Mobile App–Guided Acupressure May Ease Ovarian Cancer Fatigue

Women with ovarian cancer who were experiencing fatigue saw meaningful improvements after learning self-acupressure through a mobile app, according to results from a randomized clinical trial published in JAMA Network Open.

In the phase 3 study, researchers found that both true and sham self-acupressure reduced cancer-related fatigue compared with usual care, with the greatest benefit seen in women assigned to true self-acupressure. The findings suggest that app-based self-acupressure may offer patients with cancer a safe, low-cost option to manage fatigue, a symptom that can affect sleep and quality of life.

In an interview with CURE, the lead study author Suzanna M. Zick explained, “They were able to get back parts of their life that fatigue took away from them, and that could be spending time with loved ones, hobbies or going back to work, if possible. I think that's the most impactful thing that fatigue takes away from people, is having a relationship to all of that.”

Zick is a research associate professor in the Department of Family Medicine and Nutritional Sciences at the University of Michigan in Ann Arbor.

Main data that support the findings

The trial included 171 women with ovarian cancer who reported clinically relevant fatigue, defined as a Brief Fatigue Inventory score of 4 or higher. Participants were randomly assigned to 6 weeks of true self-acupressure, sham self-acupressure or usual care.

At the end of treatment at week 6, 58.5% of women in the true self-acupressure arm achieved a clinically normal fatigue level, compared with 51.1% in the sham arm and 17.6% in the usual care arm.

When researchers looked at changes in fatigue scores, women in the true self-acupressure group had a significantly greater reduction in fatigue compared with those receiving usual care. The adjusted mean difference between true self-acupressure and usual care at week 6 was −1.23. The difference between sham self-acupressure and usual care did not reach statistical significance at week 6.

The relative benefit of self-acupressure persisted over time. At week 24, which followed an 18-week washout period after stopping acupressure at week 6, women in the true self-acupressure arm continued to show significantly lower fatigue scores compared with usual care, with a mean difference of −1.38.

The proportion of women who were no longer clinically fatigued at week 24 was 56.8% in the true self-acupressure arm, 47.5% in the sham arm and 21.7% in the usual care arm. The odds of achieving normal fatigue levels were significantly higher for true self-acupressure compared with usual care at both week 6 and week 24.

Sleep quality did not significantly differ between groups at any time point. However, quality of life improved in the true self-acupressure arm. At week 6, 57.5% of women in the true self-acupressure arm experienced a clinically meaningful improvement in quality of life compared with 30.0% in the usual care arm. This difference was statistically significant. Similar findings were observed at week 24.

“A unique aspect of cancer fatigue is that it is often separate or independent from other symptoms that you'd think it would be connected to, like sleep. That doesn't mean they aren't related to each other,” Zick stated.

Trial details

The remotely administered trial was conducted from October 2019 to December 2023, with data collection ending in November 2024. Women were recruited through tumor registries and social media. Eligible participants were aged 21 years or older, had a diagnosis of ovarian cancer at any stage or histotype and had initiated treatment at least 4 weeks before enrollment. All participants reported fatigue that began at or after their cancer diagnosis.

Participants were randomly assigned in a 1:1:1 ratio to one of three groups: true self-acupressure, sham self-acupressure or usual care. Both self-acupressure groups used a mobile app installed on a tablet and an acupressure device mailed to their homes. The app provided illustrations and videos demonstrating how to locate acupoints, apply pressure and perform the technique.

“There is very little access to supportive care services overall even if you're in urban areas. Especially for evidence based integrative approaches like acupressure. So we wanted to make something that was easily available to the vast majority of individuals,” Zick stated.

Women in the true self-acupressure arm were instructed to stimulate five specific acupoints daily for 3 minutes per point, for a total of 27 minutes per day, over 6 weeks. The sham group followed the same schedule but applied pressure to nontherapeutic points in similar body areas. The usual care group continued fatigue management as directed by their health care teams.

Safety

No serious or nonserious side effects related to self-acupressure were reported in any study arm.

Adherence to the protocol was high. In the true self-acupressure arm, mean adherence was 84%, equivalent to 22.7 minutes per day. In the sham arm, mean adherence was 78%, or 21.1 minutes per day. Fidelity, or correct performance of the technique, averaged 88% in the true arm and 86% in the sham arm.

More women withdrew from the self-acupressure arms compared with usual care, with 29% withdrawing from the true arm and 22% from the sham arm, compared with 7% in the usual care arm.

Overall, the study found that app-based self-acupressure was safe and associated with sustained reductions in cancer-related fatigue for women with ovarian cancer.

References

1. “Self-Acupressure for Fatigue in Patients Surviving Ovarian Cancer” by Dr. Suzanna M. Zick, et al., JAMA Network Open.

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