increased^[6,7], and to date, clinical practice guideline groups from 13 countries, including the National Comprehensive Cancer Network (NCCN), National Institutes of Health and the Chinese Cancer Center, have included acupuncture in the management of cancer-related symptoms^[7,8]. With the development of modern science and technology, the acupuncture system has been continuously enriched, and many forms such as electroacupuncture (EA), ear acupuncture, transcutaneous electrical nerve stimulation (TENS) and needle-warming moxibustion have been developed. In this review, the historical development of acupuncture in the treatment of cancer-related symptoms, clinical applications in recent years, research on the mechanisms of acupuncture treatment, and the opportunities and challenges of acupuncture in the future treatment of cancer are presented (Figure 1).

2 The Historical Origin of Acupuncture and Moxibustion in Preventing and Treating Tumor

In the history of Chinese medicine, tumor was first seen in the Yin and Shang Dynasties more than 3,700 years ago. In the Inner Canon of Yellow Emperor period, the understanding of tumor in traditional Chinese medicine was further enriched^[9]. And the theory and application of acupuncture treatment of tumor also began to form during this period, for example, acupuncture treatment of tumor should abide by a principle. It’s “deficiency syndrome should be treated by supplementing therapy, while excess syndrome should be treated by purgative therapy”^[10]. And Lingshu·Jingjin records that the use of fire needle can treat the symptoms of expectoration and hemoptysis related to lung cancer. Then in the Wei, Jin, Sui and Tang Dynasties, with the gradual deepening of the understanding of tumor by ancient doctors, the theory of acupuncture and moxibustion for the prevention and treatment of malignancy related diseases was gradually systematized^[9]. For example, The A-B Classic of Acupuncture and Moxibustion records that Chongmen (SP12) and Shang Qu (KI17) treat cancer pain. Qianjin Yi Fang records the compatibility principles and operation techniques of acupuncture treatment. In the Song, Jin and Yuan Dynasties, with political stability and economic prosperity, traditional Chinese medicine (TCM) oncology entered a stage of prosperity and development, and acupuncture also made a qualitative leap in tumor prevention and treatment^[11]. For example, casting bronze figures, unifying acupuncture points, focusing on the treatment of cancer according to the meridians of TCM, such as Qianjin Baoyao proposed acupuncture points on the feet to treat tumor as an external treatment therapy, enriched the mode of acupuncture treatment of tumor. In the Ming and Qing Dynasties, many doctors summarized the tumor prevention and treatment theory of acupuncture on the basis of predecessors, and formed a relatively complete diagnosis and treatment system^[9]. During this period, acupuncture and moxibustion treatment paid more attention to the balance of Yin and Yang, and the coordination of Zangfu organs. In treatment, moxibustion was good at supporting healthy Qi and removing evil Qi to treat cancer^[10]. For example, Authentic Surgery mentions the use of moxa moxibustion to treat lip cancer, and yellow wax moxibustion to treat skin cancer. After the late Qing Dynasty, a large amount of modern medicine was introduced into China, and the understanding of tumor in TCM was further improved. Moreover, thousands of years of TCM clinical practice has proved that TCM acupuncture and moxibustion can regulate human body function, enhance human immunity and anti-tumor ability, prevent and treat malignant tumors, so more and more people apply this therapy to the clinical treatment of tumors, and attract wide attention in the international community^[12].

At present, there has been an “acupuncture fever” in the world, as many as 140 countries and regions actively carry out acupuncture medical treatment, practitioners are up to about 200,000 to 300,000 people, some countries and regions also carry out acupuncture education and acupuncture research work^[13]. Because of its wide curative effect, health safety and environment, simple operation and quick effect, it has great advantages in the prevention and treatment of cancer and can effectively improve the adverse effects brought by radiotherapy and chemotherapy, and become an auxiliary anti-tumor program^[14]. However, at present, there are few studies on the summary, induction and mechanism of acupuncture for the prevention and treatment of tumors. In this study, the relevant research progress in recent years around the world to provide a more scientific basis of acupuncture for the prevention and treatment of tumors will be summarized and analyzed.

