Acupressure on Xerostomia in Head and Neck Cancer Patients

Xerostomia is defined as "the subjective sensation of dryness of the mouth". It is commonin patients with acute/chronic medical conditions, especially in patients with cancer.Results from observational studies reported 40% to 75% prevalence of xerostomia amongcancer patients. Head and neck cancer patients, as the seventh most common type ofcancer, reported an even higher prevalence (80%) of xerostomia after treatment comparedwith other cancer types. Despite the high prevalence of xerostomia, it is oftenunderrecognized by patients and healthcare providers.Xerostomia in head and neck cancer patients is largely induced by radiation in the headand neck region, which can damage salivary glands, and thereby change the volume,consistency, and pH of their saliva. Besides, xerostomia may be caused or exacerbated bythe concomitant or sequential use of chemotherapy agents and other drugs (e.g., opioid).Consistent lacking saliva in cancer patients can lead to increased risk of oral fungalinfection, caries, swallowing problems, sleep problems, depression, fatigue and alteredtaste, which may even result in poor nutritional status. Furthermore, xerostomia maybecome a chronic and even irreversible side effect.Current therapies for xerostomia in cancer patients include both pharmacological andnon‐pharmacological treatments. Pharmacotherapy has been considered as a generaltreatment for stimulating saliva secretion in alleviating xerostomia for head and neckcancer patients. However, the evidence of pharmacological interventions (e.g.,pilocarpine, bethanechol, amifostin, cevimeline and palifermin) on xerostomia isinsufficient, and the use of pharmacotherapy may cause some common adverse effects,including nausea, sweating, nervousness, and urinary frequency. Non‐pharmacologicaltreatments such as saliva stimulants (e.g. citric and malic acids, chewing gum,toothpaste and lozenges) and saliva substitute (e.g. liquids, gels and sprays) have alsobeen suggested to treat xerostomia, but neither with sufficient evidence of significanteffect, and may also lead to adverse effects (e.g., nausea, unpleasant taste, diarrhea,and tooth mineralization). Some patients may find regular sips of water useful, but onlyfor temporary benefit, because saliva is a complex substance with irreplaceable functions(antibacterial and immunologic protection). Therefore, an evidence‐based effectivestrategy with few adverse events is warranted for head and neck cancer patients withxerostomia.Both acupressure and acupuncture aim to improve health and cure illnesses by improvingenergy flow through stimulating meridian points. Acupressure is a non‐invasive techniqueof activating acupoints using hands, fingers, or thumbs along the meridians, whileacupuncture involves the use of needles. Stimulation on acupoints may increase the flowof blood and qi along the related meridians, as well as stimulate the local blood flowaround the salivary glands, thereby increasing salivary secretion. Also,acupressure/acupuncture may stimulate the parasympathetic nervous system, henceindirectly stimulate salivary glands secretion. Besides, microcirculation may be promotedthrough the release of sensory neuropeptides, so as to increase the tissue oxygenationand metabolism. Some studies had demonstrated positive effect of acupuncture onxerostomia for head and neck cancer patients, while none examined acupressure. Based onthe same meridian theory, both acupuncture and acupressure were widely applied to thesymptom management (e.g. fatigue, nausea, pain) for cancer patients, effectively withgood adherence. Compared to acupuncture, acupressure can be administered by patientsthemselves after training. The purpose of this study is to examine the effect ofself‐administered acupressure on xerostomia for head and neck cancer patients.