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Study: Can acupressure be used to treat cancer-related fatigue?

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Contents

At a glance                  In-depth
Findings               Limitations                
Clinical trials Resources
Questions for your doctor  


STUDY AT A GLANCE

This study is about:

Whether self-administered acupressure can improve persistent cancer-related fatigue in breast cancer survivors.

Why is this study important?

Breast cancer survivors commonly experience fatigue, which can lead to poor sleep and quality of life, yet few treatments are available.

Study findings: 

  1. Some breast cancer survivors who used acupressure had less fatigue over a 10-week period than breast cancer survivors who did not use acupressure. 

What does this mean for me?

This study suggests that acupressure, which uses firm finger pressure to stimulate the same sensitivity points used in acupuncture, may be used for treating fatigue in breast cancer survivors. However, not all breast cancer survivors who used acupressure benefited from it. More work needs to be done to determine which patients might benefit most from acupressure, and how long patients should use it. Breast cancer survivors experiencing cancer-related fatigue should talk to their health care providers to see if acupressure is an option they might explore, and to find out what other options are available.

Posted 8/9/16

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References

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, A .” JAMA Oncology. Published online first on July 16, 2016.
 

Disclosure

FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

This article is relevant for:

Breast cancer survivors and people in treatment who are experiencing fatigue

This article is also relevant for:

people with breast cancer

people with ER/PR + cancer

people with Her2-positive cancer

men with breast cancer

people with metastatic or advanced cancer

people with a genetic mutation linked to cancer risk

people with triple negative breast cancer

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IN DEPTH REVIEW OF RESEARCH

Study background:

About one-third of breast cancer survivors report experiencing moderate to severe fatigue after breast cancer treatment.  In some cases, this fatigue can last up to 10 years!  Finding ways to combat this fatigue is critical, as it affects quality of life.  Even though fatigue is a major issue for some breast cancer survivors, few therapeutic options are available.  

Suzanna Zick and her colleagues from the University of Michigan published work in the journal JAMA Oncology in July 2016 that examined acupressure as a potential treatment for persistent fatigue in breast cancer survivors.    

Researchers of this study wanted to know:

Can relaxing acupressure or stimulating acupressure help breast cancer survivors with their persistent cancer-related fatigue?

Population(s) looked at in the study:

The women in this study were recruited from the Michigan Tumor Registry, with data collected from women who live in Michigan. These women previously had breast cancer between stages 0 to III, completed their cancer treatments 12 months prior to the study, and were currently cancer free.  All women in the study scored 4 or higher on the Brief Fatigue Inventory (BFI), which assesses the severity and impact of cancer-related fatigue. Scores on the BFI range from zero (no fatigue) to 10 (as bad [fatigue] as you can imagine). Women who had a cancer diagnosis other than breast or skin cancer in the past 10 years, an untreated major depressive disorder, another diagnosed condition associated with fatigue, or who had previously done acupressure were not included in the study.

Study participants included 270 women, each randomly assigned to one of three groups:

  • 94 women received relaxing acupressure
  • 90 women received stimulating acupressure
  • 86 women received only usual care—any treatment for fatigue that they were already receiving from their health care providers.

The women who received the acupressure treatments were taught by a trained acupressure educator to self-administer the therapy. They were assessed to see how well they performed the acupressure (for example, if they could locate the correct acupoints) at their first visit and at weeks 3 and 6.

Study findings: 

  1. A score of less than 4 on the Brief Fatigue Inventory (BFI) is considered normal for fatigue levels. After doing acupressure or usual care once daily for 6 weeks:
    • about 66% of breast cancer survivors who did relaxing acupressure had a BFI score of less than 4
    • about 61% of women who did stimulating acupressure had a BFI score of less than 4
    • about 30% of women who did usual care had a BFI score of less than 4
  2. The women stopped doing the acupressure after 6 weeks. Their BFI scores were assessed again at 10 weeks to see if the effects of acupressure remained. At 10 weeks:
    • about 56% of breast cancer survivors who did relaxing acupressure had a BFI of less than 4
    • about 61% of women who did stimulating acupressure had a BFI of less than 4
    • about 30% of women who did usual care had a BFI score of less than 4
  3. At week 6, women who did relaxing acupressure saw an improvement in their sleep quality compared to women who did usual care. However, that improvement did not persist once acupressure was stopped.
  4. Women who did stimulating acupressure did not see any improvement in sleep quality.
  5. At weeks 6 and 10, women who did relaxing acupressure had a better quality of life compared to women who had usual care.
  6. Women who did stimulating acupressure did not see any improvement in quality of life.

