The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial.
BACKGROUND
Cancer-related fatigue after chemotherapy is a difficult symptom to manage in practice and the most disruptive symptom in patients' lives. Acupuncture is a popular complementary therapy among cancer patients and some evidence exists that it could potentially alleviate fatigue by stimulating 'energy' points in the body. Hence, this study was carried out to assess the effects of acupuncture and acupressure in managing cancer-related fatigue and the feasibility of running a randomised trial with these two complementary therapies in preparation for a large trial.


METHODS
This study was a randomised controlled trial. Forty-seven patients with cancer who experienced moderate to severe fatigue were randomised either to an acupuncture group (n=15), an acupressure group (n=16) or a sham acupressure group (n=16). The acupuncture group received six 20-min sessions over 2 weeks, while the patients in the two acupressure groups were taught to massage/press the points and did so daily thereafter for 2 weeks on their own. Patients completed the Multidimensional Fatigue Inventory before randomisation, at the end of the 2-week intervention and again about 2 weeks after the end of the intervention.


RESULTS
Significant improvements were found with regards to General fatigue (P<0.001), Physical fatigue (P=0.016), Activity (p=0.004) and Motivation (P=0.024). At the end of the intervention, there was a 36% improvement in fatigue levels in the acupuncture group, while the acupressure group improved by 19% and the sham acupressure by 0.6%. Improvements were observed even 2 weeks after treatments, although they were lower (22%, 15%, 7%, respectively). Acupuncture was a more effective method than acupressure or sham acupressure. Subjects needed a longer treatment period to have more sustained results. The trial was methodologically feasible.


CONCLUSIONS
Acupuncture shows great potential in the management of cancer-related fatigue. As a randomised trial with acupuncture is feasible and preliminary data shows significant improvements, it should be tested further using a large sample and a multicentre design.
University of Manchester, School of Nursing, Midwifery & Social Work, Coupland III, Coupland Street, Manchester M13 9PL, UK. alex.molassiotis@manchester.ac.uk
Alexander
A
Molassiotis
Paola
P
Sylt
Helen
H
Diggins
D019050:Acupressure / Q000379:methods*; D015669:Acupuncture Points; D015670:Acupuncture Therapy / Q000379:methods; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005221:Fatigue / Q000139:chemically induced / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D010865:Pilot Projects; D012107:Research Design; D016896:Treatment Outcome; D014481:United States
D000970:Antineoplastic Agents