3 Effects of Acupuncture on Cancer-Related Symptoms

3.1 Cancer-Related Fatigue (CRF)

The NCCN defines cancer-related fatigue (CRF) as subjectively persistent emotional fatigue and physical stress and cannot be relieved by rest or sleep^[15]. Studies have shown that the probability of CRF occurring is as high as 99% in cancer patients during chemotherapy, and it is one of the most distressing and unbearable symptoms among the adverse reactions to cancer treatment^[16,17].

Acupuncture has gradually become the main treatment strategy for CRF because of its advantages of small side effects and obvious effects. A randomized controlled trial showed that acupuncture combined with ginger moxibustion is a safe and effective intervention to relieve CRF^[18]. In addition, several recent studies have shown that acupuncture can relieve fatigue after chemotherapy for breast cancer^[19,20], etc. Besides, acupuncture Qihai (CV6), Guanyuan (CV4), and bilateral Zusanli (ST36) can reduce the degree of fatigue caused by chemotherapy in patients with colorectal cancer, improving the symptoms of physical fatigue and mental fatigue^[21]. Therefore, various treatment modalities of acupuncture may successfully intervene in CRF.

3.2 Cancer-Related Pain (CRP)

The causes of cancer pain are complex and may be induced by factors such as tumor invasion of nerves, release of inflammatory factors, or bone metastasis. In addition, dysregulation of the neuroendocrine system (such as the thalamic-pituitary-adrenal axis) may simultaneously exacerbate pain sensitivity and hot flashes (HFs), which are one of the adverse effects of cancer, as described in detail in the following article. Studies have shown that more than 70% of cancer patients suffer from cancer pain, which greatly reduces their quality of life and mental health^[1]. Non-drug therapies such as acupuncture have been widely used in the treatment of cancer pain in recent years due to the high side effects and strict control of opioids^[22].

For example, morphine is commonly used to treat moderate and severe cancer pain, but long-term use is easy to develop drug tolerance. One study showed that electroacupuncture can delay the occurrence of morphine tolerance in rats with bone cancer pain^[23]. In addition, bee venom acupuncture (BVA) has been confirmed to attenuate oxaliplatin induced neuropathic pain and peripheral neuropathic pain induced by repeated peritoneal injection of vincristine^[24,25]. There is also evidence that acupuncture combined with analgesics can better relieve lung cancer pain^[26]. Compared with other interventions, acupuncture is the most effective method in inhibiting arthralgia among breast cancer patients induced by aromatase inhibitor^[27]. Ear acupuncture combined with thunder fire moxibustion treatment can reduce the toxic and side effects of colorectal cancer patients after chemotherapy, narrow the focus, reduce the cancer pain, improve sleep quality, improve body fatigue, and facilitate the recovery of the disease^[28]. Other studies, including 17 randomized controlled trials (RCTS) involving 1,162 patients, showed that acupuncture treatment was effective in relieving pain caused by primary liver cancer (PLC), either alone or in combination with traditional Chinese and western medicine^[29]. Therefore, numerous clinical practices have confirmed the remarkable efficacy of acupuncture in the treatment of cancer pain.

3.3 Chemotherapy-Induced Nausea and Vomiting (CINV)

Nausea and vomiting are common adverse reactions after cancer chemotherapy, with incidence of 7% and 58% respectively^[30,31]. Not only does it make life extremely difficult for patients, but it also puts pressure on cancer treatment and even reduces long-term survival rates^[32]. Acupuncture has been shown to control vomiting in studies in various countries^[33], so it has great feasibility as a supplementary therapy to relieve nausea and vomiting symptoms after chemotherapy.

Auriculotherapy and acupuncture can reduce acute vomiting and delayed nausea in cancer patients undergoing chemotherapy^[34]. Clinical data show that acupuncture combined with antiemetic drugs can reduce the incidence of nausea and vomiting and reduce the incidence of adverse side effects of antiemetic drugs^[35]. In a randomized and pseudocontrolled trial, electroacupuncture combined with standard triple antiemetic therapy significantly improved chemotherapy-induced nausea and vomiting (CINV) treatment in breast cancer patients receiving hyperemetic chemotherapy (HEC)^[36]. Finally, Acupoint needle-embedding can also reduce the incidence of CINV in patients with gynecological malignant tumors and improve the quality of life^[37]. Therefore, acupuncture can significantly reduce the frequency and severity of nausea and vomiting in chemotherapy patients, and when combined with conventional drugs, acupuncture can enhance the efficacy and reduce dependence on drugs, especially in patients who do not respond well to anti-nausea drugs.

