Feasibility of acupressure intervention to improve chemotherapy-related symptoms and functioning among gastrointestinal cancer patients.

Abstract

657 Background: Chemotherapy-related symptoms, including fatigue, pain, insomnia, nausea, and vomiting, affect cancer patients’ (pt) physical and mental functioning. Acupressure (AP), which uses fingers to stimulate acupoints in the body per traditional Chinese medicine, has shown beneficial effects in improving chemotherapy-related symptoms. Yet, AP has been understudied in gastrointestinal cancer (GI) pts’ symptom management. Methods: This single-arm pilot trial enrolled 24 patients with stage I-IV GI cancers undergoing chemotherapy. They were trained to self-administer AP to 4 acupoints (Li4, PC6, ST36, SP6) on each side of the body, then practice one minute per acupoint for 8 minutes every day and fill daily logs through an 8-week intervention period. The primary endpoint examined the feasibility (interest, retention, and adherence rates) of delivering self-administered AP. Chemotherapy-related symptoms and functional status at baseline and 8-week post-intervention follow-up were assessed using NIH patient-reported outcome assessments (PRO-CTCAE and PROMIS short forms). Paired t-tests were run to examine change scores in symptom outcomes before and after intervention. Results: Pt demographics were 50% male, 21% African American, 67% Caucasian and 12% other (mean age = 56). They included 38% colorectal cancer, 25% pancreatic cancer, 17% cholangiocarcinoma, and 20% upper GI cancers. Feasibility outcomes showed that 83% of approached pts were interested in participation; 24 of 31 eligible pts (77%) were enrolled; retention rate was 71% (N = 17). Seven pts did not complete the trial due to two with infections, three concerning time to fill daily logs, and two with unspecified reasons. Approximately 65% of pts adhered to performing AP for over 80% of the time and filling daily logs every week. No adverse events were attributed to AP. Data from PRO-CTCAE showed that over 93% of pts reported no or mild nausea and vomiting through the intervention period except one reporting a moderate level of vomiting. Data from PROMIS surveys showed that after the 8-week intervention, patient-reported pain interference with daily activities and physical functioning remained similar to the baseline level. Yet, pts had reduced fatigue (-4.4 points), sleep disturbance (-3.1), depression (-3.3), anxiety (-2.7), and increased cognitive function (2.6) after AP intervention. These improvements were not statistically significant due to the small sample size, but a 3-point change in the PROMIS symptom scores is clinically meaningful. Conclusions: This trial shows that self-administered AP proves to be a feasible, safe, and low-cost approach and may be beneficial for GI cancer pts to relieve treatment-related symptoms. Future randomized trials are needed to determine efficacy.