Effect of Acupressure on Constipation in

Patients with cancer often suffer from constipation. The prevalence of constipation in patients with cancer ranges from 42.7% to 87% [1,2]. A study of 206 patients with cancer reported that 74.3% took laxatives [2]. Americans spend $ 725 million on laxatives each year [3]. Long term use of laxatives may have side effects such as bloating, allergic reaction, abdominal pain, metabolic disturbances, and hepatotoxicity [4]. Constipation decreases quality of life and is related to depressive symptoms [5,6]. Acupressure is the application of pressure or localized massage to specific sites on the body to manage symptoms such as pain or nausea [7]. Acupressure can be an alternative and cost-effective therapy for constipation which has fewer side effects than laxatives. The purpose of this study was to examine the effect of acupressure on constipation in cancer patients with constipation.


Introduction
Patients with cancer often suffer from constipation. The prevalence of constipation in patients with cancer ranges from 42.7% to 87% [1,2]. A study of 206 patients with cancer reported that 74.3% took laxatives [2]. Americans spend $ 725 million on laxatives each year [3]. Long term use of laxatives may have side effects such as bloating, allergic reaction, abdominal pain, metabolic disturbances, and hepatotoxicity [4]. Constipation decreases quality of life and is related to depressive symptoms [5,6]. Acupressure is the application of pressure or localized massage to specific sites on the body to manage symptoms such as pain or nausea [7]. Acupressure can be an alternative and cost-effective therapy for constipation which has fewer side effects than laxatives. The purpose of this study was to examine the effect of acupressure on constipation in cancer patients with constipation.

Methods
A pilot study was conducted from February 1, 2010 through March 5, 2010 with eight cancer patients who were constipated. Prior to beginning the study, approval from the UK Markey Cancer Center IRB and the UK Medical IRB was obtained. Subjects were recruited from UK Markey Cancer Center chemotherapy outpatient department. The Constipation Assessment Scale (CAS) was used to measure constipation severity [8]. The experimental group was instructed to perform 5 minute acupressure at SP 14 every day for 7 days. The placebo group was instructed to perform 5 minute acupressure daily at PC 6 for 7 days. Left SP 14 is located at 1.3cun below and 4cun left lateral to the umbilicus.

Results
The basic characteristics of 8 patients were a mean age 62.5 (±7.58) years, 100% female, and 62% unemployed status. Their mean number of months since cancer diagnosis was 13.1 (±19.9) months; the majority had stage three cancer and all were presently receiving chemotherapy. The characteristics of constipation were: mean onset of constipation were 10.3 weeks (±16.11) not including one outlier--a patient who had experienced constipation for 20 years; 86% used laxatives, stool softeners, or enemas and averaged 5.5 (±3.8) bowel movements per week. Three out of five patients in the experimental group reported improvement of constipation in terms of either the frequency of bowel movements or the CAS scores. Two out of three patients in the placebo group reported that acupressure did not help constipation even though they had improvement of constipation in the frequency of bowel movements and laxatives use.

Case Description
Ms. Jones, a 59-year-old female, had multiple myeloma for 60 months with co-morbidity of hypertension and hyperlipidemia. She had constipation for 2 weeks since she started the new chemotherapy (Cafilzomib). She did not take any laxatives, suppositories, stool softeners, or enemas for constipation. She drank prune juice for constipation, more than 5 cups of fluid, and ate 1 cup of fruits and vegetables for the 24 hours, and had not exercised for the past week. She had taken six Aleve tablets for the past week. She wanted to learn acupressure because she did not like taking medication for constipation. She performed acupressure for 5 minutes, a total of five times for one week. Bowel movements increased from two to five times per week. She did not take any medication for constipation for the past week. Her score on the Constipation Assessment Scale did not improve. She reported that performing acupressure was easy and it worked. She rated the effect of acupressure on constipation as 4 out of 5 (very helpful). She did not have any side effects.

Discussion
The results of this study are consistent with previous studies. Auricular acupressure reduced constipation compared