3.4 Cancer-Related Psychological Symptoms (CRPS)

Cancer-related psychological symptoms (CRPS) mainly include depression, anxiety, and insomnia, and the overall prevalence of cancer patients is from 30% to 40%^[38], which can not cure by conventional antidepressant treatment, and can produce additional side effects (dizziness, drowsiness, fatigue) and increase the risk of cancer recurrence^[39,40]. As a traditional Chinese medicine, acupuncture can effectively improve CRPS, improve the quality of life of patients with advanced cancer, and it is simple to operate, with low price, and has no side effects. In recent years, it has played an important role in various cancer patients^[41].

Ear acupuncture, as a form of acupuncture, is used to stimulate auricular points to treat breast cancer-related depression^[42]. A clinical study shows that acupuncture combined with sertraline hydrochloride can treat tumor-related depression and improve quality of life in patients^[43]. In addition, there are clinical reports that acupressure can also improve anxiety and depression symptoms in cancer survivors^[44]. Therefore, acupuncture therapy has a positive effect on improving psychological symptoms in cancer patients, but a large number of experimental studies and clinical data are still needed to prove it.

3.5 Cancer-Related Insomnia (CRI)

Cancer-related insomnia (CRI), as an important complication after cancer diagnosis/treatment, is characterized by difficulty falling asleep, repeated awakenings, daytime trance, and decreased memory and attention, which seriously diminishes the quality of life of cancer survivors^[45]. The common sedative hypnotic drugs have the problem of drug resistance during use, so there is an urgent need for more safe and effective non-drug therapies, such as acupuncture^[2].

Acupuncture is effective in reducing breast CRI and may gradually be offered as an alternative to sleeping pills, a multiterm, randomized, sham-controlled trial has shown^[46,47]. At the same time, auricular point acupressure (APA) is also a cost-effective treatment that may improve sleep quality and reduce sleep disorders in breast cancer patients^[48]. In addition, acupuncture can also treat insomnia in breast cancer climacteric through Fengfu (GV16), Baihui (GV20), Shenshu (BL23) and Qihai (CV6)^[49]. Therefore, multiple data have proved that acupuncture therapy can alleviate CRI.

3.6 Opioid-Induced Constipation (OIC)

Opioids, as the first choice for the treatment of cancer pain, are widely used in all stages of cancer treatment, but long-term acceptance of opioids can induce constipation in 60% to 90% of patients, seriously affecting patients’ daily activities and quality of life^[50,51]. Acupuncture not only plays a role in the treatment of cancer pain, but also has a unique application in the treatment of opioid-induced constipation (OIC).

Clinical trials have verified that the effect of electroacupuncture does not interfere with opioid analgesia, while alleviating constipation symptoms, reducing defecation force, and increasing the happiness of defecation, which may become an alternative to OIC management for patients with chronic cancer pain^[52]. Therefore, acupuncture therapy has a positive effect on alleviating OIC.

3.7 Hot Flashes (HFs)

Hot flashes (HFs), the feeling of heat flushing over the skin, are a common pain that occurs in cancer patients and cancer survivors, especially those who have undergone oophorectomy, orchiectomy, chemotherapy, and/or hormone therapy^[53]. HFs can cause a range of adverse effects, such as sweating, palpitations, dizziness, nausea, chills, fatigue, poor sleep, or mood disturbances. These symptoms can be with the patient for several years, seriously affecting quality of life^[2] .

Drug treatment options are limited or may have unpleasant side effects, so researchers and clinicians are constantly looking for alternative treatments. A recent multicenter randomized clinical trial with a large sample size confirmed that acupuncture is an effective means for HFs in prostate cancer patients on androgen deprivation therapy (ADT)^[54]. Meanwhile, a recent study examined whether acupuncture intervention can have a positive effect on HFs in women with breast cancer undergoing endocrine therapy, and found that acupuncture is beneficial to the recovery of HFs in breast cancer patients^[55]. Therefore, acupuncture can be used as an effective means to relieve hot flashes in cancer patients.

