In a phase III single-blind randomized clinical trial reported in JAMA Network Open, Zick et al found that self-acupressure—taught via a mobile app—provided a safe, low-cost approach for managing fatigue in ovarian cancer survivors.
“In this randomized clinical trial, true self-acupressure and sham self-acupressure significantly reduced fatigue compared with usual care, and these changes were both clinically meaningful and sustained,” the investigators commented. “No impact was observed on sleep quality.”
Study Details
Ovarian cancer survivors who were fatigued (Brief Fatigue Inventory [BFI] score ≥ 4) were recruited from tumor registries and social media. A total of 171 patients were randomly assigned in a 1:1:1 ratio to 6 weeks of true or sham self-acupressure—taught via mobile app—or usual care. Of the 160 who were allocated to the arms, 53 (33.1%) performed true self-acupressure, 56 (35.0%) performed sham self-acupressure, and 51 (31.9%) received usual care.
“The primary outcome was the change in the BFI from baseline to week 6,” the investigators explained. “Secondary analyses were the BFI score at week 24 and sleep disturbance [based on the Pittsburgh Sleep Quality Index] and quality of life [based on the Functional Assessment of Cancer Therapy–Ovarian] administered at baseline and at weeks 6, 12, and 24.”
Key Findings
A total of 58.5%, 51.1%, and 17.6% of patients in the true self-acupressure, sham self-acupressure, and usual care arms, respectively, achieved a clinically normal fatigue level at the end of treatment. At 6 weeks, compared with usual care, the BFI change scores were found to be significantly better with true (adjusted mean difference = −1.23, 95% confidence interval [CI] = −2.17 to −0.29]) but not sham (adjusted mean difference = −0.91, 95% CI = −1.83–0.02]) self-acupressure. Change scores with true vs sham self-acupressure did not appear to significantly differ. According to the investigators, the relative benefit of self-acupressure compared with usual care on fatigue persisted at 24 weeks (true: mean difference = −1.38, 95% CI = −2.36–−0.41; sham: mean difference = −0.97, 95% CI = −1.93 to −0.02).
Sleep quality did not seem to differ significantly between true or sham self-acupressure and usual care, nor between true and sham self-acupressure. Compared with usual care, only true self-acupressure was found to significantly improve quality of life (odds ratio = 2.85, 95% CI = 1.20–6.80). No adverse events were reported with either true or sham self-acupressure.
“In this randomized clinical trial, self-acupressure, taught by an app, was found to be an inexpensive, safe, and effective therapy for improving cancer-related fatigue to normal fatigue levels in approximately 60% of women with ovarian cancer using true self-acupressure,” the investigators concluded.
They continued, “Few trials, to our knowledge, that have investigated therapies for cancer-related fatigue have included people with ovarian cancer. Only two randomized clinical trials in the newest [ASCO]–Society for Integrative Oncology [SIO] clinical guidelines included people with ovarian cancer [with a total of 216 ovarian cancer survivors]. Of these two studies, only one—a home-based cognitive behavioral therapy and exercise intervention—showed a statistically significant improvement in cancer-related fatigue.”
“Given the large burden of cancer-related fatigue in this population,” they wrote, “more research and therapies are needed.”
Suzanna M. Zick, ND, MPH, of University of Michigan, Ann Arbor, is the corresponding author of the JAMA Network Open article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
