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

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 metastatic 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

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