Effect Of Acupressure On Nausea And Vomiting During Chemotherapy Cycle For China Gastroenteritic Cancer Patients

Background:Nausea,vomiting,and retching are universal symptoms that affect individuals' health states and self-care activities.Despite continued advances in pharmacology,the ability to prevent or control the symptoms of nausea,vomiting,and retching from chemotherapy,radiation are among the most challenging side effects to control.In fact,the long-term consequences of nausea and vomiting can seriously compromise the treatment of patients.Persistent nausea can significantly decrease a patient's perception if his or her quality of life,possibly even influencing the decision to refuse treatment.One study discovered a 59%noncompliance rate among adolescents treated for cancer.Many adolescents have stated that the treatment for cancer was worse than cancer it self.Chronic vomiting can lead to dehydration,metabolic disturbances,and compromised nutrition that may further compromise the patient's health and feeling of self-worth.Research has demonstrated that successful management of nausea,vomiting,and retching induced by chemotherapy and radiation refines proactive treatment and continuous assessment.Researchers and clinicians need accurate measurement of individual symptoms for obtaining definitive data,understanding,planning,and implementing to maintain a high quality of care. Aim:In China,we are short of effective tools for assessing clinical nausea,vomiting,and retching.The study used Rhodes Index of Nausea,Vomiting,and Retching Scale (RINVR)to assess chemotherapy-induced nausea,vomiting(CINV)in cancer patients,successfully evaluated the experiences of patients' receiving chemotherapy. The RINVR is an eight-item scale measuring nausea,vomiting,and retching experience.Each item is measured on a five-point Liken scale,and subjects are asked to report their symptoms over the past 12(or 24 hours).Each response is assigned a number based on a predefined scoring algorithm.Scores are tallied into three subscales measuring occurrence,distress,and experience with nausea and vomiting.Prior study has demonstrated excellent internal consistency reliability of the INVR,with a Cronbach's alpha of 0.89-0.97,and split-half procedure 0.83-0.99.The scale of RINVR was translated to Chinese by Ms Xu(Beijing Cancer Institute and Hospital,Chinese Academy of Medical Science)in 2002.The Chinese version of RINVR was found to have high Cronbach's alpha scores and high agreement rates.Acupressure involves pressure with fingers on the body's acu-points and is easy to perform,painless,inexpensive,and an effective approach.The P6 point(Nei-Guan)is located on the anterior surface of the forearm,2-finger widths up from the first wrist crease and between the tendons of flexor Carpi radialis and Palmaris longus. According to Chinese Traditional Medicine,acupressure on P6 can treat heart-throb, nausea,vomiting,hiccup,and tachycardia symptoms and so on.Design:This study was a design for a single cycle trail.78 patients(between Aug 2007 to Feb 2008)undergoing adjuvant chemotherapy after diagnosed as gastroenteritis cancer were selected into trial.Using RINVR to assess nausea,vomiting,and retching every 24 hours from the day before chemotherapy.Results:Significant differences between before and after intervention.82%of patients felt acupressure decreasing the duration of nausea and vomiting.Data shows that in occurrence,distress,and experience with nausea and vomiting,all threes P＜0.05,it demonstrates acupressure can reduce the occurrence,distress,and experience in patients effectively,and induce patients' quality of life.Discuss:In this study,acupressure shows its good effect in reducing the occurrence,distress, and experience of CINV.It has been used in other countries and Taiwan,but it is the first time we use RINVR to evaluate CINV in our country.At the same time,we found that after one cycle of chemotherapy,some of patients' CINV symptoms could not clear away or lower,maybe it is because of the antineoplastic metabolites and psychology of patients themselves.For instance, cisplatin is a kind of drug can induce strong vomiting,about 90%patients will have acute vomit,and about 30%-50%have delayed vomit,which can last 5-7 days. Though our intervention can reduce this kind of vomit,but delayed vomit and psychology of patient are the focus of attention in our future research.Future study of acupressure as a complementary therapy for CINV should be carried out in a large number of cases with a randomized control design.We also need to clearly understand the multifactor etiology of CINV that may be considered as other confounding factors. Finally,nurse educators and clinical nurses should recognize information on nonpharmacologic management of nausea and vomiting,such as acupressure techniques and need to develop educational tools(e.g.,pamphlets,audiovisual tapes) for training nursing students,patients,and families on the use of acupressure techniques.