Antiemetic efficacy of transcutaneous electrical nerve stimulation (TENS) at pericardium 6 acupuncture point (P6) in the treatment of chemotherapy-induced delayed nausea and vomiting (CINV) in stage I to III breast cancer patients during adjuvant/neoadjuvant chemotherapy (Ad/nAd).

Abstract

TPS648 Background: CINV remain major adverse effects of highly emetic chemotherapy for breast cancer patients (BC). Patients (PT) rate nausea & vomiting as the most feared chemotherapy-related symptoms. There is substantial evidence that P6 (located in the region in the middle of the wrist 3 finger breaths from the juncture of the hand & wrist) acupuncture is an effective antiemetic treatment in a variety of PT including the post-anesthesia, obstetrical, and motion sickness PT. We hypothesized that application of TENS at P6 point will reduce:1) the overall incidence of CINV episodes in stage 1-3 BC PT, 2) the severity & duration of CINV, 3) the requirement for rescue antiemetics 4) & that TENS is well tolerated & feasible. Maxima III Transcutaneous Electrical Nerve Stimulation unit is utilized in this study & is self-administered by PT. Patients and Methods: We are conducting a prospective, randomized, double-blinded, controlled trial to determine if self-stimulating P6 may decrease the incidence and severity of delayed CINV in stage 1-3 BC treated with the initial dose of highly emetic Ad/nAd (AC, AC-T, TAC, TC, TCH) and reduce PT' need for rescue oral antiemetic medications. PT will be randomized in a 1:1 ratio to the active treatment group (TENS self-stimulation at P6) & the control group (TENS self-stimulation at a point on the lateral side of the elbow that does not conform to any known acupuncture points). The assignments are blinded to the PT & the investigators. Subjects self-administer TENS at home q4 hours for 20 minutes during days 2-5 postchemotherapy. The use of conventional antiemetic therapy (corticosteroids, setrons, aprepitant, phenergan & prochlorperazine) is similar for both treatment groups. The severity of nausea symptoms, episodes of emesis, use of rescue antiemetics, and compliance are recorded daily by the PT in diaries. A brief questionnaire is also administered to evaluate PT tolerability of TENS & their ability to comply with the treatment regimen. Twenty six out of 70 planned PT have been enrolled. Recruitment is ongoing.