Implementing an evidence-based somatic acupressure intervention in breast cancer survivors with the symptom cluster of fatigue, sleep disturbance and depression: study protocol of a phase II randomised controlled trial

Tao Wang, Jing-Yu Benjamin Tan, Xian-Liang Liu, Si-Lin Zheng, Isabella Zhao, Sabina Eliseeva, Mary Janice Polotan, Hui-Lin Cheng, Hou-Qiang Huang, Tao Wang, Jing-Yu Benjamin Tan, Xian-Liang Liu, Si-Lin Zheng, Isabella Zhao, Sabina Eliseeva, Mary Janice Polotan, Hui-Lin Cheng, Hou-Qiang Huang

Abstract

Introduction: The fatigue-sleep disturbance-depression (FSD) symptom cluster, as one of the most common symptom clusters in breast cancer (BC) survivors, can significantly decrease patients' quality of life. Since the management of the FSD symptom cluster has been unsatisfactory with the use of pharmacological treatments alone, non-pharmacological approaches have, therefore, been recommended. Somatic acupressure (SA) is a promising approach given its potential benefits of cancer-related symptom alleviation and the convenience of self-practice. However, research evidence on using acupressure to manage the FSD symptom cluster has been limited. The proposed trial aims to examine the feasibility and preliminary effects of an evidence-based SA intervention for FSD symptom cluster management in BC survivors.

Methods and analysis: This study will be a phase II randomised controlled trial with three study arms and 1:1:1 allocation. Fifty-one early-stage BC survivors who are experiencing the FSD symptom cluster will be randomly assigned to a true SA group, a sham SA group or a usual care group. All participants will receive an education booklet regarding FSD symptom cluster management advice as the usual care package. The participants in the true SA group will additionally receive a 7-week self-administered SA intervention. The participants in the sham SA group will additionally receive self-administered light acupressure at non-acupoints with the same frequency, session and duration as the true SA group. The primary outcomes will be feasibility outcomes related to subject recruitment and completion of study questionnaires and interventions. The secondary outcomes will be the effects of SA on fatigue, sleep disturbance, depression and quality of life. Descriptive statistics will be used to present all the outcomes. The secondary outcomes will be analysed using an intent-to-treat approach.

Ethics and dissemination: Ethical approvals of this trial have been granted by the Human Research Ethics Committee at Charles Darwin University (H19017) and the Clinical Trial Ethics Committee at The Affiliated Hospital of Southwest Medical University (KY2019039). Findings from this trial will be published in peer-reviewed journals and presented at professional conferences.

Trial registration number: This trial was registered at ClinicalTrials.gov and the registration number is NCT04118140, with the stage at Recruiting.

Keywords: breast tumours; oncology; palliative care.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
The CONSORT flow chart of this trial. CONSORT, Consolidated Standards of Reporting Trials; SA, somatic acupressure.