3.8 Chemotherapy-Induced Peripheral Neuropathy (CIPN)

Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limited toxic reaction caused by chemotherapy drugs, which mainly presents with paresthesia and motor dysfunction at the extremities, such as numbness, pain, tingling, burning, etc^[56]. CIPN symptoms are generally dose-dependent, and many cancer patients have no improvement in symptoms for a long time after stopping chemotherapy drugs, and may even continue to worsen^[57]. Acupuncture has a better effect in alleviating the toxic side effects of radiotherapy and chemotherapy, and its application is gradually increasing. A clinical study of 100 patients with breast cancer showed that needle-warming moxibustion was effective in treating breast cancer CIPN, and effectively improved patients’ functional status and quality of life^[58].

This section has summarized the use of acupuncture in recent years to improve cancer-related symptoms, including CRF, CRP, CINV, CRPS, CRI, OIC, HFs, CIPN, etc, as shown in Table 1.

Table 1

4 The Underlying Mechanism Behind Acupuncture Treatment of Cancer-Related Symptoms

In November 2010, United Nations Educational, Scientific and Cultural Organization (UNESCO) listed “TCM acupuncture” in the representative list of human intangible culture, and Chinese acupuncture has become the world’s acupuncture and moxibustion^[59]. Chinese acupuncture has made great progress in the clinical treatment of tumors, but the mechanism of action are still unclear. This section will summarize the mechanisms underlying the current effects of acupuncture on cancer, focusing on its role in immune regulation and activation of neurohormonal pathways (Table 2).

Table 2

Acupuncture plays an anti-fatigue role mainly by improving the abundance of intestinal microbes and changing the bacterial species of central nervous system-related emotional diseases^[73–75]. For example, acupuncture can regulate intestinal dysbacteriosis, increase the abundance of beneficial bacteria, reduce the abundance of pathogenic bacteria, and treat fatigue after chemotherapy for breast cancer^[60]. Besides, moxibustion may play a role in improving cancer fatigue by down-regulating the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway mediated by inflammatory factors, and infrared ray is one of the effective factors of moxibustion^[61]. Triple needling can relieve fatigue, improve quality of life and reduce anemia in patients with middle and advanced adenocarcinoma of stomach. The mechanism of action may be to increase the number of lymphocytes, improve immune function and anemia^[62].

The analgesic effects of acupuncture involve the release of endogenous opioids and an integration between afferent pain impulses and acupuncture stimulation in the central nervous system^[27]. For example, electroacupuncture reduces dysalgesia and hyperalgesia after chemotherapy by activating 5-hydroxytryptamine (5-HT) 1A receptors in the spinal cord and inhibiting phospho-Ca²⁺/calmodulin-dependent protein kinase II (p-CaMKII)^[63]. In addition, on the basis of tertiary analgesia combined with needle-warming moxibustion at Siguan points can effectively relieve the pain symptoms of cervical cancer pain in the middle and late stage of Qi stagnation and blood stasis syndrome, improve the body condition, immune function, regulate the release of pain stress substances, and improve the quality of life^[64]. Electroacupuncture intervention with Zusanli and Sanyinjiao, once a day for 20 min each time for 12 d, can significantly relieve cancer pain and its induced depression-like mood, and its mechanism may be related to the remission of neuroinflammatory response in basolateral amygdala (BLA) and the recovery of abnormal activity of specific neurons in model animals^[65]. Early bone edge acupuncture combined with electroacupuncture can reduce morphine tolerance in bone cancer pain rats, and this effect may be related to the down-regulation of histone deacetylase 1 (HDAC1) protein expression and up-regulation of μ-opioid receptor (MOR) protein expression in dorsal root ganglion (DRG)^[66]. Bone edge electroacupuncture can effectively interfere with morphine tolerance in bone cancer pain, and its mechanism may be related to increasing the level of G protein-coupled receptor kinase 5 (GRK5), inhibiting β-arrestin, protein kinase Cα (PKCα) and its phosphorylation^[67]. Electric acupuncture at Zusanli and Kunlun points, frequency 2/100 Hz, intensity 0.5–1.0–1.5 mA (10 min each), and 30 min each time, once every other day, can treat bone cancer pain in rats and enhance immunity. The latter is mainly effective by enhancing the killing activity of rat spleen natural killer (NK) cells and increasing the number of non-NK cells^[68].

