Yeh, C.H., Chien, L.C., Chiang, Y.C., Lin, S.W., Huang, C.K., & Ren, D. (2012). Reduction in nausea and vomiting in children undergoing cancer chemotherapy by either appropriate or sham auricular acupuncture points with standard care. Journal of Alternative and Complementary Medicine, 18, 334-340.

To report the findings of a feasibility and pilot study using auricular point acupressure for chemotherapy-induced nausea and vomiting (CINV) in a small group of children in Taiwain

• To examine the feasibility of recruiting children with cancer into a larger study
• To assess the feasibility of successfully completing each of the three protocols (standard care, auricular acupressure using sham auricular points [SAP], and auricular acupressure intervention [AAP])
• To analyze the longitudinal CINV data
• To determine the effect size for use in a future study of the efficacy of the intervention.

Subjects were entered into the study for three successive rounds of chemotherapy. Round one was used as the standard care (SC) group and provided baseline data. Subjects were then randomized to one of two treatments: auricular acupressure intervention (AAP) or auricular acupressure using sham points (SAP). In the third cycle, participants were crossed over to the other treatment. Patients had a seed application prior to their round of chemotherapy and seeds remained for seven days. They were instructed to press their acupoints three times a day for three-minute periods. They also were instructed to press the seeds as soon as they felt nausea. Each participant received a booklet with a diary to keep track of stimulation times, sites stimulation, duration, and whether or not the child felt relief. Data was collected prior to chemotherapy administration and daily for seven days.

• The study consisted of 10 participants.
• Mean age of participants was 13.29 years (SD = 3.31).
• The smaple was 60% male and 40% female.
• Cancer diagnoses was 30% leukemia and 70% “other solid tumor.\"

This was a single site study conducted at a large children’s hospital in Taiwan.

All patients were pediatric and in active antitumor treatment.

This was a crossover, randomized design feasibility study.

The study used the Morrow Assessment of Nausea and Emetics (MANE), a 17-item, self-report questionnaire that measures occurrence, duration, and severity of nausea and vomiting. Demographic data was collection from medical chart review. Patients and their parents kept study booklets to record stimulation times, the number of acupoints stimulated, and stimulation duration at each of the acupoints, as well as whether or not the child felt relief from symptoms.

The authors were able to recruit 10 patients from a possible 22, all of whom were able to complete the entire study. Subjects kept the taped seeds on for 88% of the possible treatment days, suggesting the intervention is feasible and acceptable to children and their families.

The SC group reported more nausea overall than either the AAP or SAP groups, with 30% still reporting nausea on day 7. The SAP group reported the same nausea as the SC during the first two days, but declining nausea after day 2, with only 20% still reporting nausea on day 6. The AAP group reported less nausea on day 1, similar nausea on day 2, and no nausea by day 5.  Although analysis did not show statistical significance, the authors described this trend as clinically significant. 

Vomiting followed similar trends with most vomiting in the SC group, followed by SCA, and then AAP, but the difference was not statistically significant.

Because of the small sample size, comparison of the efficacy of the acupuncture intervention group and the sham acupuncture point group is not possible. The intervention group did demonstrate lower occurrence of acute and delayed nausea and shorter duration of nausea, but these results varied.  A larger study using a similar design would be necessary to evaluate this question.

• The sample size was small sample  with fewer than 30 patients.
• A risk of bias exists because of the sample characteristics and the lack of blinding.
• The measurement validity and reliability was questionable.
• The increased presence of research staff may have had a potential psychologic benefit, impacting results.

Acupuncture is an acceptable intervention to children and their parents for CINV. Potential clinical trends toward efficacy exist, but the small sample size limits the ability to draw definitive conclusions regarding its effectiveness.