References

    1. Harbeck N, Penault-Llorca F, Cortes J, et al. . Breast cancer. Nat Rev Dis Primers 2019;5:66. 10.1038/s41572-019-0111-2
    1. Leong E, Madli F, Ong SK. Five-year survival rate of breast cancer patients in Brunei Darussalam. Brunei International Medical Journal 2019;15:73–81.
    1. McFarland DC, Shaffer KM, Tiersten A, et al. . Physical symptom burden and its association with distress, anxiety, and depression in breast cancer. Psychosomatics 2018;59:464–71. 10.1016/j.psym.2018.01.005
    1. Peoples AR, Roscoe JA, Block RC, et al. . Nausea and disturbed sleep as predictors of cancer-related fatigue in breast cancer patients: a multicenter NCORP study. Supportive Care in Cancer 2017;25:1271–8. 10.1007/s00520-016-3520-8
    1. Berger AM, Mooney K, Alvarez-Perez A, et al. . Cancer-related fatigue, version 2.2015. J Natl Compr Canc Netw 2015;13:1012–39. 10.6004/jnccn.2015.0122
    1. Bower JE. Cancer-related fatigue—mechanisms, risk factors, and treatments. Nat Rev Clin Oncol 2014;11:597–609. 10.1038/nrclinonc.2014.127
    1. Accortt EE, Bower JE, Stanton AL, et al. . Depression and vasomotor symptoms in young breast cancer survivors: the mediating role of sleep disturbance. Arch Womens Ment Health 2015;18:565–8. 10.1007/s00737-015-0504-5
    1. Bower JE, Ganz PA, Irwin MR, et al. . Inflammation and behavioral symptoms after breast cancer treatment: do fatigue, depression, and sleep disturbance share a common underlying mechanism? Journal of Clinical Oncology 2011;29:3517–22. 10.1200/JCO.2011.36.1154
    1. Colagiuri B, Christensen S, Jensen AB, et al. . Prevalence and predictors of sleep difficulty in a national cohort of women with primary breast cancer three to four months postsurgery. J Pain Symptom Manage 2011;42:710–20. 10.1016/j.jpainsymman.2011.02.012
    1. Reinertsen KV, Engebraaten O, Loge JH, et al. . Fatigue during and after breast cancer therapy—a prospective study. J Pain Symptom Manage 2017;53:551–60. 10.1016/j.jpainsymman.2016.09.011
    1. Ho S-H, Rohan KJ, Parent J. A longitudinal study of depression, fatigue, and sleep disturbances as a symptom cluster in women with breast cancer. J Pain Symptom Manage 2015;49:707–15. 10.1016/j.jpainsymman.2014.09.009
    1. Trudel-Fitzgerald C, Savard J, Ivers H. Which symptoms come first? Exploration of temporal relationships between cancer-related symptoms over an 18-month period. Ann Behav Med 2013;45:329–37. 10.1007/s12160-012-9459-1
    1. Irwin MR. Depression and insomnia in cancer: prevalence, risk factors, and effects on cancer outcomes. Curr Psychiatry Rep 2013;15:404. 10.1007/s11920-013-0404-1
    1. Dodd MJ, Cho MH, Cooper BA, et al. . The effect of symptom clusters on functional status and quality of life in women with breast cancer. Eur J Oncol Nurs 2010;14:101–10. 10.1016/j.ejon.2009.09.005
    1. Fiorentino L, Rissling M, Liu L, et al. . The symptom cluster of sleep, fatigue and depressive symptoms in breast cancer patients: severity of the problem and treatment options. Drug Discov Today Dis Models 2011;8:167–73. 10.1016/j.ddmod.2011.05.001
    1. Induru RR, Walsh D. Cancer-related insomnia. Am J Hosp Palliat Care 2014;31:777–85. 10.1177/1049909113508302
    1. Sanford SD, Beaumont JL, Butt Z, et al. . Prospective longitudinal evaluation of a symptom cluster in breast cancer. J Pain Symptom Manage 2014;47:721–30. 10.1016/j.jpainsymman.2013.05.010
    1. Innominato PF, Lim AS, Palesh O, et al. . The effect of melatonin on sleep and quality of life in patients with advanced breast cancer. Supportive Care in Cancer 2016;24:1097–105. 10.1007/s00520-015-2883-6
    1. Madsen MT, Hansen MV, Andersen LT, et al. . Effect of melatonin on sleep in the perioperative period after breast cancer surgery: a randomized, double-blind, placebo-controlled trial. Journal of Clinical Sleep Medicine 2016;12:225–33. 10.5664/jcsm.5490
    1. Choi T-Y, Kim JI, Lim H-J, et al. . Acupuncture for managing cancer-related insomnia: a systematic review of randomized clinical trials. Integr Cancer Ther 2017;16:135–46. 10.1177/1534735416664172
    1. Finnegan-John J, Molassiotis A, Richardson A, et al. . A systematic review of complementary and alternative medicine interventions for the management of cancer-related fatigue. Integr Cancer Ther 2013;12:276–90. 10.1177/1534735413485816
    1. Rieger KL, Lobchuk MM, Duff MA, et al. . Mindfulness‐based arts interventions for cancer care: a systematic review of the effects on wellbeing and fatigue. Psychooncology 2021;30:240–51. 10.1002/pon.5560
    1. Kumar JVR, Uma M. Effectiveness of acupressure on improving the quality of sleep among cancer patients. Asian Journal of Nursing Education and Research 2015;5:513–7. 10.5958/2349-2996.2015.00105.6
    1. Wang T, Deng R, Tan J-Y, et al. . Acupoints stimulation for anxiety and depression in cancer patients: a quantitative synthesis of randomized controlled trials. Evid Based Complement Alternat Med 2016;2016:1–15. 10.1155/2016/5645632
    1. So K, Law BM, Chan DN. The effect of nonpharmacological interventions on managing symptom clusters among cancer patients: a systematic review. Cancer Nurs 2020;43:E304–27. 10.1097/NCC.0000000000000730
    1. Cheung DS, Yeung WF, Chau PH. Patient‐centred, self‐administered acupressure for Chinese advanced cancer patients experiencing fatigue and co‐occurring symptoms: a pilot randomised controlled trial. Eur J Cancer Care 2020;7:e13314. 10.1111/ecc.13314