Studies have shown that the pathogenesis of CINV is closely related to serotonin receptors and substance P^[76], and acupuncture affects the emetic initiation and antiemetic effects of neurotransmitters in chemoreceptor trigger zone (CTZ). For example, acupuncture can affect the transmission of endogenous opioid peptides and 5-HT, promote the secretion of pituitary endorphins and adrenal corticosteroids in patients, inhibit the CTZ sensing area and the vomiting center, and produce antiemetic effects^[69]. Zusanli electroacupuncture, 5 min each time, once every 3 d for 21 d, can alleviate intestinal mucosal injury after 5-fluorouracil (5-FU) chemotherapy in colorectal cancer mice, and its mechanism may be related to regulating oxidative stress in colon tissue and inhibiting apoptosis^[70].

Acupuncture may fight depression in a number of ways, such as stimulating the growth of neuroprotective factors and restoring neuronal structure^[77]. Electroacupuncture at GV20 and GV29 acupoints increases the expression of brain-derived neurotrophic factor (BDNF) in the hippocampus, and promotes nerve regeneration and improves depression-like behavior in rats^[71].

Early studies have shown that acupuncture can affect sleep by activating the parasympathetic nerve and inhibiting the sympathetic nerve. Modern research believes that acupuncture improves sleep mainly through regulating central neurotransmitters, chemical factors, immune cytokines and antioxidant defense systems, and promoting the restoration of Yin and Yang balance in the body^[72].

5 Study on Acupunture and Its Combined Application in Preventing and Treating Tumor and Its Mechanis

In addition to research on acupuncture treatment of cancer-related symptoms, acupuncture and its use in combination with traditional Chinese and western medicine have also made great progress in cancer treatment in recent years.

Acupuncture mainly enhances innate immunity and adaptive immunity helps the body fight against tumor development. Studies have shown that innate immune cells NK cells can induce target cell death by releasing granulozyme and perforin, and can also secrete pro-inflammatory cytokines (such as tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ)) to regulate immune function, which is the first line of defense against cancer^[78]. Recent clinical studies have shown that electroacupuncture immunoenhancement points (ST36) increase the number of NK cells and reduce tumor size in patients with cervical squamous cell carcinoma^[79]. In addition, regulatory tregs (T) cells in adaptive immune cells mainly play an immunosuppressive role. A study found that acupuncture Dazhi (GV14) can effectively reduce the number of tregs cells in the spleens of tumor-bearing mice and inhibit cell growth^[80].

The mechanisms of acupuncture combined with traditional Chinese and western medicine in the treatment of cancer are widely involved (Figure 2). For example, the treatment effect of acupuncture combined with Houpo exhaust mixture on patients undergoing radical resection of cervical cancer is obvious, which can effectively alleviate clinical symptoms, reduce inflammatory response, reduce the levels of procalcitonin (PCT), interleukin-6 (IL-6), TNF-α, interleukin-8 (IL-8), gastrin (GAS), motilin (MTL), improve gastrointestinal function and improve quality of life in patients with radical cervical cancer^[81]. Zusanli electroacupuncture can enhance the efficacy of CapeOX in inhibiting colorectal cancer, and its mechanism may be related to promoting apoptosis of tumor cells, inhibiting ferroptosis and regulating immune tolerance. In addition, electroacupuncture ST36 combined with CapeOX can also reduce the damage of CapeOX to hematopoietic function, immune function, liver and kidney function^[82]. Yiyi Fuzi Baijiang powder combined with electroacupuncture can prevent colitis-associated colorectal cancer development in azoxymethane/dextran sodium sulfate (AOM/DSS) model mice, and its mechanism may be related to down-regulating nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathway and slowing down epithelial-mesenchymal transition (EMT) process^[83]. Studies have shown that electroacupuncture Zusanli may slow down the tumor growth rate of breast cancer mice by improving the anti-tumor immune response^[84]. Zusanli electroacupuncture, 30 min each time, once every other day, 12 times in total, can inhibit the inflammatory response of AOM/DSS inflammatory associated colon cancer mice and delay the transformation of colon inflammation to cancer^[85]. Bilateral Zusanli and Fenglong electroacupuncture, 20 min each time, 3 times a week for 11 consecutive weeks, can reduce the number of tumors in the transformed mouse model of colorectal cancer, reduce the level of inflammatory response, increase the body mass of mice, and reduce disease activity index (DAI) score. The mechanism may be related to the activation of sirtuin 1 (SIRT1) expression in intestinal tissue by electroacupuncture, and then regulate autophagy^[86].

