Somatic acupressure for the fatigue-sleep disturbance-depression symptom cluster in breast cancer survivors: A phase II randomized controlled trial

Meng Yuan Li, Stephen Wai Hang Kwok, Jing Yu (Benjamin) Tan, Daniel Bressington, Xian Liang Liu, Tao Wang, Shun Li Chen

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Abstract

Objective: To evaluate the feasibility of the somatic acupressure (SA) for managing the fatigue-sleep disturbance-depression symptom cluster (FSDSC) among breast cancer (BC) survivors and its preliminary effects. Methods: In this Phase II randomized controlled trial (RCT), 51 participants were randomised evenly into the true SA group, sham SA group, and usual care group. All the participants received usual care. The two SA groups performed additional true or sham self-acupressure daily for seven weeks. The primary outcomes related to the assessment of participants' recruitment and compliance with study questionnaires and interventions. Clinical outcomes assessed the preliminary effects of SA on fatigue, sleep disturbance, depression, and quality of life. Semi-structured interviews were undertaken to capture participants' experiences of participating in this study. The statistical effects of the intervention on the outcomes were modelled in repeated measures ANOVA and adjusted generalized estimating equations. Results: Forty-five participants completed the SA intervention. No adverse events were reported. Over 85% of the participants could sustain for 25 days or more and 15 min or more per session, but the adherence to the intervention requirement was yet to improve. The group by time effect of the FSDSC and depression were significant (p < 0.05). Qualitative findings showed that participants positively viewed SA as a beneficial strategy for symptom management. Conclusions: The SA intervention protocol and the trial procedures were feasible. The results demonstrated signs of improvements in targeted outcomes, and a full-scale RCT is warranted to validate the effects of SA on the FSDSC.

Original languageEnglish
Article number102380
JournalEuropean Journal of Oncology Nursing
Volume66
DOIs
Publication statusPublished - Oct 2023

Bibliographical note

Funding Information:
This study is supported by the Charles Darwin University Rainmaker Readiness Grant (2018) and the Grant number is not applicable.

Funding Information:
The adoption of pharmacological interventions to manage the FSDSC can be hindered by a range of major concerns over medication use such as daytime drowsiness, dependence on and tolerance to drugs, risk of falls and fractures, and drug-to-drug interactions with concurrent antineoplastic regimens (Fiorentino et al., 2011). Moreover, pharmacologic agents are tailored to manage a limited number of symptoms individually instead of targeting the composite symptom cluster (Chan et al., 2020; Wong et al., 2023). Therefore, efforts have been made to explore some alternative non-pharmacological solutions including the cognitive-behavioral therapy (CBT), complementary and alternative medicine (e.g., acupuncture, yoga), physical activity, mindfulness-based arts interventions (e.g., meditation), which have demonstrated encouraging results in the management of symptom clusters, including the FSDSC (Fiorentino et al., 2011; Jain et al., 2015; Wong et al., 2023). Nonetheless, these non-pharmacological interventions are not without barriers and side effects in their implementations. Such interventions require a substantial amount of time to implement (e.g., yoga, CBT and meditation), and can be costly since they need to be implemented in professional settings and require extensive support by qualified practitioners. Therefore, they are unlikely to be a regular self-practice at home. For invasive interventions such as acupuncture, they carry risks of injuries such as soft tissue infection, pain and subcutaneous ecchymosis, which need clinical care and supervision (Xu et al., 2013). Some interventions (e.g., physical activities) are energy-consuming and can have low participation rates as some cancer survivors who are intolerant of fatigue may not prefer it (Bower, 2014). To improve FSDSC management, an intervention should not only offer promising effects on the symptoms, but also be easy to access, safe, inexpensive, and self-practicable, given the long-term increasing burden of symptoms and finance throughout the illness trajectory of cancer survivors.In the repeated measures ANOVA (Table 4a), the effect size of FSDSC between the true SA group and the usual care group at posttest was small (partial eta squared = 0.002). The within-subject effect of time on the FSDSC composite score was significant (p < 0.001), but there was no significant between-subject effect. After 7 weeks, the improvement of FSDSC in true SA was the greatest as evidenced by the significant group by time effect (True SA by Baseline) in GEE (Table 4b). But the effect size on FSDSC between true SA and control at posttest was small (Cohen's d = 0.075) (Table 4c). In all groups, the estimated marginal means of sleep quality (PSQI), depressive symptoms (HADS-D) and fatigue (MFI) decreased, and the QoL (FACT-B) increased (Table 4c). But the improvements in true SA were greater for depression and fatigue as evidenced by the group by time effects in GEE (Table 4b). Yet, the effect sizes (Cohen's d) between groups at posttest were small (Table 4c). Significant improvement in FACT-B over time (B = −4.5, 95%CI [−7.61, −1.4], p = 0.0045) indicated an overall improvement in QoL (Table 4b). More severe depressive mood in the last month (0–10-point scale) was associated with worse QoL (p = 0.0034), supporting the conceptual framework that depressive mood is associated with lower QoL among BC patients. As expected, the sleep disturbance scores over the last month (0–10-point scale) was associated with worse sleep quality in terms of PSQI (p < 0.001). Furthermore, the working class and those who received public health care or other health benefits were associated with less depressive symptoms when compared with the retired class and those covered by new rural cooperative medical care, suggesting that economic factors may have contributed to depressive symptoms among the participants.Qualitative interview results supported the utilization of the four questionnaires (FACT-B, MFI, PSQI and HADS-D), which were considered “Easy to understand and answer” and “Well reflect the FSDSC” from most participants. Almost all participants in the qualitative interview expressed that they would prefer to recommend self-acupressure to other cancer survivors since they believed that self-acupressure is an acceptable and beneficial treatment for FSDSC in cancer survivors. Additionally, none of the participants in the qualitative interviews complained about the intervention duration and the number of sessions of the intervention. Only one negative response regarding the number of selected acupoints which is hard to perform one session on the required eleven acupoints due to busy work schedules.This study is supported by the Charles Darwin University Rainmaker Readiness Grant (2018) and the Grant number is not applicable.

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