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Title: Self-administered acupressure for the cancer-related symptom cluster of insomnia, depression, and anxiety : a feasibility randomized controlled trial
Authors: Hoang Thi, Xuan Huong
Degree: Ph.D.
Issue Date: 2020
Abstract: Background: About 40% to 60% of cancer patients receiving chemotherapy experienced insomnia during their treatment. Moreover, insomnia correlated with others to form a sleep-related symptom cluster. Our literature review has identified several limitations in previous research that lead to a wide range of insomnia prevalence, unclear risk factors, and the unclear correlation between insomnia and other symptoms in cancer patients. Results from our review also indicated that just a small number of interventions for sleep-related symptom clusters were conducted during the past decade. Nevertheless, most of the current non-pharmacological interventions for sleep-related symptoms clusters require the physical presence of an instructor to deliver the intervention as well as require patients to spend time and effort for administering it. Hence, there is a need to develop an intervention using a self-management approach to manage insomnia and insomnia-related symptom clusters in cancer patients. Among non-pharmacological treatments, self-administered acupressure is a promising approach, but the relevant research evidence is unknown at present. Aims: This doctoral project was carried out with the following aims: 1. To ascertain the prevalence of insomnia and to identify the risk factors and correlations between insomnia and other symptoms among cancer patients receiving chemotherapy in Vietnam. Data from this study (study one) would highlight the extent of the problem and offer information that should be considered in the development of an intervention trial. 2. To develop a self-acupressure treatment protocol. 3. To test the feasibility of an intervention using self-acupressure to manage the an insomnia-related symptom cluster that will be identified from study one. Methods: This doctoral project covered the first two phases of The Medical Research Council (MRC) framework for developing and evaluating complex interventions. In the first phase, a cross-sectional survey was conducted among 214 cancer patients undergoing chemotherapy in three hospitals in Hanoi, Vietnam. The outcome measures included The Insomnia Severity Index (ISI), the Hospital Anxiety and Depression scale (HADS), the Memorial Symptom Assessment Scale (MSAS), the Functional Assessment of Cancer Therapy - General (FATC-G), Actigraph, and a sleep log. Afterward, an acupressure treatment protocol was developed based on the findings of the cross-sectional survey. It was then validated by a panel of six Traditional Chinese Medicine (TCM) experts.
In the second phase of the MRC framework, a three-arm parallel randomized control trial (RCT) was adopted. A total of 114 participants scheduled to receive chemotherapy treatment were recruited from two hospitals in Hanoi, Vietnam and were randomly assigned to one of three groups: The true self-acupressure group (True AP), the sham self-acupressure group (Sham AP), and the enhanced standard care group (ESC). Participants in the true and sham self-acupressure group received a self-acupressure training session on how to locate and stimulate acupoints/sham acupoints. They were requested to perform self-acupressure at home once a day for four weeks. Weekly phone calls were made to encourage them to practice self-acupressure at home. Participants in the ESC group received an education training session on ten recommendations to manage insomnia, depression, and anxiety. They were also requested to practice these recommendations at home for four weeks. During the study period, they also received weekly follow up phone calls. The outcome assessments were the Numeric Rating Scale for each of the symptom (NRS), the ISI, the HADS, the FACT-G, the sleep diary, and the Intervention Rating Scale-15 (IRS-15). Assessments were carried out at baseline (T1), at the end of the intervention (T2) and a month later (T3). Results: Results from the cross-sectional survey reported a high prevalence of insomnia among participants (42.8%), with one-third of those with insomnia reporting severe insomnia. Insomnia occurrence and severity were not correlated with the participants' characteristics, cancer-related or treatment-related factors, only with the participants' anxiety/depression scores. The principal component analysis showed that insomnia, depression, and anxiety formed a symptom cluster (p.<.0.001). Results from the feasibility study indicated the intervention using self-administered acupressure to manage the symptom cluster of insomnia, depression, and anxiety was feasible, with only six months required to recruit and conduct the intervention in 114 cancer patients (recruitment rate 12.6%, attrition rate 35.1%). It was also highly acceptable by participants (the mean IRS-15 was 76.73). Besides, the self-acupressure treatment protocol used in the intervention was safe as associated adverse events were mild, tolerable, and transient. The results indicated that the self-acupressure had clinical significance in improving the targeted symptoms and quality of life. In the true AP group, the SC severity was significantly lower than in the other groups at T2 (p<0.05). Insomnia and anxiety severity in the true AP and sham AP group were significantly lower than those in the ESC at T2 and T3 (p<0.05). Conclusion: The doctoral project results provide new knowledge to fill significant gaps related to insomnia prevalence and managing the sleep-related symptom cluster, which includes insomnia, depression, and anxiety in cancer patients undergoing chemotherapy. The results from the feasibility RCT indicated the validated evidence-based acupressure treatment protocol used in the study was demonstrated to be safe, convenient and with promising effectiveness to improve the symptom cluster of insomnia, depression, and anxiety among cancer patients undergoing chemotherapy. However, the effect of self-administered acupressure was a mixture of therapeutic effect and placebo effect. Future full-scale RCT is recommended to examine the promising effect of self-administered acupressure on the symptom cluster of insomnia, depression, and anxiety as well as its effect in improving quality of life status in cancer patients undergoing chemotherapy.
Subjects: Acupressure
Insomnia -- Treatment
Cancer -- Patients -- Psychology
Hong Kong Polytechnic University -- Dissertations
Pages: xxv, 363 pages : color illustrations
Appears in Collections:Thesis

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