Padjadjaran Nursing Journal (Jurnal Keperawatan Padjadjaran)

ISSN 2338-5324 (print)

ISSN 2442-7276 (online)
Online di http://jkp.fkep.unpad.ac.id
DOI : 10.24198/jkp

Effect of Nei Guan Acupressure Point as Adjuvant Therapy on Highly

Emetogenic Chemotherapy-Induced Nausea-Vomiting in School-Age
Children with Cancer

Triliana Purwadesi Yuliar, Susi Susanah, Ikeu Nurhidayah

Faculty of Nursing Universitas Padjadjaran
Email : triliana_py@yahoo.co.id

Submitted: 01-09-2018 Accepted: 15-04-2019 Published: 28-04-2019

Abstract

Chemotherapy as a pediatric cancer treatment has nausea and vomiting side effects. Nausea and vomiting in
school-age children with cancer can lead to nutritional, emotional, playing, and school function disorders,
decreasing the quality of life in children. An adjuvant therapy that can decrease chemotherapy-induced nausea and
vomiting is acupressure which is non-invasive and safe. Nei Guan acupressure point uses pressure technique on
the wrist. This study was conducted to determine effects of Nei Guan acupressure on nausea and vomiting due to
highly emetogenic chemotherapy in school-age children with cancer. The study design was quasi-experimental
through a pre-post test design study approach, with single-blind control. Thirty respondents obtained from
the average calculation of two population hypothesis test, were divided into a control and intervention group
comprising 15 people respectively. Both groups got the same antiemetic. Measurement of nausea was performed
three times during the study using the Pediatric Nausea Assessment Tools (PeNAT), while vomiting intervals
were documented for every vomiting and retching. Data analysis used the Mann Whitney and independent
t-test. The analysis result in the control group showed that the average nausea value tended to increase and the
vomiting interval was faster than in the intervention group. In conclusion, Nei Guan acupressure affects nausea
and vomiting due to highly emetogenic chemotherapy in school-aged children with cancer although it is not
statistically significant (p-value> 0.05). Nurses are expected to monitor ongoing nausea and vomiting, and consider
acupressure as adjuvant therapy, besides providing pharmacological treatment to reduce nausea and vomiting.

Keywords: Acupressure, chemotherapy, nausea, school-age children, vomiting.

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 Triliana Purwadesi Yuliar: Effect of Nei Guan Acupressure Point as Adjuvant Therapy

Introduction Group, 2015).

School-age children are the group at risk
The Ministry of Health of the Republic of of experiencing nausea and vomiting. Batson
Indonesia (2015) explains that cancer is et al. (2016) reveal that school-age children
included in non-communicable diseases and with cancer, who experienced nausea and
is the cause of around 8.2 million deaths vomiting after three months of chemotherapy
in the world in 2012. WHO data (2016) show 24% increase in anxiety level and
revealed the prevalence of pediatric cancer 28% in depression rate which results in
is approximately 4% of all cancer cases, and emotional behavior changes, and nutritional
child mortality in the world due to cancer is disorders. This condition can interfere with
estimated at 90,000 children each year. The the primary task of school children, namely
Indonesian Hospital Association Data and fulfilling adequate nutritional needs, carrying
Information Center (PERSI) (2014) reports out school functions and playing (Wong,
that 2–4% of cancer incidence in Indonesia Hockenberry, & David, 2011).
occur in pediatric patients. It estimates that Nutrition is a top priority in the growth
every year there are approximately 11,000 period of school-age children as at this age
cases of childhood cancer, and about 10% of children need sufficient energy to think and
child mortality is caused by cancer. move according to their developmental tasks
Childhood cancer management includes (Ball, Bindler, & Cowen, 2012). Also, a
surgery, chemotherapy, and radiotherapy. The study conducted by Nurhidayah, Hendrawati,
therapy can be single or combined. Providing Mediani, and Adistie (2016) found that 53.3%
treatment through radiotherapy and surgery is of school-age cancer patients had a poor
a local therapy while giving treatment through quality of life with the lowest score on school
chemo is a systemic therapy (Balduci, 2008). functions due to chemotherapy-induced
The primary goal of chemotherapy is to cure, nausea and vomiting. The impact of nausea
control or reduce the growth of cancer cells and vomiting on school function results in
(Price & Wilson, 2009). children often skip school, get quickly tired
The incidence of side effects in pediatric when attending lessons and have difficulty
patients is bone marrow depression, diarrhea, to concentrate while studying. The playing
stomatitis, hair loss, skin disorders, and function impairment in school children may
vomiting and nausea (Apriany, 2010). be caused by fatigue due to chemotherapy-
Chemotherapy-induced nausea and vomiting induced nausea and vomiting.
are the most common side effect in children. The management of nausea can be
The study of Millennials, Baraz, Baraz, performed by pharmacological and non-
Nourt, and Baeis (2015) explained that the pharmacological therapy while the non-
prevalence of chemotherapy-induced nausea pharmacological management can be
and vomiting in pediatric patients is 54% performed on pediatric patients as adjuvant
-96%. The most feared experience by patients therapy both in hospitals and at home as
is nausea, while in the third place is vomiting. palliative care to improve quality of life.
The response of vomiting to chemotherapy According to Suardi (2011), the use of
can occur after emetogenic agents have complementary therapy can divert a person’s
chemically stimulated the vomiting center. uncomfortable perception so that a balance
Emetogenic agents directly stimulate the between body, mind, and spirit is expected
release of serotonin (5 HT3) from intestinal to reduce the stress he/she faces. Nurses, as
enterochromaffin cells to the Chemoreceptor health workers can perform complementary
Trigger Zone (CTZ) in the area postrema of traditional health services which are
the cortex and arouse the vomiting center, empirically beneficial and safe, as is stated in
resulting in nausea and vomiting reactions the Government Regulation of the Republic
(Rhodes & Mc Daniels, 2001). Related to of Indonesia No. 103 the Year 2014, article
this, chemotherapy drugs are classified into 30 paragraph 2.
4 emetogenic levels, which are high (> 90%), Some types of complementary therapy
medium (30% – <90%), low (10% – <30%) that can be executed in pediatric cancer
and minimal (<10%) (Children’s Oncology patients are music therapy, food supplements

