Acupuncture and Acupressure for Chemotherapy-Induced Nausea and Vomiting: A Systematic Review

摘要

Background: Control of chemotherapy-induced nausea and vomiting (CINV) has improved with advances in antiemetics, such as NK antagonists. Despite these advances, patients still experience these symptoms, and expert panels encourage additional methods to reduce these symptoms. Objectives: The objective was to assess the effectiveness of acupuncture and acupressure on acute and delayed CINV in cancer patients. Search strategy: The following databases were searched: AMED, MEDLINE, CINAHL, PubMed, Cochrane Controlled Trials Registry, and Science Direct. The search was undertaken from the inception of the database to January 2012. Selection criteria: Randomised controlled trials and systematic reviews of acupoint stimulation by needles, electrical stimulation or acupressure (excluding laser, point injection and non-invasive electrostimulation) and assessing chemotherapy-induced nausea or vomiting, or both. Data collection and analysis: Data was provided by publications of original trials and pooled. Standardised mean differences with confidence incidences were calculated. Main results: Seven trials were pooled for acupuncture and six for acupressure. Acupuncture reduced the frequency of acute vomiting (mean difference [MD] -7.40, 95% confidence interval [CI] -9.07 to -5.72), but did not reduce acute nausea severity or frequency compared to control. Delayed symptoms for acupuncture were not reported. Acupuncture showed a reduction in the dose of rescue medication (MD -5.52, 95% CI -7.45 to -3.58). Acupressure showed a decrease in frequency of nausea (MD -0.32, 95% CI -0.59 to 0.06) but not acute vomiting or delayed symptoms. All trials used state-of-the-art combination antiemetics, except for the early electroacupuncture trials. Authors' conclusions: Acupuncture has demonstrated some benefit for chemotherapy-induced acute vomiting by reducing the frequency of vomiting and reducing the use of rescue medication, while acupressure has shown a decrease in the frequency of nausea. Further trials of acupuncture and acupressure for chemotherapy-induced nausea and vomiting in patients with refractory symptoms are needed before recommendations for clinical practice can be made. Future trials must be sufficiently powered, as this remains a major flaw with the majority of studies to date.