Introduction

The Global Cancer Report released by the International Agency for Research on Cancer (IARC) points out that cancer has become the second leading cause of death in the world. In 2022, there will be approximately 19.965 million new cancer cases and 9.737 million deaths globally, and the number of new cases is expected to increase to 35 million by 2050.1 As the level of care continues to improve, the number of long-term cancer survivors increases, and more and more cancer patients are entering a chronic disease state.2 In the process of treatment, cancer patients often face physiological, psychological and other aspects of symptom distress, which seriously affects the survival rate and quality of life of patients.3 Symptom management is defined as the assessment, intervention and coordination of care to prevent, alleviate or treat symptoms that occur during the course of a disease and its treatment, including associated psychological, social and spiritual problems, in order to improve a patient’s quality of life and overall health.4 Symptom management tools for cancer patients include two main categories, pharmacologic and nonpharmacologic, but pharmacologic therapies may have toxic side effects, create new symptomatic problems or exacerbate other symptoms within the cluster; therefore, it is important to seek a nonpharmacologic therapy that is efficacious, easy to administer, and has few side effects. Auricular acupoint therapy is a purely green external treatment method of traditional Chinese medicine. It involves attaching pills or magnetic beads to specific acupoints on the ear using adhesive tape, and stimulating the auricular vagus nerve through pressing. The signals generated by this stimulation can be projected to the nucleus tractus solitarius, which then directly or indirectly projects to multiple brain regions, including the hippocampus, amygdala, thalamus, striatum, and prefrontal cortex. This process regulates the autonomic nervous system and alleviates patients’ symptoms. Characterized by simplicity of operation, low cost, and wide applicability, it is one of the common complementary and alternative therapies used clinically to relieve cancer-related symptoms.5 Currently, auricular acupoint therapy is widely used in symptom management of cancer patients, but systematic summarization and comprehensive assessment are still relatively insufficient. Therefore, this study adopted the method of scope review6,7 to sort out and analyze the current status and existing problems of the application of auricular acupoint therapy in cancer symptom management, with a view to providing reference for clinical practice.

Materials and Methods Defining the Research Question

According to the “PCC” principles published by the Joanna BriggsInstitute (JBI)8 in Australia. The object of this research review is cancer patients; the concept is the application of auricular acupoint therapy in symptom management of cancer patients; and the context is symptom management of cancer patients. Therefore, the main research questions of this study are what are the basic components and intervention forms of auricular acupoint therapy applied in symptom management of cancer patients? What is the effectiveness of the application of auricular acupoint therapy in symptom management of cancer patients?

Search Strategy

The system searched PubMed, Web of Science, Cochrane Library, Embase, CINAHL, Sinomed, CNKI, Wanfang Database, and VIP Database, with a timeframe of database construction to April 2025. The Chinese search subject terms refer to the 13 symptoms within the MD Anderson Symptom Inventory (MDASI),9 and the free words are “cancer/tumor/neoplasm/malignant tumor” “auricular plaster therapy/auricular acupoint pressing with beans/auricular acupoint seed embedding/auricular acupoint pressing/auricular acupoint therapy/Vaccaria seed/magnetic beads”; the English search terms are “neoplasms/neoplasm/tumors/tumor/cancer/cancers/carcinoma/carcinomas” “auricular acupressure/auricular acupoint pressing/auricular point sticking/auricular point pressing beans/auricular point embedding beans/auricular point therapy/auricular point embedding seeds/auricular point pressing seeds/auricular point treatment/Wang Buliuxing seeds/transcutaneous auricular Vagus Nerve Stimulation/taVNS.

Searches were conducted using a combination of subject and free word and manual searches while snowballing through the included literature. The search timeframe was from database construction to April 20, 2025.

Literature Inclusion and Exclusion Criteria

Inclusion Criteria: (1) The study subjects were cancer patients aged ≥18 years; (2) The intervention method was auricular acupoint therapy, and the form of intervention was open-ended; (3) The type of literature was original research, including randomizedcontrolled trial, quasi-experimental study, mixed-methods study, qualitative study; (4) The language was Chinese or English.

Exclusion Criteria: (1) duplicate publications and (2) inaccessible full text.

