Beneficial effects of auricular acupressure on preventing constipation in breast cancer patients undergoing chemotherapy:evidence from systematic review and meta-analysis

Objective: To evaluate the available evidence from randomized controlled trials（RCTs） of auricular acupressure（AA） therapy for preventing constipation in breast cancer patients undergoing chemotherapy.Methods: The following databases were searched from their inception until August 2017: Ovid Medline, Embase, the Cochrane Central Register of Controlled Trials（CENTRAL）, and Allied and Alternative Medieine（AMED）. We also searched four Chinese databases:Chinese BioMedical Database（CBM）, China National Knowledge Infrastructure（CNKI）, WANFANG Data, and Chinese VIP Database.Only the RCTs related to the effects of AA therapy on preventing constipation in breast cancer patients undergoing chemotherapy were included in this study. Quantitative syntheses of data from RCTs were conducted using RevMan 5.3 software. Study selection, data extraction, and validation were performed independently by two authors. Cochrane criteria for risk of bias were used to assess the methodological quality of the trials.Results: Four RCTs met the inclusion criteria, and most were of low methodological quality. Study participants in the AA plus routine care group showed significantly greater improvements in the response rate（risk ratio [RR] = 1.27, 95% confidence interval [CI][1.14,1.42], P < 0.01） with low heterogeneity（χ;= 2.31, P = 0.31,I;= 14%）. In addition, when compared with routine care alone,one RCT suggested favorable statistically significant effects of AA plus routine care on Constipation Assessment Scale（CAS; mean difference [MD] =-5.07,95% CI [-6.86,-3.28], P < 0.01）. Furthermore, when compared with routine care alone, one RCT suggested positive statistically significant effects of AA plus routine care on Patient Assessment of Constipation-Quality of Life（PAC-QOL; MD =-1.26, 95% CI [-1.59,-0.93], P < 0.01）.Conclusions: Overall, as a potential safety therapy, only weak evidence can support the hypothesis that AA can effectively prevent constipation in breast cancer patients undergoing chemotherapy.