Visual abstract

Introduction

Cancer has become one of the most common causes of death worldwide in recent years [1]. In a survey study of 115 countries by the World Health Organization in 2022, it was reported that cancer caused an estimated 9.7 million deaths and 20 million new cases of cancer [1]. This was a significant rise in the worldwide cancer burden from 18.1 million in 2018 [2].

In Korea, the number of cancer cases between 2020 and 2021 increased by 10.8% [3], and in 2024, the lifetime probability of developing cancer among Koreans was reported to be 38.1% [4]. Data from the National Health Insurance Service showed that the number of patients who visited Korean medicine hospitals for cancer treatments increased from 16,071 in 2019 to 21,099 in 2022 [5]. With this increase in the number of cancer patients visiting Korean medicine hospitals for treatments, there has been an increase in the number of efficacy studies of Korean medicine. A review was performed by Meedeniya et al [6] of studies between 2011 and 2020 which determined breast cancer was the most common type of cancer treated and an integrative medicine approach was typically applied using conventional, and traditional Korean medicine.

In a survey carried out in 2017, many cancer patients viewed Korean medicine treatments as ineffective or “unscientific” but were useful for alleviating symptoms and side effects [7]. This poses a barrier to the implementation of Korean medicine treatments as a cancer treatment. Evidence-based medicine is important to both health caregivers and patients in order to show effectiveness and safety of Korean medicine treatments for cancer.

Studies on traditional Korean medicine treatments and/or integrative care for cancer have mainly focused on patients in East Asia (China, South Korea, and Japan) where these treatments have been traditionally and widely utilized, but for patients outside East Asia, there is a lack of reference for integrative cancer care [8–10]. In Europe, traditional medicine, including acupuncture and herbal medicine, is not typically used to treat cancer. However, Iscador (which is a long standing cancer medicine treatment) is made from European mistletoe (Viscum album) [11].

As of 2021, Europe holds the largest market share in complementary and alternative medicine (CAM), with an annual growth rate of approximately 21%, and the market is projected to reach 107 billion euros (125 billion USD) by 2028 [12]. This growth reflects policy support, such as including CAM as part of national health insurance coverage in some European countries, as well as a longstanding history of using natural medicine in countries like Germany and the UK. Despite insufficient evidence for CAM efficacy, it is actively utilized by general practitioners in European countries, such as Germany and Italy, distinguishing Europe from East Asia [13,14].

Evaluating the cancer research trends and effectiveness of herbal medicine and acupuncture in Europe would be meaningful. In this review, research from Europe including Turkey and the Russian Federation to the definition of ‘Europe’, as both were considered European countries according to the Republic of Korea’s Ministry of Foreign Affairs (MOFA) [15,16] was reviewed. Since most studies have focused on alleviating the adverse events of chemotherapy, with very few addressing cancer itself as the primary target of treatment, the necessity of systematically reviewing studies on the use of herbal medicine and acupuncture for cancer treatment in Europe has become evident.

Given the active and growing usage of Korean medicine treatment against cancer, a scoping review was necessary to broaden the perspective of its clinical effectiveness and to provide scientific evidence of acupuncture and herbal medicine as primary treatment in cancer care.

Materials and Methods

This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews [17] (Supplementary 1). This review also followed the methodology framework of Arksey and O’Malley [18]. This methodology consists of 5 steps: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; and (5) collating, summarizing, and reporting the funds.

1. Identifying the research question

The research questions were: (1) what are the common types of cancer treated with acupuncture and herbal medicine in European clinical studies; (2) which types of herbal compounds or acupuncture points are typically used in European clinical studies for cancer treatment; and (3) how satisfied are European cancer patients with the use of acupuncture and herbal medicine as treatment?