Literature Screening and Data Extraction

The retrieved literature was imported into NoteExpress software for de-duplication, and 2 researchers independently screened the studies that met the criteria based on the inclusion and exclusion criteria, and then re-screened based on the full-text content, and in case of disputes, they could be resolved after discussion or by asking a third researcher to resolve the issue. Establish the data extraction form for the study on the application strategy and management effect of auricular acupoint therapy in symptom management of cancer patients, 2 persons independently extracted the basic information and data from the included literature, and agreed with the 3rd researcher in case of disagreement or doubt during the extraction process. The extraction included first author, country of publication, time of publication, sample size, stage of implementation, implementer, target group, mode of implementation, and effect of implementation.

Results Results of Literature Search and Screening

The preliminary search yielded 3160 documents, with 1940 documents remaining after de-weighting, and 42 documents were finally included after reading the titles, abstracts, and full texts,10–51 of which 26 were in Chinese,10–13,15–20,22–25,32–34,38,39,41,44–47,50,51 and 16 were in English.14,21,26–31,35–37,40,42,43,48,49 The flowchart of literature screening is shown in Figure 1. The basic characteristics of the included literature are shown in Table 1.

Table 1 The Basic Characteristics of the Included Literature (n=42)

Figure 1 Literature retrieval and screening process.

Basic Characteristics of Included Literature

Forty-two papers published between 1984 and 2025 were included. Among them, 33 were from China,10–13,15–20,22–26,29,31–36,38–41,43–47,50,51 3 from the United States,14,27,37 3 from Brazil,28,42,49 2 from Korea,21,48 and 1 from France.30 The included literature included 32 randomized controlled trials,13–17,19,21–24,26–29,31–36,38–44,46,48–51 4 quasi-experimental studies,10,20,37,45 5 cross-sectional studies,11,12,18,25,47 and 1 case-control study.30 The basic characteristics of the included literature are shown in Table 1.

Research Subjects of Included Literature

All study subjects were cancer patients, including 11 studies on gastrointestinal cancer patients,11–13,18–20,33,36,38,41,47 7 studies on breast cancer patients,14,15,21,29,31,35,48,49 6 studies on lung cancer patients,22,26,32,44,46,50 2 studies on head and neck cancer patients,10,28 1 study on esophageal cancer patients,12 1 study on pancreatic cancer patients,25 1 study on liver cancer patients,23 1 study on hematological malignancy patients,34 1 study on cervical cancer patients,45 1 study on prostate cancer patients,42 and 10 studies without specified cancer types.16,17,24,27,30,37,39,40,43,51 The basic characteristics of the included studies are summarized in Table 1.

Application Features of Auricular Therapy in Symptom Management of Cancer Patients Implementation Personnel

Auricular therapy can be directly administered by healthcare professionals or researchers10,15,17,20,27,30,33,36,39,42,43,45,46,49 or, after healthcare professionals accurately locate the acupoints, and then guiding patients to perform the stimulation.13,14,16,19,21–24,26,28,29,31,32,34,35,37,38,40,41,44,48,50,51 Among the 42 included studies, 16 studies24,27–29,31,32,34,35,37,40,42,44,48–51 noted that operators must possess certain qualifications or be trained professionals. Training typically includes theoretical and practical learning, such as identifying positive points, intervention techniques, safety training, and how to provide health guidance to patients. The basic characteristics of the included studies are summarized in Table 1.

Intervention Phase

Auricular therapy plays a multifaceted role in symptom management for cancer patients, including prevention, diagnosis, and adjunctive treatment. (1) Diagnostic phase: Five studies11,12,18,25,47 indicate that ear acupuncture points in cancer patients exhibit changes in color, shape, and low resistance responses, among other aspects, which have certain auxiliary diagnostic significance. (2) Perioperative period: Ear acupuncture therapy is safe and effective, with a wide range of applications during the perioperative period of cancer treatment. Preoperative application of ear acupuncture point pressure can achieve preemptive analgesia, assist with anesthesia, and alleviate anxiety symptoms in patients;10,20,23,32 during surgery, it enhances analgesic effects and stabilizes vital signs;10 postoperatively, it promotes gastrointestinal function recovery, enhances patient immunity, shortens anesthesia recovery time, and reduces the incidence of adverse reactions.33,36,39,42,45 (3) Comprehensive treatment period or treatment interval period: 28 studies13–17,19,21,22,24,26–28,30,31,34,35,37,38,40,41,43,44,46,48–51 indicate 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. The basic characteristics of the included studies are summarized in Table 1.

