World Journal of Medical Sciences 8 (4): 373-381, 2013

ISSN 1817-3055
IDOSI Publications, 2013
DOI: 10.5829/idosi.wjms.2013.8.4.7581

Acupressure for Chemotherapy Induced Vomiting

Among School Age Children
1

Hewida A. Hussein and 2Basma R. Abdel Sadek

Department of Pediatric Nursing, Faculty of Nursing, Cairo University, Cairo, Egypt

Department Pediatric Nursing, Faculty of Nursing, Banha University, Banha, Egypt

Abstract: Chemotherapy is a cornerstone of therapy for most children with cancer but unfortunately,
chemotherapy is accompanied by adverse side effects, the most prevalent of which is vomiting. Acupressure
is one of non pharmacological methods used for reducing frequency of vomiting. The aim of current study was
to assess the effect of acupressure for chemotherapy induced vomiting among school age children with
antiemetic drugs on controlling frequency of vomiting. A quasi experimental design was utilized in the study.
A purposive sample of 50 school age children with leukemia was included in the study. There were four tools
utilized to collect the required data which were: a structured interview questionnaire schedule, childs
knowledge about acupressure assessment tool, acupressure observational checklist and childs vomiting
record. Results of the study showed that there is a statistically significant difference between study and control
groups regarding to decreasing frequency of vomiting, which reflects the effectiveness of applying acupressure
on reducing frequency of vomiting associated with chemotherapy. It is recommended that acupressure should
be included in the management of vomiting associated with chemotherapy in children.
Key words: School age children

Chemotherapy

Vomiting

INTRODUCTION

Leukemia

of children, increases the uses of health care resources

and may compromise adherence to treatment [2].
Induced vomiting is the burden that CIV places on
pediatric patients with cancer. Despite improvements in
available antiemetic medications, the incidence of CIV in
pediatric patients with cancer continues to be problematic.
Vomiting can adversely affect pediatric patients QOL and
makes it difficult for them to perform their activities of
daily living. Uncontrolled CIV can give rise to medical
complications, including poor nutrition, dehydration,
electrolyte imbalances and physical and mental
deterioration. In some cases, pediatric patients may refuse
to continue potentially beneficial treatment regimens
because of treatment associated vomiting [1].
As CIV is the most prevalent chemotherapy induced
side effects; scientists have discovered that acupressure
may hold the solution to the problem. Acupressure
succeeded in preventing vomiting in 66% of the children
[3]. Efforts have been made by investigators to find non
pharmacological techniques as alternatives to antiemetic
drugs. Acupressure is one of the well-investigated non
pharmacological methods for reducing the incidence of

Chemotherapy is a cornerstone of therapy for most

children with cancer and it has played an important role
in improving childs outcomes in oncology. Advances
in early diagnosis and better treatments made this
improvement in childs survival possible. Although
chemotherapy has enabled many pediatric patients to live
longer, high cost, in terms of adverse events and quality
of life (QOL), is associated with it. Between 500.000-1
million Americans receive chemotherapy/year and a high
proportion as many as 80% experience adverse effects. Of
these adverse effects none is more feared than
chemotherapy induced vomiting (CIV) [1].
The supportive care of pediatric patients receiving
chemotherapy has dramatically improved over the past
two decades. The development of effective means to
prevent vomiting arising from chemotherapy serves as
one of the most important examples of this progress,
pediatric patients beginning cancer treatment constantly
list CIV is one of their greatest fears. Inadequately
controlled vomiting impairs functional activity and QOL

Corresponding Author: Hewida Ahmed Hussein, Department of Pediatric Nursing, Faculty of Nursing,
Cairo University, Postal code: 11562, Cairo, Egypt.

