"Exploring the Feasibility and Acceptability of Acupuncture and Acupressure among Patients with Advanced Cancer Pain and their Primary Family Caregivers"

Background: Pain affects an estimated 44.5% patients with cancer, with 30.6% of patients reporting moderate to severe pain. Chemotherapy-induced peripheral neuropathy (CIPN) is one particularly difficult type of cancer-related pain that affects approximately 30-40% of patients and can have a profound effect upon quality of life (QoL). Non-pharmacologic therapies including complementary and alternative medicine (CAM) are used by an estimated 80% of patients with cancer pain. Self-efficacy is associated with decreased cancer pain and symptom burden and can be increased through self-management of symptoms. Acupuncture/pressure is a CAM therapy that is increasing in use for cancer pain and CIPN; however, there is limited research on the feasibility and acceptability of acupuncture/pressure among patients with advanced cancer and their family caregivers.
Specific Aims: The aims of this research are to explore: 1) the feasibility and acceptability of acupuncture/pressure and other non-pharmacologic therapies for pain management reported by patients with advanced cancer and their family caregivers; 2) the association between self-efficacy in cancer pain management and acupuncture/pressure; and 3) demographic and clinical variables that predict use of acupuncture/pressure for pain among patients with advanced cancer.
Study Design: This study is a secondary data analysis using survey data from the parent study Characterizing the Complexity of Advanced Cancer Pain in the Home Context. Variables included: 1) reported use and belief in effectiveness of acupuncture/pressure and other non-pharmacologic approaches, such as positioning, being with others, rest/sleep, and guided imagery/hypnosis; 2) self-efficacy in pain management; and 3) demographic and clinical characteristics obtained from both patients and their family caregivers. Feasibility and acceptability were evaluated using: 1) descriptive statistics to evaluate self-reported use of acupuncture/pressure compared to other non-pharmacologic therapies; and 2) independent two-sample t-tests to compare belief in effectiveness of the patient’s pain management regimen between patients and caregivers who reported use of acupuncture/pressure and those who did not. Independent two-sample t-tests were used to compare self-efficacy through confidence in pain management between patients and caregivers who reported use of acupuncture/pressure and those who did not. The effect of acupuncture/pressure use on self-efficacy was determined using multiple linear regression. Demographic and clinical variables for patients who used acupuncture/pressure were compared to those who did not using t-tests for continuous variables and chi-square tests for categorical variables.
Results: Feasibility and acceptability were highest for positioning, being with others, and rest/sleep, which all had reported use > 95%. Use of guided imagery/hypnosis and acupuncture/pressure were lowest at 43.8%. Acupuncture/pressure was associated with decreased self-efficacy in pain management, at a significance of p-value= 0.02. Demographic and clinical variables did not predict use of acupuncture/pressure at a significance of p-value < 0.05; educational level was close at p= 0.05.
Conclusions: The relationship between reported use of acupuncture/pressure and decreased self-efficacy may indicate that patients with cancer and the highest symptom management needs are more likely to try acupuncture/pressure. Acupressure can be self-administered and may facilitate access for patients with advanced cancer pain to obtain the benefits of acupuncture/pressure for symptom management. Future research should evaluate acupressure techniques that can be self-managed for advanced cancer pain among patients and their family caregivers.