Intervention Methods

(1) Ear acupuncture point application:13,14,16,19,21–23,26,28,29,31,32,35,37,38,40,44,48,50,51 Applying medicinal seeds, magnetic beads, etc., to ear acupuncture points, stimulating them through pressure. This method allows for treatment in any body position and offers high controllability, making it the most commonly used ear acupuncture therapy. (2) Ear acupuncture:10,20,27,30,39,42,45 This includes battlefield ear acupuncture, pressing needles, and long needles, using a method of inserting needles through the skin to penetrate the acupoints. This method has a broad stimulation range, rapid onset of action, and requires fewer treatment sessions. (3) Ear vagus nerve stimulation:17,33,36,43 This involves stimulation through surface electrodes on the ear, avoiding the surgical risks associated with implantable vagus nerve stimulation. However, due to individual patient differences, optimal stimulation parameters (frequency, intensity, pulse width, etc.) have not yet been standardized. (4) Ear acupoint massage:34 This method regulates physiological functions by massaging ear acupoints. It is simple to perform, safe, and easy for patients to master, with a broad stimulation range. (5) Ear acupoint injection:15 This involves injecting medication into the ear, combining acupoint stimulation with pharmacological effects to enhance therapeutic efficacy. Accurate selection of acupoints, control of injection depth, and proper dosage are essential to avoid complications such as local infection or hardening. (6) Ear scraping:46 Scraping specific areas of the ear with a scraping board, which is highly comfortable During treatment, changes in skin color and the appearance of scraping marks can be observed to assess the patient’s qi and blood condition and disease status. (7) Ear acupoint laser therapy:49 Using low-intensity laser irradiation on ear acupoints without needling or injection, reducing the risk of infection or bleeding, suitable for patients sensitive to pain. (8) Combined therapy:23,24,28,29,39,41,45,46 Combining ear acupuncture therapy with other treatment methods to enhance efficacy. Additionally, clinical practices include ear tip bloodletting, ear acupuncture thread implantation, ear moxibustion, and ear incision therapy. However, due to insufficient research evidence, these methods were not included in this study. The basic characteristics of the included literature are shown in Table 1.

Types of Symptoms

Among the 42 included studies, the symptoms covered included sleep disorders (11 studies),14,21,26,29,32,34,35,37,38,44,46 pain (10 studies),10,14,20,23,27,32,34,37,38,44 fatigue (9 studies),14,22,26,32,34,37,38,44,49 anxiety (4 studies),26,28,41,49 and chemotherapy-induced nausea, vomiting, and diarrhea (5 studies),15,17,19,31,50 constipation (2 studies),16,51 chemotherapy-induced neurotoxicity (4 studies),30,40,43,48 chemotherapy-induced intractable hiccups (1 study),24 chemotherapy-induced stomatitis (1 study),13 and other symptoms.20,28,33,36,39,42,45 Among these, 28 studies focused on a single symptom in cancer patients,10,13,15–17,19–24,27,29–31,33,35,36,39–43,45,46,48,50,51 while 9 studies explored multiple symptoms or symptom clusters in cancer patients.14,26,28,32,34,37,38,44,49 The basic characteristics of the included studies are detailed in Table 1.

Effect Evaluation Pain

Ten studies10,14,20,23,26,27,32,37,38,44 have 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 al37 noted that auricular pressure application can significantly reduce pain intensity in cancer pain patients and decrease the use of analgesic medications. Wu Qiaohong et al23 applied ear acupuncture patches to 150 liver cancer patients undergoing radiofrequency ablation prior to the procedure. The results showed that patients experienced pain relief during surgery without significant adverse reactions, providing an advanced analgesic strategy for perioperative pain management in liver cancer patients. Jun J. Mao et al27 compared electroacupuncture and battlefield ear acupuncture in 360 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 studies14,22,26,32,34,37,38,44,49 have indicated that auricular therapy can improve fatigue symptoms in cancer patients. Lu Lin et al26 found that auricular pressure application can significantly alleviate cancer-related fatigue in lung cancer patients undergoing chemotherapy, with Wang Buliu Xing seeds yielding better results, consistent with the findings of Zhang Yan et al.22 Yeh et al14 analyzed 31 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 studies14,21,26,29,35,37,38,44,46 have shown that auricular therapy can improve sleep quality in cancer patients. Wang et al35 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 al46 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, with the combined therapy yielding the best results. However, in a study by Lu Lin et al,26 ear acupuncture did not show a significant improvement in sleep quality. Korean scholars Yoon et al21 also noted in their study that while the PSQI total score was lower in the ear acupuncture group compared to the sham ear acupuncture group, Fitbit data (objective measures) did not show differences between the two groups in terms of sleep duration and efficiency.