Limitations:

The majority (about 90%) of women who participated in this study were white non-Hispanics; the majority of the minority women were black women. Because this study did not observe how male breast cancer survivors or people with breast cancer respond to acupressure, these findings may not be applicable to all breast cancer survivors. Additionally, this study looked only at doing acupressure for 6 weeks and only measured its effects after 10 weeks; researchers do not know how well the effects might hold up beyond 10 weeks. Six women could not complete the study because of bruising or difficulty doing the acupressure. And while the women were assessed to see how well they performed the acupressure, the therapy was self-administered, which means that the women’s techniques may have varied, and that they may have not adhered perfectly to the recommended daily schedule.

Finally, as pointed out in a PLOS blog post by James Coyne, a professor of health psychology, this was a single blind trial, which means that the patients’ health care providers knew which treatment they were getting, which could potentially bias how they were treated by their health care provider. And while the patients technically did not know which treatment they were getting, it would be obvious to the patients if they were getting the control treatment (no acupressure). More work should be done to see which breast cancer survivors are more likely to benefit from acupressure.

Conclusions:

The results of this study suggest that acupressure may be a therapeutic option for breast cancer survivors experiencing persistent cancer-related fatigue. According to the study authors, “Self-administered relaxing acupressure could offer an inexpensive, easy-to-learn intervention for improving fatigue, sleep, and quality of life in fatigued breast cancer survivors.” However, more work needs to be done to explore these findings further. These findings have not changed clinical guidelines—acupressure is not guaranteed to improve fatigue for breast cancer survivors. Patients should discuss with their health care providers to see if acupressure would be a good option for them.

Posted 8/9/16

Share your thoughts on this XRAYS article by taking our brief survey.

Expert Guidelines
Expert Guidelines

The National Comprehensive Cancer Network (NCCN) in their Survivorship Guidelines has specific recommendations related to fatigue in people diagnosed with cancer.

  • Patients should be told that fatigue management is an important part of their care and that fatigue can persist even after treatment ends. 
  • Patients should be screened for fatigue at their first visit and at regular intervals during and after treatment as indicated. 
  • Treating fatigue is best managed by a team of experts with specialties in different areas of supportive care, including:
    • survivorship
    • nutrition
    • integrative medicine
    • mental health
    • physical therapy
    • occupational therapy
    • sleep therapy
  • Patients should be screened and treated for symptoms that may be seen along with fatigue, including pain, emotional distress and sleep disruption. 
  • Interventions may include:
    • physical activity
    • rehabilitation, physical therapy
    • yoga
    • acupunture
    • massage therapy
    • behavioral therapy
    • nutrition consultation
    • consider stimulant drugs
    • treatment for sleep dysfunction

Updated: 08/06/2022

Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • Should I try acupressure for my cancer-related fatigue?
  • What are the side effects of acupressure?
  • What other methods can I use to reduce my cancer-related fatigue?
  • Who should I call if I experience a side effect from treatment?
  • Do all women experience side effects after breast cancer treatment?
  • What are potential side effects I may have after breast cancer treatment?
  • What are ways to alleviate the side effects that I may experience after breast cancer treatment?

Open Clinical Trials
Open Clinical Trials

The following studies are looking at management of side effects: 

Multiple cancers

Breast cancer

Colorectal cancer

Ovarian cancer

  • NCT04533763: Living WELL: A Web-Based Program for Ovarian Cancer Survivors. This studies a group-based and web-delivered tool for ovarian cancer survivors in increasing quality of life and decreasing stress, depressive mood, anxiety, and fatigue across a 12-month period.
  • NCT05047926: Prehabilitation for Advanced Ovarian Cancer Patients. Prehabilitation may improve peri-operative outcomes in patients undergoing cancer surgery. This study will look at structured activity for women undergoing chemotherapy to improve their physical state prior to surgical intervention and thus improve outcomes.

cancer

Updated: 08/28/2024

Who covered this study?

Reuters

Also published in:

The same article was also covered by Fox News

Acupressure may ease fatigue after breast cancer This article rates 3.5 out of 5 stars

Oncology Nurse Advisor

Acupressure improves fatigue, sleep, and quality of life for survivors of breast cancer This article rates 3.0 out of 5 stars

The Telegraph

Acupressure cuts fatigue after breast cancer treatment This article rates 2.5 out of 5 stars

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