Current Evidence on Auricular Therapy for Chemotherapy-Induced Nausea and Vomiting in Cancer Patients: A Systematic Review of Randomized Controlled Trials
Table 5
Therapeutic effects for CINV and reports of adverse events in included trials.
Study
Evaluation of therapeutic effect
Therapeutic effects
Effective rate
Adverse event
Markedly effective (number)
Effective (number)
Not effective (number)
Sa1
Not reported
Not reported
Nausea: I = 53 (88.33%), C = 47 (78.33%) Vomiting: I = 55 (91.67%), C = 48 (80.00%)
Nausea: I = 7 (11.67%), C = 13 (21.67%) Vomiting: I = 5 (8.33%), C = 12 (20.00%)
Nausea: I = 88.33%, C = 78.33% Vomiting: I = 91.67%, C = 80.00%
Not reported
S2
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)b
Grade 0 I = 3 (7.89%), C = 1 (5.00%)
Grades 1 I = 34 (89.47%), C = 15 (75.00%)
Grades 2–4 I = 1 (2.63%), C = 4 (20.00%)
I = 97.37%, C = 80.00%
Not reported
S3
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)
Grades 0-1 I = 11 (68.75%), C = 7 (43.75%)
Grades 2 1 = 5 (31.25%), C = 6 (37.50%)
Grades 3-4 I = 0 (0.00%), C = 3 (18.75%)
I = 100.00%, C = 81.25%
Not reported
S4
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)
Grades 0-1 I = 38 (76.00%), C = 12 (24.00%)
Grades 2-3 I = 7 (14.00%), C = 18 (36.00%)
Grades 4 I = 5 (10.00%), C = 20 (40.00%)
I = 90.00%, C = 60.00%
Not reported
S5
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)
Grade 0 I = 13 (32.50%), C = 7 (17.50%)
Grades 1-2 I = 22 (55.00%), C = 11 (27.50%)
Grades 3-4 I = 5 (12.50%), C = 22 (55.00%)
I = 87.50%, C = 45.00%
Not reported
S6
Morrow assessment of nausea and emeticsc
Real auricular acupressure group showed a better impact on managing CINV compared with usual care group (); no difference in CINV can be found between real acupressure group and sham acupressure group.
Not applicable
Itching of the tapes ()
S7
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4), Diagnostic standard for TCM differentiation of symptoms and signsd
Grades 0-1 Day 1: acute CINV I = 12 (24.00%), C = 12 (24.00%) Day 2–7: delayed CINV Day 2: I = 12 (24.00%), C = 8 (16.00%) Day 3: I = 13 (26.00%), C = 10 (20.00%) Day 4: I = 13 (26.00%), C = 10 (20.00%) Day 5: I = 12 (24.00%), C = 8 (16.00%) Day 6: I = 13 (26.00%), C = 10 (20.00%) Day 7: I = 13 (26.00%), C = 10 (20.00%)
Grade 2 Day 1: acute CINV I = 32 (64.00%), C = 32 (64.00%) Day 2–7: delayed CINV Day 2: I = 34 (68.00%), C = 30 (60.00%) Day 3: I = 33 (66.00%), C = 29 (58.00%) Day 4: I = 33 (66.00%), C = 29 (58.00%) Day 5: I = 33 (66.00%), C = 28 (56.00%) Day 6: I = 34 (68.00%), C = 25 (50.00%) Day 7: I = 34 (68.00%), C = 26 (52.00%)
Grades 3-4 Day 1: acute CINV I = 6 (12.00%), C = 6 (12.00%) Day 2–7: delayed CINV Day 2: I = 4 (8.00%), C = 12 (24.00%) Day 3: I = 4 (8.00%), C = 11 (22.00%) Day 4: I = 4 (8.00%), C = 11 (22.00%) Day 5: I = 5 (10.00%), C = 14 (28.00%) Day 6: I = 3 (6.00%), C = 15 (30.00%) Day 7: I = 3 (6.00%), C = 14 (28.00%)