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 Triliana Purwadesi Yuliar: Effect of Nei Guan Acupressure Point as Adjuvant Therapy

(herbal), aromatherapy, imaginary guidance patients. This study aimed to determine

and massage therapy (Ball et al., 2012). the effect of Nei Guan acupressure point
Massage therapy in the form of applying as adjuvant therapy for highly emetogenic
pressure to specific points has advantages over chemotherapy-induced nausea and vomiting
other treatments in reducing chemotherapy- in school-age children with cancer.
induced nausea and vomiting in children can
be performed in a caring room, is non-toxic,
free of charge, harmless and does not use any Method
media.
Acupressure uses fingertip pressure. This research was a quantitative study with
The pressure is applied using the fingertips, a quasi-experimental research design using
beginning with mild stress then gradually a single-blind approach to pre-post test
the pressure is increased until a gentle design study. The study was conducted at the
but painless sensation is felt (Rusdiatin & Kenanga 2 Room, Dr. Hasan Sadikin Hospital
Maulana, 2007). This therapy is derived from Bandung in August-September 2017. This
an acupuncture therapy based on the concept study obtained approval from the Health
of ancient China that uses special needles to Research Ethics Committee of Universitas
acupuncture points (Xie Wei) (Jie, 2008). The Padjadjaran with number LB.04.01/A05/
central principle in acupressure is to balance EC/204/VII/2017.
between yin and yang. In the human body, The study subjects were obtained in
there is a meridian line (Jing Luo) which is parallel based on a randomized allocation
a channel for flowing vital energy (Qi) and list (randomization table) that was made
blood (Xue) and serves to connect Zhang Fu without the knowledge of the researcher and
organs that are associated with four limbs was only known by the coordinator rater as
(Sukanta, 2008). The choice of acupressure as the study was single blind. The selection
a complementary therapy is safe and effective of study subjects was through consecutive
which can minimize the side effects of nausea sampling technique based on specific criteria
and vomit with the pharmacological treatment until the minimum number of study subjects
provided (Hosseini, Tirgari, Forouzi, & was fulfilled. Inclusion criteria for the study
Jahani, 2016). One of the acupressure subjects used in this study included obtaining
points to reduce chemotherapy-induced highly emetogenic pharmacology, platelets
nausea and vomiting is the Nei Guan point. > 50,000 / mm3, obtaining intra-vena or
A study conducted by Shen & Yang (2016) intrathecal chemotherapy.
state that Nei Guan acupressure therapy can The number of the study sample was 30
significantly increase energy on the meridian people obtained from the results of calculation
line by reducing severe vomiting nausea in of the average hypothesis test of two
cancer patients receiving chemotherapy. This populations. The study sample was school-
acupressure point is easier to use in pediatric age children (6–12 years) who received
patients than other positions because the highly emetogenic chemotherapy. The
location of the pressure point is accessible, sample was divided into two groups, namely
easy to learn, non-invasive and recommended the control and intervention group as many
for the recovery of the digestive tract (Miao as 15 people respectively. The control group
et al., 2017). received standard pharmacological therapy in
Based on the previous explanation, the the form of anti-emetic administration, while
inference is that Nei Guan point acupressure the intervention group received standard
can be performed quickly, effectively, and is pharmacological treatment in the form of
well tolerated in pediatric cancer patients as anti-emetic and intervention of Nei Guan
adjuvant therapy. Acupressure is non-invasive, acupressure as adjuvant therapy. Nei Guan
so it is not painful and is a touch therapy. The acupressure is performed for two days and
difference with the above research is that the given three times a day, 30 minutes before
study would be carried out by considering chemotherapy, before breakfast and before
highly emetogenic chemotherapy and specific dinner. Five raters (research assistants) who
nausea and vomiting instruments to pediatric were previously trained, assisted in the

