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Original Investigation
November 2016

Investigation of 2 Types of Self-administered Acupressure for Persistent Cancer-Related Fatigue in Breast Cancer Survivors: A Randomized Clinical Trial

Author Affiliations
  • 1Department of Family Medicine, University of Michigan, Ann Arbor
  • 2Department of Nutritional Sciences, University of Michigan, Ann Arbor
  • 3Department of Biostatistics, University of Michigan, Ann Arbor
  • 4College of Nursing, Michigan State University, East Lansing
  • 5Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
  • 6Geriatric Research, Education and Clinical Center, Ann Arbor, Michigan
  • 7Sleep and Circadian Research Laboratory, University of Michigan, Ann Arbor
  • 8Department of Psychiatry, University of Michigan, Ann Arbor
  • 9Department of Neurology, University of Michigan, Ann Arbor
  • 10Department of Anesthesiology, University of Michigan, Ann Arbor
JAMA Oncol. 2016;2(11):1470-1476. doi:10.1001/jamaoncol.2016.1867
Key Points

Question  What is the efficacy of 2 types of self-administered acupressure compared with usual care for treating chronic fatigue, poor sleep, and low quality of life in fatigued breast cancer survivors?

Findings  In this randomized clinical trial that included 288 breast cancer survivors, the percentages of women who achieved normal fatigue levels at week 6 were 66.2% in relaxing acupressure, 60.9% in stimulating acupressure, and 31.3% in usual care. Only women in the stimulating acupressure arm experienced significant improvement in both sleep quality and quality of life vs usual care.

Meaning  Self-administered relaxing acupressure may be a useful treatment for improving fatigue, sleep, and quality of life.

Abstract

Importance  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.

Objectives  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.

Design, Setting, and Participants  Phase 3 randomized, single-blind, clinical trial conducted from March 1, 2011, through October 31, 2014. Women were recruited from the Michigan Tumor Registry.

Interventions  Randomization (1:1:1) to 6 weeks of daily self-administered relaxing acupressure, stimulating acupressure, or usual care.

Main Outcomes and Measures  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 and Relevance  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.

Trial Registration  clinicaltrials.gov Identifier: NCT01281904

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