liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Nausea and vomiting in patients receiving acupuncture, sham acupuncture or standard care during radiotherapy
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aim: Many patients with cancer experience emesis (nausea and vomiting) during radiotherapy. The overall aim of this thesis was to improve the situation for patients with risk for emesis during radiotherapy, by evaluating emesis in patients receiving verum (genuine) acupuncture, sham (simulated) acupuncture or standard care during radiotherapy.

Methods: In study I, a cross-sectional sample (n=368) treated with radiotherapy over various fields answered a study-specific questionnaire. In study II, 80 healthy volunteers were randomized to receive needling with verum acupuncture or non-penetrating telescopic sham needles by one of four physiotherapists. In study III, 215 patients were randomly allocated to verum (n=109) or non-penetrating telescopic sham (n=106) acupuncture during their entire radiotherapy period over abdominal or pelvic fields. The same 215 patients were also included in study IV. They were compared to 62 patients irradiated over abdominal or pelvic fields, selected from study I.

Results: In study I, the weekly prevalence of nausea was 39 % in all radiotherapy-treated patients and 63 % in abdominal or pelvic irradiated patients. Age younger than 40 years and previous experience of nausea in other situations were characteristics associated with an increased risk for nausea. Of the 145 nauseous patients, 34 % considered their antiemetic treatment as insufficient. Patients with nausea reported lower level of quality of life compared to patients free from nausea. In study II, most individuals needled with verum (68 %) or sham (68 %) acupuncture could not identify needling type, and that blinding result varied from 55 to 80 % between the four therapists. In study III, nausea was experienced by 70 % (mean number of days=10.1) and 25 % vomited during the radiotherapy period. In the sham group 62 % experienced nausea (mean number of days=8.7) and 28 % vomited. Ninety five percent in the verum and 96 % in the sham group believed that the treatment had been effective for nausea. In both groups, 67 % experienced other positive effects, on relaxation, mood, sleep or pain-reduction, and 89 % were interested in receiving the treatment again. In study IV, the weekly prevalence of nausea and vomiting was 38 and 8 % in the verum group, 37 and 7 % in the sham group and 63 and 15 % in the standard care group. The nausea difference between the acupuncture and the standard care cohort was statistically significant, also after overall adjustments for potential confounding factors. The nausea intensity in the acupuncture cohort was lower compared to the standard care cohort (p=0.002). Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (Relative risk 1.6).

Conclusions and implications: Nausea was common during abdominal or pelvic field irradiation in patients receiving standard care. Verum acupuncture did not reduce emesis compared to sham acupuncture, while reduced emesis was seen in both patients treated with verum or sham acupuncture. Health-care professionals may consider identifying and treating patients with increased risk for nausea in advance. The telescopic sham needle was credible. Researchers may thus use and standardize the sham procedure in acupuncture control groups. The choice of performing acupuncture during radiotherapy cannot be based on arguments that the specific characters of verum acupuncture have effects on nausea. It is important to further study what components in the acupuncture procedures that produce the dramatic positive but yet not fully understood antiemetic effect, making it possible to use those components to further increase quality of care during radiotherapy.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2008. , 69 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1088
Keyword [en]
Acupuncture, Cancer, Emesis, Placebo, Radiotherapy
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-17237ISBN: 978-91-7393-754-2 (print)OAI: oai:DiVA.org:liu-17237DiVA: diva2:207705
Public defence
2008-12-05, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2009-03-12 Created: 2009-03-12 Last updated: 2013-09-03Bibliographically approved
List of papers
1. One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient
Open this publication in new window or tab >>One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient
Show others...
2009 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 17, no 1, 23-32 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To describe the prevalence of nausea and vomiting during radiotherapy and to compare quality of life, psychological and functional status in patients experiencing or not experiencing nausea.

Materials and methods: A cross-sectional selection of 368 cancer patients treated with radiotherapy answered a questionnaire (=93% answering rate) regarding nausea, vomiting, actual use of and interest in antiemetic treatment, quality of life and psychological and functional status during the preceding week of radiotherapy. Mean age was 60 years and 66% were women.

