Article

Effectiveness of Acupressure in Chemotherapy Induced Nausea and Vomiting Among Women with Reproductive Organ Cancer


 K Kavichelvi

Author Information

 Professor, St. Mary's College of Nursing, Lucknow

Volume No.

01

DOI

https://doi.org/10.53926/YNJR/0002

Published on

10/1/2021 12:00:00 AM

Issue No.

01

View PDF

Full Article

Introduction

Nausea and vomiting are among the most common and distressing symptoms that patients with cancer endure, both as a result of anti – neoplastic treatment and from the disease itself, and significantly affect patients selfcare, coping abilities, and quality of life.[1] Although people may experience seemingly identical symptoms, the causes of symptoms and the response of each person to the symptoms may vary. Regardless of the frequency, duration or severity of symptoms, the distress resulting from it may escalate over time. Effective management of these individual symptom's response must be there throughout the cancer treatment. Even mild nausea, vomiting and retching may have later sequalae, e.g., anticipatory symptoms in patients.

Unless the nausea and vomiting have been prophylactically managed during the initial therapy i.e., first cycle of first course the actual or perceived threat of the disease, its treatment and discomfort relating to the treatment can arouse a variety of emotional and physiological response.[2], [3], [4]

Few drugs are available to reduce the symptoms of nausea, but many people receiving chemotherapy do not wish to add drugs on top of the chemotherapy. As many as 60% of cancer patients report being nauseous after undergoing chemotherapy, and many cancer patients identify nausea as a main reason for being reluctant to begin chemotherapy or for discontinuing the treatment.[5] Non pharmacological interventions can be used alone, in combination or as adjuvant therapy with pharmaceutical agents. These interventions can be effective in controlling nausea and vomiting by relaxing the patient and when used in conjunction with anti – emetics, can reduce the dose and frequency of drug requirements also.[6]

Dundee and colleagues suggested that finger acupressure (Shiatsu) maneuver for five minutes on P6 (nei –guan) point at least three times a day before chemotherapy and meal times or based on their needs, appears to be an effective adjuvant maneuver in the course of nausea and emesis control.[7] The art of shiatsu is called acupressure. In Japanese, the word ‘Shi’ means finger and ‘atsu’ means pressure. It is an Eastern technique of healing and relaxation that has been successfully used for centuries. Shiatsu is a safe, effective means of easing pain, and also creates a feeling of wellbeing, vitality and relaxation. It requires no special equipment and can be done anywhere and anytime. [8]The nei – guan point (P6) was first recognized by Kenyon (1988) as an effective acupressure point for the treatment of nausea and vomiting. In particular, nei – guan point was shown to be statistically, significantly effective for relieving nausea and vomiting by enhancing the blood circulation, inhibiting gastric movements and brain cortex stimulation through neural stimulation.[9]

Since the acupressure is an easily applicable method regardless of time and place, cost effective, self-controlled and noninvasive method, it can be used to treat chemotherapy induced nausea and vomiting among clients with cancer receiving chemotherapy.[10] The purpose of this study was to assess the effectiveness of non-pharmacological method, acupressure as a treatment modality to relieve nausea and vomiting among patients receiving chemotherapy.

Materials and Methods

A quasi-experimental pretest posttest design was adopted. The study sample comprised of 80 women admitted with ovarian cancer and cancer cervix receiving second and third cycle of chemotherapy.  Non probability purposive sampling technique was adopted. Self-administered modified Rhode's index scale was administered to the level of CHNV. The assessment scale was divided in to two categories 1. Nausea and 2. Vomiting. These two categories were measured in terms of frequency, severity and interference with the activities.  Score was interpreted as 7 – Normal, 8 –14 Mild nausea and vomiting, 15 – 21 Moderate nausea and vomiting, 22 – 28 Severe nausea and vomiting, 29 – 35 Very severe nausea and vomiting. Pretest was done in both experimental and control group after the first day of chemotherapy. The level of CINV was assessed by asking the women to indicate the level of chemotherapy induced nausea and vomiting being experienced by her, and preceded by a brief explanation about self-administered modified Rhodes index of nausea and vomiting scale and its purpose.

