Purpose/Objectives: To compare differences in the chemotherapy-induced nausea and vomiting (CINV) among three groups of women (acupressure, placebo acupressure, and usual care) undergoing chemo-therapy for breast cancer.
Design: A multicenter, longitudinal, randomized clinical trial throughout one cycle of chemotherapy.
Setting: Ten community clinical oncology programs associated with the M.D. Anderson Cancer Center and nine independent sites located throughout the United States.
Sample: 160 women who were beginning their second or third cycle of chemotherapy for breast cancer treatment and had moderate nausea intensity scores with their previous cycles.
Methods: Subjects were randomized to one of three groups: acupressure to P6 point (active), acupressure to SI3 point (placebo), or usual care only. Subjects in the acupressure group were taught to apply an acupressure wrist device by research assistants who were unaware of the active acupressure point. All subjects completed a daily log for 21 days containing measures of nausea and vomiting and recording methods (including antiemetics and acupressure) used to control these symptoms.
Main Research Variables: Acute and delayed nausea and vomiting.
Results: No significant differences existed in the demographic, disease, or treatment variables among the treatment groups. No significant differences were found in acute nausea or emesis by treatment group. With delayed nausea and vomiting, the acupressure group had a statistically significant reduction in the amount of vomiting and the intensity of nausea over time when compared with the placebo and usual-care groups. No significant differences were found between the placebo and usual-care groups in delayed nausea or vomiting.
Conclusions: Acupressure at the P6 point is a value-added technique in addition to pharmaceutical management for women undergoing treatment for breast cancer to reduce the amount and intensity of delayed CINV.
Implications for Nursing: Acupressure is a safe and effective tool for managing delayed CINV and should be offered to women undergoing chemotherapy for breast cancer.
American Cancer Society (2007). Cancer facts and figures. Atlanta, GA: Author.
Carr, B., Bertrand, M., Browning, S., Doroshow, J.H., Presant, C., Pulone, B., et al. (1985). A comparison of the antiemetic efficacy of prochlorperazine and metoclopramide for the treatment of cisplatin-induced emesis: A prospective, randomized, double-blind study. Journal of Clinical Oncology, 3, 1127-1132.
Cohen, M.R., & Doner, K. (1996). The Chinese way to healing: Many paths to wholeness. New York: Berkley Publishing Group.
Craze, R., & Fou, J.T. (1998). Traditional Chinese medicine. Chicago: NTC Publishing Group.
Dibble, S.L., Casey, K., Nussey, B., Israel, J., & Luce, J. (2004). Chemotherapy-induced vomiting in women treated for breast cancer. Oncology Nursing Forum, 31, E1-E8.
Dibble, S.L., Chapman, J., Mack, K.A., & Shih, A. (2000). Acupressure for nausea: Results of a pilot study. Oncology Nursing Forum, 27, 41-47.
Dibble, S.L., Israel, J., Nussey, B., Casey, K., & Luce, J. (2003). Delayed chemotherapy-induced nausea in women treated for breast cancer. Oncology Nursing Forum, 30, E40-E47.
Dundee, J.W., & Yang, J. (1990). Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy. Journal of the Royal Society of Medicine, 83, 360-362.
Ezzo, J.M., Richardson, M.A., Vickers, A., Allen, C., Dibble, S.L., Issell, B.F., et al. (2006). Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database of Systematic Reviews, 19, CD002285.
Gach, M.R. (1990). Acupressure's potent points: A guide to self-care for common ailments. New York: Bantam Books.
Goldstein, H. (2003). Multilevel statistical models (3rd ed.). London: Edward Arnold Publishers.
Gottlieb, B. (Ed.). (1995). New choices in natural healing. Emmaus, PA: Rodale Press.
Kienle, G., & Kiene, H. (1996). Placebo effect and placebo concept: A critical methodological and conceptual analysis of reports on the magnitude of the placebo effect. Alternative Therapies in Health and Medicine, 2(6), 39-54.
Naughton, M.J., Shumaker, S.A., Anderson, R.T., & Czaijkowski, S.M. (1996). Psychological aspects of health-related quality of life measurement: Tests and scales. In B. Spilker (Ed.), Quality of life and pharmacoeconomics in clinical trials (2nd ed., pp. 117-131). Philadelphia: Lippincott-Raven.
Piantadosi, S. (2005). Clinical trials: A methodologic perspective (2nd ed.). Hoboken, NJ: John Wiley and Sons.
Porkert, M., & Ullman, C. (1988). Chinese medicine. New York: William Morrow.
Raudenbush, S.W., & Bryk, A.S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks, CA: Sage.
Rhodes, V.A., & McDaniel, R.W. (1997). Measuring nausea, vomiting, and retching. In M. Frank-Stromborg & S.J. Olsen (Eds.), Instruments for clinical health-care research (2nd ed., pp. 509-518). Sudbury, MA: Jones and Bartlett.
Rhodes, V.A., Watson, P.M., & Johnson, M.H. (1984). Development of reliable and valid measures of nausea and vomiting. Cancer Nursing, 7, 33-41.
Rhodes, V.A., Watson, P.M., Johnson, M.H., Madsen, R.W., & Beck, N.C. (1987). Patterns of nausea, vomiting, and distress in patients receiving antineoplastic drug protocols. Oncology Nursing Forum, 14(4), 35-44.
SAS Institute, Inc. (2004). The GLIMMIX procedure. Cary, NC: Author.
Shin, Y.H., Kim, T.I., Shin, M.S., & Juon, H. (2004). Effect of acupressure on nausea and vomiting during chemotherapy cycle for Korean postoperative stomach cancer patients. Cancer Nursing, 27, 267-274.
Spielberger, C.D. (1983). Manual for the State-Trait Anxiety Inventory (form Y). Palo Alto, CA: Consulting Psychologists Press.
Stannard, D. (1989). Pressure prevents nausea. Nursing Times, 85(4), 33-34.