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 Triliana Purwadesi Yuliar: Effect of Nei Guan Acupressure Point as Adjuvant Therapy

acupressure treatment and data collection. informed consent, the researcher explained
The measuring instrument used in this about recording the time of vomiting/nearly
study is the Pediatric Nausea Assessment vomiting for two days. Vomiting intervals
Tools (PeNAT) made by L. Lee Dupuis, M.Sc., were recorded in the sheet provided by the
Phm., FCSHP. The researcher has received researcher. Parents wrote down the time
permission to use the instrument and change each child experienced vomiting or almost
the language, so the researcher conducted vomited.
a back translation, content validity and The numerical comparative hypothesis
reliability test with the Interclass Correlation test in pairs for the measurement of nausea
Coefficient (ICC) test to 5 raters using media values P1, P2 and P3 in each group used
hand out and video. The content validity the Friedman test because measurements
test was carried out by two experts, namely were performed more than twice and were
child nursing and palliative care experts. The not normally distributed. The numerical
result of the test obtained a value of 0.75 after comparative hypothesis test between the
using the Gregory formula, so it indicated control and intervention group in the nausea
that the instrument had a high validity value. scale measurement P1, P2 and P3 used
The reliability test was carried out on ten the Mann Whitney test because it was not
pediatric patients with cancer whose results normally distributed. The analysis was also
were obtained with a kappa value of 0.866 used to determine the difference in mean of
which indicated that the degree of conformity vomiting interval between the control and
among the five raters had high stability. intervention group calculated in minutes.
Measurement of nausea value was The measurement of an unpaired numerical
carried out three times, namely 1 hour after comparative hypothesis test for the difference
chemotherapy (P1), after waking up the in vomiting interval used unpaired t-test
second day (P2) and before going to bed the because it was normally distributed.
second day (P3). Measurement of vomiting
interval in both groups was carried out on the
first day of chemotherapy until the second day. Result
After the respondent parents’ submitted the
Table 1 Frequency Distribution Based on Characteristics of Respondents in Control and
Intervention Group (n = 30) at Dr. Hasan Sadikin Hospital Bandung
Variable Total % Group
Control (n=15 Intervention
(n=15)
Sex
Man 17 56.67 9 (60,0) 8 (53,3)
Woman 13 43.33 6 (40,0) 7 (46,7)
Age (years)
6–8 years 19 63.34
9–10 years 4 13.33
11–12 years 7 23.33
Average
± SB 8±3 8±2
Range 6–12 6–12
Type of Cancer
Systemic 11 36.67 4 (26,7) 7 (46,7)
Solid 19 63.33 11(73.3) 7 (46.7)
Experience of
Vomiting

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 Triliana Purwadesi Yuliar: Effect of Nei Guan Acupressure Point as Adjuvant Therapy

Yes 25 83.33 11(73.3) 14(93.3)

No 5 16.67 4(26.7) 1(6.7)

Table 2 Nausea Value Differences on First (P1), Second (P2) and Third (P3) Measurement in
Control Group
Control Nausea Value pa-Value
Group First Measuremen Second Third
(n=15) t (P1) Measurement Measurement (P3)
(P2)

Median 1,00 1,00 2,00 0,001*

Min.-max. Range 1,00 – 2,00 1,00 – 3,00 1,00 – 4,00
* Analysis using the Friedman test, significant p≤ 0.05

Table 3 Nausea Value Differences on First (P1), Second (P2) and Third (P3) Measurement in
Intervention Group
Intervention Nausea Value pa-Value
Group First Measuremen Second Third
(n=15) t (P1) Measurement Measurement (P3)
(P2)