373

World J. Med. Sci., 8 (4): 373-381, 2013

vomiting [4, 5]. Acupressure and its related therapies are

several techniques which have been used to stimulate the
pericardium 6 (P6) site. Acupressure is noninvasive and
painless pressure on the skin over the (P6) pressure point
[6].
Because oncology nurses are usually the most
common point of contact for pediatric patients with
cancer, they are in a key position to assess for the
presence of CIV as well as help in management the
symptoms among pediatric patients receiving
chemotherapy. Pediatric patients may be reluctant to
report side effects of chemotherapy because they expect
and accept the effects. Nurses should assess for CIV
during all three time periods (anticipatory, acute and
delayed) and help pediatric patients find strategies to
manage it [7].
Oncology nurses can play a critical role in
decreasing the burden of chemotherapy associated
adverse effects. More accurate assessments of pediatric
patients before and during chemotherapy can ensure that
the most appropriate antiemetic therapy is received. More
effective communication with children can improve
adherence. Taking the time to address children as human
beings and accounting for differences in educational
level, age cultural background and expectations will
improve communication and ultimately, childs outcomes
[1].
Optimal management of CIV is important for
compliance with chemotherapy, adequate nutritional
intake and the QOL of children patients. Currently
available antiemetic drugs provide obvious benefits, but
none is completely satisfactory especially for the highly
emotogenic treatment [8]. CIV is a multifactorial issue
which is not obviated by drugs alone; in addition there
are little researches available about acupressure in
children undergoing chemotherapy. Therefore the current
study aims to assess the effect of acupressure in
improving the control of CIV.During the present study
applying acupressure will be to specific point called
pericardium 6 (point P6) located in both arms and the
pressure will be gentle but by using the fingers of
opposite hands for 3-5 minutes, 05-1 cm in-depth

School age children who will apply acupressure in

study group will experience less frequency of
vomiting than those in control group.
There will be no relation between sociodemographic
factors (age, sex, residence) and frequency of
vomiting in both study and control groups.
Setting: This study was conducted in oncology unit in
Mubarak Educational Hospital / Zagazeg University. This
hospital receives children who are suffering from all types
of cancer from all over Egypt and provides treatment and
care free without any financial burden.
Sample: A purposive sample of 50 school age children
with leukemia was included in the study according to the
inclusion criteria. Those (50) school age children were
divided equally and randomly into 2 constructed groups
(25 school age children in study group and 25 school age
children in control group). Determination of sample size
was calculated according to statistical procedure known
as power analysis of the sample. According to
phenomenon of leukemia and power analysis, the size of
the sample which resulted was 50 school age children.
The inclusion criteria for school age children
were: Age between 6-12 years, both sexes and children
have same diagnosis (leukemia) and first time to be treated
from leukemia and are on the same protocol of treatment.
Tools for Data Collection: There were four tools utilized
to collect the required data for this study, all of these
tools were developed by research investigators after
reviewing the related literature:Structured interview questionnaire schedule: it
included 6 questions related to the child's age, sex,
educational level, residence,etc.
Childs knowledge about chemotherapy and
acupressure assessment tool: it included 10
questions related to definition, benefits, side effects
and management of side effects of chemotherapy,
definition, times, benefits, duration of applying
acupressure
and
number
of
applying
acupressure/day.
Scoring System of Childs Knowledge about
Chemotherapy Acupressure Tool: This tool contains 10
questions, the questions in the form of closed ended and
answers in the form of correct / incorrect. Each correct
answer takes 1 mark and incorrect answer takes 0. The
total scores of knowledge were 10 marks, scores ranged
from 0-5 were considered unsatisfactory and scores
ranged from 6-10 were considered satisfactory.

MATERIALS AND METHODS

Research Design: A quasi experimental research design
was utilized in the study.
Research Hypotheses: To achieve the aim of the study,
the following research hypotheses were tested:
374

World J. Med. Sci., 8 (4): 373-381, 2013

Acupressure observational checklist: it included 6

questions related to steps of performing acupressure.
Answers of the checklist were in form of done
correctly/ done incorrectly.

of methods of teaching. During this session sociodemographic data were collected by using the structured
interview questionnaire, it took about 10-15 minutes and
each childs knowledge about acupressure by using
childs knowledge about acupressure assessment tool
was done; it took about 20-30 minutes. This phase
included both study and control groups

Scoring System Acupressure Observational Checklist:

The total scores of checklist were 6 marks, scores range
from 0-3 were considered unsatisfactory and scores range
from 4-6 were considered satisfactory.

