Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, USA.
Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Support Care Cancer. 2019 Dec;27(12):4597-4605. doi: 10.1007/s00520-019-04736-x. Epub 2019 Mar 30.
Research by our group has shown that acupressure bands are efficacious in reducing chemotherapy-induced nausea (CIN) for breast cancer patients who expect nausea, and that their effectiveness in controlling CIN can largely be accounted for by patients' expectations of efficacy, i.e., a placebo effect. The present research examined if the effectiveness of acupressure bands could be enhanced by boosting patients' expectation of the bands' efficacy.
Two hundred forty-two chemotherapy-naïve patients with breast cancer who expected nausea were randomized. Arms 1 and 2 received acupressure bands, plus a relaxation MP3 and written handout that were either expectancy-enhancing (arm 1) or expectancy-neutral (arm 2). Arm 3 was the control without bands or MP3 and received standard care. All participants received guideline-specified antiemetics.
Peak CIN for arms 1, 2, and 3 on a 1-7 scale was 3.52, 3.55, and 3.87, respectively (p = 0.46). Because no differences were observed between arms 1 and 2 (primary analysis), we combined these two arms (intervention) and compared them to controls for the following analyses. A significant interaction was found between intervention/control and receiving doxorubicin-based chemotherapy (yes/no) and pre-treatment anxiety (high/low). Intervention patients receiving doxorubicin had lower peak CIN than controls (3.62 vs. 4.38; p = 0.02). Similarly, intervention patients with high pre-treatment anxiety had a lower peak CIN than controls (3.62 vs. 4.62; p = 0.01).
In breast cancer patients undergoing chemotherapy and having high CIN expectation, acupressure bands combined with a relaxation recording were effective in reducing CIN for patients who received doxorubicin or had high anxiety.
本研究组的研究表明，对于预期会出现恶心的乳腺癌患者，指压腕带在减轻化疗引起的恶心（CIN）方面是有效的，其控制 CIN 的有效性在很大程度上可以归因于患者对疗效的期望，即安慰剂效应。本研究旨在检验通过增强患者对指压腕带疗效的期望是否可以提高其效果。
将 242 名接受初次化疗且预期会出现恶心的乳腺癌患者随机分组。第 1 组和第 2 组接受指压腕带，外加放松的 MP3 和书面说明，这些说明要么是增强预期（第 1 组），要么是中性预期（第 2 组）。第 3 组为对照组，不使用腕带或 MP3，接受标准护理。所有参与者均接受了指南规定的止吐药。
1-7 分制下，第 1、2 和 3 组的 CIN 峰值分别为 3.52、3.55 和 3.87（p=0.46）。由于第 1 组和第 2 组之间没有观察到差异（主要分析），因此我们将这两组（干预组）合并，并与对照组进行以下分析。结果发现干预/对照组与接受阿霉素类化疗（是/否）和治疗前焦虑（高/低）之间存在显著的交互作用。接受阿霉素化疗的干预组患者的 CIN 峰值低于对照组（3.62 比 4.38；p=0.02）。同样，治疗前焦虑较高的干预组患者的 CIN 峰值也低于对照组（3.62 比 4.62；p=0.01）。
在接受化疗且 CIN 预期较高的乳腺癌患者中，指压腕带联合放松录音对接受阿霉素或焦虑较高的患者有效降低 CIN。