Median 1.00 1.00 2.00 0.244

Min.-max. Range 1.00 – 4.00 1.00 – 4.00 1.00 – 4.00
Note: Analysis using the Friedman test, significant p≤ 0.05

Table 4 Nausea Value Differences among P1, P2, and P3 in Control and
Intervention Group
Measurement Control Intervention p-Value
Group Group
(n=15) (n=15)

Median Min-Max Median Min-Max

First (P1) 1.00 1.00–2.00 1.00 1.00–4.00 0.967
Second (P2) 1.00 1.00–3.00 1.00 1.00–4.00 0.713
Third (P3) 2.00 1.00–4.00 1.00 1.00–4.00 0.305
Note: Analysis using the Mann Whitney test, significant p≤ 0.05

Intervensi
Skala Mual

2 Kontrol

0
P1 P2 P3
Waktu Pemeriksaan

Graph 1 Differences in mean values of nausea in the control and intervention group

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Table 5 Differences in Vomiting Intervals between Control and Intervention Group

Vomiting Interval Group p-Value
(Minute) Control Intervention
n=11 n=9
Median ± SD 289,4 ± 148,4 313,6±187,0 0,751
Range 82,5 – 513,3 84,6 – 724,5
Note: Analysis using an unpaired t-test, significant p≤ 0.05

The characteristics of the respondents group was faster (289.4 minutes) compared
indicated sex was dominated by male to the intervention group (313.6 minutes).
(56.67%). The highest age in the two The results of unpaired t-test showed that the
groups was 6–8 years on average (63.34%) use of acupressure affected vomiting/ almost
(Table 1). Most cancers were solid tumors vomiting after chemotherapy even though
(63.33%) with the most diagnosed disease, it was not statistically significant (p-value>
Rhabdomyosarcoma. Most respondents in 0.05) (Table 5).
both groups had previous experiences of
nausea and vomiting (83.33%).
The mean of nausea value in the first Discussion
measurement and the second measurement
had the same value (median = 1). The mean Nausea and vomiting are side effects of
value of nausea in the third measurement chemotherapy which are most often felt
tended to increase (median = 2). Results of by pediatric cancer patients. The response
the Friedman test obtained a p-value of 0.001 of vomiting to chemotherapy can occur
(p-value ≤0.05) so it can be inferred that after the vomiting center receives chemical
in the control group there was a significant stimulation from the emetogenic level. The
difference in the mean value of nausea acute phase of nausea vomiting occurs when
between P1, P2, and P3 (Table 2). chemotherapy and radiation drugs cause
There was no difference in the mean serotonin release from enterochromaffin cells
value of nausea for the three measurements in the intestine. Increased serotonin receptors
because they had the same value (Median = or 5-Hydroxytryptamine type 3 (5HT3) in the
1.00). Statistical tests using the Friedman test central nervous system area, especially in the
obtained a p-value of 0.244 (p value> 0.05), CTZ area, will cause nausea and vomiting.
so the result showed that in the intervention Vomiting occurs when the CTZ stimulates
group there was no significant difference in the vomiting center, and efferent impulses
the mean of nausea value between P1, P2, are sent through cranial nerves V, VII, IX, X,
and P3 in the intervention group (Table 3). XII and spinal nerves to the central area of
Statistical test results on measurements salivation, abdominal muscles, respiratory
between the control and intervention group center, and nerve center (Rhodes & Mc
using the Mann Whitney test showed that Daniels, 2001).
the first measurement (P1) was 0.967, the Some of the effects of nausea complained
second measurement (P2) was 0.713, and the by several study subjects were reduced
third measurement (P3) was 0.305. The three appetite and sleep disorders. Decreased
measurements showed that there were no appetite can lead to a risk of nutritional
significant differences marked with a p-value deficiencies. Owen, Hanson, Mc Arthur and
> 0.05 (Table 4). Mikhailov (2013) explain, approximately
Furthermore, there was a tendency of 46% of children and adolescents with cancer
rising nausea values in the control group are malnourished or at risk of malnutrition.
compared to the intervention group (Graph Many of those who lose appetite do not even
1). The study results explained it as clinically want to eat at all. Hence, it is often found that
significant, but statistically insignificant hospital food is still left or not touched at all.
(Dahlan, 2010). Besides a decreasing appetite is the impact of
Also, the mean vomiting interval showed chemotherapy side effects, it can also be due
that the vomiting interval in the control to the type of food that is not generally served