6 Discussions

To sum up, acupuncture plays a multi-level and all-round comprehensive role in cancer prevention and treatment. Acupuncture and moxibustion can increase curative effects and reduce toxic side effects. It can alleviate various adverse reactions caused by radiotherapy and chemotherapy through single application or combined application with various first-line treatment drugs, improve drug efficacy and improve patients’ quality of life. Acupuncture and moxibustion can tonify the healthy Qi and resist cancer. By regulating the whole body Qi, supporting the healthy Qi and promoting immunity, it can inhibit tumor growth and relieve the systemic and local symptoms induced by cancer. Acupuncture can prevent precancerous lesions and delay cancer progression, reduce the chance of cancer in advance through anti-inflammatory effects, and slow down the transformation process of patients from inflammation to cancer^[10]. Moreover, the technology of acupuncture treatment is also constantly innovating, combining traditional acupuncture with modern physical therapy, creating electroacupuncture therapy, heat acupuncture therapy, and magnetic pole acupuncture therapy. In addition, innovative approaches such asbee venom acupuncture,acupoint leech therapy, and acupoint therapy combined with biological therapy have emerged^[14]. Compared with traditional acupuncture and moxibustion, these innovative technologies offer more abundant stimulation methods, and have been improved in different degrees in terms of stimulation intensity, effectiveness speed and indications, and their efficacy and safety in clinical application have been verified in many aspects, and are expected to play a greater role in cancer treatment in the future.

However, there are still limitations in current development of acupuncture and moxibustion. Randomized controlled trials (RCTs) on acupuncture for cancer treatment mainly focus on symptoms associated with breast cancer and head/neck cancer. There are few studies involving other cancers such as lung cancer and colorectal cancer, and the sample size is small, and the clinical trials are not rigorous. Therefore, multi-center international cooperation should be strengthened in future research, and cancer centers in China, Europe and the United States should be united to share data through a unified research program (e.g., the SPIRIT-Acupuncture Guideline). And the scale of data should be expanded through international cooperation. In addition, in clinical trials, the sample size can be dynamically adjusted according to the interim results to include a wider group of patients, reduce exclusion bias, increase multi-cancer combined trials, break the cancer barriers, focus on common symptoms and mechanisms, and build a multi-level evidence system of acupuncture and moxibustion oncology. In addition, the common acupuncture points for the treatment of cancer are mainly Qihai, Guanyuan and Zusanli, which tonify positive Qi, but different doctors rely on clinical experience when choosing acupoints, resulting in differences in efficacy, and cannot accurately evaluate the scientific and safety of the efficacy. Therefore, modern electronic information technology can be used to establish a database of acupuncture treatment, statistical common acupuncture point selection of different symptoms, while retaining the flexibility of personalized treatment. With the development of the times, acupuncture and moxibustion has gradually become an intervention science that integrates the wisdom of traditional oriental medicine with the mechanism of modern biomedicine. Future studies need to further integrate interdisciplinary techniques to clarify the specific action path of the “acupoint-brain-target organ” axis, so as to promote the standardization and international development of acupuncture medicine. Future research is suggested to focus on the following aspects: First, the role of acupuncture in the whole process of cancer treatment (such as whole-cycle management from diagnosis to rehabilitation). Second, the combination of acupuncture and other therapeutic means (such as immunotherapy, targeted therapy). Third, the design of individual acupuncture treatment and the establishment of therapeutic effect prediction model. These efforts will promote the standardization and international development of acupuncture medicine.