A systematic review and meta-analysis examining the efficacy of acupressure for managing chemotherapy-induced nausea and vomiting (CINV) in breast cancer patients was recently published in the Asian Pacific Journal of Cancer Prevention. The study, conducted by researchers from various institutions in India, aimed to evaluate whether acupressure could effectively reduce both acute and delayed nausea and vomiting in breast cancer patients undergoing chemotherapy.
This comprehensive review followed the Cochrane Collaboration guidelines and adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2015 statement. The researchers systematically searched multiple databases, including PubMed, Cochrane Central Register of Controlled Trials, CINAHL, ClinicalKey, Web of Science, EMBASE, and Scopus, for relevant studies published from inception to September 2022.
The review included randomized controlled trials and quasi-experimental studies that met specific criteria. The population of interest was breast cancer patients receiving chemotherapy, with acupressure as the intervention (either alone or in combination with antiemetics). The comparison group received routine medical care or antiemetic medications. The primary outcomes were chemotherapy-induced nausea and vomiting.
After a thorough screening process, six studies involving a total of 287 breast cancer patients were included in the meta-analysis. The average age of participants across the studies was 47.86 (±8.11) years. The review protocol was registered on PROSPERO (CRD42022297481), ensuring transparency and reproducibility of the research process.
The results of the meta-analysis revealed several significant findings. Acupressure combined with antiemetics was found to significantly reduce the severity of acute nausea [Standardized Mean Difference (SMD), (95% CI): -0.35 (-0.62, -0.08), P=0.01], delayed nausea [SMD, (95% CI): -0.52 (-0.78, -0.26), P<0.001], and delayed vomiting [SMD, (95% CI): -0.46 (-0.83, -0.08), P=0.02] induced by chemotherapy. However, there was no statistically significant difference in the severity of acute vomiting between the intervention and control groups.
Subgroup analyses were conducted to assess the impact of acupressure plus antiemetics on the frequency of CINV. These analyses showed no statistically significant differences in the frequency of acute nausea, acute vomiting, or delayed vomiting between the intervention and control groups.
The study had several strengths, including its comprehensive search strategy, adherence to established guidelines for systematic reviews, and the use of standardized tools for assessing risk of bias. The most frequently employed instrument in the included studies was the Index of Nausea, Vomiting, and Retching, which adds credibility to the findings.
However, the review also had some limitations. The researchers noted heterogeneity in terms of chemotherapy regimens, patient demographics, acupressure points, and protocols across the included studies. Additionally, the review was limited to English-language publications, which may introduce language bias. Due to the small number of included studies, an assessment of publication bias was not performed.
The authors concluded that acupressure, when used in conjunction with conventional antiemetic medication and care, was more effective in controlling CINV in breast cancer patients undergoing chemotherapy compared to standard care alone. They suggest that acupressure is a valuable complementary approach that can help reduce the severity of acute nausea, delayed nausea, and delayed vomiting in women receiving treatment for breast cancer.
These findings have potential clinical implications for the management of CINV in breast cancer patients. Acupressure represents a non-pharmacological, cost-effective, and non-invasive technique that could be incorporated into standard care protocols. The authors recommend that nurses consider using this complementary treatment strategy for CINV relief in breast cancer patients undergoing chemotherapy.
It is important to note that while the results are promising, further research may be needed to address the heterogeneity observed across studies and to determine the most effective acupressure protocols and acupoints for managing CINV. Future studies could also explore the long-term effects of acupressure on CINV and its impact on patients' quality of life and treatment adherence.
This systematic review and meta-analysis contributes valuable evidence to the growing body of research on complementary therapies in oncology. As the management of chemotherapy side effects remains a critical aspect of cancer care, the potential of acupressure to alleviate CINV could lead to improved patient outcomes and experiences during breast cancer treatment.
Medical professionals should consider these findings when developing comprehensive care plans for breast cancer patients undergoing chemotherapy. However, it is crucial to remember that acupressure should be viewed as a complementary therapy to be used alongside, not in place of, standard antiemetic medications. Individualized treatment approaches, taking into account patient preferences and specific risk factors for CINV, remain essential in optimizing care for breast cancer patients.
References
Issac A, Nayak SG, Halemani K, Mishra P, Chand G. Acupressure On Chemotherapy-Induced Nausea and Vomiting among Breast Cancer Patients: A Systematic Review and Meta-analysis. Asian Pac J Cancer Prev. 2024;25(10):3421-3428. Published 2024 Oct 1. doi:10.31557/APJCP.2024.25.10.3421
