Lee, J., Dibble, S., Dodd, M., Abrams, D., & Burns, B. (2010). The relationship of chemotherapy-induced nausea to the frequency of pericardium 6 digital acupressure. Oncology Nursing Forum, 37, E419–E425. 

To explain the relationship between the intensity of chemotherapy-induced nausea and vomiting (CINV) and the frequency of P6 digital acupressure in a group of patients with breast cancer who received moderately to highly emetogenic chemotherapy and applied P6 digital acupressure as an additional intervention for CINV control.

This was a secondary analysis of a multicenter, longitudinal, randomized, clinical trial that compared differences in CINV among three groups (P6 acupressure, placebo digital acupressure, and usual care). The original study was published in 2007.

Patients in the group receiving P6 acupressure in the parent study were instructed to perform digital acupressure for three minutes or point release at the P6 points on both arms in the morning plus an additional three minutes of acupressure to one arm whenever nausea occurred. Secondary analysis was conducted of this group’s data from the patient information questionnaire and daily log.

• The study consisted of 53 participants.
• Participant mean age was 49 years (SD = 10.55) with a range of 27–74 years.
• All of the participants were female patients with breast cancer who were beginning their second or third cycle of moderately to highly emetogenic chemotherapy (cyclophosphamide with or without 5-fluorouracil; doxorubicin with paclitaxel or docetaxel; or 5-fluorouracil, epirubicin, and cyclophosphamide).
• All participants had been in the group in the parent study which applied P6 digital acupressure in addition to antiemetics to control CINV.
• All participants had had a nausea intensity score with previous chemotherapy of at least 3.

This was a multisite study conducted at 15 different sites in the United States.

All patients were in active treatment.

The study was design was a descriptive secondary analysis.

• A Patient Information Questionnaire was used to record demographic information and predisposing factors.
• A disease and treatment questionnaire was used to collect medical information.
• Participants recorded nausea and use of P6 digital acupressure each evening in daily logs for 11 days after chemotherapy.
• Nausea was measured on a 0-10 nausea intensity numeric rating scale (NRS) and on the 0-12 nausea score from the Index of Nausea, Vomiting and Retching (INVR). Interrater reliability for these two scales has been reported as having a significant high correlation (r = 0.75–0.95).

• The average amount of acupressure use over 11 days was two times per day.
• Participants used acupressure for an average of seven days after chemotherapy.
• The most frequent day of acupressure was day 3.
• An increase in nausea intensity ratings from days 1–3 was not associated with the frequency of acupressure (incidence rate ratio [IRR] = 0.96; p = 0.02).
• A decrease in nausea intensity ratings for days 4—11 was associated with the frequency of the acupressure (IRR = 1.11; p < 0.01).
• Women who used acupressure more than five times on day 4 experienced the highest nausea intensity over the 11 days, and their peak of nausea intensity was different from the other groups. Hierarchical generalized linear model (HGLM) analysis did not support this difference as significant.
• Age was the only significant predisposing factor for nausea intensity in the acute phase. With each year increase in age, a significant decrease in NIR and the use of acupressure on day 4 was found.

Nausea intensity was not found to be consistently related to frequency of acupressure use.

Types and dosages of antiemetics used were not described.

Based on the results of the parent study and the indepth secondary analysis of the acupressure group, patients with CINV may benefit from P6 acupressure throughout the first 11 days after chemotherapy. Because each patient is different, individualized patient teaching and resources for managing CINV are important.