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Comment & Response
December 4, 2018

Acupuncture for Aromatase Inhibitor–Related Joint Pain Among Breast Cancer Patients

Author Affiliations
  • 1Memorial Sloan Kettering Cancer Center, New York, New York
  • 2University of Pennsylvania, Philadelphia
JAMA. 2018;320(21):2269-2270. doi:10.1001/jama.2018.16736

To the Editor Dr Hershman and colleagues1 conducted a randomized clinical trial (RCT) of acupuncture’s efficacy in reducing aromatase inhibitor–related joint pain among breast cancer survivors compared with sham acupuncture and waitlist control. They concluded that “the study results rejected the null hypothesis that true acupuncture generated the same outcomes as sham acupuncture and waitlist control, although the magnitude of the effect did not achieve the prespecified difference of 2 points,” having selected a 2-point difference as clinically important.2 However, the difference of 2 points or 30% was never meant to be applied to between-group differences, but rather is the change that represents a clinically important difference for an individual patient, creating dichotomous groups of responders and nonresponders to the therapy. The authors did appropriately apply the clinically important criteria to their data in a post hoc analysis showing that the number of patients who achieved a 30% difference was 52.0% in the treatment group compared with 33.3% in the sham acupuncture group and 29.4% in the waitlist control group. This dichotomous outcome was also statistically significant.