title: Investigation of 2 Types of Self-administered Acupressure for Persistent Cancer-Related Fatigue in Breast Cancer Survivors: A Randomized Clinical Trial.
abstract: OBJECTIVE
  Fatigue is a common and debilitating late-term effect of breast cancer that is associated with poor sleep and decreased quality of life, yet therapies remain limited. Acupressure has reduced fatigue in previous small studies, but rigorous clinical trials are needed.
  
  
  OBJECTIVE
  To investigate if 6 weeks of 2 types of self-administered acupressure improved fatigue, sleep, and quality of life vs usual care in breast cancer survivors and to determine if changes were sustained during a 4-week washout period.
  
  
  METHODS
  Phase 3 randomized, single-blind, clinical trial conducted from March 1, 2011, through October 31, 2014. Women were recruited from the Michigan Tumor Registry.
  
  
  METHODS
  Randomization (1:1:1) to 6 weeks of daily self-administered relaxing acupressure, stimulating acupressure, or usual care.
  
  
  METHODS
  The primary outcome was change in the Brief Fatigue Inventory score from baseline to weeks 6 and 10. Secondary analyses were sleep (Pittsburgh Sleep Quality Index) and quality of life (Long-Term Quality of Life Instrument).
  
  
  RESULTS
  A total of 424 survivors of stages 0 to III breast cancer who had completed cancer treatments at least 12 months previously were screened, and 288 were randomized, with 270 receiving relaxing acupressure (n = 94), stimulating acupressure (n = 90), or usual care (n = 86). One woman withdrew owing to bruising at the acupoints. At week 6, the percentages of participants who achieved normal fatigue levels (Brief Fatigue Inventory score <4) were 66.2% (49 of 74) in relaxing acupressure, 60.9% (42 of 70) in stimulating acupressure, and 31.3% (26 of 84) in usual care. At week 10, a total of 56.3% (40 of 71) in relaxing acupressure, 60.9% (42 of 69) in stimulating acupressure, and 30.1% (25 of 83) in usual care continued to have normal fatigue. At neither time point were the 2 acupressure groups significantly different. Relaxing acupressure, but not stimulating acupressure, showed significant improvements in sleep quality compared with usual care at week 6, but not at week 10. Only relaxing acupressure significantly improved quality of life vs usual care at weeks 6 and 10.
  
  
  CONCLUSIONS
  Both acupressure arms significantly reduced persistent fatigue compared with usual care, but only relaxing acupressure had significant effects on sleep quality and quality of life. Relaxing acupressure offers a possible low-cost option for managing symptoms.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01281904.
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor2Department of Nutritional Sciences, University of Michigan, Ann Arbor.
authors.forename: Suzanna M
authors.initials: SM
authors.lastname: Zick
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor3Department of Biostatistics, University of Michigan, Ann Arbor.
authors.forename: Ananda
authors.initials: A
authors.lastname: Sen
authors.affiliation: College of Nursing, Michigan State University, East Lansing.
authors.forename: Gwen K
authors.initials: GK
authors.lastname: Wyatt
authors.affiliation: Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor6Geriatric Research, Education and Clinical Center, Ann Arbor, Michigan.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Murphy
authors.affiliation: Sleep and Circadian Research Laboratory, University of Michigan, Ann Arbor8Department of Psychiatry, University of Michigan, Ann Arbor9Department of Neurology, University of Michigan, Ann Arbor.
authors.forename: J Todd
authors.initials: JT
authors.lastname: Arnedt
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Harris
mesh_terms: D019050:Acupressure; D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy*; D005221:Fatigue / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D011788:Quality of Life; D012648:Self Care; D016037:Single-Blind Method; D012890:Sleep; D017741:Survivors; D016896:Treatment Outcome