2. Identifying relevant studies

Electronic databases and relevant medical journals were used for article selection (PubMed, Cochrane Library, and Web of Science). Due to limited access to journals and manpower, the journal-specific search was narrowed down to 2 journals: BMC Complementary Medicine and Therapies and European Journal of Integrative Medicine. These journals were selected using the Scimago Journal and Country Rank database. Journals that were categorized as CAM were screened first, and sorted by the highest number of publications over the past 3 years. The journals that were based outside of Europe or journals that focused solely on herbal medicine or natural products were excluded. BMC Complementary Medicine and Therapies met the criteria with the highest number of relevant publications, and European Journal of Integrative Medicine was selected because it showed specific regional focus on Europe. Major keywords used in finding relevant studies included “acupuncture,” “herbal medicine” and “cancer.” Since the journal web page did not provide an advanced search method, the search terms “acupuncture, cancer,” and “acupuncture, herbal medicine” were entered and the articles retrieved were manually screened. If full texts of articles could not be accessed through the databases or journal website, Google Scholar was used to retrieve them. Two specific herbal medicines were included in the search strategy, mistletoe and medical cannabis i.e. tetrahydrocannabinol (THC), because these herbal medicines are actively used in Europe and there are researches on its effectiveness against cancer [18–20]. The search strategies used for each database are presented in Supplementary 2. For reference management, Papers 3 (ReadCube) and Microsoft Excel 365 (Microsoft) were used.

3. Study selection

3.1. Inclusion criteria

Studies were included that met the inclusion criteria: (1) either conducted in the European region, or the first author’s affiliation was with the European region; (2) included acupuncture or herbal medicines; (3) full-text provided articles; (4) had relation to cancer treatment; and (5) articles published after January 1, 2000. The decision of whether articles were included in the “European region” was made primarily based on whether the first author's institutional affiliation was with Europe.

Due to the limitations of MeSH terms and other available tools to indicate the geographical context of studies, we selected this criterion for its practicality during database filtering. While we acknowledge that the first author’s affiliation does not always perfectly reflect the setting of the study, it worked as a realistic alternative under the constraints in the screening process. To further minimize potential misclassifications during screening, an additional review was conducted during screening to assess whether the studies reflected European research or clinical context, if an article was ambiguous. During the screening of abstracts of each article, the final decision was made about its validity on “European region.” There were exceptions, as some articles had first authors’ affiliations with Europe but the study was not carried out in Europe. Decisions on whether the disease should be considered as cancer were guided by the National Cancer Institute's list of cancer types [21] or whether the article mentioned the disease as a type of cancer. Decisions of whether certain drugs should qualify as a herbal medicine were informed by classical Chinese medical texts and related articles that used herbal medicines. For treatments that were similar to acupuncture, but the article did not mention whether it was a type of acupuncture, Medical Insurance Reimbursement Costs published by the Health Insurance Review and Assessment Service [22], and other acupuncture-related articles were used as guidelines for the decision to call the treatment acupuncture. If certain treatments were considered a separate treatment to acupuncture treatment by Medical Insurance Reimbursement Costs or acupuncture-related articles, the treatment was considered as a separate treatment and excluded from the research. The timeline January 2000 to August 2024 was selected for the inclusion criteria to ensure that the review reflected relatively recent clinical evidence, research methodologies, and standards.

3.2. Exclusion criteria

Studies that met the exclusion criteria were excluded from analysis: (1) duplicated articles; (2) no relation to treatments of acupuncture nor herbal medicines; (3) had no relation to cancer or cancer treatments; (4) written in languages other than English; (5) study protocols, systematic reviews, meta-analysis articles and case reports; (6) survey articles solely focused on the use of acupuncture or herbal medicine; (7) articles related to the treatment of chemotherapy-related adverse events; (8) articles that were difficult to examine the sole effects of acupuncture or herbal medicine on cancer treatment; and (9) case reports and articles about prescription drugs with herbal medicine composition usage.

As discussed above, one of the goals of this study was to examine clinical research related to the use of acupuncture and herbal medicine in cancer treatment. To align with this goal, noninterventional studies such as observational surveys and literature reviews were excluded. While we acknowledge these studies can offer meaningful insights into patterns of usage or conceptual frameworks, we believe they do not provide the level of clinical evidence that is necessary to validate therapeutic efficacy of cancer care. Since this review aimed to contribute to the scientific basis for integrative cancer care, we focused on studies that directly evaluated treatment outcomes. The initial selection was performed by 2 independent authors, who screened the articles’ title and abstract using the inclusion and exclusion criteria. Articles that had little or no relation to the research questions were excluded. Articles related to the treatment of chemotherapy-related symptoms, although actively treated by doctors of Korean medicine [23,24], were excluded because these symptoms are not caused directly by cancer, they are side effects. In this review we aimed to include articles with direct cancer care. Case reports were also excluded from this study because the sample size is typically very small, and we believed it would not provide sufficient or statistically significant evidence. Although case reports are useful for documenting individual treatment outcomes, they lack the sample size and methodological rigor needed for broader conclusions about treatment effectiveness. Articles that used prescription drugs with herbal medicine, like Iscador, where the sole effects of the herbal medicine could not be determined were not considered eligible for this study. Studies that used other types of CAM treatments, such as yoga and massages, along with acupuncture or herbal medicines were excluded because they did not show nor prove sole effects of acupuncture or herbal medicine in cancer care.

