Nausée en Chimiothérapie
Dundee JW, Yang J.
"Prolongation of the antiemetic action of P6 acupuncture by acupressure in patients having cancer chemotherapy"
Northern Ireland Radiotherapy Centre, Belvoir Park Hospital, Belfast.
J R Soc Med 1990; 83(6):360-2
Previous work from our department has shown that P6 acupuncture is an effective adjuvant to conventional antiemetic therapy for patients having cytotoxic drugs. However, its efficacy is limited to about 8 h. The current studies show that the application of an elasticized wrist band with a stud placed over the acupuncture point, and pressed regularly every 2 h, will prolong the antiemetic action for 24 h. This proved more effective in hospitalized patients (20/20) than in outpatients (15/20), presumably due to the encouragement given to regularly press the stud. Nausea and vomiting remain problems with cancer chemotherapy despite the use of antiemetics. Following encouraging results with P6 acupuncture (ACP) in postoperative sickness this has been shown to be effective in cancer chemotherapy in 105 patients who, despite the use of conventional antiemetics had been sick following the previous treatment. Electrical stimulation (10 Hz DC) of P6 point for 5 min before administration of the cytotoxic drugs was effective in preventing sickness in 66% and only 6% got no benefit. The ACP was given with the antiemetics which the patients had been receiving. Although there were no side effects with the ACP, the benefit only lasted 6-8 h. This was not important in hospitalized patients where the treatment could be repeated, but was a problem with outpatients. It has been shown that pressure on the P6 point (acupressure) has an antiemetic action. A commercially available elasticized band with a plastic stud (Sea Band) is an effective method of applying pressure to P6 point.(ABSTRACT TRUNCATED AT 250 WORDS)
Dundee JW, Ghaly RG et all.
"Acupuncture to prevent cisplatin-associated vomiting"
Department of Anaesthetics, The Queen's University of Belfast, EIRE. Lancet, May 9, 1987
OBIETTIVO: dimostrare l'effetto antiemetico dell'agopuntura sul vomito e sulla nausea post-chirurgica. Il Cisplatino è un agente efficace nel trattamento del cancro, tuttavia la nausea ed il vomito associati a tale trattamento possono rivelarsi talmente gravi da indurre alcuni pazienti a rifiutare ulteriori terapie. STUDIO: studio sull'elettroagopuntura effettuato in pazienti affetti da nausea/vomito associati a Cisplatino. MATERIALI E METODI: lo studio è stato condotto in 10 pazienti trattati con una infusione contenente 30 mg di Cisplatino costituente parte di un regime posologico per il trattamento del cancro testicolare. Tutti i pazienti avevano già riscontrato nusea/vomito in seguito ad un precedente corso terapeutico, nonostante la somministrazione di Metoclopramide. I pazienti scelti in ordine randomizzato sono stati sottoposti ad agopuntura al punto P6 (Neiguan) oppure in un punto falso situato vicino al gomito destro. L'elettroagopuntura è stata praticata mediante uno stimolatore a corrente continua (frequenza 10 Hz, larghezza impulso 0,25 ms). Ad ogni paziente sono state praticate 5 o 6 agopunture durante un arco di 3 giorni, du cui una soltanto effettuata nel punto falso. L'agopuntura veniva praticata con intervalli di ameno 8 ore tra un'applicazione e l'altra. I pazienti ignoravano se la stimolazione venisse praticata nel punto P6 oppure nel punto falso. RISULTATI: È stata riscontrata una diminuzione significativa per quanto riguarda nausea/vomito dopo l'agopuntura al P6 rispetto all'applicazione nel punto falso (p<0.001). Non è stato riscontrato alcun effetto collaterale attribuibile all'agopuntura. CONCLUSIONI: si è certi che i risultati con l'agopuntura rappresentino una reale riduzione negli effetti emetici del Cisplatino. Nonostante l'efficacia, l'agopuntura al P6 richiede tempo. Possibile rendere tale pratica più semplice chiedendo al paziente di praticarla su se stesso, oppure adottando l'acupressione.
Dibble SL, Chapman J, Mack KA, Shih AS.
"Acupressure for nausea: results of a pilot study"
Institute for Health and Aging, University of California, San Francisco, USA.
