Effectiveness of Acupressure in Managing the Pain-Fatigue-Sleep Disturbance-Depression Symptom Cluster in Patients with Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Abstract

Objective: To assess the effectiveness of acupressure in addressing the symptom cluster of pain, fatigue, sleep disturbances, and depression (P-F-S-D) in patients with cancer through a systematic review. Methods: A comprehensive search was conducted across three English-language medical databases (PubMed, Embase, and the Cochrane Library) and two Chinese databases (China National Knowledge Infrastructure and Wanfang). Only randomized controlled trials (RCTs) examining the impact of acupressure on the P-F-S-D symptom cluster were included. Two reviewers independently screened studies, evaluated the risk of bias, and extracted relevant data in parallel. The risk of bias in eligible RCTs was appraised using the revised Cochrane Risk of Bias tool (RoB 2.0). Meta-analysis was performed using Stata software. Results: A total of 20 studies (reported in 21 articles) met the inclusion criteria and were classified as either having a low risk of bias or some concerns regarding bias. Meta-analysis revealed that acupressure achieved large-effect reductions in the P-F-S-D symptom cluster compared to both sham acupoint (endpoint standardized mean difference [SMD] = -0.84 [-1.05, -0.63], 4-week follow-up SMD = -0.87 [-1.35, -0.39]) and usual care groups (endpoint SMD = -0.68 [-0.83, -0.53], 4-week follow-up SMD = -0.60 [-0.87, -0.33]) (all p = 0.000). Initial high heterogeneity (I² = 65.6%-67.1%) resolved after sensitivity analysis (I² = 19.7%-35.2%), confirming result robustness. Subgroup analysis further revealed that acupressure significantly benefited various symptom combinations, including P-F-S-D, P-F-S, F-S-D, F-S, P-S, and P-F. No serious adverse events were reported. Conclusions: The findings of this study suggest that acupressure should be considered for patients with cancer experiencing the P-F-S-D symptom cluster. However, given the considerable heterogeneity, potential bias, and lack of systematic adverse event reporting in the included studies, further large-scale, multicenter, high-quality RCTs are necessary to better evaluate the effectiveness and safety of acupressure for multisymptom relief.