Main results: Nausea was experienced by 39% ( 145) and vomiting by 7% ( 28) of patients in general, by 63% in abdominal or pelvic fields and by 48% in head/neck/brain fields. Abdominal/pelvic field (Relative risk (RR) 2.0), age <= 40 years (RR 1.9) and previous nausea in other situations (RR 1.8) implied an increased risk for nausea. Antiemetics were used by 17% and 78% were interested in or wanted more information about acupuncture treatment against nausea. Of the 145 nauseous patients only 25% felt that antiemetics had helped them and 34% would have liked additional treatment, although the nausea intensity was mild in 72%. The nauseous patients reported lower well-being and quality of life, lower satisfaction with aspects of daily living and more frequent anxiety and depressed mood than the patients without nausea.

Conclusions: Of all patients undergoing radiotherapy, 39% experienced nausea and one third of them would have liked more treatment against the nausea. This study stresses the importance to identify and adequately treat patients with increased risk for nausea related to radiotherapy.

Place, publisher, year, edition, pages
Springer, 2009
Keyword
Antiemetics, Daily living, Risk factors, Vomiting, Quality of life
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-16236 (URN)10.1007/s00520-008-0445-x (DOI)000261577400004 ()18528717 (PubMedID)2-s2.0-57949084679 (Scopus ID)
Available from: 2009-01-12 Created: 2009-01-09 Last updated: 2015-11-18Bibliographically approved
2. Can individuals identify if needling was performed with an acupuncture needle or a non-penetrating sham needle?
Open this publication in new window or tab >>Can individuals identify if needling was performed with an acupuncture needle or a non-penetrating sham needle?
2008 (English)In: Complementary Therapies in Medicine, ISSN 0965-2299, E-ISSN 1873-6963, Vol. 16, no 5, 288-94 p.Article in journal (Refereed) Published
Abstract [en]

A control treatment in acupuncture research must be credible, regardless if the needling is performed by one or by several therapists.

Objective: To investigate if individuals could identify whether needling had been given with an acupuncture needle or a sham needle and if the therapist influenced this ability.

Design: Eighty individuals were randomized to one single needling given by one of four physiotherapists using either an invasive needle or a non-penetrating telescopic sham needle.

Results: An equal proportion of individuals, 27 (68%), in the acupuncture group and the sham group answered incorrectly or was not sure at all regarding needling type but the proportion varied between the therapists from 55 to 80% (ns). Bang's blinding index was 0.20 (95% CI 0.03-0.36) in the acupuncture group and 0.10 (95% CI 0.09-0.29) in the sham group (interpretation: 20 and 10% identified needling type beyond statistical chance). Acupuncture was on a four-grade scale rated as median "mildly painful" and sham as "not painful" (ns). Pain ratings varied from median "not" to "mildly painful" in the therapists (p = 0.01).

Conclusions: Two thirds of individuals needled by acupuncture as well as sham could not identify needling type and only 10-20% of the individuals were unblinded beyond chance. The therapists, not the needling type, influenced how painful the needling was perceived. IMPLICATIONS: To achieve blinding success in acupuncture efficacy studies using the sham needle, the needling procedure must be strictly standardized in order to minimize differences between the therapists.

Keyword
Acupuncture therapy, Blinding, Research methodology, Reliability, Sham
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:liu:diva-17231 (URN)10.1016/j.ctim.2008.02.012 (DOI)19186344 (PubMedID)
Available from: 2009-03-12 Created: 2009-03-12 Last updated: 2013-09-12Bibliographically approved
3. Acupuncture Compared To Placebo Acupuncture in Radiotherapy-induced Nausea: a Randomized Controlled Study
Open this publication in new window or tab >>Acupuncture Compared To Placebo Acupuncture in Radiotherapy-induced Nausea: a Randomized Controlled Study
Show others...
2012 (English)In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 23, no 5, 1353-1361 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate if verum (real) acupuncture is effective against nausea and vomiting during radiotherapy.

PATIENTS AND METHODS: We randomised blinded cancer patients to verum; penetrating “deqi” creating acupuncture (n=109) in the antiemetic acupuncture point PC6 (three cm above the wrist), or sham (n=106) with a non-penetrating sham needle at a non-acupuncture point six cm above the wrist 2-3 times/week. The patients daily during the radiotherapy period documented nausea and vomiting. Primary endpoint was number of patients with at least one episode of nausea during the whole radiotherapy period. RESULTS: Data was provided by 205 patients (95 %). In the verum acupuncture group, 70 % experienced nausea at least once during the radiotherapy period (p=0.12 compared to the sham group) (mean number of days of 10.1), 25 % vomited and 42 % used antiemetic drugs at least once. In the sham group 62 % experienced nausea (mean number of days 8.7), 28 % vomited and 37 % consumed antiemetic drugs. Ninety five percent in the verum and 96 % in the sham acupuncture group believed that the treatment had been effective against nausea. In both groups 67 % experienced positive effects on relaxation, mood, sleep or pain-reduction, and 89 % wished to receive the treatment again.

