Suh, E.E. (2012). The effects of P6 acupressure and nurse-provided counseling on chemotherapy-induced nausea and vomiting in patients with breast cancer. Oncology Nursing Forum, 39(1), E1-9.

To evaluate the effects of pericardium 6 (P6) acupressure and nurse-provided counseling on chemotherapy-induced nausea and vomiting (CINV) in patients with breast cancer

Participants were randomized to one of four treatment groups. The control group received sham acupressure on SI3 point—the ulnar side of the metacarpophalangeal joint of the little finger of both hands. The three experimental groups consisted of counseling only, P6 acupressure-only, and P6 acupressure and counseling.

Counseling consisted of a one-hour cognitive behavioral session which included an introduction, cognitive preparation, symptom acceptance, the use of available resources, and question and answer session. Participants were instructed to perform the cognitive-behavioral session daily for 5 days (C2, D 1-5). 

The P6 acupressure groups wore Sea-Band® bands on both wrists for 5 days.

All participants completed baseline data then received a booklet of instruments and a daily log. They were asked to check their gastrointestinal (GI) distress level nine different times the evening of the first day of cycle 2 of chemotherapy and then once in the morning and once in the evening of days 2–5. Patients were asked to keep a daily log of the antiemetic medications taken and the overall status of their GI symptoms. The research assistants called each participant once and sent two text messages during the 5-day period to increase adherence.

• The study consisted of 105 patients.
• The mean age of patients was 45 years (SD = 8.661). To be included, patients must have been older than 20 years.
• All of the patients were female and had been diagnosed with stage I-III breast cancer.                                                       
• Participants had previously received definitive breast surgery and were currently undergoing the second cycle of adjuvant chemotherapy with either the FAC (5-fluorouracil, Adriamycin, and cyclophosphamide) or ACT (Adriamycin, cyclophosphamide, and paclitaxel) regimen. All participants had experienced more than mild levels of nausea and vomiting with the first cycle of chemotherapy.  
• Patients who agreed to participate had their level of acute and delayed nausea measured on the 5th day of the first cycle, and only those with an average nausea level of more than 4 on a scale of 1–10 were included in the study.
• More than half of the participants had at least some college education, claimed a religion, were married at the time of the data collection, had stage II breast cancer, and had received the FAC regimen.
• Antiemetics used were granisetron (39%), aprepitant plus dexamethasone (30%), aprepitant only (20%), and ondansetron (9%).
   

This study was conducted at a single outpatient setting in Seoul, South Korea.

All patients were in active treatment.

This was a randomized, controlled trial.

• The Index of Nausea, Vomiting and Retching (INVR, Rhodes & McDaniel) self-report instrument was translated into Korean to measure frequency, distress, and duration of nausea, vomiting, and retching.
• Antiemetic medications taken and the severity of GI distress were reported daily in logs.

• CINV levels were significantly different among the groups from day 2 to day 5.
• These differences were attributed mainly to the difference between the control group and the group with P6 acupressure plus nurse-provided counseling (p = 0.01).
• The effects of acupressure were proven from day 2 to day 5 (p = 0.005, 0.002, 0.001, 0.001 respectively), and the effects of the nurse-provided counseling were proven on day 4 (p = 0.025) and close to significance on day 5.

Synergic effects of P6 acupressure with nurse-provided counseling appeared to be effective in reducing CINV in patients with breast cancer.

• Generalizability is limited because the study involved only women in one cancer center.
• The relatively small sample size of each treatment group may have limited that ability to measure the isolated effect of either P6 acupressure or counseling.  
• Substantially different antiemetics were used in the different study groups. 
• Overall, 17% of patients dropped out before completing the study.

The addition of P6 acupressure and nurse-provided counseling focused on cognitive awareness, affective readiness, symptom acceptance, and the use of available resources both appear to be effective as adjuncts to antiemetic medicine for the control of CINV in patients with breast cancer.