Oncol Nurs Forum 200; 2781):41-7
PURPOSE/OBJECTIVES: To compare differences in nausea experience and intensity in women undergoing chemotherapy for breast cancer between those receiving usual care plus acupressure training and treatment and those receiving only usual care. DESIGN: Single-cycle, randomized clinical trial. SETTING: Outpatient oncology clinic in a major teaching medical center and a private outpatient oncology practice. SAMPLE: Seventeen women participated in the study. The typical participant was 49.5 years old (SD = 6.0), Caucasian (59%), not married/partnered (76%), on disability (53%), born a U.S. citizen (76%), and heterosexual (88%); lived alone (59%); had at least graduated from high school (100%); and had an annual personal income of $50,000 or greater (65%). METHODS: The intervention included finger acupressure bilaterally at P6 and ST36, acupressure points located on the forearm and by the knee. Baseline and poststudy questionnaires plus a daily log were used to collect data. MAIN RESEARCH VARIABLES: Nausea experience measured by the Rhodes inventory of Nausea, Vomiting, and Retching and nausea intensity. FINDINGS: Significant differences existed between the two groups in regard to nausea experience (p < 0.01) and nausea intensity (p < 0.04) during the first 10 days of the chemotherapy cycle, with the acupressure group reporting less intensity and experience of nausea. CONCLUSIONS: Finger acupressure may decrease nausea among women undergoing chemotherapy for breast cancer. IMPLICATIONS FOR NURSING PRACTICE: This study must be replicated prior to advising patients about the efficacy of acupressure for the treatment of nausea.
Dundee JW, Abram WP
"P6 Acupuncture, an effective non-toxic anti-emetic in cancer chemotherapy"
Northern Ireland Radiotherapy Centre, Montgomery House, Belvoir Park Hospital, Belfast, EIRE.
Nausea and vomiting, ever present problems in cancer chemotherapy, are often not controlled by standard anti-emetics. In 105 patients, receiving a variety of agents, whose sickness persisted despite anti-emetics, we proceeded the next course of therapy with P6 electro acupuncture (ACP) and continued the anti-emetics as before. Symptoms were completely relieved in 66 patients, with a further 33 having marked reduction in sickness i.e. 94% success. Three patients who had dropped out from cisplatin therapy because of sickness were persuaded to try ACP and completed their treatment with little sickness. A limited cross over showed a point at R elbow to be ineffective as anti-emetic. The anti-emetic action of invasive P6 ACP lasts 6-8 hours and this can be prolonged to 24 hours by application of a Sea Band, elasticated band with a stud which is placed over p6 point and pressed for 5 minutes every 2 hour by the patients. This has been effective in 21725 patients studied. There were no side effects associated with this simple anti-emetic therapy. To be effective, ACP must be applied 5-10 minutes before chemotherapy, which is much shorter than the time for standard anti-emetics.
K Sergiou K
"An evaluation of the Sea-Band in alleviating nausea and vomiting in patients receiving chemotherapy"
Department of Medical Oncology University of Southampton.
PURPOSE: To assess by means of a single blind cross-over model if acupressure by Sea-Band on Wrist point (active) versus acupressure on an ankle point (sham) reduces nausea and vomiting in patients receiving chemotherapy. METHOD: Patients receiving chemotherapy at the RSH Hospital were asked to participate in the study during their next two treatments. For one treatment they wore the bands on both wrists continuously for seven days, and for the other treatment they wore the bans on both ankles. The ankle and wrist treatments were randomised. While wearing the bands the patients were asked to record their symptoms daily in a diary card. After wearing the bands at both sites the patients were asked to complete a questionnaire concerning their preference for the wrist versus ankle treatments. Throughout the study the patients still received their usual pharmacological anti-emetics. RESULTS: 105 patients entered the study; 67 patients completed the study, 38 patients withdrew. Questionnaire analysis found that 49% of patients found P6 acupressure provided better control of nausea and vomiting, 17% found sham acupressure provided better control and 34% found no difference between the two. The diary cards indicated that P6 was more effective than sham acupressure in alleviating sickness, nausea, mood and overall condition in the high emetic intensity group. CONCLUSION: P6 acupressure is a good method to complement conventional anti-emetic therapy for people having chemotherapy, particularly that of a high emetic intensity. It is recommended that it should be included into a standard anti-emetic protocol for chemotherapy, subject to further work on it.
