Efficacy of Auricular Acupressure in Prevention and Treatment of Chemotherapy-Induced Nausea and Vomiting in Patients with Cancer: A Systematic Review and Meta-Analysis

Abstract

Background. More than 40% of patients with cancer have reported that chemotherapy-induced nausea and vomiting (CINV) remained the most debilitating side effects of treatment even in the era of new antiemetics. Objective. The purpose of this review was to systematically evaluate the clinical effect of auricular acupressure (AA) in prevention and treatment of chemotherapy-induced nausea and vomiting. Methods. The following databases were searched: PubMed, Cochrane Library, EMBASE, the Web of Science, Chinese Biological Medicine (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang, and VIP (from database inception to April 2020). Eligible randomized controlled trials of auricular acupressure in treating CINV were collected, including crossover randomized design study. The meta-analysis was carried out by RevMan software (5.3). Results. Totally 19 RCTs with 1449 patients met the inclusion criteria. Compared with control groups, the relief efficiency of overall CINV was enhanced by AA combined with antiemetics (RR = 1.31, CI 1.22 to 1.41, p ≤ 0.001). Although the therapeutic effect on acute nausea and vomiting was not obvious, AA still played an important role in reducing delayed nausea and vomiting (delayed nausea frequency: RR = 0.68, CI −1.01 to −1.35, p ≤ 0.001; delayed vomiting frequency: RR = 0.91, CI −1.22 to −0.61, p ≤ 0.001). The likelihood of adverse reactions related to antiemetics was reduced by AA combined with antiemetics (RR = 0.62, CI 0.53 to 0.74, p ≤ 0.001). Statistically significant association was found between AA and incidence of constipation, diarrhea, and tiredness, while there was no statistically significant association between AA and abdominal distension or headache. Conclusion. Auricular acupressure supplementation benefited delayed chemotherapy-induced nausea and vomiting as well as constipation, diarrhea, and tiredness. AA alone or AA supplementation has little effect on acute nausea and acute vomiting. There is no conclusion on whether AA alone is superior to antiemetics in the management of delayed CINV. Further studies are needed to confirm the efficacy of auricular acupressure alone in delayed CINV and anticipatory CINV. The results of this review provided the basis for further research with more rigorous study designs, adequate sample sizes, and standardized implementation to confirm the efficacy of auricular acupressure.

Evidence Summary for Nonpharmacological Management of Chemotherapy‐Induced Nausea and Vomiting

“…The study designs of the 2 guidelines were complete and of high quality; all were approved for inclusion. Among the 13 included systematic reviews [ 17 , 29 ], 6 were in English literature [ 17 , 19 , 21 , 22 , 24 , 27 ], and 7 were in Chinese [ 18 , 20 , 23 , 25 , 26 , 28 , 29 ]. The methodological quality of the 13 systematic reviews is shown in Table 3 .…”

“…(1) Auricular Point Therapy . Auricular point therapy can be used as an adjuvant therapy in the prevention and treatment of CINV [ 17 ]. This therapy regulates a patient's physical and psychological function through meridians and acupoints; it is noninvasive, has relatively few side effects, safe, effective, and affordable.…”

“…The liver and spleen are often selected as matching points. A compression effect is then created from the De-qi acuesthesia [ 17 , 18 , 32 ]. Pan et al [ 32 ] combined antiemetic drugs with auricular point sticking to patients with platinum-based chemotherapy from the 1st to 5th day of their chemotherapy cycles, pressed 3 times a day for 2 minutes on each point on both ears.…”

“…The liver and spleen are often selected as matching points. A compression effect is then created from the De-qi acuesthesia [17,18,32 5 BioMed Research International recommended that nursing staff provide health education on CINV related knowledge to the patients, teach the patients to self-assess the MAT score, and improve the health knowledge level of the patients on CINV during hospitalization. Place a vomiting record sheet at the bedside or foot of the bed to record the vomiting time, frequency, contents, and MAT score which can transparent the patients' nausea and vomiting information to promote the communication between doctors and nurses [15,16].…”

Effects of auricular acupressure on dysmenorrhea: A systematic review and meta-analysis of randomized controlled trials

“…Auricular acupressure (AA) is a noninvasive treatment in traditional Chinese medicine technique, and it has been proved to be a valuable strategy to improve menstrual symptoms through pressing vaccaria, magnetic beads and cowherb seeds sticked on auricular acupoints corresponding to all parts of the human body ( 6 , 7 ). As a typical traditional Chinese medical therapy using acupoints without needle insertion, AA stimulates acupoints by pressure from fingers or automatically by the seeds themselves ( 8 ).…”