Relaxation acupressure reduces persistent cancer-related fatigue

Suzanna M Zick, Sara Alrawi, Gary Merel, Brodie Burris, Ananda Sen, Amie Litzinger, Richard E Harris, Suzanna M Zick, Sara Alrawi, Gary Merel, Brodie Burris, Ananda Sen, Amie Litzinger, Richard E Harris

Abstract

Persistent cancer-related fatigue (PCRF) is a symptom experienced by many cancer survivors. Acupressure offers a potential treatment for PCRF. We investigated if acupressure treatments with opposing actions would result in differential effects on fatigue and examined the effect of different "doses" of acupressure on fatigue. We performed a trial of acupressure in cancer survivors experiencing moderate to severe PCRF. Participants were randomized to one of three treatment groups: relaxation acupressure (RA), high-dose stimulatory acupressure (HIS), and low-dose stimulatory acupressure (LIS). Participants performed acupressure for 12-weeks. Change in fatigue as measured by the Brief Fatigue Inventory (BFI) was our primary outcome. Secondary outcomes were assessment of blinding and compliance to treatment. Fatigue was significantly reduced across all treatment groups (mean ± SD reduction in BFI: RA 4.0 ± 1.5, HIS 2.2 ± 1.6, LIS 2.7 ± 2.2), with significantly greater reductions in the RA group. In an adjusted analysis, RA resulted in significantly less fatigue after controlling for age, cancer type, cancer stage, and cancer treatments. Self-administered RA caused greater reductions in fatigue compared to either HIS or LIS. The magnitude of the reduction in fatigue was clinically relevant and could represent a viable alternative for cancer survivors with PCRF.

Figures

Figure 1
Figure 1
Acupressure point locations. HIS and LIS specific point locations in black: Conception Vessel 6 (CV6), Large Intestine 4 (LI4), Stomach 36 (St36), Kidney 3 (K3), and Si Shen Chong. RA specific point locations in red: Heart 7 (Ht7), Liver 3 (Liv3), Anmian, and Yin Tang. Common point for all groups HIS, LIS, and RA in gray: Spleen 6 (Sp6).
Figure 2
Figure 2
CONSORT diagram of flow of participants through the clinical trial.
Figure 3
Figure 3
Self-administered relaxation acupressure reduces persistent cancer fatigue. A plot of mean weekly fatigue scores for RA (red circles), HIS (closed black circles), and LIS (open circles) across study weeks demonstrates that RA evokes greater reductions in fatigue scores compared to HIS and LIS.
Figure 4
Figure 4
Self-Administered Relaxation Acupressure Engenders Greater Reductions in Fatigue than Stimulation Acupressure. Scatter plot of individual participant BFI change scores (week 12— week 0) indicate greater reductions for RA (red circles) than HIS (closed black circles) and LIS (open circles).