The second session (started in the same day after

finishing first session about 5-10minutes)

Childs vomiting reported record (daily log): it was

used to record number of vomiting of child /day.

The aim of this session was to present by researchers

the plan and content out lines of the program sessions.
Each session was preceded by revision about what had
given in previous session and ended by summary of what
had said. Teaching methods used were discussion, role
playing and demonstration and redomensteration.
Researchers used educational booklet and handouts. This
session took about 20-30 minutes. This phase included
study group only.

Procedure: The study was carried out through four

phases: preliminary, implementation, follow up and
evaluation phases.
Preliminary Phase: An official permission obtained from
the head of the director of Mubarak Educational Hospital
/ Zagazeg University after an explanation of the aim of the
study, tools and duration to proceed with the study.
Children who met the criteria for inclusion were
determined, each child and his/her parent were informed
about the purpose, duration, benefits and the nature of
the study. Children and their parents' agreement to
participate in the study was obtained written and orally.
Each newly admitted child with leukemia was submitted to
protocol of management including 28 days of
hospitalization; the first 8 days of 28 days the child was
submitted to laboratory investigations and examinations
and preparations for starting chemotherapy. After that
each child received chemotherapy for 5 days/week, every
day of these 5 days of chemotherapy was started by
taking antiemetic medication (Zofran) and followed by 3
doses of chemotherapeutic medications. This phase
included both study and control groups

The third session The aim of this session was to

orient each child about definition, benefits, side
effects and management of side effects of
chemotherapy and definition of acupressure, benefits
of acupressure, times and duration of applying
acupressure. This session took about 20-30 minutes.
This phase included study group only.
The fourth session (started in the same day after
finishing 3 rd session about 5-10minutes):
It aimed at demonstrating to each child how to apply
acupressure on them, followed by each child allowed redemonstrating how to apply acupressure on him/her. This
session took about 20-30 minutes. This phase included
study group only.

Implementation Phase
Program Implementation: The total program included 6
sessions (2 sessions offered in one hour/day) and this
program was carried out during week of preparation as the
following:

The fifth session The aim of this session was to

follow up with each child redmonsreation of
applying acupressure on him/her, this session took
about 5-10 minutes. This phase included study group
only.
The sixth session (in the same day after finishing 5th
session about 5-10minutes):

The first session (in the first/or second day after

admission)

Aimed at summarizing and revising of all the

information and techniques taught answer child's
questions and clarifying any ambiguous. Then it was
explained to the parent and child how they can contact
the researchers when they are needed. This session took
about 20-30 minutes. This phase included study group
only.

The aim of this session was to introduce the

researchers with parent and child and make a contract of
the work which will start. This contract contained; parent'
agreement about participation of child in the study, the
schedule of meeting, childs commitment to continue and
researchers commitment to help child and determination
375

World J. Med. Sci., 8 (4): 373-381, 2013

Statistical Analysis: Data was analyzed using SPSS

version 20. Numerical data were expressed as mean
standard deviation (SD. Qualitative data were expressed
as frequency and percentage). Chi-square test was used
to examine the relation between qualitative variables, one
way Anova test and repeated measures were used to
examine the relation between qualitative and quantitative
variables. For quantitative data, comparison between
mean of the two groups was done using t-test,
comparison within two groups was done using paired ttest, Pearson (r) Correlation was used to test correlation
between variables, P-value = 0.05 was considered
significant.

The follow up phase Research investigators

followed up children daily by visiting or
sometimes by phone during days of chemotherapy
to follow their application of acupressure and record
frequency of vomiting/day. This follow up was done
while the children still stay (hospitalized) in the
hospital. This phase included both study and control
groups.
The evaluation phase The post program assessment
carried this phase took about 20-30 minutes. This
phase included study group only.
The current study started from the beginning of
October 2012 till the end of March 2013.
Pilot Study: An initial pilot study was done on 10% of
children receiving chemotherapy and antiemetic
medication to evaluate the content of tools, their
objectivity and feasibility and to explain any
discrepancies in the tools. Children involved in pilot
study were included in the study.