Day 1: acute CINV I = 88.00%, C = 88.00% Day 2–7: delayed CINV Day 2: I = 92.00%, C = 76.00% Day 3: I = 92.00%, C = 78.00% Day 4: I = 92.00%, C = 78.00% Day 5: I = 90.00%, C = 72.00% Day 6: I = 94.00%, C = 70.00% Day 7: I = 94.00%, C = 72.00%
Not reported
S8
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)
Grade 0 Day 1: acute CINV I = 0 (00.00%), C = 0 (00.00%) Day 2–7: delayed CINV I = 0 (00.00%), C = 0 (00.00%)
Grades 1-2 Day 1: acute CINV I = 39 (90.70%), C = 29 (69.05%) Day 2–7: delayed CINV I = 43 (100.00%), C=36 (85.71%)
Grades 3-4 Day 1: acute CINV I = 4 (9.30%), C = 13 (30.95%) Day 2–7: delayed CINV I = 0 (00.00%), C = 6 (14.29%)
Day 1: acute CINV I = 90.70%, C = 69.05% Day 2–7: delayed CINV I = 100.00%, C = 85.71%
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)
Grade 0 I = 44 (46.81%), C = 23 (24.47%)
Grades 1-2 I = 45 (47.87%), C=58 (61.70%)
Grades 3-4 I = 5 (5.32%), C = 13 (13.83%)
I = 94.68%, C = 86.17%
Not reported
S10
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)
Complete relief (grade 0) I = 28 (43.75%), C = 4 (6.25%)
Partial relief (Grade 1-2) I = 32 (50.00%), C=18 (28.13%)
Minor relief + failure (grades 3-4) I = 4 (6.25%), C = 42 (65.63%)
I = 93.75%, C = 34.38%
Not reported
S11
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)
Grades 0-1 I = 28 (70.00%), C = 23 (57.50%)
Grade 2 I = 10 (25.00%), C = 9 (22.50%)
Grades 3-4 I = 2 (5.00%), C = 8 (20.00%)
I = 95.00%, C = 80.00%
Not reported
S12
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)
Grades 0-1 I = 19 (73.08%), C = 12 (46.15%)
Grade 2 I = 6 (23.08), C = 9 (34.62%)
Grades 3-4 I = 1 (3.85%), C = 5 (19.23%)
I = 96.15%, C = 80.77%
Not reported
S13
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)
Grades 0-1 I = 32 (53.33%), C = 7 (11.67%)
Grade 2 I = 20 (33.33%), C = 24 (40.00%)
Grades 3-4 I = 8 (13.33%), C = 29 (48.33%)
I = 86.67%, C = 51.67%
Not reported
S14
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)
Grade 0 I = 16 (18.82), C = 5 (11.90%)
Grade 1 I = 62 (72.94%), C = 27 (64.29%)
Grades 2–4 I = 7 (8.24%), C = 10 (23.81%)
I = 91.76%, C = 76.19%
Not reported
S15
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)
Grades 0-1 Acute CINV I = 5 (18.52%), C = 1 (5.00%) Delayed CINV I = 11 (40.74%), C = 1 (5.00%)
Grade 2 Acute CINV I = 7 (25.93%), C = 2 (10.00%) Delayed CINV I = 6 (22.22%), C = 4 (20.00%)
Grades 3-4 Acute CINV I = 15 (55.56%), C = 17 (85.00%) Delayed CINV I = 10 (37.04%), C = 15 (75.00%)
Acute CINV I = 44.44%, C = 15.00% Delayed CINV I = 62.96%, C = 25.00%
Not reported
S16
Use of antiemetic medications (ondansetron), (categories: >20 mg/d, 10–20 mg/d, and <10 mg/d)
Number of patients using ondansetron at dose of >20 mg/d in intervention group was significantly less than those in control group. Number of patients using ondansetron at dose of <10 mg/d in intervention group was significantly more than those in control group. No statistical difference can be found in the number of patients using ondansetron at dose of 10–20 mg/d between groups.