Women in the experimental group and the control group were given anti emetics. In the experimental group investigator identified the P6 acupressure point. The acupressure was applied consistently in each forearm over the P6 acupressure point for three minutes, three times a day before meals for three days. One of the third, the fourth and the fifth day, the post test was done for the clients in both the groups. Three to four samples were collected per day. Both descriptive and inferential statistics were used to analyze the data.

Results

Pre-test level of chemo therapy induced nausea and vomiting (CINV) in the experimental and control group

In the experimental group majority of the women with ovarian cancer receiving second and third cycle of chemotherapy experienced very severe level of CINV 8 (80%) and 7 (70%) respectively and cancer cervix women second and third cycle of chemotherapy experienced very severe level of CINV ie, 60 (60 %) and 8 (80%).

In control group, a majority of the women with ovarian cancer receiving second and third cycle of chemotherapy experienced very severe level of CINV 6(60%) and 9 (90%). In cancer cervix, women receiving second and third cycle of chemotherapy experienced very severe level of CINV 7 (70%) AND 8 (80%) respectively.

Post-test level of chemotherapy induced nausea and vomiting (CINV) in the experimental and the control group

In the experimental group, a majority of the women with ovarian cancer receiving second and third cycle of chemotherapy came to normal level 5 (50%), and 8(80%) respectively and the cancer cervix women recovered from CINV to normal level 8(80%) and 5 (50%) respectively.

In the control group, a majority of women with ovarian cancer receiving second, and third cycle of chemotherapy experienced very severe level CINV 8 (80%) and 10 (100%) respectively. In cancer cervix women experienced very severe level of CINV 8(80%) and 8 (80%) respectively.

Discussion
Pre - test level of chemo therapy induced nausea and vomiting in the experimental and control group

Overall, the comparison of mean values between both the group shows that, in the experimental group the mean value found to have 31.02, with the standard deviation 2.519. In the control group, the mean value was 31.1 and the standard deviation was 2.638, with the ‘t’ value of 1.08 (p>0.001).


Table -1 Pre - test level of chemo therapy induced nausea and vomiting in the experimental and control group


Post-test level of chemo therapy induced nausea and vomiting in the experimental and control group

Overall, the experimental group had the mean value of 7.2, with standard deviation 2.548 and in the control group the mean was 29.3 and the standard deviation was 0.78. The repeated measures 0f ANOVA shows F = 162.545 *** (p<0.001). The result was highly significant.


Table - 2 Post-test level of chemo therapy induced nausea and vomiting in the experimental and control group


Table – 3 Comparison of mean scores between pre and post-test level of chemotherapy induced nausea and vomiting among women receiving second cycle of chemotherapy in the experimental group

In women with cancer cervix, pre - test mean value was 30.9 with the standard deviation 3.75. The post – test mean values were 12.1, 8.2, and 7.2 respectively with the standard deviation 2.514, 1.475 and 0.421 respectively and the F value was 201.56*** at p < 0.001 which was highly significant. In women with ovarian cancer, the pre- test mean value was 30.8 with the standard deviation 3.62. The post – test mean values were 11.9, 9.2 and 7.6 respectively with the standard deviation of 2.46, 2.20 and 0.69 respectively. The F value was 177.97*** at p< 0.001 which was highly significant.


Table -3 Comparison of mean scores between pre and post-test level of chemotherapy induced nausea and vomiting among women receiving second cycle of chemotherapy in the experimental group


Table – 4 Comparison of mean scores between pre and post - test level of chemotherapy induced nausea and vomiting among women receiving third cycle of chemotherapy in the experimental group

In women with cancer cervix, pre - test mean value was 31 with the standard deviation of 1.897. The post - test mean values were 12.1, 8.9 and 7.7 respectively with the standard deviation of 2.46, 1.44 and 0.82 respectively and the F value was 191.377*** P<0.001 which was highly significant.

In women with ovarian cancer, the pre-test mean value was 30.9 with the standard deviation of 2.62. The post – test mean values were 11.4, 8.4, and 7.2 respectively with the standard deviation of 1.50, 1.57, and 0.42 respectively and the F value was 390.91*** P<0.001 which was highly significant.


