Dibble, S.L., Luce, J., Cooper, B.A., Israel, J., Cohen, M., Nussey, B., Rugo, H. (2007). Acupressure for chemotherapy-induced nausea and vomiting: A randomized clinical trial. Oncology Nursing Forum, 34, 813-820.

To compare the differences in chemotherapy-induced nausea and vomiting (CINV) in women receiving chemotherapy for breast cancer among three groups: acupressure, acupressure placebo, and usual care

Subjects were randomized to one of three groups: acupressure to P6 point (active), acupressure to S13 point (placebo), or usual care. Participants in the acupressure groups were taught to apply acupressure wrist devices by research assistants unaware of the active pressure point. All participants completed daily logs for 21 days. Patients measured nausea and vomiting and recorded methods for controlling the symptoms, including antiemetics and acupressure. Research assistants, who had received two hours of training on the study protocol, instructed participants. In an examination or private room, the participants were taught to find a quiet place each morning to perform the acupressure treatment to both P6 points sequentially either as treatment or practice. During the day, participants in the acupressure groups were encouraged to apply digital pressure to one of the points whenever nausea occurred regardless of where they were. Each session was six minutes in the morning and three minutes each during the rest of the day. Self-ratings were completed on a daily basis prior to bedtime. All participants were called or seen on day eight for review of the log and coaching, if needed.

• The study consisted of 160 women beginning their second or third cycle of chemotherapy for breast cancer.
• Participants had experienced moderate nausea intensity scores with previous cycles of chemotherapy, based on a score of at least 3 on the Morrow Assessment of Nausea and Emesis.
• Participants were able to read and write in English.

The study was conducted in community oncology programs associated with M.D. Anderson Cancer Center and nine independent sites.

This was a multicenter, longitudinal, randomized controlled trial.

• The Rhodes Index of Nausea and Vomiting (three-item nausea; single-item vomiting subscales) was used.
• Nausea intensity also was rated with a descriptive, numeric rating scale, ranging from 0–10.
• The State-Trait Anxiety Index also was used.

• No significant differences were found in demographic data, disease, or treatment variables among the groups.
• No significant differences were identified in acute nausea and vomiting among the treatment groups.
• With delayed nausea and vomiting, the acupressure group demonstrated a statistically significant reduction in the amount of vomiting and intensity of nausea over time when compared with the placebo or usual care groups.
• No significant differences were found between the placebo and usual care groups.

In conjunction with pharmaceutical management, acupressure at P6 was  found to reduce the amount and intensity of delayed CINV in women undergoing treatment for breast cancer.

• The same research assistants and nurses taught both pressure points. Although most did not know which pressure point was active, a few referenced the Internet for the information.
• Some patients with uncontrolled nausea also broke the blind by pursuing more information online.
• Some participants had challenges finding the location consistently; some needed markings on their wrist. Two participants found application of pressure difficult because of long fingernails.
• Staff training on the technique and return demonstration were not specifically described.
• No men or children were included in the study population.

Acupressure is a safe and effective tool to be offered to women undergoing breast cancer chemotherapy treatment.