Results Summary
What was the research about?
Children and youth who receive cancer treatment, such as chemotherapy, often have side effects such as nausea and vomiting. Medicines can reduce these side effects, but they can cause others.
In this study, the research team wanted to learn if acupressure reduced treatment side effects in children and youth with cancer. In acupressure, a trained therapist applies pressure to points on the body. The team also wanted to know if teaching caregivers how to use acupressure on their children reduced caregivers’ distress.
What were the results?
Patients who had cancer treatment with and without acupressure didn’t differ in their reports of
- Nausea and vomiting
- Pain intensity
- Fatigue
- Overall physical and emotional symptoms
- Depression, anxiety, or positive emotions
Compared with patients who didn’t have acupressure, those who did had
- A higher amount of pain noted in their health record
- More patient-reported effects from pain on their lives
Patients didn’t differ in how likely they were to take pain or nausea medicine. Among those who took pain medicine, patients who had acupressure took more medicine than those who didn’t have acupressure.
Caregivers who did and didn’t learn to give acupressure had similar depression, anxiety, and positive emotions. They also had similar confidence in their ability to be a caregiver.
Who was in the study?
The study included 95 patients, ages 5–24, receiving cancer treatment and 90 caregivers. All patients received chemotherapy as part or all of their cancer treatment. Patients received care from a Northern California hospital system. Among patients, 36 percent were White, 13 percent were Asian, 5 percent were Black, 3 percent were American Indian or Alaska Native, and 43 percent reported other or more than one race; 34 percent were Latinx. The average age was 12, and 61 percent were boys or young men. Among caregivers, 80 percent were mothers, and the average age was 41.
What did the research team do?
The research team assigned patients by chance to one of two groups, acupressure plus usual care or usual care alone. For patients who received acupressure, a trained therapist offered sessions at the hospital each weekday for 30 days. The therapist also taught caregivers how to use acupressure on the patients when needed. All patients received usual care, which included medicines to reduce cancer treatment side effects.
Patients and caregivers filled out surveys before starting treatment, daily during treatment, and a month after treatment ended. The research team also looked at health records.
Cancer survivors, a specialist in treating nausea and vomiting, and a hospital director gave input on the study.
What were the limits of the study?
Fewer patients enrolled in the study than planned, making it hard to find differences in symptoms. Patients who received acupressure had more pain at the start of the study, which may have affected the results.
Future research could look at other ways to manage side effects in children and youth having cancer treatment.
How can people use the results?
Doctors can use these results when considering ways to help children and youth manage cancer treatment side effects.
Professional Abstract
Objective
To compare the effectiveness of acupressure in addition to usual care versus usual care alone on symptom management in children and youth undergoing cancer treatment
Study Design
| Design Element | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 95 children and youth, ages 5–24, who were receiving inpatient and outpatient treatment for pediatric cancer and 90 parents or caregivers |
| Interventions/ Comparators |
|
| Outcomes |
Primary: combined measure of patient-reported nausea and vomiting Secondary: patient-reported nausea, vomiting, antiemetic use, pain interference and intensity, pain medication use, fatigue, anxiety, depression, physical and psychological symptoms, positive affect; caregiver-reported posttraumatic stress symptoms, anxiety, depression, positive affect, caregiving self-efficacy |
| Timeframe | Up to 1-month follow-up for primary outcome |
This randomized controlled trial compared the effectiveness of acupressure in addition to usual care versus usual care alone on improving symptoms in children and youth receiving cancer treatment. The study also explored whether training caregivers to provide acupressure decreased caregivers’ posttraumatic stress symptoms, anxiety, and depression and improved positive affect and caregiver self-efficacy.
Researchers randomly assigned patients to one of two groups, acupressure plus usual care or usual care alone. For patients receiving acupressure, a licensed acupressure provider offered acupressure sessions at the hospital each weekday for 30 days. The acupressure provider also trained caregivers to provide acupressure and encouraged caregivers to provide acupressure daily or as needed by the patient. All patients received usual care, which followed national guidelines to manage side effects from cancer treatment and included medications to control chemotherapy-induced nausea and vomiting.
The study included 95 children and youth receiving treatment for pediatric cancer at one hospital system in Northern California and 90 caregivers. All patients received chemotherapy as part or all of their cancer treatment. Of these patients, 36% were White, 13% were Asian, 5% were Black, 3% were American Indian or Alaska Native, 26% identified their race as other, and 17% reported more than one race; 34% were Latinx. The average age was 12, and 61% were male. Among caregivers, 80% were mothers, and the mean age was 41.
Patients and caregivers completed surveys before treatment, daily for 30 days while receiving treatment, and a month after treatment ended. Researchers reviewed electronic health records for information about patient symptoms and medications.
Cancer survivors, a pharmacologist, and a healthcare administrator helped choose the outcomes and design the study.
Results
Patients who received cancer treatment with and without acupressure did not differ significantly in combined nausea and vomiting, nausea, vomiting, antiemetic use, self-reported pain intensity, fatigue, overall symptoms, depression, anxiety, or positive affect.
Patients also did not differ in the odds of daily narcotic use. However, among patients given narcotics, patients receiving acupressure had higher doses of narcotic medications (p=0.004) compared with patients receiving usual care alone.
Compared with patients receiving usual care alone, patients receiving acupressure had higher pain levels recorded in the electronic health records (p=0.01) and self-reported pain interference (p=0.02).
The caregiver groups did not differ significantly in any outcomes.
Limitations
The study had fewer patients than planned and may have been underpowered to detect meaningful differences in symptoms. Although researchers randomized patients, patients in the acupressure arm had higher baseline pain levels, which could have affected the results.
Conclusions and Relevance
In this study, acupressure did not decrease treatment-related symptoms for patients undergoing cancer treatment or improve caregiver outcomes.
Future Research Needs
Future research could examine other approaches to manage treatment-related symptoms in children and youth undergoing cancer treatment.
Final Research Report
View this project's final research report.
Journal Citations
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- The reviewers asked for additional information on changes made to the study to reduce the scope of the work at six months and wanted more information on the factors that contributed to changes in the study objectives. The researchers added more detail about their difficulties in recruiting the target number of participants, leading to a substantial reduction in the study’s sample size. Therefore, although the study objectives did not change per se, the study itself was reduced in scope to the extent that it could be considered a pilot study or feasibility trial rather than a comparative effectiveness study.
- The reviewers questioned the reasonability of conducting a large effectiveness study on acupressure in this population given the null results in this study. The researchers expanded their discussion in the report on what the goals would be for future trials. They admitted that any future definitive effectiveness study would need multiple sites to successfully enroll the patients they needed. The researchers said they considered several factors in any plans for a future effectiveness trial, including families’ enthusiasm to use integrative therapy, parents’ capacity to complete questionnaires while their children were receiving treatment for cancer, and availability of a sufficient patient population.