Table - 4 Comparison of mean scores between pre and post - test level of chemotherapy induced nausea and vomiting among women receiving third cycle of chemotherapy in the experimental group


Table – 5 Comparison of mean scores between pre and post – test levels of chemotherapy induced nausea and vomiting among women with reproductive organ cancer receiving second cycle of chemotherapy in the control group

In control group, women with cancer cervix receiving second cycle of chemotherapy the pre – test mean value was 30.1 with the standard deviation of 28.1. The post – test mean values were 29.6, 30.5, and 28.7 with the standard deviation of 2.91, 2.121 and 2.71 and the F value was 1.45 at P>0.01 which was non- significant.

In ovarian cancer, pre – test mean value was 30.3 with the standard deviation of 29. The post – test mean values were 31.1, 31, and 29 with the standard deviation of 2.88, 2.78 and 2.86 and the F value was 1.16 at P>0.001, which was non-significant.


Table - 5 Comparison of mean scores between pre and post – test levels of chemotherapy induced nausea and vomiting among women with reproductive organ cancer receiving second cycle of chemotherapy in the control group


Table – 6 Comparison of mean scores between pre and post - test level of chemotherapy induced nausea and vomiting among women receiving third cycle of chemotherapy in the control group

In women with cancer cervix the pre – test mean value was 31.4 with the standard deviation of 28. In post – test, mean values were 31.9, 29.3 and 28 respectively with the standard deviation of 2.469, 1.766 and 2.106 respectively. The F value was 2.35 at P>0.001 which shows non – significant results.

In women with ovarian cancer the pre – test mean was 32.6 with the standard deviation of 1.907. The post test mean values are 33, 31.9 and 31.5 respectively with the standard deviation of 1.76, 1.911 and 1.84 and the F value was 1.28 at P>0.001, which shows non-significant results.


Table - 6 Comparison of mean scores between pre and post - test level of chemotherapy induced nausea and vomiting among women receiving third cycle of chemotherapy in the control group


Multiple comparisons of mean difference between the experimental and the control group

Table- 7 represents multiple comparison of mean difference between the experimental and the control group. By using BON Ferroni test, the overall result shows, acupressure is an effective method in reducing the level of chemotherapy induced nausea and vomiting (CINV) among women with reproductive cancer in experimental group.

This study findings were consistent with the study of Anju Byju which showed that the subjects in the experimental group experienced mild (65%) to moderate (35%) nausea and vomiting, whereas the subjects in the control group experienced moderate (35%) to severe (65%) nausea and vomiting, t (38) = 2.693, 8.270, 8.401 respectively for days 1, 2 and 3; p < 0.05). The results point to the fact that acupressure is effective in reducing nausea and vomiting among patients receiving chemotherapy.[12]


Table - 7 Multiple comparisons of mean difference between the experimental and the control group


Conclusion

Findings of this study revealed that acupressure has an effect on the women with ovarian and cervix cancer who were receiving chemotherapy by decreasing the level of CINV. Hence the investigator concluded that acupressure will be an effective adjunctive in controlling chemotherapy induced nausea and vomiting (CINV) and it can be tried in any oncological setting of clinical practice.

Recommendations

A similar study can be undertaken with larger samples in different oncological settings because better generalization would be possible if larger number of samples had been selected from each type of cancer and each type of chemotherapy.

Acknowledgement

Author is thankful to all the participants of the study.

Financial support and sponsorship

Nil

Conflicts of Interest

There is no conflict of interest

Creative Commons Licence
This work is licensed under a Creative Commons Attribution 4.0 International License.