RESULTS
Table (1) shows socio-demographic characteristics of
children in both study and control groups. Regarding to
sex of children, more than two thirds of children (62%) of
study group and more than half (52%) of control group
were male children. The same table shows that the mean
age of children in study group was 8.96 1.78 years while
the mean age of children in control group was 8.36 1.89
years. Table (1) represents that residence of children of
both study and control groups (56 and 72% respectively);
was from urban areas. Table (1) indicates that there were
no statistically significant differences between both study
and control groups regarding to sex (x2=. 739, p=. 284) and
residence (x2= 1.389, p=. 239). Figure 1 explains that more
than one third of children (36%) of study group were in
3 rd level of education whereas 32% of control group were
in 2 nd level of education.
It is clear from table (2) that the mean scores of the
knowledge of children in both study and control groups
before giving them the health educational program about
chemotherapy and acupressure was 0.48 0.872 in study
group and 0. 54 .717 in control group with no statistically
significant difference between both groups,whereas the
mean scores of the knowledge of children in study group
after giving them health educational program was
increased to be 5.520.510, also, mean scores of the
knowledge of children in the control group increased to
be 0.840.643 but, there was a statistically significant
(P<0.05) difference between both groups..
Table (3) explains that children in the study group
were able to perform steps of acupressure correctly in the
redemonstration, as it is clear from this table that the
percentages of all items were above 70% except one item
only which was press about 1cm deep (65.7%).

Validity of Tools: Content validity was done by 5 experts

in the field of pediatric oncology and nursing. Construct
validity was done by using constructed groups approach;
the mean performance between two groups was
significantly different (P<0.001)) which supported and
gave an evidence of construct validity.
Reliability of Tools: As regard reliability of tools,
Cronbach's alpha between questions was 0.782. It was
obvious that the alpha value is quite high and interrater
reliability had been established and Pearson product
correlation between observers was r=.89, p < 0.001),
indicating that the tools demonstrated internal
consistency.
Ethical Considerations: The control group was left to
hospital routine management of CIV. All children patients
and their relatives (mothers/fathers/ siblings) in both
study and control groups were informed about the
purpose, tools and duration of the study after explaining
to them the benefits of the study. Oral consent of the
relatives was gained. The researcher investigators
assured relatives about confidentiality about the data
which were gathered from them during the study. During
the study the researcher investigators informed the
parents about their right to withdraw their children
patients at any time without any effect on the care
provided for their children patients.
376

World J. Med. Sci., 8 (4): 373-381, 2013

Table 1: Percentage Distribution of Socio-demographic Characteristics of Children in Study and Control Groups (N = 25).
Study group

Control group

----------------------------------------

----------------------------------------

No.

No.

1-Male

16

64

13

52

.739

.284

2-Female

36

12

48

8.96 1.780

8.36 1.890
1.389

.239

Item

P value

Sex:

Age:
X SD
Residence:
1-Urban

14

56

18

72

2-Rural

11

44

28

Table 2: Comparison of Mean Scores of Knowledge between Study and Control Groups (N = 25)
Item

Study group X SD

Control group X SD

t. test

P value

Mean of knowledge of children Before educational program

..48..872

. 54 .717

2.092

.769

Mean of knowledge of children After educational program

5.52.510

.84.643

2929.846

.000**

** Significance at p 0.001
Table 3: Frequency Distribution of Performing Acupressure Procedure among Study Group (N = 25)
correct

incorrect

-----------------------------------------------------

------------------------------------------------

Steps of procedure

No.

No.

- Locate wrist.

25

100

%
0

-Measure 2-3 fingers from wrist.

20

85.7

14.3

-Locate P6 point.

21

88.5

11.5

-Apply pressure gently.

15

71.4

10

28.6

-Press about 1cm deep

13

65.7

12

34.3

- Apply pressure for 5 minutes.