4. Charting the data

Following article selection, qualitative data analysis including study design, intervention, type of herbal medicine, outcome measurement methodology, outcomes, adverse events, and satisfaction was performed. Quantitative data analysis included authors, publication year, country, and the number of participants. Data extraction and analysis were conducted by all authors except the corresponding author.

5. Collating, summarizing, and reporting the funds

For the classification of the eligible articles Group A included articles associated with acupuncture, and Group B included articles associated with herbal medicine. The data was extracted from the eligible articles and analyzed (Table 1 [25–30]).

Results

There were 6,109 articles retrieved from the initial screening by title and abstract, 746 duplicate records were removed, and 4,532 records were marked as ineligible. The remaining 830 records were partially screened using the inclusion and exclusion criteria. This stage excluded studies that were clearly ineligible, such as invitro or noninterventional articles that could not be excluded during abstract screening. There were 517 articles excluded. Specifically, 466 invitro articles were identified in PubMed, 20 in Web of Science, and 20 in the European Journal of Integrative Medicine, while no invitro studies were identified in the Cochrane Library or BMC Complementary Medicine and Therapies. In addition, 11 articles underwent further discussion amongst the reviewers due to ambiguous classification; all of these were ultimately categorized as invitro studies. This classification process ensured transparency and methodological consistency in the exclusion process. Originally, 1 group of excluded articles was labeled as “survey articles.” However, this label was inaccurate, as this category included a broader range of nonexperimental study designs, such as survey-based studies, cohort studies, and literature reviews. To better reflect the characteristics of these studies, this group was relabeled as “noninterventional articles.” After the screening process, 6 articles were included in this scoping review. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews flow diagram that shows the article selection process is presented in Figure 1. There were 3 articles which were randomized clinical trials, 1 article was an observational study, and 2 articles were nonrandomized clinical trials. Two articles used acupuncture, and 4 articles used herbal medicine.

1. Overview of the included articles

In a pragmatic, randomized controlled trial conducted in the United Kingdom by Molassiotis et al [25], the effectiveness of acupuncture for cancer-related fatigue (CRF) in patients with breast cancer was assessed. There were 302 breast cancer patients who received either usual care, where the patient received a booklet about fatigue and its management (n = 75) or usual care and acupuncture (n = 227). The intervention group treated with acupuncture had lower physical and mental fatigue, anxiety, and depression, and higher quality-of-life scores. Although this study focused on the mild level of CRF, the article concluded that acupuncture could be recommended for managing the CRF and quality of life [25].

A prospective RCT in Sweden was conducted by Frisk et al [26] as a part of an international, multicenter study (HABITS-hormonal replacement therapy after breast cancer - is it safe?). In this study the long-term effects (up to 24 months) of 12 weeks of electro-acupuncture or hormone therapy on vasomotor symptoms (hot flushes and sweating) were assessed in women treated for breast cancer. There were 45 patients with breast cancer who were assigned to either the electro-acupuncture treatment group (n = 27) or a hormone therapy group (n = 18), and numbers of hot flushes were measured at baseline, and the 12^th week of treatment. Then again during the first week of 6^th, 9^th, 12^th, 18^th and 24^th month after the start of treatment. Although only 19 patients completed the 12-week course of treatment, both the number of hot flushes per 24 hours and the Kupperman Index showed a significant reduction. Results showed that electro-acupuncture ameliorated the vasomotor symptoms in most of the patients with breast cancer [26].