CONCLUSION: Acupuncture creating deqi is not more effective than sham in radiotherapy-induced nausea, but in this study nearly all patients in both groups experienced that the treatment was effective for nausea.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17235 (URN)10.1093/annonc/mdr402 (DOI)000303336400040 ()
Note

funding agencies|Swedish Cancer Society| 04 0483 |Swedish Institute for Health Sciences (the Vardal institute)||County Council of Ostergotland| LIO-4998 2005-279-83 LIO-4762 LIO-7433 LIO-10456 LIO-20071 |University of Linkoping| C 40111 |Vardal Foundation-for Health Care Sciences and Allergy Research||Ostgota Cancer Fund||

Available from: 2009-03-12 Created: 2009-03-12 Last updated: 2013-09-12Bibliographically approved
4. Radiotherapy-induced Emesis in Patients Treated with Acupuncture, Sham Acupuncture or Standard Care: Effects of Unspecific Acupuncture Mechanisms
Open this publication in new window or tab >>Radiotherapy-induced Emesis in Patients Treated with Acupuncture, Sham Acupuncture or Standard Care: Effects of Unspecific Acupuncture Mechanisms
Show others...
2010 (English)Article in journal (Other academic) Submitted
Abstract [en]

Background: It is not known if acupuncture or sham reduces radiotherapy-induced emesis more than standard care.

Methods: Cancer patients were randomized to verum (skin penetrating) acupuncture (n = 109) in the alleged antiemetic acupuncture point PC6 or sham acupuncture (n = 106) performed with a telescopic nonpenetrating needle at a sham point during the whole radiotherapy period. The verum and sham treated patients were compared to a reference cohort receiving standard care only (n = 62). All patients received radiotherapy over abdominal or pelvic regions. The occurrence of emesis in each group was compared using replies documented in questionnaires after a mean dose of 27 Gray.

Findings: Nausea (p=0.001) and vomiting were experienced during the preceding week by 37 and 7%, respectively, in the verum group, 38 and 7% in the sham group and 63 and 15% in the standard care group. The nausea intensity in the acupuncture cohort was lower (78% no nausea, 13% a little, 8% moderate, 1% much) compared to the standard care cohort (52% no nausea, 32% a little, 15% moderate, 2% much) (p=0.002). Almost all the verum and sham treated patients (95%) expected antiemetic effects from their treatment. Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (relative risk 1.6; 95 % confidence interval 1.2-2.4).

Interpretations: Both verum acupuncture and nonpenetrating sham acupuncture seem to reduce nausea and vomiting during radiotherapy, possibly by psychobiological mechanisms related to the extra care and expectancy.

Keyword
Acupuncture therapy, cancer care, emesis, expectations, placebo
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17236 (URN)
Available from: 2009-03-12 Created: 2009-03-12 Last updated: 2013-09-03Bibliographically approved

Open Access in DiVA

Nausea and vomiting in patients receiving acupuncture, sham acupuncture or standard care during radiotherapy(673 kB)1692 downloads
File information
File name FULLTEXT01.pdfFile size 673 kBChecksum SHA-512
5b7b9f9e6acfb71a44bc7abc99aa9358322f3f94c6a8cc67ccaeb7cedcfc23f5bcf7f47779a11bb78ab9ed071d76a14d9028f102bb01a085e88a4ac2e604da95
Type fulltextMimetype application/pdf
Cover/Omslag(1373 kB)90 downloads
File information
File name COVER01.pdfFile size 1373 kBChecksum SHA-512
76dc7a4be6c41c975565e1f92826f1ee20150c18ed6ada941f8879c690323e63ef11cb43b7752cee00f68be2bdf8d9adbc9473d62852d6d3e8d6c688f0ea1514
Type coverMimetype application/pdf

Authority records BETA

Enblom, Anna

Search in DiVA

By author/editor
Enblom, Anna
By organisation
Nursing ScienceFaculty of Health Sciences
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 1692 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 4536 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf