Tan, J.Y., Molassiotis, A., Wang, T., & Suen, L.K. (2014). Current evidence on auricular therapy for chemotherapy-induced nausea and vomiting in cancer patients: A systematic review of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2014, 430796. 

DOI Link

Purpose

STUDY PURPOSE: To assess the evidence for the therapeutic effects of auricular therapy (AT) on chemotherapy-induced nausea and vomiting (CINV) in patients with cancer 
 
TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL,AMED, PsycINFO, Thomson Reuters Web of Science, Science Direct, China National Knowledge Infrastructure (CNKI), WanFang Data, Chinese Scientific Journal Database (VIP), and Chinese Biomedical Literature Database (CBMdisc)
 
KEYWORDS: Auriculotherapy, acupuncture, ear, auricular therapy, ear acupunctur, nausea, vomiting, antiemetic, chemotherapy, antineoplastic agent, and neoplasms
 
INCLUSION CRITERIA: (a) Randomized controlled trials, (b) patients with cancer and acute or delayed nausea and vomiting after receiving chemotherapy, and (c) trials comparing AT with or without antiemetic medications to one or more of the following: sham AT control, concomitant antiemetic medications, usual care, waiting-list control, or no treatment
 
EXCLUSION CRITERIA: Clinical case reports and case series, nonrandomized controlled trials, and other uncontrolled clinical trials

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,056 records were obtained. 166 duplicated items were removed, and another 809 items were excluded after browsing their titles and abstracts. Ultimately, 21 studies were eligible for analysis.
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The study selection was performed by two independent reviewers.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 21
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,713
  • KEY SAMPLE CHARACTERISTICS: Patients were aged 6–80 years and were recruited from inpatient settings and outpatient clinics. The average sample size was 81 patients. The studies focused on a variety of malignancies including breast cancer, lung cancer, leukemia, gastrointestinal cancer, and (in one study) pediatric cancer.

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment
 
APPLICATIONS: Pediatrics and elder care

Results

Among all trials:
  • Effective rate of AT with acute CINV: 44.44%–93.33% intervention group; 15%–91.67% control group
  • Effective rate of AT with delayed CINV: 62.96%–100% intervention group; 25%–100% control group
  • Studies comparing antiemetics versus antiemetics plus AT found the intervention group more effective. Intervention group: 54.62%–100%; control group 34.38%–100%
  • Four studies investigated the effect of auricular acupressure on either acute or delayed CINV. There was no concordance of results. Some studies showed more improvement in acute, some in delayed, and some showed no difference.
  • Three studies that included information about the performance statuses of patients using the Karnofsky Performance Status (KPS) index demonstrated a favorable effect on KPS scores in the intervention group compared to the control group.
  • Twenty studies did not monitor patient compliance with the intervention, and the length of pressing acupuncture points varied from 30 seconds to 5 minutes.

Conclusions

This review was a helpful starting point to spur more research on the use of AT for the management of CINV. There was significant heterogeneity among the trials, but there appeared to be encouraging results for the use of AT to justify additional research. To better answer the question about AT's benefit, well-designed, randomized, controlled trials will be needed. From the information presented, it appears that AT may have a role in the management of delayed CINV, which can be challenging to manage and very troublesome for patients.

Limitations

The investigators were only able to evaluate English and Chinese studies, which may have prevented the review of other studies such as Korean trials.

Nursing Implications

Encouraging results were identified about the adjunct use of AT for CINV, but this review demonstrated the need for well-designed trials incorporating AT with antiemetic regimens for acute and delayed CINV. The trials need to incorporate standard AT points, standard pressing length at each point, and a standard CINV assessment scale. Patient compliance also should be assessed and documented.

Legacy ID

5402