A double-blind, randomized, placebo-controlled trial was conducted in Sweden by Wode et al (N = 290) [27]. This study assessed the effect of mistletoe extract on advanced pancreatic cancer patients’ overall survival (OS) and health-related quality of life (HRQoL) over 9 months (n = 143). The results showed that there were no significant effects of mistletoe extract on patients’ overall survival and HRQoL. For HRQoL, the mean change value for mistletoe was greater at the 2-month, 3-month, 5-month, and 6-month time points; however, both overall survival and HRQoL showed an overall decreasing trend. The author suggested that exocrine pancreatic cancer in the study patients might have been in a more advanced state of pancreas cancer compared with a previous study which reported mistletoe extract was an effective treatment for the pancreatic cancer patients [27].

A clinical trial was conducted in Germany by Elsässer-Beile et al [28] where the aim of this study was to assess the potential of mistletoe extract as an alternative adjuvant treatment for superficial bladder cancer (N = 30). This study showed that mistletoe extract therapy, within the observation time of 12 months, showed a similar tumor recurrence rate compared with adjuvant intravesical immunotherapy using bacillus Calmette-Guerin, but it did not have the severe local and systemic side effects associated with bacillus Calmette-Guerin [28].

A single-center, open-label, controlled, pilot study was conducted in France by Freyer et al [29] (N = 31). This study evaluated the effect of at least an 8-week course (or until clinical progression) of Ruta graveolens 9c treatment on patients with advanced cancer. The patient's quality of life improved statistically significantly from baseline to 8 weeks. However, there were no significant changes in anxiety/depression, performance status, and tumor response. Median overall survival was 6.7 months, median progression-free survival was 1.9 months and median survival without any deterioration in quality of life (QoL) was 2.2 months [29].

A retrospective multicenter cohort study in Germany, conducted by Gastmeier et al [30], was performed to determine the effect of THC on survival of palliative cancer patients. Patients were given low dose (≤ 4.7 mg per day) or high dose (≥ 4.7 mg per day) THC and survival was compared with no THC. Analysis was performed using 2 cohorts. The first cohort was a patient group with a survival time of at least 7 days after inclusion in specialized ambulatory palliative care (N = 9,419) and the second cohort was a subgroup of the first cohort that had a survival time between 7 and 100 days (n = 7,085). Across these 2 groups, THC was found to statistically significantly increase survival time from 15 to 39 days, based on the patients’ survival time [30]. Furthermore, when high dose THC were prescribed patients survived 15 days longer in Cohort 2 [30]. The study showed that THC, used to improve sleep quality and appetite and to reduce anxiety, stress, and pain, also statistically significantly extended the survival time for palliative cancer patients.

2. First author affiliation or studies conducted in Europe

Germany and Sweden had the most studies in this review, as each contributed 2 of the 6 studies. Other countries included the United Kingdom and France, which had 1 study each. In terms of European countries’ regional affiliation, Western Europe had 5 articles and accounted for the most appearances, followed by Northern Europe with 1 article.

3. Mentioned herbal medicines and acupuncture points

In general, acupuncture points that have proven effective in previous studies were selected. One article mentioned acupuncture points including ST36, SP6, LI4, GB34, and SP9. Mistletoe was the most frequently used herbal medicine across the included articles. Other herbal medicines mentioned include Ruta graveolens and THC.

4. Cancer types and the number of included articles

Breast cancer was the most common type of cancer in included articles, followed by pancreatic cancer and superficial bladder cancer (one of the included articles in our review did not mention the specific type of cancer in their study). The predominance of breast cancer as the most frequently studied type in this review may be influenced by its high incidence in Europe. The European Cancer Information System has been reported that breast cancer is the most diagnosed cancer among women across EU countries, and it accounts for approximately 30% of all new cancer cases in females in 2022 [31]. Similarly, pancreatic cancer has shown a notable rise in both incidence and mortality in recent years. Recent Europe-wide data shows that pancreatic cancer now ranks among the top 3 causes of cancer death, with over 90,000 deaths annually and an increasing trend in both men and women [32,33]. This may partially explain why these cancer types are more frequently studied in clinical research involving acupuncture and herbal medicine, as they represent areas of urgent clinical interest for supportive care interventions.

In the study by Freyer et al [29], multiple types of cancer were included, but predominant cancers were the only types of cancer considered in our statistical analysis. These included locally advanced or metastatic solid cancers that were difficult to cure by standard therapies, including breast (29%), kidney (16%), ovary (13%), colorectal (10%), lung (6%), prostate (6%), pancreas (3%), stomach (3%), endometrium (3%), peritoneum (3%) and appendix (3%).

