ACUPRESSURE IN HOSPITALIZED PEDIATRIC ONCOLOGY PATIENTS WITH FEBRILE NEUTROPENIA - A PILOT STUDY

ABSTRACT

Background: Chemotherapy-induced neutropenia is an expected side effect during cancer therapy. Prolonged neutropenia can lead to treatment delays and chemotherapy dose reduction. Patients with neutropenia are at increased risk for life-threatening infections, and when febrile they require hospitalization and broad-spectrum IV antibiotics. Acupuncture and related techniques have received increased interest in several clinical trials in adult oncology, where their use has resulted in improved blood cell counts. Little is known regarding the impact of needleless acupressure intervention in pediatric oncology patients. Objectives: The purpose of this pilot study was to evaluate the effects of daily treatment using predetermined acupressure points on hospitalized pediatric oncology patients with febrile neutropenia. Our primary objective was to determine if this protocol decreased the time to blood cell count recovery, a requirement for hospital discharge. The metric used for count recovery was absolute phagocyte count (APC), which is ANC (absolute neutrophil count) + AMC (absolute monocyte count). The endpoint for count recovery was APC ≥ 500/μL. Design/Method: In this pilot study, pediatric oncology patients admitted to the University of Minnesota Masonic Children's Hospital who had febrile neutropenia (ANC < 500/μL and temperature > 100.3F) were offered enrollment. Enrolled subjects received daily acupressure treatments until APC recovery. Cases were disease-matched to historical controls by treatment protocol as closely as possible. Time variables, including time to APC recovery and length of stay (LOS), were analyzed using the non-parametric Wilcoxon rank sum test. Results: Twelve cases (enrolled October 2020-September 2021) were group-matched to thirty-four historical controls (pulled from the medical records database, January 2015-October 2019). APC recovery in days was the same in both groups, with a median of 3.0 days, p = 0.352. The LOS in days was also similar cases 4.94 vs. controls 3.43 days, p = 0.431. No enrolled patients experienced treatment-related adverse events. One patient was removed from the study early due to contracting COVID-19 when there was a limited supply of personal protective equipment. Conclusion: Acupressure presents a unique non-pharmacologic method to potentially support count recovery. Although we were unable to demonstrate a significant impact of acupressure on APC recovery in our pediatric population, we note limited sample size. Only 12 of the goal 35 patients (per initial power analysis) were enrolled. This was due, in part, to impacts of the COVID-19 pandemic, including necessary restrictions on elective research protocols during the study window. Further studies are needed to explore the role of acupressure in pediatric oncology.