This pilot project was aimed at determining whether improvement in post-chemotherapy fatigue following acupuncture treatment is substantial enough to warrant a controlled trial. The authors accrued patients who had completed cytotoxic chemotherapy and who experienced persisting fatigue. A total of 37 patients were registered in two cohorts; 31 provided follow-up data. Patients received acupuncture either twice per week for 4 weeks (25 patients) or once per week for 6 weeks (12 patients). The primary endpoint was a change in score of the Brief Fatigue Inventory between baseline and 2 weeks after the final treatment. A baseline Brief Fatigue Inventory score of four or greater was an eligibility requirement for the trial. Patients had completed cytotoxic chemotherapy an average of more than 2 years previously. Baseline fatigue scores were high, with approximately half of the sample scoring in the ‘severe’ range. Mean improvement following acupuncture was 31.1% (95% CI 20.6 to 41.5%), meeting the prespecified criterion for declaring acupuncture worthy of further study. Increasing age was associated with poorer response and failure to complete the study. There was no important difference in improvement following once weekly and twice-weekly treatments.