Gastrointestinal Reactions Caused by Chemotherapy

Seven studies15,17,19,31,32,34,50 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 patients31 showed that patients who received ear acupuncture had a significantly higher rate of complete remission of acute nausea and vomiting (CINV) (especially acute nausea) compared to those who only received standard antiemetic treatment. Yang Li et al15 administered fluoropropylene ear acupuncture to 32 breast cancer patients undergoing chemotherapy. The results showed that the incidence of nausea and vomiting during chemotherapy was significantly lower in the ear acupuncture group than in the control group.

Peripheral Neuropathy by Chemotherapy

A case series study of CIPN patients30 showed that 65% of patients with peripheral neuropathy were satisfied with auricular acupuncture treatment, with 31% of patients experiencing significant positive effects on daily life due to symptom improvement, and 96% of patients showing efficacy after 1–2 treatments. Yang Yifan et al43 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, and no treatment-related adverse events were observed. However, it is important to note that Mi Sook Jung et al48 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. Wu Jing et al41 found that combining ear acupuncture with mindfulness-based stress reduction effectively alleviated anxiety and improved quality of life in gastric cancer patients undergoing chemotherapy; Menezes et al28 confirmed that acupuncture combined with ear acupuncture significantly alleviated anxiety in patients. Zhang Dan et al33 administered ear electrical stimulation to elderly gastrointestinal patients with diabetes during the perioperative period, The results showed that electrical stimulation of the vagus nerve region of the ear acupoints can improve postoperative cognitive function in elderly gastrointestinal tumor patients with diabetes. Ouyang Ru et al36 administered low-intensity transcutaneous vagus nerve stimulation to patients after radical surgery for colorectal cancer. The results indicated that vagus nerve stimulation can effectively reduce the incidence of postoperative intestinal obstruction, improve gastrointestinal function, and promote patient recovery.

Safety Evaluation

22 studies reported14,17,19,22–24,27–31,34,35,37–40,42,43,48,50,51 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

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.52 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.53 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.54–57 Additionally, studies have found58 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 (Figure 2).

Figure 2 Auricular Acupoint Stimulation Regulates Systemic Function via Meridian and Neural Pathways.

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.59,60 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.61 Jiang Xiao et al32 conducted ear acupuncture intervention on lung cancer patients undergoing thoracoscopic surgery and found that ear acupuncture pressure could effectively alleviate multiple symptom clusters in cancer patients (respiratory symptom cluster, pain-fatigue-sleep disorder symptom cluster, psychological symptom cluster, gastrointestinal symptom cluster, and neurological symptom cluster), thereby improving patients’ quality of life; Fei Chaonan et al38 identified sentinel symptoms in gastric cancer patients, they used ear acupuncture point pressure to implement preventive symptom management for gastric cancer chemotherapy patients, significantly reducing the incidence of the pain-fatigue-sleep disturbance symptom cluster and alleviating the severity of symptom distress; Lin Meixiang et al44 applied ear acupuncture point pressure to 78 lung cancer patients with insomnia and found that symptom clusters improved during chemotherapy intervals, consistent with the findings of Chao Hsing Yeh et al.14 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 stages62,63 and lacking comprehensive studies on the identification of core symptom clusters and the overall progression of cancer across different stages (Figure 3).

Figure 3 Mechanism of Auricular Therapy in Managing Symptom Clusters in Cancer Patients.

Auricular Therapy Is Used in Various Forms in Symptom Management for Cancer Patients, but There Is Heterogeneity in the Content of 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,64 the qualifications and certification standards for practitioners have not yet been clearly defined or standardized. (2) Lack of standardized operating procedures: In 2015, the “Handbook of Traditional Chinese Medicine Techniques for Nurses”65 issued in China initially standardized the operational procedures, pressing frequency, and intensity of auricular acupoint application. However, with the continuous accumulation of new research findings and clinical experience, the operational standards of auricular therapy still need to be continuously updated and optimized. However, as new research findings and clinical experience continue to accumulate, the operational standards for ear acupuncture therapy still require ongoing updates and optimization. Nevertheless, due to factors such as regional and institutional differences, the absence of a unified certification and regulatory mechanism, and individual variations in clinical practice, 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.66

Perspective

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.