25

100

Fig. 1: Level of Education of Children in Study and Control Groups

Table (4) and figure (2) illustrate the comparison
of total mean scores of frequency of vomiting between
both study and control groups. It is obvious from the
table that there were statistically significant (P<0.05)
differences between study and control groups regarding
to mean scores of vomiting from first day till twenty day

also, there was a statistically significant (P<0.001)

difference between study and control groups regarding to
grand mean scores of frequency vomiting from first day
till twenty day. It is clear from the results in table (4) and
figure (2) that the first hypothesis of the study was
proved.
377

World J. Med. Sci., 8 (4): 373-381, 2013

6
5
4
3
study group
2

control group

1s
t.d
a
2n y
dd
a
3r y
dd
a
4th y
da
5th y
da
6th y
da
7th y
da
8th y
da
9th y
d
10 ay
th
d
11 ay
th
d
12 ay
th
da
13 y
th
d
14 ay
th
d
15 ay
th
d
16 ay
th
d
17 ay
th
da
18 y
th
d
19 ay
th
d
20 ay
th
da
y

Fig. 2: Comparison of Mean Scores of Vomiting between Study and Control Groups.
Table 4: Comparison of Mean Scores of Total Vomiting between Study and Control Groups (N = 25)
Item

Control group SD

F. test

P value

1st day

Study group SD
3..281.190

4.801.00

22.831

.000**

2 day

3.041.00

5.08.862

26.899

.000**

3rd day

2.04.676

4.92. 909

30.710

.000**

4th day

1.80.707

4.96.889

30.880

.000**

5th day

1.72.737

4.88.881

30.034

.000**

6th day

1.40.645

4.92.909

31.200

.000**

7th day

1.52.653

4.92.909

31.075

.000**

8th day

1.24.723

5.00.913

30.354

.000**

9 day

1.20.577

5.16.943

32.988

.000**

10th day

1.24.597

5.241.02

31.541

.000**

11th day

1.04.611

5.121.04

29.726

.000**

12th day

1.08.493

4.761.20

25.942

.000**

13th day

1.12.600

4.521.06

26.512

.000**

14th day

.92.640

5.20 1.04

30.089

.000**

15th day

.88.600

5.121.10

28.299

.000**

16th day

.84.624

4.84. 800

33.722

.000**

17 day

.92.493

4.80.913

32.710

.000**

18th day

1.16.624

4.88.332

48.800

.000**

19th day

1.00 .408

4.12.781

33.057

.000**

20th day

.88.440

3.88.881

27.857

.000**

Total mean

27.4412.598

97.1218.382

2867.827

.000**

Grand mean

1.416.6299

4.856.9191

862.696

.000**

nd

th

th

* * Significance at p 0.001
Table 5: Correlation between Sex, Age and Residence of Children and Total Frequency of Vomiting In both Study and Control Groups
Study group (frequency of vomiting)

Control group (frequency of vomiting)

--------------------------------------------------------------------

-------------------------------------------------------------------

Item

P value

Sex

.270

.192

.177

.398

Age

.066

.753

.157

.454

Residence

.091

.666

.180

.388

378

P value

World J. Med. Sci., 8 (4): 373-381, 2013

Table 5 highlights that there was no statistically

significant correlation between sex, age and residence of
children with total frequency of vomiting in study group.
The same results were observed in the control group for
sex, age and residence of children with total frequency of
vomiting. It is obvious from the results in table (5) that the
second hypothesis of the study was proved.