5. Effect of acupuncture on cancer patients

The adverse events caused by chemotherapy, and the symptoms that are caused by cancer itself rather than treatment were distinguished in this review. Articles on acupuncture use showed direct efficacy for cancer-related symptoms, such as cancer-related fatigue.

In the study by Molassiotis et al [25], statistically significant evidence was provided to support the effectiveness of treating cancer-related fatigue. Improvements in both physical and mental fatigue and anxiety could be achieved through acupuncture care in breast cancer patients.

In the study by Frisk et al [26], statistically significant evidence was provided that long-term electro-acupuncture treatments were effective in treating hot flushes and sweating in breast cancer patients. In this study, a comparison was made between the electro-acupuncture and hormone therapy group, and the electro-acupuncture group showed a greater reduction in hot flushes.

6. Effect of herbal medicine on cancer patients based on evidence

All articles related to herbal medicine were directly related to cancer itself. However, not all articles reported the positive or statistically significant effects of herbal treatment of cancer.

In the study by Wode et al [27], mistletoe extract was used in patients with pancreatic cancer, but the results did not show significant effects on patient survival, global health, QoL, and occurrence rate of local skin reaction compared with the placebo group. Although mistletoe extract did not yield a significant effect on pancreatic cancer, the authors suggested that results may be different to prior studies (which showed positive effects of mistletoe extracts against pancreatic cancer) because of the high severity of cases of pancreatic cancer in their study.

In the study by Elsässer-Beile et al [28] where mistletoe extract was used in patients with superficial bladder cancer, the authors reported that the mistletoe extract group showed no significant difference compared with the control group in recurrence rate, levels of cytokines in urine, p75 Tumor Necrosis Factor receptor levels, and no cytotoxic effect was observed against bladder cancer cells.

In the study by Freyer et al [29], Ruta graveolens 9c were administered to end-stage cancer patients with various types of cancer. QoL was significantly improved among patients, but no significant improvements in anxiety, depression, performance status, or tumor response were observed. A small number of patients showed improvements in performance status of 50%, and 40% of patients with morphological stability showed stability after 8 and 16 weeks of treatment.

In the study by Gastmeier et al [30] THC was used, a herbal medicine used for palliative treatment of cancers, but specific cancer types were not mentioned. In both cohorts, survival time significantly increased in patients treated with high dose (4.7 mg/day) THC.

7. Overview of satisfaction and adverse events with acupuncture and herbal medicine

Not every study in this review evaluated or questioned patient satisfaction, but for articles that did, the satisfaction of patients was relatively high [26,29]. The patients expressed their satisfaction or expressed willingness to continue integrative cancer treatments (Table 1 [25–30]).

Among the 6 included studies, 2 studies reported patient satisfaction outcomes, with generally positive results. In the study by Frisk et al [26], it was reported that 85% of patients at 12 weeks electro-acupuncture treatment were satisfied with its treatment of vasomotor symptoms caused by breast cancer treatment, and 63% of patients showed satisfaction after 2 years. Freyer et al [29] noted that 20% of patients expressed a desire to continue Ruta graveolens 9c therapy after the study period. Other studies did not formally assess patient satisfaction, but they reported a continued use or acceptance of the used therapeutic methods.

No serious adverse events were reported to have occurred during the study period of the included studies. In the study by Gastmeier et al [30], it was noted that THC was well tolerated in the palliative settings, and in the study by Freyer et al [29], it was noted that adverse events were mostly mild (fatigue or abdominal pain) with no clear relation with the herbal medicine intervention. In the studies by Molassiotis et al [25] and Frisk et al [26] no adverse events related to acupuncture treatment were reported. These findings suggest an overall high level of safety and acceptability in cancer patients.

Discussion

To explore studies in Europe researching the effects of herbal medicine and acupuncture to cancer-related symptoms alleviate cancer-related symptoms, a scoping review was performed. Initially, we anticipated that there would be many studies reporting the use of herbal medicine and acupuncture for cancer treatment in Europe. This prompted the collection of comprehensive research data. There were 830 relevant papers that were identified, which led to the suggestion that there would be sufficient evidence to investigate the direct anti-cancer effects of herbal medicine and acupuncture. However, it was determined that the majority of studies focused on alleviating the adverse events of chemotherapy. The focus of this study was to analyze the direct effects of herbal medicine and acupuncture on cancer rather than alleviation of chemotherapy-related adverse events.

