Molassiotis, A., Russell, W., Hughes, J., Breckons, M., Lloyd-Williams, M., Richardson, J., … Ryder, W.D. (2013). The effectiveness of acupressure for the control and management of chemotherapy-related acute and delayed nausea: A randomized controlled trial. Journal of Pain and Symptom Management. Advanced online publication. 

To determine the effectiveness of acupressure in the management of chemotherapy-induced nausea and vomiting (CINV)

Patients were randomly assigned to one of three groups: use of P6 acupressure wristband, sham acupressure wristband, or usual care only. 

Prior to randomization, subjects were stratified by age group, gender, and emetogenicity of planned chemotherapy.  Patients were instructed to wear wristbands on both arms from the morning before chemotherapy administration and for the following 6 days, and to only remove them for showering or bathing. 

All patients received antiemetics based on American Society of Clinical Oncology (ASCO) and Multinational Association of Supportive Care in Cancer (MASCC) guidelines with the exception that NK1 receptor antagonists were not used with highly emetogenic chemotherapy, as these were not widely available in the country. 

All patients had rescue antiemetics available.  Study questionnaires were completed on day 10 of each cycle. Patients graded nausea daily.

• The study consisted of 372 patients.
• Two-thirds of the patients were over age 50. The sample included a few children. No other data was available.
• The majority (77.2%) of patients were female.
• A variety of tumor types and regimens were represented, with breast cancer as the most frequent.
• The majority of patients were receiving moderately emetogenic treatments.
• Almost all patients were Caucasian.

The study was conducted at multiple outpatient sites in the United Kingdom.

All patients were in active antitumor treatment.

This was a randomized controlled trial.

Measurement tools used were

• Rhodes Index of Nausea Vomiting and Retching
• MASCC Antiemesis Tool
• Functional Assessment of Cancer Therapy (FACT)-General
• The Hospital Anxiety and Depression Scale
• Patient expectations of nausea/vomiting, a two item, 11-point scale.

• The entire group showed relatively low levels of nausea. No significant differences were found between the three study groups in the experiences and measures of nausea; some improvement was found in both the actual and sham intervention groups. 
• The sham acupressure group had better odds ratio in improving nausea than the acupressure group. 
• No differences were found between groups in MASCC tool results for either acute or delayed nausea. 
• No differences were found in other outcome measures.
• Auditing of wristband use showed that compliance was good, with only four cases observed where use was incorrect. 
• Regression analysis showed that older age and male gender were predictive of better nausea outcomes (p = 0.005).

P6 acupressure was not shown to have a significant impact on prevention of CINV.  Findings suggest a potential placebo effect with both acupressure and sham acupressure wristbands.

• This study had unintended interventions or applicable interventions not described that would influence results.
• Participant withdrawals were 10% or more.
• No information about the use of any rescue medication was provided. 
• This study had very low nausea levels.

Findings did not show a significant effect of P6 acupressure on CINV; however, use of an actual and sham acupressure wristband may have a placebo effect.