area, the same result was incongruence with what

reported by Parodi et al. [12] as they stated that the main
finding of their study is the detection of statistically
significant higher risks of leukemia in males living in an
industrialized area.
The highest percent of school age children in the
current study in both study and control groups were in
second and third level in primary stage. This result was
interpreted as shortage of ministry of health, health care
team and ministry of raising and education in Egypt in
reaching to these children and providing health education
and raising awareness of children about all carcinogenic
agents and at least early detection of such cases as early
as possible.
Concerning to knowledge of school age children
about chemotherapy and acupressure, the results of the
current study revealed that all school age children in both
study and control groups have not satisfactory
knowledge about chemotherapy and acupressure before
health educational program but the picture changed in the
study group after giving health educational program.
Actually this is a common feature in most of the
Egyptians hospitals and Egyptians society in general,
as rarely can be find one of the health team in Egyptians
hospitals prepare newly admitted hospitalized child and
tell him/her anything about diagnosis and its management
even what is going on. As regard Egyptians society most
of the families do not tell their ill children anything about
their disease and its management as they may be afraid to
tell them the truth or think that children unable to
understand their disease.
This results is supported by Hussein [13] who found
in her study that the majority of her study sample is the
first time for them to be admitted to hospital, all the study
sample reported that no hospital orientation is provided
to them and no one of the health team in the hospital tell
them anything about their diseases even their families.
Concerning whether it is important to provide hospital
orientation and inform children about their diseases to
every newly admitted child or not, most of children in the
sample thought it was very important
Regarding to application of school age children to
acupressure and in study group the current study
explained their ability to apply acupressure after being
provided by research investigators. This indicates to
shortage of health team in oncology institutions in raising
health awareness about alternative medicine in general
and acupressure in specific and its benefits in many
health problems as in vomiting with chemotherapy. At the
same time this gives hope to health care team about
extent to which that children need to know

DISCUSSION
Chemotherapy induced emesis is one of the major
problems observed during the treatment of childhood
malignancies and it also has a great clinical importance
since it can considerably limit the administration of
chemotherapy regimens. All these issues can lead to
greater children morbidity, difficulties in adaptation to
chemotherapy regimens and increased length of time
spent in the hospital [9].
Regarding to socio-demographic characteristics of
study sample, the majority of the school age children in
the current study were male in both study and control
groups. This does not mean leukemia is common in males
than females Egyptians children but this could be return
to most of the Egyptian families care, pay attention and
seek medical advice for their boys than girls. This is based
upon Egyptians believes that males are more important to
their families than females.
This result is supported by another study carried out
by Abd Elghani [10] who reported in his study that the
majority of children who are admitted to National Cancer
Institute for chemotherapy from 2002-2006 showed a
marked male predominance than female.
The mean age of these children was 8.96 1.780 years
in study group and 8.36 1.890 years in control group.
The majority of the school age children in the current
study in both study and control groups were from urban
areas. This result may be interpreted as spread of
carcinogenic factors in urban areas as air pollutions,
unsafe seeds of vegetables and food and unhealthy life in
urban areas, at the same time reflects healthy life in rural
areas as healthy agriculture of seeds of vegetables,
healthy atmosphere and adequate ventilation. All these
can lead to burden puts upon health care services in
urban areas. Moreover, it reflects shortage of ministry of
health and ministry of agriculture in controlling all
carcinogenic agents in urban areas.
The result of the current study is supported by the
findings of study done by Adelman et al. [11] who found
in their study that incidence of Acute lymphatic leukemia
among children is higher in urban areas or high density
regions and increasing degree of urbanization than rural
379

World J. Med. Sci., 8 (4): 373-381, 2013

everything can help them in relive their health problems

with chemotherapy.
With respect to teaching children how to apply
acupressure technique, the result of the current study
matches with result of study done by Jones et al. [14],
pediatric oncology patients have reported effectiveness
of acupressure in preventing vomiting. Acupressure
was feasible and children learn it easily and effectively
and it is well tolerated. Also, Hee et al. [15]
observed in their study that acupressure is easy to
teach to children who are receiving chemotherapy,
children acquired acupressure technique rapidly and
their main motive in that is their need to control feeling of
vomiting.
In the current study, acupressure technique showed
the ability to reduce the frequency of CIV, this result in
the same line with findings of study carried out by Abd
ElMoneem [16] who reported in his study that
acupressure (P6) proves its effectiveness in decreasing
frequency of CIV. Not only had this but proved also its
effectiveness in decreasing amount of vomiting and
severity of vomiting. In the same line Lee et al. [17] and
Bastani et al. [5] mentioned in their study that vomiting
occurrence is significantly lower in the experimental group
who applied acupressure technique compared to the
control group and therefore they reported that applying
acupressure should be recommended as an effective and
non pharmacological method for CIV control.
The result of the present study is in agreement with
what was found by Kim et al. [18] who reported in their
study that acupressure on P6 point shows an effective
adjunct maneuver in reducing vomiting and they
proposed that acupressure should be applied as
supportive nursing intervention strategies to relieve
chemotherapy induced vomiting in pediatric cancer
patients. In addition, the findings from study done by
Garica et al. [6] and Taspinar and Sirin [19] and in
congruence with the result of present study as they
reported that the acupressure applied to P6 is effective in
reducing CIV and may decrease the antiemetic use after
chemotherapy.
Furthermore Gottschling et al. [20] in agreement with
the result of the present study as they found that the
need for rescue antiemetic medication is significantly
lower in acupressure courses compared to control courses
and episodes of vomiting per course are also significantly
lower in courses with acupressure, acupressure as applied
in their study was being effective in preventing vomiting
in pediatric cancer patients. Beside that Reindl et al. [21]
reported in their study that acupressure enables pediatric
cancer patients to experience higher levels of alertness

