Despite advances in symptom management, children undergoing cancer treatment or receiving a chemotherapy-based hematopoietic stem cell transplant (HSCT) often experience moderate to severe symptoms. Parents of children with cancer also report having distress. Pharmacologic treatments of symptoms can cause adverse effects. Patients, parents, and clinicians have expressed interest in including nonpharmacologic approaches to improve symptom management. Acupressure is a promising adjunctive therapy to usual care. More evidence is needed from well-designed trials with larger samples and rigorous designs to make definitive recommendations about the inclusion of acupressure among patients being treated for pediatric cancer or receiving HSCT.
This randomized controlled feasibility trial recruited children, adolescents, and young adults (N = 95) who were receiving hospital-based treatment for pediatric cancer or a chemotherapy-based HSCT and were aged 5 to 24 years. Participants were randomly assigned to either an acupressure arm (n = 47) and received professional acupressure 5 days/week plus usual care, with their parent or caregiver being instructed in acupressure delivery for the child; or a usual care arm (n = 48) in which they received usual symptom management care alone. Patient-reported outcomes (PROs) were recorded for nausea/vomiting, pain, fatigue, and psychological distress over ∼30 days. Clinical information and supportive care medication data were collected from patient records. Parents/caregivers were also enrolled (N = 90); those in the acupressure arm were taught to perform acupressure, and PROs on mood were assessed. Log linear and analysis of variance models were used to assess differences in symptoms or supportive care drug use between arms. Due to recruitment limitations, the study was reclassified as a feasibility trial during year 1.
A trial involving acupressure is both feasible and acceptable to patients and families receiving treatment for pediatric cancer or receiving an HSCT. The participation rate among eligible patients was 71.4%, and there were no serious adverse events (SAEs). The composite measures of nausea/vomiting, nausea, daily antiemetic use, fatigue, overall symptoms, depression, anxiety, and positive affect did not differ significantly between study arms. Vomiting (PRO) was reduced by 36% (95% CI, −65% to 16.4%; = .14) in the acupressure arm. Average pain intensity (PRO) was higher in the acupressure arm than in the usual care arm (17%, = .17). Narcotic use was marginally greater with acupressure (adjusted odds ratio, 1.8; 95% CI, 1.0-3.3; = .067), and given narcotic use, the average dose was greater ( = .004). Patients in the acupressure arm reported greater baseline pain, fatigue, and treatment-related symptoms, which could be markers for greater disease severity or treatment intensity at baseline. Parent-delivered acupressure to support symptom management did not decrease parent depression, anxiety, or posttraumatic stress symptoms or increase positive affect and caregiver self-efficacy as hypothesized. No SAEs were reported.
The acupressure intervention was feasible and safe but did not indicate effectiveness. There was a trend toward reduced vomiting among pediatric oncology or HSCT patients, but the intervention did not reduce other symptoms. Pain measures from the electronic medical record showed a significant increase in pain in the acupressure arm; given narcotic use among patients in both arms, the total dose was greater in those who received the intervention.
Small sample size, greater disease severity in the acupressure arm, and relatively short-term relief from acupressure may have contributed to inconclusive study findings.
