Miao, J., Liu, X., Wu, C., Kong, H., Xie, W., & Liu, K. (2017). Effects of acupressure on chemotherapy-induced nausea and vomiting-a systematic review with meta-analyses and trial sequential analysis of randomized controlled trials. International Journal of Nursing Studies, 70, 27–37.

STUDY PURPOSE: Assess effectiveness of acupressure on chemotherapy-induced nausea and vomiting (CINV)

TYPE OF STUDY: Meta-analysis and systematic review

• DATABASES USED: PubMed, CINAHL, EMBASE, Science Direct, China Biology Medicine, Chinese National Knolwedge Infrastructure, Wan Fang, Database for Chinese Technical Periodicals, Cochrane collaboration
• INCLUSION CRITERIA: Patients on IV chemotherapy, acupressure was used with or without antiemetics, comparisons were antiemetics or nursing care, English or Chinese language
• EXCLUSION CRITERIA: Auricular acupressure

• TOTAL REFERENCES RETRIEVED: 1,326
• EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane risk of bias assessment; if any item was considered high risk, the study was deemed high risk of bias.

• FINAL NUMBER STUDIES INCLUDED: 12
• TOTAL PATIENTS INCLUDED IN REVIEW: 1,419
• SAMPLE RANGE ACROSS STUDIES: 17-500
• KEY SAMPLE CHARACTERISTICS: Various tumor types. Where reported, chemotherapy was MEC or HEC

PHASE OF CARE: Active anti-tumor treatment

Relative risk for incidence of acute vomiting across five trials was 0.84 in favor of acupressure, but this was not significant (p = 0.08). There was not a significant difference in relative risk with or without acupressure (p = 0.29) (two trials). Acupressure combined with antiemetics decreased nausea severity in the delayed phase (SMD = -0.33, p = 0.04), but there was no significant effect on incidence and frequency of delayed vomiting. P6 was the most frequently used acupoint. Interventions used either a wristband or manual acupressure, and findings for these two approaches differed. Sham control trials did not demonstrate a significant effect.

Acupressure may reduce the severity of nausea, particularly in the delayed phase in patients receiving MEC or HEC

• High heterogeneity
• No description of antiemetics used.

Acupressure might be a useful adjunct to antiemetics for management of CINV.  Findings suggest that this may be helpful to reduce the severity of nausea, which has remained a problem even with maximum antiemetics. Findings of this analysis showed differences with sham controlled trials, suggesting there may be a placebo effect of acupressure.