Moxibustion for chemotherapy-induced myelosuppression: A systematic review and meta-analysis

Introduction: Myelosuppression is a common treatment-related complication in cancer patients. Moxibustion has been proposed as a potentially effective intervention to alleviate the side effects of chemotherapy-induced myelosuppression. This review aimed to investigate the effectiveness and safety of moxibustion in treating chemotherapy-induced myelosuppression, as well as the most promising modalities and patterns of moxibustion application.Methods: We included randomised controlled trials (RCTs) focusing on the effectiveness of moxibustion on chemotherapy-induced myelosuppression, including the total effective rate, leukocyte count, hemoglobin level, platelet count, neutrophil count, and quality of life as outcomes. Six English and four Chinese databases were searched. Two researchers independently screened the articles, extracted data, and evaluated the quality of the included studies. The quality was assessed using the revised Cochrane Risk-of-Bias tool (RoB 2.0). Metaregression and subgroup analyses were used to find the most effective modalities and treatment patterns. In addition, we utilised the Grading of Recommendations Assessment, Development, and Evaluation system to establish a persuasive conclusion. Data were meta-analysed using Stata (version 14.0).Results: Twenty-one studies were included in this systematic review, including 1887 patients. The overall quality of all included studies was moderate. Meta-analysis of 9 RCTs indicated that moxibustion provided a greater therapeutic benefit in the treatment of chemotherapy-induced myelosuppression (RR=1.22, 95%CI=1.15, 1.29, P<0.001). Moreover, the results of 15 RCTs showed a significant increase in leukocyte count (WMD=0.62, 95% CI=0.08, 1.16, P=0.025); 3 RCTs showed elevated hemoglobin level (WMD=11.72, 95%CI=5.67, 17.76, P<0.001), and 3 RCTs showed increased platelet count (WMD=16.24, 95% CI=10.37, 22.11, P<0.001). Furthermore, the results of 5 RCTs showed a significant favourable effect on the quality of life (WMD=5.54, 95% CI=3.09, 7.98, P<0.001). We also assessed the certainty of the body of evidence and the results showed that the total effective rate was assessed as moderate quality, while others were rated as very low. There was no publication bias in this meta-analysis. In addition, five studies reported adverse effects, and none were serious.Conclusions: Moxibustion may affect chemotherapy-induced myelosuppression. However, owing to the small number of included studies and their low methodological quality, more large-scale, multi-center, high-quality RCTs on moxibustion for chemotherapy-induced myelosuppression are needed.