Not reported
S17
National Cancer Institute- (NCI-) Common Toxicity Criteria, Version 2.0 (vomiting, grades 0–4)f
Complete relief (vomiting grade 0) Day 1: acute vomiting I = 18 (75.00%), C = 16 (66.67%) Day 2–7: delayed vomiting Day 2: I = 18 (69.23%), C = 10 (41.67%) Day 3: I = 17 (65.38%), C = 9 (37.50%) Day 4: I = 15 (57.69%), C = 7 (29.17%) Day 5: I = 16 (61.54%), C = 8 (33.33%) Day 6: I = 19 (73.08%), C = 11 (45.83%) Day 7: I = 25 (96.15%), C = 18 (75.00%)
Partial relief (vomiting grade 1) Day 1: acute Vomiting I = 3 (12.50%), C = 4 (16.67%) Day 2–7: delayed Vomiting Day 2: I = 5 (19.23%), C = 8 (33.33%) Day 3: I = 5 (19.23%), C = 10 (41.67%) Day 4: I = 8 (30.77%), C = 15 (62.50%) Day 5: I = 8 (30.77%), C = 15 (62.50%) Day 6: I = 6 (23.08%), C = 13 (54.17%) Day 7: I = 1 (3.85%), C = 6 (25.00%)
Minor relief + failure (vomiting grades 2–4) Day 1: acute Vomiting I = 3 (12.50%), C = 4 (16.67%) Day 2–7: delayed Vomiting Day 2: I = 3 (11.54%), C = 6 (25.00%) Day 3: I = 4 (15.38%), C = 5 (20.83%) Day 4: I = 3 (11.54%), C = 2 (8.33%) Day 5: I = 2 (7.69%), C = 1 (4.17%) Day 6: I = 1 (3.85%), C = 0 (00.00%) Day 7: I = 0 (00.00%), C = 0 (00.00%)
Day 1: acute vomiting I = 87.50%, C = 83.33% Day 2–7: delayed vomiting Day 2: I = 88.46%, C = 75.00% Day 3: I = 84.62%, C = 79.17% Day 4: I = 88.46%, C = 91.67% Day 5: I = 92.31%, C = 95.83% Day 6: I = 96.15%, C = 100.00% Day 7: I = 100.00%, C = 100.00%
No adverse events
S18
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0-4)g
Grade 0 Acute CINV I = 19 (63.33%), C = 14 (58.33%) Delayed CINV I = 18 (60.00%), C = 8 (33.33%)
Grade 1 Acute CINV I = 9 (30.00%), C = 8 (33.33%) Delayed CINV I = 9 (30.00%), C = 6 (25.00%)
Grades 2–4 (Minor relief + no effect) Acute CINV I = 2 (6.67%), C = 2 (8.33%) Delayed CINV I = 3 (10.00%), C = 10 (41.67%)
Acute CINV I = 93.33%, C = 91.67 Delayed CINV I = 90.00%, C = 58.33%
Not reported
S19
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)
Grades 0-1 I = 32 (88.89%), C = 11 (35.48%)
Grade 2 I = 3 (8.33%), C = 12 (38.71%)
Grades 3-4 I = 1 (2.78%), C = 8 (25.81%)
I = 97.22%, C = 74.19%
Not reported
S20
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)h
WHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)h
Grades 0-1 I = 16 (40.00%), C = 7 (17.50%)
Grade 2 I = 18 (45.00%), C = 10 (25.00%)
Grade 3 I = 6 (15.00%), C = 23 (57.50%)
I = 85.00%, C = 42.50%
Not reported
I: intervention group, C: control group, CINV: chemotherapy-induced nausea and vomiting, WHO: World Health Organization, and NA: not applicable.
aStudy.
bWHO Recommendations for Grading of Acute and Subacute Toxicity (nausea/vomiting, grades 0–4)*, Grade 0: none, Grade 1: nausea, Grade 2: transient vomiting, Grade 3: vomiting requiring therapy, and Grade 4: intractable vomiting [45].
cMorrow Assessment of Nausea and Emetics: A 17-item self-rated questionnaire used for assessing the occurrence, duration, and severity of nausea and vomiting.
dDiagnostic Standard for TCM Differentiation of Symptoms and Signs, A standardized diagnostic criteria developed by State Administration of TCM of People’s Republic of China.
eTherapeutic effects of auricular therapy on adverse events caused By antiemetic medications.
fNational Cancer Institute-Common Toxicity Criteria, Version 2.0: vomiting, grade 0: none, grade 1: 1 episode in 24 hours over pretreatment, grade 2: 2–5 episodes in 24 hours over pretreatment, grade 3: ≥6 episodes in 24 hours over pretreatment or need for IV fluids, grade 4: requiring parenteral nutrition, or physiologic consequences requiring intensive care, hemodynamic collapse [46].
gUsed the WHO Recommendations to judge the incidence and severity of nausea and vomiting but did not specify the source of the criteria.
hOnly applied the first four grades (grades 0–3) to evaluate the incidence and severity of nausea and vomiting.
