Acupressure for Co-Occurring Symptoms in Breast Cancer Patients

A new study finds acupressure could be a low-cost, at-home solution to a suite of persistent side effects that linger after breast cancer treatment ends. Researchers from the University of Michigan Rogel Cancer Center reported in 2016 that acupressure helped reduce fatigue in breast cancer survivors.

In the new study, they looked at the impact of acupressure on symptoms that frequently accompany fatigue in this population: chronic pain, anxiety, depression and poor sleep. They found acupressure improved all of these symptoms compared with standard care.

In the study, breast cancer survivors who reported fatigue were randomized to one of two types of acupressure or to usual care, which included typical sleep-management techniques. The women were taught how to find and stimulate the acupressure points so that they could perform it at home once per day for six weeks.

Of the 424 survivors experiencing fatigue from the original study, researchers found half had at least one other symptom and 17 percent experienced all of them.

  • Following treatment, depressive symptoms improved statistically significantly for the relaxing acupressure group (41.5%) compared with stimulating acupressure (25%) and usual care (7.7%).
  • Both acupressure groups were associated with greater improvements in anxiety than usual care, but only relaxing acupressure was associated with greater reductions in pain severity, and only stimulating acupressure was associated with greater reductions in pain interference.
  • There were no statistically significant moderators of sleep quality, anxiety, or depressive symptoms.
  • Fatigue statistically significantly moderated pain, and age statistically significantly modified fatigue.
  • Changes in depressive symptoms and sleep quality statistically significantly mediated the relationship between relaxing acupressure and usual care on fatigue; however, the effect was small.

“It was actually unusual for a woman to have just fatigue. These long-term side effects are a big problem. For some women, they are significant barriers in their life,” says study author Suzanna M. Zick, N.D., MPH, research associate professor of family medicine at Michigan Medicine.

The new analysis focused on the 288 patients who reported symptoms in addition to fatigue. They were asked weekly about fatigue, sleep quality, depressive symptoms, anxiety and pain. Results are published in JNCI Cancer Spectrum.

The researchers taught the participants to apply pressure with fingers, thumbs or a device to specific points on the body. Researchers tested two types of acupressure: relaxing acupressure, which is traditionally used to treat insomnia, and stimulating acupressure, which is used to increase energy. The two techniques differ by which points on the body are stimulated.

After six weeks, relaxing acupressure was significantly better than stimulating acupressure or standard care at improving depressive symptoms and sleep. Both types of acupressure were more effective than standard care for improving anxiety, severity of pain and pain interfering with daily life.

“If you have a person who is fatigued and depressed, it would be the obvious conclusion to use relaxing acupressure. For anxiety or pain, either approach might work,” Zick says.

The researchers also assessed whether improving one symptom helped improve other symptoms. They found that improving symptoms of depression improved sleep quality, accounting for about 20 percent of the improvement in fatigue.

“That means we don’t know 80 percent of what’s impacting fatigue. Depressive symptoms and sleep quality are a small part, and it makes sense. But clearly, there are other factors,” Zick says.

She suspects these symptoms impact several different mechanistic pathways, possibly impacting the brain in multiple ways. This means treatments will likely need to be tailored and varied based on a woman’s symptoms and other factors.

The researchers plan to gather more information using neuroimaging to understand the brain pathways involved. They’re also currently conducting two clinical trials to look at using an acupressure app. Working with U-M College of Engineering experts, they developed a special wand to assist patients in performing acupressure. The wand helps ensure appropriate pressure and tracks how long patients use it.

Acupressure is an appealing option because it can be done at home with minimal negative effects. The study showed that women could learn to apply correct pressure to the appropriate points. Some women reported minor bruising at the acupressure sites.

Conclusion / Acupressure was associated with greater improvements than usual care in anxiety, pain, and symptoms of depression in breast cancer survivors with troublesome fatigue. These findings warrant further evaluation in suitably controlled randomized trials.

Suzanna Maria Zick, Ananda Sen, Afton Luevano Hassett, Andrew Schrepf, Gwen Karilyn Wyatt, Susan Lynn Murphy, John Todd Arnedt, Richard Edmund Harris. Impact of Self-Acupressure on Co-Occurring Symptoms in Cancer Survivors. JNCI Cancer Spectrum, 2018; 2 (4) DOI: 10.1093/jncics/pky064