Ling, W., Lui, L.Y.Y., So, W.K.W., & Chan, K. (2014). Effects of acupuncture and acupressure on cancer-related fatigue: A systematic review. Oncology Nursing Forum, 41, 581–592. 

DOI Link

Purpose

STUDY PURPOSE: To critically examine the evidence for acupuncture and acupressure in the management of cancer-related fatigue (CRF) in adult patients with cancer
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: AMED, British Nursing Index, CINAHL, Evidence-Based Medicine Reviews, Embase, Journals@Ovid, MEDLINE, Physiotherapy Evidence Database, ProQuest, PubMed, ScienceDirect, SpringerLink, TRIP, Wiley Online Library, China Academic Journals Full-Text Database, and Wanfang Data China Online Journals
 
KEYWORDS: Fatigue, cancer, acupuncture, and acupressure
 
INCLUSION CRITERIA: Randomized, controlled trials (RCTs) of acupuncture and acupressure for CRF in adult patients with cancer regardless of the type of cancer, duration of disease, and type of treatment received. CRF was a key outcome to be clearly measured and reported. Only studies published in English or Chinese were included.
 
EXCLUSION CRITERIA: Articles whose sole target participants were patients with fatigue other than CRF were excluded. Studies using shiatsu or reflexology for therapeutic intervention also were excluded.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 716
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Two reviewers independently appraised the methodologic quality of the full texts of all potentially eligible articles by means of the standard checklist for RCTs developed by the Scottish Intercollegiate Guidelines Network ([SIGN], 2014). The 10 appraisal criteria for internal validity in the SIGN checklist were equally weighted. Most studies were underpowered or consisted of small sample sizes.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 11
  • TOTAL PATIENTS INCLUDED IN REVIEW = 731
  • SAMPLE RANGE ACROSS STUDIES: 13–302 patients
  • KEY SAMPLE CHARACTERISTICS: Age range was 20–81 years; average age was 52–59 years; variety of diagnoses but mainly breast cancer

Phase of Care and Clinical Applications

PHASE OF CARE: All phases

Results

Seven out of eight acupuncture studies showed improvement in CRF, but only four reached statistic significance. All four acupressure studies showed significant improvement. The four studies that showed improvement during initial treatment determined that results could be maintained for as many as 12 weeks. However, the maintenance study did not determine any extra benefit. Three studies reported no side effects. In other studies, adverse events were identified as minor and transient. Four studies used acupressure. These showed positive results. However, three studies were underpowered, and the comparability of study groups was questionable.

Conclusions

Acupuncture and acupressure may be helpful in reducing fatigue. However, because of multiple methodologic flaws in studies reviewed, no firm conclusions can be made regarding the effectiveness of these interventions.

Limitations

  • Heterogeneity of the samples, sizes, types of cancer, treatments administered, length, dose, and intensity of treatment
  • Studies had multiple flaws

Nursing Implications

Acupuncture and acupressure appear to be safe and may be effective. Therefore, this intervention may be suggested for patients with CRF. Additional research is needed to confirm their effectiveness.

Legacy ID

5297