Genc, F., & Tan, M. (2014). The effect of acupressure application on chemotherapy-induced nausea, vomiting, and anxiety in patients with breast cancer. Palliative & Supportive Care. Advance online publication.

DOI Link

Study Purpose

To determine the effects of acupressure applied to the pericardium 6 (P 6) acupuncture point on chemotherapy-induced nausea and vomiting (CINV) and anxiety in patients with breast cancer undergoing chemotherapy

Intervention Characteristics/Basic Study Process

Stage 1–3 patients with breast cancer who were receiving cycle two and more advance-cycle chemotherapy in an ambulatory setting were trained to apply P 6 acupressure. Patients were randomly selected from a sample that met the study inclusion criteria. An acupressure wrist band was utilized with the research group. Patients were taught how to use the band with repeat demonstration. Patients continuously wore the acupressure band on both wrists for five days. Antiemetic medications used for the experimental and control group were not described.

Sample Characteristics

  • N = 64 
  • AVERAGE AGE: 51.21 years (research arm); 50.87 years (control arm)
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Stage 1–3 breast cancer after cycle two and more advance-cycle chemotherapy
  • OTHER KEY SAMPLE CHARACTERISTICS: Breast cancer, female patients

Setting

  • SITE: Single-site  
  • SETTING TYPE: Outpatient  
  • LOCATION: Turkey

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Elder care 

Study Design

  • Quasi-experimental with a control group.
  • Patients selected via randomized sample

Measurement Instruments/Methods

  • Beck Anxiety Inventory (BAI)
  • Index of Nausea, Vomiting and Retching (INVR)
  • Patient information form

Results

Nausea experience scores were significantly lower in the experimental group on days 3 (p < 0.05), 4 (p < 0.01), and 5 (p < 0.001). Nausea occurrence scores were significantly lower in the experimental group on days 3 (p < 0.05), 4 (p < 0.01), and 5 (p < 0.001). There was no significant difference in the mean vomiting or retching experience or occurrence scores between groups. Mean scores combining nausea, vomiting, and retching experiences were lower in the experimental group on days 4 (p < 0.05) and 5 (p < 0.01). Mean scores combining nausea, vomiting, and retching occurrence were significant on days 4 (p < 0.05) and 5 (p < 0.01). 
 
Patients in the experimental group had lower anxiety scores than those in the control group (p < 0.001). Anxiety declined in both groups over the course of the study. Though post-test anxiety scores were significantly lower in the experimental group at conclusion, these scores were also significantly lower at baseline in the experimental group.

Conclusions

The authors concluded that acupressure wristbands applied at the P 6 point decreased patients' nausea occurrence and experience and the overall experience and occurrence of nausea, vomiting, and retching combined. There was no effect on the occurrence or experience of vomiting or retching. Acupressure is an inexpensive intervention that may be able to provide additional relief to patients above and beyond recommended antiemetic therapy. Effects on anxiety are unclear.

Limitations

  • Small sample (< 100)
  • Risk of bias (sample characteristics)
  • Key sample group differences that could influence results
  • Findings not generalizable
  • Other limitations/explanation: No discussion on why the researchers waited till cycle two to start intervention; prevention at the first cycle is key to good control; no sham band/possible placebo effect; significantly lower anxiety at baseline in the experimental group

Nursing Implications

Acupressure is inexpensive, is easy to use, and can be considered in conjugation with medication or CINV prophylaxis. Acupressure can be considered in addition to recommended antiemetic therapy for additional support of patients experiencing CINV.