Current Evidence on Auricular Therapy for Chemotherapy-Induced Nausea and Vomiting in Cancer Patients: A Systematic Review of Randomized Controlled Trials

Evidence-Based Complementary and Alternative Medicine, Nov 2014

Auricular therapy (AT) has been historically viewed as a convenient approach adjunct to pharmacological therapy for cancer patients with chemotherapy-induced nausea and vomiting (CINV). The aim of this study was to assess the evidence of the therapeutic effect of AT for CINV management in cancer patients. Relevant randomized controlled trials were retrieved from 12 electronic databases without language restrictions. Meanwhile, manual search was conducted for Chinese journals on complementary medicine published within the last five years, and the reference lists of included studies were also checked to identify any possible eligible studies. Twenty-one studies with 1713 participants were included. The effect rate of AT for managing acute CINV ranged from 44.44% to 93.33% in the intervention groups and 15% to 91.67% in the control groups. For delayed CINV, it was 62.96% to 100% and 25% to 100%, respectively. AT seems to be a promising approach in managing CINV. However, the level of evidence was low and the definite effect cannot be concluded as there were significant methodological flaws identified in the analyzed studies. The implications drawn from the 21 studies put some clues for future practice in this area including the need to conduct more rigorously designed randomized controlled trials.

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Current Evidence on Auricular Therapy for Chemotherapy-Induced Nausea and Vomiting in Cancer Patients: A Systematic Review of Randomized Controlled Trials

Current Evidence on Auricular Therapy for Chemotherapy-Induced Nausea and Vomiting in Cancer Patients: A Systematic Review of Randomized Controlled Trials Jing-Yu Tan,1 Alexander Molassiotis,1 Tao Wang,2 and Lorna K. P. Suen1 1School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong 2The Second Affiliated People’s Hospital, Fujian University of Traditional Chinese Medicine, No. 13, Hudong Road, Gulou District, Fuzhou 350003, China Received 6 July 2014; Revised 13 August 2014; Accepted 17 August 2014; Published 25 November 2014 Academic Editor: Manuel Arroyo-Morales Copyright © 2014 Jing-Yu Tan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Auricular therapy (AT) has been historically viewed as a convenient approach adjunct to pharmacological therapy for cancer patients with chemotherapy-induced nausea and vomiting (CINV). The aim of this study was to assess the evidence of the therapeutic effect of AT for CINV management in cancer patients. Relevant randomized controlled trials were retrieved from 12 electronic databases without language restrictions. Meanwhile, manual search was conducted for Chinese journals on complementary medicine published within the last five years, and the reference lists of included studies were also checked to identify any possible eligible studies. Twenty-one studies with 1713 participants were included. The effect rate of AT for managing acute CINV ranged from 44.44% to 93.33% in the intervention groups and 15% to 91.67% in the control groups. For delayed CINV, it was 62.96% to 100% and 25% to 100%, respectively. AT seems to be a promising approach in managing CINV. However, the level of evidence was low and the definite effect cannot be concluded as there were significant methodological flaws identified in the analyzed studies. The implications drawn from the 21 studies put some clues for future practice in this area including the need to conduct more rigorously designed randomized controlled trials. 1. Introduction Chemotherapy-induced nausea and vomiting (CINV) is one of the most common and distressing side effects among cancer patients, and the severity and incidence of CINV are usually determined by the particular chemotherapeutic agent, dosage, combinations with other treatment approaches, and patient characteristics [1–3]. Some of the most commonly used regimens, such as cisplatin or cyclophosphamide, are regarded to be of moderate to high emetic potential, respectively [3, 4], which can have a significant negative impact on patients’ health status. CINV occurs in approximately 40–80% of cancer patients when receiving chemotherapy with moderate to high emetic potential [5], and it can severely impair the patients’ physical and psychological status. Complications caused by CINV may increase unnecessary healthcare costs, aggravate burden on medical and nursing resources, and prolong hospitalizations [6, 7]. Moreover, uncontrolled CINV can also decrease the patients’ quality of life, influence their physical activities and social function, and induce emotional problems [8, 9]. The most popular approach applied for controlling CINV nowadays is the regular use of antiemetic drugs. Of which, 5-HT3 receptor antagonists, NK-1 receptor antagonists, and corticosteroids are identified as first-line treatment [1]. However, even with the help of antiemetics, nearly half of cancer patients receiving moderate to high emetic chemotherapy still experience some CINV, particularly delayed nausea and vomiting [10]. In addition to their therapeutic effects, antiemetic drugs can also produce some undesirable side effects, such as constipation, dizziness, and headache [11, 12]. Considering the fact that CINV is very difficult to be completely controlled by antiemetic drugs alone, healthcare professionals should explore other nonpharmacological approaches as adjuncts to pharmacological interventions. Nonpharmacological interventions used in CINV refer to a variety of approaches including acupuncture, acupressure, massage, progressive muscle relaxation, exercise, and psychological support [13]. Of which, acupuncture-point stimulation on neiguan (P6) is one of the most popular techniques and it is recommended as a “likely to be effective” approach for managing CINV [13]. Despite the fact that the current evidence of acupuncture-point stimulation for CINV is still judged as highly suggestive but not conclusive [13–16], this kind of intervention has already drawn extensive attention in clinical practice and has been accepted by a wide range of healthcare professionals and cancer patients. However, as another therapeutic modality of acupuncture, the role of auricular therapy (AT) has received less attention. AT is defined as “a health care modality whereby the external surface of t (...truncated)


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Jing-Yu Tan, Alexander Molassiotis, Tao Wang, Lorna K. P. Suen. Current Evidence on Auricular Therapy for Chemotherapy-Induced Nausea and Vomiting in Cancer Patients: A Systematic Review of Randomized Controlled Trials, Evidence-Based Complementary and Alternative Medicine, 2014, 2014, DOI: 10.1155/2014/430796