    1. Hoang HT, Molassiotis A, Chan CW. Pilot randomized sham-controlled trial of self-acupressure to manage the symptom cluster of insomnia, depression, and anxiety in cancer patients undergoing chemotherapy. Sleep Breathing 2021;14:1–2. 10.1007/s11325-021-02370-8
    1. Craig P, Dieppe P, Macintyre S, et al. . Developing and evaluating complex interventions: the new medical Research Council guidance. Int J Nurs Stud 2013;50:587–92. 10.1016/j.ijnurstu.2012.09.010
    1. Chan A-W, Tetzlaff JM, Altman DG, et al. . Spirit 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 2013;158:200–7. 10.7326/0003-4819-158-3-201302050-00583
    1. Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat 2005;4:287–91. 10.1002/pst.185
    1. Zick SM, Sen A, Wyatt GK, et al. . Investigation of 2 types of self-administered acupressure for persistent cancer-related fatigue in breast cancer survivors. JAMA Oncol 2016;2:1470–6. 10.1001/jamaoncol.2016.1867
    1. Vickers AJ, Cronin AM, Maschino AC. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 2012;172:1444–53. 10.1001/archinternmed.2012.3654
    1. Liu X-L, Cheng HL, Moss S, et al. . Somatic acupoint stimulation for cancer-related sleep disturbance: a systematic review of randomized controlled trials. Evid Based Complement Alternat Med 2020;2020:1–12. 10.1155/2020/2591320
    1. Tan J-YB, Wang T, Kirshbaum MN, et al. . Acupoint stimulation for cancer-related fatigue: a quantitative synthesis of randomised controlled trials. Complement Ther Clin Pract 2021;45:101490. 10.1016/j.ctcp.2021.101490
    1. Liang FR, Wang H. Acupuncture and moxibustion. 4th ed. Beijing: China Press of Traditional Chinese Medicine Co. Ltd, 2016.
    1. Shen XY. Meridians and acupoints. 4th ed. Beijing: China Press of Traditional Chinese Medicine Co. Ltd, 2008.
    1. Zick SM, Alrawi S, Merel G, et al. . Relaxation acupressure reduces persistent cancer-related fatigue. Evid Based Complement Alternat Med 2011;2011:1–10. 10.1155/2011/142913
    1. Tan J-Y, Suen LKP, Wang T, et al. . Sham acupressure controls used in randomized controlled trials: a systematic review and critique. PLoS One 2015;10:e0132989. 10.1371/journal.pone.0132989
    1. Dincer F, Linde K. Sham interventions in randomized clinical trials of acupuncture—a review. Complement Ther Med 2003;11:235–42. 10.1016/S0965-2299(03)00124-9
    1. National Comprehensive Cancer Network Cancer-Related Fatigue Panel . National comprehensive cancer network clinical practice guidelines in oncology. cancer-related fatigue, version 2, 2018.
    1. Department of health at the government of Western Australia. Available:
    1. Berger AM, Mitchell SA, Jacobsen PB, et al. . Screening, evaluation, and management of cancer-related fatigue: ready for implementation to practice? CA Cancer J Clin 2015;65:190–211. 10.3322/caac.21268
    1. Li M, Fitzgerald P, Rodin G. Evidence-based treatment of depression in patients with cancer. J Clin Oncol 2012;30:1187–96. 10.1200/JCO.2011.39.7372
    1. Bellg AJ, Borrelli B, Resnick B, et al. . Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH behavior change Consortium. Health Psychol 2004;23:443–51. 10.1037/0278-6133.23.5.443
    1. Smith SW, Daunic AP, Taylor GG. Treatment fidelity in applied educational research: expanding the adoption and application of measures to ensure evidence-based practice. Education and Treatment of Children 2007;30:121–34. 10.1353/etc.2007.0033
    1. Tan J. Effects of auricular acupressure on chemotherapy-induced nausea and vomiting in breast cancer patients: a preliminary randomized controlled trial [PhD thesis]. The Hong Kong Polytechnic University, 2017.
    1. Tian J, Hong J-S. Validation of the Chinese version of multidimensional fatigue Inventory-20 in Chinese patients with cancer. Supportive Care Cancer 2012;20:2379–83. 10.1007/s00520-011-1357-8
    1. Buysse DJ, Reynolds CF, Monk TH, et al. . The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193–213. 10.1016/0165-1781(89)90047-4
    1. Ho RT, Fong TC. Factor structure of the Chinese version of the Pittsburgh sleep quality index in breast cancer patients. Sleep Med 2014;15:565–9. 10.1016/j.sleep.2013.10.019
    1. Li Q, Lin Y, Hu C, et al. . The Chinese version of hospital anxiety and depression scale: psychometric properties in Chinese cancer patients and their family caregivers. Eur J Oncol Nurs 2016;25:16–23. 10.1016/j.ejon.2016.09.004
    1. Wan C, Zhang D, Yang Z, et al. . Validation of the simplified Chinese version of the FACT-B for measuring quality of life for patients with breast cancer. Breast Cancer Res Treat 2007;106:413–8. 10.1007/s10549-007-9511-1
    1. Thabane L, Ma J, Chu R, et al. . A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol 2010;10. 10.1186/1471-2288-10-1
    1. Nguyen LT, Alexander K, Yates P. Psychoeducational intervention for symptom management of fatigue, pain, and sleep disturbance cluster among cancer patients: a pilot quasi-experimental study. J Pain Symptom Manage 2018;55:1459–72. 10.1016/j.jpainsymman.2018.02.019
    1. Fitzgerald P, Lo C, Li M, et al. . The relationship between depression and physical symptom burden in advanced cancer. BMJ Support Palliat Care 2015;5:381–8. 10.1136/bmjspcare-2012-000380
    1. Oh H, Seo Y, Jeong H, et al. . The identification of multiple symptom clusters and their effects on functional performance in cancer patients. J Clin Nurs 2012;21:2832–42. 10.1111/j.1365-2702.2011.04057.x

Source: PubMed

3
Subscribe