during chemotherapy and reduced vomiting and no side

effects are noted. They concluded that acupressure
reduces antiemetic medication and episodes of vomiting
in pediatric oncology. But the result of the present study
contradicts with results of study carried out by Wulffa et
al. [22] who found that no significant difference regarding
to frequency of vomiting is detected for children receiving
acupressure in their study compared with control group.
As regards to relationship between sex, age,
residence and frequency of vomiting, the current study
showed that there is no relationship between sex, age,
residence and frequency of vomiting in both study and
control groups. This result is supported by Gottschling et
al. [20] who reported in their study that there is no
relationship between sex and frequency of vomiting in
children in their studied sample. But this result contradict
with what reported by Hesketh [2] who found relationship
between sex, age and frequency of vomiting in children in
his studied sample as reported that female patients and
younger patients being at greater risk for vomiting.
This could be interpreted that Hesketh [2] who found
relationship between sex, age and frequency of vomiting
may be return to another factors predispose child to CIV
as highly emotogenic effect of chemotherapy,
chemotherapeutic regimen, childs expectations and
previous experiences which is not assessed/or discussed
in the current study.
The current study concluded that acupressure P6
decreases frequency of CIV among school age children in
addition, there are no statistically significant relations
between sex, age and residence of children and frequency
of vomiting in both study and control groups. Based on
the results of the present study the hypotheses of the
present study were proved.
The current study recommends that nurses and
physicians should be aware of this technique and teach
to children with leukemia. Acupressure (P6) technique
must be practiced beside antiemetic medications as it
decreases suffering of children with leukemia and cost
effective intervention that can save much money.
Replication of such study on a lager and different age
groups and different types of cancer in children to be able
to generalize the results of current study.
REFERENCES
1.

380

Hawkins,
R.
and
S. Grunberg, 2009.
Chemotherapy induced nausea and vomiting:
challenges and opportunities for improved patient
outcomes. Clinical Journal of Oncology Nursing,
13: 14-21.

World J. Med. Sci., 8 (4): 373-381, 2013

2.
3.
4.

5.

6.
7.

8.

9.

10.

11.

12.

13.