Data Sharing Statement

All data relevant to the study are included in the article or available upon reasonable request from the corresponding author.

Acknowledgments

We thank all investigators and institutions who contributed to this scoping review.

Funding

This work was supported by: Henan Provincial Science and Technology Association Popular Science Project (HNKP2025089, 2025). Henan Provincial Health Commission TCM Culture and Management Research Project (TCM2023009, 2023). Henan Provincial Health Commission TCM Clinical Research Base Special Project (2021JDZX2032, 2022). Henan Provincial Health Commission TCM Scientific Research Special Project (20-21ZY2113, 2020).

Disclosure

The authors declare no conflicts of interest.

References

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–263. doi:10.3322/caac.21834

2. Zeng H, Zheng R, Sun K, et al. Cancer survival statistics in China 2019–2021: a multicenter, population-based study. J Natl Cancer Cent. 2024;4(3):203–213. doi:10.1016/j.jncc.2024.06.005

3. de Rooij BH, Oerlemans S, van Deun K, et al. Symptom clusters in 1330 survivors of 7 cancer types from the PROFILES registry: a network analysis. Cancer. 2021;127(24):4665–4674. doi:10.1002/cncr.33852

4. Mathew A, Doorenbos AZ, Vincent C. Symptom management theory: analysis, evaluation, and implications for caring for adults with cancer. ANS Adv Nurs Sci. 2021;44(3):E93–E112. doi:10.1097/ANS.0000000000000347

5. Zhu HH, Rong PJ, Chen Y, et al. To explore the possible mechanism of auricular acupoint in the treatment of migraine from auricular vagus nerve. Acupuncture Res. 2024;49(4):403–408. doi:10.13702/j.1000-0607.20221262

6. Veroniki AA, Hutton B, Stevens A, et al. Update to the PRISMA guidelines for network meta-analyses and scoping reviews and development of guidelines for rapid reviews: a scoping review protocol. JBI Evid Synth. 2025;23(3):517–526. doi:10.11124/JBIES-24-00308

7. Peters MDJ, Marnie C, Tricco AC, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Implement. 2021;19(1):3–10. doi:10.1097/XEB.0000000000000277

8. Doern GV, Carroll KC, Diekema DJ, et al. Practical guidance for clinical microbiology laboratories: a comprehensive update on the problem of blood culture contamination and a discussion of methods for addressing the problem. Clin Microbiol Rev. 2019;33(1):e00009–19. doi:10.1128/CMR.00009-19

9. Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients: the M.D. Anderson symptom inventory. Cancer. 2000;89(7):1634–1646. doi:10.1002/1097-0142(20001001)89:7<1634::aid-cncr29>3.0.co;2-v

10. Liu S. 120 cases of nasal tumor surgeries were performed under auricular acupuncture anesthesia. Chin Acupunct Moxibustion. 1984;1984(01):43.

11. Zhao W, Zhong Y, Ji Z, et al. Clinical study of multiple electrical information on human auricular points for gastric cancer. J Nanjing Univer Chin Med. 2010;26(02):111–114.

12. Zhu W, Liu X, Zhong Y, et al. Clinical study on specificity of auricular points of esophageal carcinoma patients. J Clin Acupunct Moxibustion. 2012;28(02):4–7.

13. Yu Y, Yu J, Wan H, et al. Effect of auricular patch on the prevention of stomatitis induced by continuous fluorouracil chemotherapy. J Navy Med. 2014;35(02):117–118.

14. Yeh CH, Chien LC, Lin WC, Bovbjerg DH, van Londen GJ. Pilot randomized controlled trial of auricular point acupressure to manage symptom clusters of pain, fatigue, and disturbed sleep in breast cancer patients. Cancer Nurs. 2016;39(5):402–410. doi:10.1097/NCC.0000000000000303

15. Yang L, Li X, Guo W, et al. Prevention of postoperative chemotherapy nausea and vomiting in breast cancer patients by droperidol auricular injection. Chin Acupunct Moxibustion. 2016;36(12):1271–1272.

16. Yang L, Duan P, Hou Q, et al. The therapeutic effect of auricular-plaster therapy at a different start time on opioid-induced constipation. J Nurs Sci. 2016;31(05):34–37.

