Shen, Y., Liu, L., Chiang, J.S., Meng, Z., Garcia, M.K., Chen, Z., . . . Cohen, L. (2014). Randomized, placebo-controlled trial of K1 acupoint acustimulation to prevent cisplatin-induced or oxaliplatin-induced nausea. Cancer, 121, 84–92. 

To examine the effects of electrostimulation at the K1 acupoint located on the sole of the foot on chemotherapy-induced nausea and vomiting (CINV)

After institutional review board approval, 103 patients with metastatic liver cancer undergoing transcatheter arterial infusions (TAIs) of cisplatin or oxaliplatin were recruited and randomized to group A (tropisetron and electroacustimulation at the K1 acupoint) or B (tropisetron and electrostimulation at a placebo point on the heel). The treatment in both groups lasted for 20 minutes one to two hours before TAI on day 1 and then daily (7 am–9 am) for the subsequent five days. The baseline rate, intensity, and duration of CINV were collected for five days after TAI. Quality of life was assessed daily.

• N = 103 (51 in group A and 52 in group B)
• MEAN AGE = 53.4 years (range = 20–73 years)
• MALES: 80 (77.7%), FEMALES: 23 (22.3%)
• KEY DISEASE CHARACTERISTICS: Liver cancer (primary and metastatic)
• OTHER KEY SAMPLE CHARACTERISTICS: Participants aged 18–75 years scheduled to receive cisplatin or oxaliplatin via TAI for the first time; negative pregnancy test for fertile female patients; no local skin infections near the acupoints; no cerebrovascular accidents; no intestinal obstructions; no vomiting or 5HT3 receptor antagonist or other antiemetic use within 24 hours before TAI; no cardiac pacemaker; not currently using acupuncture; and no mental incapacity or psychiatric disorder

• SITE: Single site    
• SETTING TYPE: Inpatient    
• LOCATION: Fudan University Shanghai Cancer Center in Shanghai, China

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

Double-blinded, randomized, placebo-controlled, longitudinal clinical trial

• Daily diaries recording episodes of emesis, the time when each episode occurred, the degree of emesis, and a rating for nausea duration and severity in the previous 24 hours
• Visual Analog Scale (VAS) on 0–10 scale used to record nausea intensity
• Medications record 
• Quality of life was assessed daily using the MD Anderson Symptom Inventory (MASI) and the EuroQoL scale (24 hours)

No differences were found between groups A and B in regard to the incidence and degree of nausea or vomiting at any time point. Patients in group A had better EuroQoL scores than patients in group B (72.83 versus 65.94, p = 5.04) on day 4 but not other days. No group differences were noted at any time point for MASI scores.

Noninvasive electrostimulation of the K1 point combined with tropisetron had no effect on cisplatin-induced or oxaliplatin-induced nausea or vomiting.

• Intervention expensive, impractical, or training needs
• Other limitations/explanation: Needed acupuncturist to locate the site of stimulation; did not follow antiemetic guidelines and did not give dexamethasone with tropisetron; gave extra antiemetics for patients who experienced CINV; opioid use was not assessed; and frequency of electrostimulation administration was not sufficient

Patients receiving chemotherapy experience CINV frequently with highly emetogenic regimens. Complementary therapies might be helpful in reducing this side effect. Instructing patients to refer to their physicians before trying a new intervention is advisable.