During the research process, it became necessary to discuss the definition and range of herbal medicines, particularly the feasibility of using specific substances. Questions arose regarding mistletoe and THC and whether they could be included as herbal medicines. Notably, THC, which is classified as a narcotic substance not permitted in South Korea, raised uncertainty about whether it could enhance the credibility of using herbal medicine in cancer treatment. Although Dongui Sasang Shinpyun: Internal Book mentions cannabis as a medicinal ingredient for Taeumin in Sasang medicine, this reference was insufficient to establish the basis for THC in its clinical use [30]. Mistletoe can be considered as a type of herbal medicine, because related plants such as Sanggiseng (Loranthi Ramulus et Folium) and Gokgiseng (Visci Ramulus et Folium) are used in traditional Korean medicine. As seen in the case of Ephedra (Ma Huang), the herbal pharmacopoeia of traditional Korean medicine often groups 2 or more species under a single herbal name [34].

To conduct a comprehensive review, the range of herbal medicine was expanded to include substances such as medical cannabis (THC) and mistletoe used in Europe. This decision reflected the use of these substances in cancer treatment in European regions. Whilst including substances that are prohibited in South Korea may seem inconsistent with the study’s purpose, this approach was deemed appropriate considering the research’s geographical and contextual focus. It was also judged that the inclusion of these substances would not significantly affect the reliability of the study.

One of the key reasons to focus this review specifically on the European region was the noticeable lack of review articles on the use of acupuncture and herbal medicine in cancer care in this geographical context. During preliminary searches using PubMed, Cochrane Library, and Web of Science, it was obvious that the majority of reviews on traditional Chinese medicine (TCM)-based treatments such as acupuncture and herbal medicine, originated from East Asia, particularly in China. Contrary to this finding, the number of reviews on TCM treatment of cancer was low, despite the region’s growing use of CAM in oncology. We believed that providing evidence in a European context would offer some new perspectives and even practical value, particularly for Korean medicine practitioners who actively use TCM-based therapies in clinical environments. While we recognize that limiting the scope to Europe may appear narrow, the intention was to address a literature gap. Comparative analysis with other continents or regions may be beneficial for future research directions.

As discussed above, the increasing number of Korean patients seeking integrative approaches to cancer care, and the need to provide evidence based medicine to improve trust in integrative cancer care instructed the design of this study. Although the included studies in this review were performed in Europe, the findings in these studies may offer valuable reference to Korean medicine practitioners and healthcare policymakers of South Korea. The results from this study may also address concerns about the scientific validity and safety of Korean medicine treatments for cancer patients.

The inclusion criteria and definitions that are used in the review, such as the classification of acupuncture, were based on definitions presented by Health Insurance Review and Assessment Service, an independent public agency of South Korea. This work was conducted for consistency and practical relevance. While further studies into healthcare policy implications were beyond the primary goal of this review, we believe the findings in this review may serve as a starting point for social and medical discussions in the future regarding how traditional medicine therapies should or can be integrated into cancer care.

We also acknowledge that the inclusion criteria of the first author's institutional affiliation carries limitations. Although we believe it provided consistent and feasible criteria for identifying European studies during the initial screening, we accept that it may not always accurately represent the study's geographical setting. To prevent the potential errors that can be caused from this, we manually reviewed each full-text article to confirm that the article aligned with the European region criteria.

Regarding acupuncture, the limited number of relevant studies caused challenges in securing sufficient data that aligned with the study’s objectives. This highlighted the need for further research and the accumulation of clinical evidence to scientifically substantiate the effects of acupuncture on cancer treatment rather than the side effects of chemotherapy.

The acupuncture points (ST36, SP6, LI4) used in the study by Molassiotis et al [25] were not unique, and reflect a clinical pattern in a broader perspective. Similar acupuncture point selections could be observed in other studies that targeted cancer-related fatigue, including the studies by Johnston et al [35] and Smith et al [36], both of which employed ST36 and SP6 as core points. These acupuncture points are also cited in clinical literature in East Asia in cancer-related fatigue treatments that have acupuncture and acupressure interventions [37,38]. Therefore, it suggests a consistent rationale across trials could be found for their use in managing cancer-related fatigue and in improvement of overall well-being of patients.

