Purpose <p>Randomized controlled trials (RCTs) of acupuncture in oncology offer strong internal validity but limited generalizability. Real-world evidence is needed to assess feasibility, effectiveness, and adherence in routine practice.</p> Methods <p>We conducted a retrospective analysis of real-world data from cancer patients receiving group Traditional Chinese acupuncture (ACP) in an outpatient oncology setting (2015–2022). Symptoms (anxiety, fatigue, hot flashes, neuropathy, pain, sleep) were rated on a 0–10 numeric scale before each session. Clinical improvement was defined as a ≥ 1-point decrease in severity.</p> Results <p>A total of 2,239 patients underwent ACP (83% female; mean age 57 ± 12; 57% breast cancer). Common symptoms included pain (61%), sleep issues (50%), fatigue (45%), hot flashes (42%), anxiety (40%), and neuropathy (40%); 68% had ≥ 2 symptoms, median baseline severity 5–6. Females and younger patients had higher symptom burden. By session two, all symptoms improved statistically, with anxiety and hot flashes showing clinical improvement; by session three, all improvements were statistically and clinically significant. Benefits were similar across age and gender. Adherent patients (≥ 2 sessions) were older with higher symptom burden.</p> Conclusion <p>Acupuncture appears effective for common cancer symptoms in real-world settings, with evidence suggesting that benefits are sustained between sessions and requiring multiple treatments for optimal effect. Both sexes and age groups experienced similar improvements, though utilization was lower among males and older adults. Expanding insurance coverage could improve access and reduce disparities. Adherence was high, and integration into outpatient oncology care proved feasible and sustainable. These findings warrant examination in RCTs.</p>