Denise M Stannard SRN
"Use of acupressure bands in Chemotherapy"
Tehidy Hospital, Camborne, Cornwall
INTRODUCTION: Being a sailor and nurse he became aware of the comparison of sea sickness and the nausea and vomiting for chemotherapy patients and decided that maybe the acupressure bands his family successfully used for sea sickness could also be helpful to the patients of Hospital. TRIAL: 1) PLACEMENT OF BANDS: a) must be correct acupressure P6 position on the wrist using patients own 3 finger for measurement b) doctors need to place the I/V infusion needle above the bands c) if only one bend used ? not so effective. 2) NAUSEA ? this still remains at times with some patients but is greatly reduced. 3) VOMITING ? is reduced by 75% on most patients and some patients have no vomiting. 4) ? ANTIEMETICS DRUGS ? these still needed to some degree in most patients but may be taken orally and the amount of PRN I/M drug is reduced. 5) DEPRESSION ? less depression and on return for further courses have not dreaded the nausea and vomiting. 6) ORAL FLUIDS ? are tolerated in some cases light diet 7) ON DISCHARGE ? post chemotherapy nausea has been non existent on using Sea Band. Patient A ? used them for two weeks after treatment Patient D ? completely relieved after feeling nauseated for four months after previous treatments. 8) COSTINGS ? use of Sea Band has reduced a. Drug costs b. Laundry costs c. Nursing time ? due vomiting. 9) FUTURE USE ? in Hospice nursing, Anaesthesia, Pregnancy. CONCLUSION: The unit has found much greater nursing satisfaction in being able to help the patients and after apprehension by some staff, they are all convinced both scientifically and mentally that Sea Band are successful
Price MR
"An evaluation of the Sea-Band in alleviating nausea and vomiting in patients receiving chemotherapy"
Department of Medical Oncology University of Southampton.
PURPOSE: To assess by means of a single blind cross-over model if acupressure by Sea-Band on Wrist point (active) versus acupressure on an ankle point (sham) reduces nausea and vomiting in patients receiving chemotherapy. METHOD: Patients receiving chemotherapy at the RSH Hospital were asked to participate in the study during their next two treatments. For one treatment they wore the bands on both wrists continuously for seven days, recording symptoms on an identical diary card. After wearing the bands at both sites, each patient filled in a questionnaire for preference of ankle and wrist treatment. The ankle and wrist treatment were randomised. All patients received standard pharmacological anti-emetics as required throughout the study. RESULTS: 53 patients entered the study; 38 patients completed the study, 15 patients withdrew for various reasons. From the questionnaires of the patients completing the study, 54% found P6 provided better control of nausea and vomiting, 17% found the sham ankle point provided better control and 29 % found no difference between the points. The diary cards showed similar results (significant at p<0.05), during which P6 acupressure had a consistently better effect than shame ankle acupressure between days 1 and 4 of wearing the Sea-Band for controlling vomiting, nausea, mood and overall condition in the high emetic intensity chemotherapy group. CONCLUSION: P6 acupressure is a good method to complement conventional anti-emetic treatment in people having chemotherapy, particularly in the high emetic intensity group. It is recommended that it should be included into a standard anti-emetic protocol for chemotherapy, subject to further work on it.
G. Gardani, R. Cerrone, C. Biella, L. Mancini, E. Proserpio, M. Caisraghi, O. Travisi, M. Meregalli, P. Trabattoni, L. Colombo, L. Giani, M. Vaghi, P. Lissoni
"Effect of Acupressure on Nausea and Vomiting induced by Chemotherapy in Cancer Patients"
Department of Radiotharapy and Oncology San Gerardo Hospital, Monza, Milan, Italy
Minerva Med 2006; 97:391-4
OBIETTIVO: Cortisonici, anti-dopaminergici a anti-serotoninergici di tipo 3, sono I farmaci più comunemente impiegati nel trattamento del vomito indotto da chemioterapia. Agopuntura ed Acupressione si sono pure rivelati in grado di esercitare effetti anti-emetici. Lo scopo dello studio è stato quello di valutare l'efficacia dell'acupressione nel trattamento del vomito da chemioterapia resistente ai trattamenti anti-emetici convenzionali. METODO: Lo studio è stato condotto su 40 pazienti con neoplasia avanzata e con vomito da chemioterapia intrattabile. Le neoplasie più frequenti nei pazienti erano rappresentate da carcinoma del colon-retto, carcinoma polmonare e carcinoma mammario. In accordo con l'istotipo di neoplasia, i pazienti venivano trattati con schermi di chemioterapia comprendenti i principali agenti citotossici emetizzanti, vale a dire cisplatino e antracicline. L'acupressione veniva realizzata mediante stimolazione del punto P6 per almeno 6 ore/die a partire dall'inizio della chemioterapia. RISULTATI: L'approccio terapeutico è stato favorevolmente accettato da tutti i pazienti. Un miglioramento evidente della sintomatologia emetica è stato conseguito in 28/40 (70%) pazienti, senza differenze significative né in relazione all'istotipo di neoplasia, né al tipo di agente chemioterapico. CONCLUSIONE: Questo studio preliminare sembra suggerire che un approccio bioenergetico mediante acupressione sul punto P6, possa essere efficace nel trattamento del vomito da chemioterapia non responsivo ai trattamenti farmacologici convenzionali, come già precedentemente dimostrato nel caso del trattamento del vomito durante la gravidanza. PAROLE CHIAVE: Agopuntura - Acupressione - Agopressione - Chemioterapia - Vomito.