References

  1. Verna A. Rhodes, EdS; Roxanne W. McDaniel, Nausea, Vomiting, and Retching: Complex Problems in Palliative Care. CA A Cancer Journal for Clinicians; 2001; 51:232-248
  2.  Rhodes VA, Watson PM, Johnson MH, et al. Patterns of nausea, vomiting and distress in patients receiving antineoplastic drug protocols. Oncol Nurs Forum 1987; 14: 35–44.
  3. McDaniel RW, Rhodes VA. Development of a preparatory sensory information video tape for women receiving chemotherapy for breast cancer. Cancer Nurs 1998; 21: 143–148.
  4.  Rhodes VA, McDaniel RW, Hanson B, et al. Sensory perception of patients on selected antineoplastic chemotherapy protocols. Cancer Nurs 1994; 17: 45–51.
  5.  Wolfe, Honora Lee. "Relieving nausea in chemotherapy patients." Townsend Letter for Doctors and Patients, no. 264, 2005, p. 135.
  6. Saeed Moradian, Doris Howell “Prevention and management of chemotherapy-induced nausea and vomiting” International Journal of Palliative Nursing Vol. 21, No. 5
  7. Dundee JW, McMillan CM. Clinical uses of P6 acupuncture antiemesis. Acupunct Electrother Res. 1990;15(3-4):211-5. Crossref. PMID: 1982043.
  8. A Beginner's Guide to Shiatsu; l Using Japanese Finger Pressure for the Relief of Headaches, Back Pain, and Hypertension by Patrick McCarty · 1995
  9. Eun Jin Lee, Susan K. Frazier, The Efficacy of Acupressure for Symptom Management: A Systematic Review, Journal of Pain and Symptom Management, 10.1016/j.jpainsymman.2011.01.007, 42, 4, (589-603), (2011)
  10. Gardani G, Cerrone R, Biella C, Mancini L, Proserpio E, Casiraghi M, Travisi O, Meregalli M, Trabattoni P, Colombo L, Giani L, Vaghi M, Lissoni P. Effect of acupressure on nausea and vomiting induced by chemotherapy in cancer patients. Minerva Med. 2006 Oct;97(5):391-4. PMID: 17146420.
  11. Molassiotis A, Russell W, Hughes J, et al. The effectiveness and cost-effectiveness of acupressure for the control and management of chemotherapy-related acute and delayed nausea: Assessment of Nausea in Chemotherapy Research (ANCHoR), a randomised controlled trial. Southampton (UK): NIHR Journals Library; 2013 Jun. (Health Technology Assessment, No. 17.26.) Appendix 1, Study scales: Rhodes Index of Nausea, Vomiting and Retching. Available from: NCBI
  12. Byju, A., Pavithran, S., & Antony, R. (2018). Effectiveness of acupressure on the experience of nausea and vomiting among patients receiving chemotherapy. Canadian oncology nursing journal = Revue canadienne de nursing oncologique, 28(2), 132–138. Crossref

Crossref logo

Welcome To YNJR



Editors


Kavichelvi K (Chief Editor)
Principal
ST.Mary's College of Nursing, Kursi Road, Lucknow
kavichelvi@stmaryscollegeofnursing.com, editor@ynj

G Ramalakshmi (Associate Editor)
Principal
SGRRIM&HS College of Nursing, Patel Nagar, Dehradun
ramalakshmibazla@gmail.com, editor@ynjr.in

Merlin Cheema (Associate Editor)
Teaching Faculty
SGPGIMS College of Nursing, Lucknow
merlincheema@yahoo.in, editor@ynjr.in

DR. R Babu, Ph.D (Associate Editor)
Principal
Mayo College of Nursing, Barabanki, Lucknow
babufranklin@gmail.com, editor@ynjr.in

Sofiya Princess Hema S (Associate Editor)
Associate Professor
PSG College of Nursing, Coimbatore, Tamilnadu
editor@ynjr.in

M Suresh (Associate Editor)
Professor
GSRM College of Nursing, Sarojini Nagar, Lucknow
sureshmerlin16@gmail.com, editor@ynjr.in

R Ramalakshmi (Associate Editor)
Professor
Shivparvathi Mandradiar Institute of Health Sciences,Triupur District, Tamilnadu
childscience@gmail.com, editor@ynjr.in

M Justin Jaspher (Managing Editor)
Professor
St. Mary's College of Nursing, Kursi Road, Lucknow
contact@indexofnj.info, editor@ynjr.in

Dr. Jabin Jose Wel (Associate Editor)
Principal
St. Mary's Institutions of Nursing, Kempapura, Hebbal, Bangalore
jabinkutty@gmail.com, editor@ynjr.in

twinkle
twinklemaddeshiya1996@gmail.com

Rishabh
rishabh@gmail.com

Fahim ahmed
I'm Hacker
Hk
fahimahmed99@gmail.com