Recognizing the high rate of satisfaction among patients in the included articles which assessed this criterion, we believe acupuncture and herbal medicine treatment of the effects of cancer can be acceptable to cancer patients. Evidence-based research will support doctors of Korean medicine in their conviction to propose acupuncture and herbal medicine treatment for cancer patients.

The therapeutic effects of traditional Korean medicine continue to be validated through various research and clinical studies. Work on the anticancer effects of herbal medicine and acupuncture have been actively conducted in South Korea and China, leading to an increase in the number of cancer patients accepting traditional Korean medicine [5]. This study provides scientific evidence of the therapeutic effects of herbal medicine and acupuncture on cancer treatment in Europe. It is anticipated that as evidence-based medicine is carried out, and similar to East Asia, cancer patients in Europe will recognize traditional Korean medicine as an effective approach to cancer treatment.

As previously mentioned, most herbal medicines that are identified in this study are commonly used in Europe but rarely used in South Korea. Future studies designed in Europe should consider using herbal medicines that are commonly used in South Korea. Additionally, employing acupuncture methods performed by certified Korean medicine practitioners may yield more definitive evidence.

This review excluded studies that were focused on the adverse events of cancer treatments such as chemotherapy. The intention was to assess the direct therapeutic effects of herbal medicine and acupuncture treatment on cancer. A study of Park et al [39] has demonstrated the effectiveness of herbal medicine and acupuncture in the management of adverse events that are related to chemotherapy, such as nausea, fatigue, and pain. These studies emphasize the value of complementary medicine in cancer care and suggest the need for further research focusing, specifically, on management of side-effects of cancer treatments such as chemotherapy. In contrast, our review deliberately excluded these studies to investigate whether acupuncture and herbal medicine show direct therapeutic effects in treating cancer rather than side effects of cancer treatments. This narrow scope of our review differentiates our review from the existing body of literature, and emphasizes a relatively underexplored aspect of integrative oncology in the European context.

While we recognize that the number of included studies in this scoping review is limited, we believe the findings will contribute to the understanding of how acupuncture and herbal medicine are utilized in cancer care within the European region. We also believe that this review provides a preliminary insight that may be valuable to doctors of Korean medicine and Korean medicine researchers who aim to study the application of TCM practices in a non-Asian geographical context. Given that many previous review articles related to cancer care using acupuncture or herbal medicine have focused on East Asian countries, especially in China, this study fills a gap by highlighting the usage in the European region, patient satisfaction, and safeties of these therapies in cancer care. Although it is evident that more research is needed, the results of this review may serve as a reference for practitioners and policymakers who investigate integrative oncology practices beyond East Asia.

Conclusion

This scoping review identified a limited but emerging body of clinical research on the use of acupuncture and herbal medicine in cancer treatment within the European region. While only 6 eligible studies were identified, these studies provide preliminary evidence that supports the potential benefits of herbal medicine and acupuncture treatment of cancer, such as improved quality of life, symptom relief, and patient satisfaction. However, due to the small number of the included studies the efficacy of treatment cannot be reliable. These findings emphasize the need for high quality research for better understanding in the roles of acupuncture and herbal medicine in integrative cancer care, especially in regions outside of East Asia.

Supplementary Materials

Article information

Author Contributions

Conceptualization: KWP. Methodology: KWP, JSP, MJK, GMP, YJL, and HKL. Formal investigation: KWP, MJK, GMP, YJL, and HKL. Writing-original draft: KWP. Writing-review and editing: KWP, JSP, MJK, GMP, YJL, and HKL.

Conflict of Interest

The authors of this article have no conflict of interest to declare.

Author Use of AI Tools Statement

During the preparation of this manuscript, the authors used ChatGPT for locating and fixing grammatical errors and typos, and for clarifying sentences.

Funding

This article was supported by a grant from Jaseng Hospital of Korean Medicine.

Ethical Statement

Not applicable.

Data Availability

Figure 1

Flow chart of article selection process.

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