References

    1. Morrow GR. Cancer-related fatigue: causes, consequences, and management. Oncologist. 2007;12(1):1–3.
    1. Montazeri A. Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. Journal of Experimental and Clinical Cancer Research. 2008;27(1, article 32)
    1. Bower JE, Ganz PA, Desmond KA, et al. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer. 2006;106(4):751–758.
    1. Reid-Arndt SA, Hsieh C, Perry MC. Neuropsychological functioning and quality of life during the first year after completing chemotherapy for breast cancer. Psycho-Oncology. 2010;19(5):535–544.
    1. Alexander S, Minton O, Andrews P, Stone P. A comparison of the characteristics of disease-free breast cancer survivors with or without cancer-related fatigue syndrome. European Journal of Cancer. 2009;45(3):384–392.
    1. Kim SH, Son BH, Hwang SY, et al. Fatigue and depression in disease-free breast cancer survivors: prevalence, correlates, and association with quality of life. Journal of Pain and Symptom Management. 2008;35(6):644–655.
    1. Bower JE. Prevalence and causes of fatigue after cancer treatment: the next generation of research. Journal of Clinical Oncology. 2005;23(33):8280–8282.
    1. Bower JE. Behavioral symptoms in patients with breast cancer and survivors. Journal of Clinical Oncology. 2008;26(5):768–777.
    1. Groenvold M, Petersen MA, Idler E, Bjorner JB, Fayers PM, Mouridsen HT. Psychological distress and fatigue predicted recurrence and survival in primary breast cancer patients. Breast Cancer Research and Treatment. 2007;105(2):209–219.
    1. Mustian KM, Morrow GR, Carroll JK, Flgueroa-Moseley CD, Jean-Pierre P, Williams GC. Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. Oncologist. 2007;12(1):52–67.
    1. Carroll JK, Kohli S, Mustian KM, Roscoe JA, Morrow GR. Pharmacologic treatment of cancer-related fatigue. Oncologist. 2007;12(1):43–51.
    1. Cerrone R, Giani L, Galbiati B, et al. Efficacy of HT 7 point acupressure stimulation in the treatment of insomnia in cancer patients and in patients suffering from disorders other than cancer. Minerva Medica. 2008;99(6):535–537.
    1. Tsay S-L. Acupressure and fatigue in patients with end-stage renal disease—a randomized controlled trial. International Journal of Nursing Studies. 2004;41(1):99–106.
    1. Tsay S-L, Chen M-L. Acupressure and quality of sleep in patients with end-stage renal disease—a randomized controlled trial. International Journal of Nursing Studies. 2003;40(1):1–7.
    1. Cho YC, Tsay SL. The effect of acupressure with massage on fatigue and depression in patients with end-stage renal disease. The Journal of Nursing Research. 2004;12(1):51–59.
    1. Vickers AJ, Straus DJ, Fearon B, Cassileth BR. Acupuncture for postchemotherapy fatigue: a phase II study. Journal of Clinical Oncology. 2004;22(9):1731–1735.
    1. Molassiotis A, Sylt P, Diggins H. The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial. Complementary Therapies in Medicine. 2007;15(4):228–237.
    1. Mao JJ, Styles T, Cheville A, Wolf J, Fernandes S, Farrar JT. Acupuncture for nonpalliative radiation therapy-related fatigue: feasibility study. Journal of the Society for Integrative Oncology. 2009;7(2):52–58.
    1. Balk J, Day R, Rosenzweig M, Beriwal S. Pilot, randomized, modified, double-blind, placebo-controlled trial of acupuncture for cancer-related fatigue. Journal of the Society for Integrative Oncology. 2009;7(1):4–11.
    1. Harris RE, Jeter J, Chan P, et al. Using acupressure to modify alertness in the classroom: a single-blinded, randomized, cross-over trial. Journal of Alternative and Complementary Medicine. 2005;11(4):673–679.
    1. Mendoza TR, Wang XS, Cleeland CS, et al. The rapid assessment of fatigue severity in cancer patients: use of the brief fatigue inventory. Cancer. 1999;85(5):1186–1196.
    1. Alfano CM, Day JM, Katz ML, et al. Exercise and dietary change after diagnosis and cancer-related symptoms in long-term survivors of breastcancer: CALGB 79804. Psycho-Oncology. 2009;18(2):128–133.
    1. CTC v2.0 and Common Terminology Criteria for Adverse Events v3.0 (CTCAE) November 2007, .
    1. Schwartz AH. Validity of cancer-related fatigue instruments. Pharmacotherapy. 2002;22(11):1433–1441.
    1. Roscoe JA, Kaufman ME, Matteson-Rusby SE, et al. Cancer-related fatigue and sleep disorders. Oncologist. 2007;12(1):35–42.
    1. Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AMK, Hochberg MC. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee. A randomized, controlled trial. Annals of Internal Medicine. 2004;141(12)
    1. Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine. 2001;26(13):1418–1424.
    1. Mondloch MV, Cole DC, Frank JW. Does how you do depend on how you think you’ll do? A systematic review of the evidence for a relation between patients’ recovery expectations and health outcomes. Canadian Medical Association Journal. 2001;165(2):174–179.
    1. Charron J, Rainville P, Marchand S. Direct comparison of placebo effects on clinical and experimental pain. Clinical Journal of Pain. 2006;22(2):204–211.
    1. Thomas KJ, MacPherson H, Thorpe L, et al. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. British Medical Journal. 2006;333(7569):623–626.
    1. Linde K, Witt CM, Streng A, et al. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain. 2007;128(3):264–271.
    1. Foster NE, Thomas E, Hill JC, Hay EM. The relationship between patient and practitioner expectations and preferences and clinical outcomes in a trial of exercise and acupuncture for knee osteoarthritis. European Journal of Pain. 2010;14(4):402–409.

Source: PubMed

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