17. Zhu W, Xu Y, Zhou J, et al. Effect observation of auricular vagus nerve stimulation by electroacupuncture in prevention and treating chemotherapy-induced nausea and vomiting in cancer patients. Shandong J Tradit Chin Med. 2016;35(05):415–419.

18. Jia T. Clinical Study on Specific Changes of Ear Acupuncture in Gastric Cancer [Master’s thesis]. Dalian Medical University; 2017.

19. Kong C, Zhang C, Li B. Curative effect of auricular point sticking for SOX chemotherapy-induced nausea, vomiting and diarrhea. Acad J Second Mil Med Univ. 2018;39(05):493–498.

20. Yang J, Li S, Peng D, et al. Effects of preoperative auricular acupoint needle intervention on anesthetic recovery in elderly patients undergoing laparoscopic colorectal cancer surgery. World Chin Med. 2019;14(05):1298–1301.

21. Yoon HG, Park H. The effect of auricular acupressure on sleep in breast cancer patients undergoing chemotherapy: a single-blind, randomized controlled trial. Appl Nurs Res. 2019;48:45–51. doi:10.1016/j.apnr.2019.05.009

22. Zhang Y, Qian H, Tian L, et al. The effect of auricular point application on cancer-related fatigue in chemotherapy patients. Chin J Gerontol. 2019;39(12):2958–2961.

23. Wu Q, Huang X, Mao J, et al. The analgesic effect of preoperative auricular point sticking pressure treatment in HCC patients receiving radiofrequency ablation therapy. J Interventional Radiol. 2020;29(10):1047–1051.

24. Lu D, Ye X. Clinical observation of Xiao Banxia Decoction combined with auricular point seed-pressing therapy for treatment of intractable hiccup after chemotherapy. J Tradit Chin Med Oncol. 2020;2(04):15–18.

25. Liu Y. Clinical Observation of Specific Changes in Auricular Points of the Right Ear in Pancreatic Cancer Patients [Master’s thesis]. Beijing University of Chinese Medicine; 2020.

26. Lin L, Zhang Y, Qian HY, et al. Auricular acupressure for cancer-related fatigue during lung cancer chemotherapy: a randomised trial. BMJ Support Palliat Care. 2021;11(1):32–39. doi:10.1136/bmjspcare-2019-001937

27. Mao JJ, Liou KT, Baser RE, et al. Effectiveness of electroacupuncture or auricular acupuncture vs usual care for chronic musculoskeletal pain among cancer survivors: the PEACE randomized clinical trial. JAMA Oncol. 2021;7(5):720–727. doi:10.1001/jamaoncol.2021.0310

28. Menezes ASDS, Sanches GLG, Gomes ESB, et al. The combination of traditional and auricular acupuncture to prevent xerostomia and anxiety in irradiated patients with HNSCC: a preventive, parallel, single-blind, 2-arm controlled study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2021;131(6):675–683. doi:10.1016/j.oooo.2021.02.016

29. Zhang J, Qin Z, So TH, et al. Electroacupuncture plus auricular acupressure for chemotherapy-associated insomnia in breast cancer patients: a pilot randomized controlled trial. Integr Cancer Ther. 2021;20:15347354211019103. doi:10.1177/15347354211019103

30. Viel E, Truong D, Rambach L, et al. Efficacy of auricular acupuncture in chemotherapy-induced peripheral neuropathy: a case series of 73 cases. Med Acupunct. 2021;33(3):212–218. doi:10.1089/acu.2020.1506

31. Tan JY, Molassiotis A, Suen LKP, Liu J, Wang T, Huang HR. Effects of auricular acupressure on chemotherapy-induced nausea and vomiting in breast cancer patients: a preliminary randomized controlled trial. BMC Complement Med Ther. 2022;22(1):87. doi:10.1186/s12906-022-03543-y

32. Jiang X, Wu Y, Liu X, et al. Effect of auricular acupoint pressing on postoperative symptom clusters of patients undergoing thoracoscopic surgery for lung cancer. J Nurs Advanc. 2022;37(21):1929–1933.

33. Zhang D, Wang J, Yang J, et al. The effect of auricular vagus nerve stimulation on postoperative cognitive function in elderly gastrointestinal tumor patients with diabetes. Mod J Integr Traditional Chinese and Western Med. 2022;31(24):3448–3451.