Hesketh, P.J., 2008. Chemotherapy induced nausea

and vomiting. N. Engl. J., 358: 2482-2494.
Nicole,
S.N.
and
A.M. Ursula, 2009.
Chemotherapy-induced nausea and vomiting.
J. Support Oncol., 5: 10-15.
Shin, Y.H., T. Kim, M.S. Shin and H.S. Juon, 2011.
Effect of acupressure on nausea and vomiting during
chemotherapy cycle for Korean postoperative
stomach cancer patients. Cancer Nurs, 27: 267-74.
Bastani, F., M. Khosravi, L. Barimnejad and
H. Haghani, 2011. The effect of acupressure on
Chemotherapy induced nausea and vomiting among
school age children with acute lymphoblastic
leukemia. Complementary Medicine Journal, 1: 1-10.
Garica, M.K., J. McQuade, R. Haddad, et al., 2013.
Systematic review of acupuncture in cancer care:
a synthesis of the evidence. J. Clin. Oncol., 31: 952.
Rodgers, C., 2012. Childrens coping strategies for
chemotherapy induced nausea and vomiting.
Clinical Journal of Oncology Nursing. Available on
line at www.onsconnect.org/2012/04/5min.
Kurucu, N. and M. Durmaz, 2012. Effect of
hydroxyzine in controlling acute chemotherapy
induced vomiting children: a randomized trial. UHOD,
2: 92.
zkan, A., I. Yildiz, L. Yksel, H. Apak and T. Celkan,
2010. Tropisetron (Navoban) in the Control of
Nausea and Vomiting Induced by Combined Cancer
Chemotherapy in Children. Jpn J. Clin. Oncol.,
29: 92-95.
Abd Elghani, R.A., 2009. Trends of pediatric
oncology at
national
cancer
institute,
Cairo University, Egypt: frequencies and survival
from Jan. 2001 to Jan.2006, M.D. thesis, IN Pediatric
Oncology. National Cancer Institute, Cairo.
Adelman, A.S., C.C. McLaughlin, V.W. Chen and
F.D. Groves, 2005. Urbanization and incidence of
acute lymphocytic leukemia among United States
children aged 0-4. Br J. Cancer, 92: 2084-2088.
Parodi, S., E. Stagnaro, M. Vercelli, A. Stella and
F. Valerio, 2013. An ecological investigation
incidence in an urban area near a coke oven
lymphohaematopoietic system cancer. Occup
Environ Med, 60: 187-193.
Hussein, H.A., 2009. Impact of hospital orientation
on anxiety level among hospitalized school age
children. Childhood Magazine, 3: 1-15.

381

14. Jones, E., S. Isom, K.J. Kemper and T.W. McLean,

2008. Acupressure for chemotherapy-associated
nausea and vomiting in children. J. Soc. Integr
Oncol., 6: 141-5.
15. Hee, S.Y., K.M. Im, S. Mi Sook and J. Hee-Soon, 2008.
Effect of Acupressure on Nausea and Vomiting
During
Chemotherapy
Cycle
for
Korean
Postoperative Stomach Cancer Patients. Cancer
Nursing, 27: 267-274.
16. Abd ElMoneem, D.S.E., 2010. Effect of acupressure
on chemotherapy induced nausea and vomiting
among cancer patient, M.D. thesis, Faculty of
Nursing, Cairo University.
17. Lee, J., M. Dodd, S. Dibble and D. Abrams, 2010.
Review
of
acupressure
studies
for
chemotherapy-induced nausea and vomiting control.
J. Pain Symptom Manage, 36: 29-544.
18. Kim, T.I., Y.H. Shin and M.S. Oh, 2009. Effect of
acupressure on nausea-vomiting and weight change
among pediatric cancer patients receiving anti-cancer
chemotherapy. KJCHN, 10: 98-107.
19. Taspinar, A. and A. Sirin, 2010. Effect of acupressure
on chemotherapy-induced nausea and vomiting in
gynecologic cancer patients in Turkey. Eur J. Oncol.
Nurs., 14: 49-54.
20. Gottschling, S., T.K. Reindl, S. Meyer, J. Berrang,
G. Henze, S. Graeber, M.F. Ong and N. Graf, 2009.
Acupuncture to alleviate chemotherapy-induced
nausea and vomiting in pediatric oncology-a
randomized multi center crossover pilot trial.
Klin Padiatr, 220: 365-370.
21. Reindl, T.K., W. Geilen,
R. Hartmann,
K.R. Wiebelitz, Kan, I. Wilhelm, S. Lugauer,
C. Behrens, T. Weiberlenn, C. Hasan, G. Gottsc,
S. hling, T. Wild-Bergner, G. Henze and P.H. Driever,
2010. Acupuncture against chemotherapy-induced
nausea and vomiting in pediatric oncology.
Support Care Cancer, 14: 172-176.
22. Wulffa, B., C. Schmidta, N. Lehmannb, Y. Liua,
A. Eggerta, B. Kremensa, G. Dobosc and G. Spahncd,
2009. Pericardium 6 acupressure and acupuncture as
additive antiemetic therapy during chemotherapy
in
children and adolescents-A randomized
placebo-controlled pilot study. Eur. J. Med.,
1: 205-206.