Acupoint stimulation, massage therapy and expressive writing for breast cancer: A systematic review and meta-analysis of randomized controlled trials

https://doi.org/10.1016/j.ctim.2016.06.003Get rights and content

Highlights

  • Acupoint stimulation has an effect for general pain and fatigue in middle-aged women with breast cancer.

  • Massage therapy has an effect for anxiety in middle-aged women with breast cancer.

  • Expressive writing has an effect for quality of life in middle-aged women with breast cancer.

  • Non-conclusive results were found for sleep and depression.

  • More conclusive outcomes may be achieved resulting upon successful shared decision-making.

Abstract

Researches have accumulated using non-pharmacologic interventions including acupoint stimulation, massage therapy and expressive writing to manage breast cancer-related symptoms. Results from randomized controlled trials (RCTs) can get contradictory.

Objective

A systematic review and meta-analysis were conducted to determine the effects on the quality of life, negative emotions and disease-related symptoms among women with breast cancer.

Methods

Two independent researchers performed a structured search using data sources including MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, PubMed and PsychINFO from the beginning of time until the first week of January 2015. A total of 23 acupoint stimulation, massage therapy and expressive writing RCTs were included in the review.

Results

The study showed that no single intervention could be put under the spotlight exhibiting an overall effective result on all measured outcomes; however, looking into each one in detail shows different results in specific outcomes. Among the three interventions, acupoint stimulation has a treatment effect for general pain (MD = −1.46, 95% CI = −2.38 to −0.53) and fatigue (MD = −2.22, 95% CI = −3.68 to −0.77), massage therapy has a treatment effect for anxiety (MD = −0.50, 95% CI = −0.77 to −0.24), and expressive writing has a treatment effect for quality of life (MD = 7.18, 95% CI = 0.38 to 13.98). The measurement other outcomes showed either ineffective or equivocal results.

Conclusion

Non-pharmacologic interventions including acupoint stimulation, massage therapy and expressive writing have an effect on a middle-age woman with breast cancer. However, because of limitations, the seemingly promising results should be interpreted with caution.

Introduction

Breast cancer continues to be the most common cancer in women worldwide. Although breast cancer mortality has dropped by 34% since 1990, it is still the most common cause of cancer death among women (522,000 deaths in 2012) and the most frequently diagnosed cancer among women in 140 of 184 countries worldwide.1 Most breast cancer patients receive supplementary chemotherapy after surgery. Breast cancer itself and the consequences of chemotherapy would bring patients extremely physical and psychological symptoms of distress. The most reported distress such as anxiety, depression, insomnia, fatigue, decreased appetite, nausea2 significantly affected patients’ quality of life.3 These symptoms of distress may not be well controlled by Western medicine. Complementary and alternative medicine (CAM) and traditional Chinese medicine (TCM), such as acupuncture, Tuina, Tai Chi, and Qigong, would represent beneficial adjunctive therapies for cancer patients.4 It is needed to have more research reporting in this field regarding intervention and research methods. Considerable amount of research have also accumulated relating to the use of TCM or CAM. More than 80% of all women with breast cancer reported using CAM to manage breast cancer in the United States.5 Among the various TCM practices, acupuncture and massage therapy is two of the TCM practices generally the most accepted by the medical profession. Another considerable alternative to traditional treatment methods is expressive writing, which has recently been liked with positive health.6

Acupoint stimulation describes a family of procedures involving the stimulation of anatomical point on the body, called acupoint, using a variety of techniques.7 Acupoint can be stimulated by electroacupuncture (acupuncture applied with electricity), manual acupuncture (acupuncture without electricity), acupressure (pressing on the acupoint usually with fingertip), or stimulation on the skin surface. While the descriptions of massage have changed over the years from the ancient and the modern practice, the overall essence of it – the application of human hands or another object to the superficial skin of a recipient for the purposed of rendering remedial or palliative aid – remains unchanged.8 Massage therapists press, rub, and otherwise manipulate the muscles and other soft tissues of the body, usually using hands and fingers, but the forearms, elbows, or feet may also be used.9 The Expressive Writing Paradigm which was first introduced by Pennebaker and Beall10 in a study where subjects who wrote about a personal trauma had better health outcomes than subjects writing about a non-traumatic topic, thereby supporting the concept that emotional expression is an important part of good health and that expressive writing can assist this process.

The quality of life (QoL) is an individual’s perception of their status in life, in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns.11 Measuring the QoL in women with breast cancer covers a lot of factors. It broadly encompasses how an individual measures the ‘goodness’ of multiple aspects of their life including one’s emotional reactions to life occurrences, disposition, sense of life fulfillment and satisfaction, and satisfaction with work and personal relationships.12 Negative emotions including anxiety and depression are two of the most commonly coexisting accompanying illnesses of breast cancer.13, 14, 15 Cancer pain can occur throughout different stages of the cancer journey16 and even during survivorship,17 affecting one’s QoL.18 Likewise, fatigue has been reported throughout the course of the disease,19 and even after survivorship.20 Similar to other disease-related symptoms, persistent chronic pain of oncologic origin has depreciated the QoL in advanced stage breast cancer survivors after treatment.18 A number of studies have confirmed that poor sleep quality is prevalent across the continuum of care for persons with breast cancer,21, 22, 23 and poorer sleep quality was correlated with a lower QoL.24, 25

The purpose of this systematic review and meta-analysis study was conducted to determine the effects on the quality of life, negative emotions and disease-related symptoms among women with breast cancer.

Section snippets

Criteria for considering studies

This study was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review and meta-analysis focused on randomized controlled trials (RCTs) claimed as random allocation or showed the baseline data without significant demographic difference among the intervention and control groups. RCTs used any technique of acupoint stimulation, massage therapy and expressive writing as the primary intervention, and compared to no

Results

A total of 1473 articles were identified, 290 duplicates were omitted, leaving 1183 articles that were screened. After which, 1033 irrelevant articles were removed, leaving 150 articles that were assessed for eligibility. Most failed to meet several of the inclusion criteria including: animal-related records (n = 8), not RCT in design (n = 102), not primarily for women with breast cancer or having other types of cancer included (n = 17). After careful extraction, review and disagreement resolution

Discussion

To the best of our knowledge, this is the first systematic review and meta-analysis that focuses on the use of three different interventions including acupoint stimulation, massage therapy and expressive writing. This review found that methodological quality of the 23 RCTs was generally not rigorous—three studies had a low risk of bias, which are the same studies that earned a Jadad score of 3 or more. Results of the meta-analysis showed that no single intervention could be put under the

Conclusions

In the view of the growing popularity of acupoint stimulation, massage therapy and expressive writing internationally, there is an urgent need for the scientific community to expend more effort in this area. It was found that the common acupoint stimulation technique from the included studies is manual acupuncture, and followed by electroacupunture; massage therapies were performed by the use of hands; and the tools used for expressive writing were paper and pen. For middle-aged women with

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