A Focus on Fatigue, Ease Common Symptoms

Although the investigators specifically targeted relief of fatigue, Dr Zick told Oncology Nurse Advisor they were also interested in sleep quality, depressive symptoms, anxiety, and chronic pain. These symptoms are more common in breast cancer survivors. The team knew there was overlap with all the symptoms; it is rare for a woman just to have fatigue by itself. She will have fatigue, or fatigue and depression. “Some unlucky women have all of the symptoms. So we said that for the study everybody had to be experiencing fatigue, but we measured all the other symptoms as well to see whether or not they were also impacted,” said Dr Zick.

Clearly, some of the pain patients felt was chemotherapy-induced neuropathy, but the researchers did not ask specifically whether the patient had neuropathic pain. Their research used the Brief Pain Inventory, which asks about having any type of pain anywhere in the body: How severe is your pain? Where in your body is it? How long have you had it? When is it the worst?

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Some women indicated having neuropathic pain, because the women would point to the hands and feet when asked to show on a body map where their pain was. The hands and feet are common sites for neuropathic pain. But patients in the study experienced pain in a variety of locations, including the lower back, knee, head, or neck.

The Michigan team did not know if any of the pain experienced by their patients was caused by metastases, which is a new and intriguing area of research for cancer survivors in general. Dr Zick said that interest in all different types of pain felt by survivors is increased. For example, even in cases of knee osteoarthritis, breast cancer survivors have more pain than one would expect. Dr Zick explained that this could be because the more centralized pain of breast cancer causes patients to be more sensitive to painful signals from their periphery.

Helpful Tools

AcuWand Many women use pencil erasers rather than their fingers or thumb to stimulate their acupoints. In focus groups, they told the researchers that having a device to do that would be easy on their hands and also enable them to apply an accurate amount of pressure. The result was the AcuWand. Currently starting production, this small stick device makes it easy to apply pressure and actually vibrates if the patient applies too much.

MeTime Acupressure The Michigan team has also developed a mobile phone app. It provides detailed video and schematic support to help anyone learn where the acupoints are and how to press on them. The app is available for iOS and Android; proceeds go towards future research projects in the department at the University of Michigan.

Focus group feedback The program continues to be successful. Positive feedback from focus group participants include: “The acupressure worked really well and I was happy to participate.” “It was extremely helpful.” “I found I was sleeping better and I had more energy. This is what it’s like to feel good!”


1. Zick SM, Sen A, Hassett AL, et al. Impact of self-acupressure on co-occurring symptoms in cancer survivors. JNCI Cancer Spectr. 2018;2(4):pky064.