34. Wang L, Shan Y. Effects of auricular acupressure on relieving symptoms of acute leukemia patients undergoing chemotherapy. Chin Nurs res. 2022;36(17):3156–3159.

35. Wang Y, Li X, Ji X, et al. Adaptive auricular point acupressure for sleep disturbance in women with breast cancer: a randomized controlled trial. Evid Based Complement Alternat Med. 2022;2022:8637386. doi:10.1155/2022/8637386

36. Ru O, Jin X, Qu L, et al. Low-intensity transcutaneous auricular vagus nerve stimulation reduces postoperative ileus after laparoscopic radical resection of colorectal cancer: a randomized controlled trial. Minerva Anestesiol. 2023;89(3):149–156. doi:10.23736/S0375-9393.22.16735-0

37. Van de Castle B, Lukkahatai N, Billing BL, et al. Nurse-administered auricular point acupressure for cancer-related pain. Integr Cancer Ther. 2023;22:15347354231198086. doi:10.1177/15347354231198086

38. Fei C, Duan P, Yang L, et al. Effects of auricular point acupressure based on sentinel symptoms on preventing symptom cluster in patients with gastric cancer undergoing chemotherapy. J Nurs Sci. 2023;38(17):65–69.

39. He G, Yang H, Xiong F. Observation on the curative effect of Tongfu Tiaoqi acupuncture combined with auricular acupoint press for accelerated recovery of gastrointestinal function after abdominal tumor operation. Chin J Trad Chin Med. 2023;38(12):6151–6154.

40. Wang M, Xu Y, Wu Y, et al. Evaluating the efficacy of auricular acupuncture for chemotherapy-induced taste alterations: a pilot randomized controlled trial. Eur J Oncol Nurs. 2023;67:102458. doi:10.1016/j.ejon.2023.102458

41. Wu J, Xi C, Ding Y, et al. Effect of auricular point sticking combined with mindfulness decompression therapy on anxiety level in patients with gastric cancer undergoing chemotherapy. Hebei J Trad Chin Med. 2023;45(05):796–799.

42. Azevedo C, Ferreira da Mata LR, Cristina de Resende Izidoro L, et al. Effectiveness of auricular acupuncture and pelvic floor muscle training in the management of urinary incontinence following surgical treatment for prostate cancer: a randomized clinical trial. Eur J Oncol Nurs. 2024;68:102490. doi:10.1016/j.ejon.2023.102490

43. Yang Y, Zhang R, Zhong Z, Li J, Feng Y. Efficacy of transauricular vagus nerve stimulation for the treatment of chemotherapy-induced painful peripheral neuropathy: a randomized controlled exploratory study. Neurol Sci. 2024;45(5):2289–2300. doi:10.1007/s10072-023-07229-2

44. Lin M, Huang L, Huang D, et al. Effects of auricular acupuncture point burying beans on symptom clusters of lung cancer insomnia patients during the chemotherapy interval based on ward-outpatient-community management model. Chin Med Herald. 2024;21(36):178–182.

45. Su Y, Zou Y, Shi F, et al. Efficacy of Simo decoction combined with ring-headed thumb-tack needle on gastrointestinal and immune function after radical resection of cervical cancer. J Contemp Urol Reprod Onco. 2024;16(06):347–352.

46. Lu N, Liu H, Ouyang D, et al. Clinical efficacy of auricular guasha combined with mindfulness therapy for insomnia related to advanced lung cancer. Tianjin J Traditional Chin Med. 2024;41(12):1533–1537.

47. Du Z, Li Q, Tao F, et al. Clinical study of the electrical specificity of ear points in patients with colorectal polyps. Shanghai J Acupuncture Moxibustion. 2024;43(09):1029–1033.

48. Jung MS, Kim M, Sohn EH, Lee JS. The effectiveness and safety of nurse-led auricular acupressure on chemotherapy-induced peripheral neuropathy among patients with breast cancer: a randomized, double-blind, sham-controlled trial. Cancer Nurs. 2025;48(2):E64–E74. doi:10.1097/NCC.0000000000001286

49. Marcondes L, Ferreira PM, Sawada NO, et al. Effect of laser auriculotherapy on quality of life, fatigue, and anxiety in women with advanced breast cancer: randomized clinical trial. Healthcare. 2025;13(2):166. doi:10.3390/healthcare13020166