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like at home, while school-age children need The statistical test results between the two
adequate nutritional intake in increasing groups showed that the test results were not
growth and development according to their significant but from the mean values between
age level. groups explained that acupressure had the
Rahmayanti and Agustin (2015) explain effect of suppressing chemotherapy-related
school-age children with cancer who get nausea. The results of the mean nausea
chemotherapy have poor sleep quality. value showed that the control group tended
Nausea can cause sleep disorders which to increase the mean value of nausea, while
causes discomfort. Discomfort due to nausea the intervention group did not experience an
from chemotherapy effects can decrease the increase (Graph 1).
quality of life of children with cancer as Acupressure is one of the adjuvant
nausea causes fatigue (Sefrina, Nurhaeni, & therapies by applying pressure to the skin
Hayati, 2014). Fatigue can interfere with the on the acupoints. The pathological state
developing tasks of school children whether of nausea and vomiting can occur due to a
playing or studying. chronic disease which causes weakness in
Several study subjects felt nauseous the stomach (Wei). Applying acupressure
complaints a few hours after undergoing can accelerate the circulation of energy
highly emetogenic chemotherapy. This is (Qi) and blood (Xue) through the flow of
in line with several studies explaining that meridian lines (Jing Luo), after performing
the peak of nausea and vomiting can occur massage stimulations to the appropriate
after 1–2 hours after chemotherapy, but points (Jie, 2008). The acupoint for nausea
other studies reveal that the height of acute and vomiting is the Nei Guan point. This
vomiting will reach a maximum of 5–6 hours point will stimulate the release of alpha beta
in the first 24 hours after administration (αβ) and alpha (α) fibers through sensory
of chemotherapy (Enikmawati, 2016; receptors. These fibers will interact with
Rithirangsriroj et al., 2014). the central nervous system which results in
The administration of antiemetic drugs endorphogenic cells removing endorphins
before chemotherapy aims to prevent from the hypothalamus. The increased levels
nausea and vomiting as a result of the highly of endorphins in the blood and cerebrospinal
emetogenic level. Gilmore et al. (2013) explain fluid will cause a sense of comfort and
that without prophylactic antiemetic drugs, decrease the impulse of nausea and vomiting
the incidence of chemotherapy vomiting is in the area of Chemoreceptor Trigger Zone
between 30% and <90% in chemotherapy (CTZ) and vomiting center (Dastgir, 1988;
drugs with moderate and high emetogenic Syarif et al., 2011).
levels, so administration of antiemetics Nausea and vomiting felt by people with
should be before chemotherapy. Prevention cancer who get chemotherapy are acute
of nausea and vomiting with antiemetic and slow nausea and vomiting. Syarif et
administration will successfully control al. (2011) explain that patients who receive
nausea and vomiting in the acute phase, chemotherapy will experience mild nausea
namely 0–24 hours after the chemotherapy and vomiting on the first day and will increase
administration. on the second day. This study contrasted with
The administration of antiemetic therapy the explanation because the intervention
in both groups was in the form of ondansetron group which received acupressure in this
via intravenous. Ondansetron is one of the study did not increase the mean value of
types of antiemetic which is antagonistic for nausea on the second day. This result is in
serotonin receptors. Katzung, Master, and line with the study result by Eunice (2012),
Trevor (2013) describe serotonin receptor explaining that the effect of Nei Guan
antagonists as potent antiemetics with the acupressure is noticeable on the second day
mechanism of action of blocking serotonin to the fifth day.
receptors in the vomiting center and The administration of acupressure and
Chemoreceptor Trigger Zone mainly through antiemetics has a similar goal, which is to
peripheral serotonin receptor blockade in provide comfort by decreasing the value
spinal afferent nerves. of nausea and vomiting. The mechanism

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of decreasing nausea and vomiting in both results can be used as input to carry out further
is different; acupressure is by increasing research related to the use of acupressure to
endorphins and antiemetics by blocking reduce chemotherapy-induced nausea and
serotonin receptors. The effect of acupressure vomiting by considering the homogeneity of
administration was illustrated in the cancer types, other age of children, and cycle
intervention group with the value of nausea of chemotherapy. Besides Nei Guan point,
in the first to third measurements did not further research can be carried out to other
increase, and the vomiting interval was points, both singly and in combination.
longer. This showed that the administration of
adjuvant therapy along with pharmacological
treatment was more influential in decreasing References
the value of nausea compared to merely
pharmacological administration. The Abusaad, F. S., & Ali, W. G. M. (2016). Effect
inference was that giving acupressure of point 6 acupressure on chemotherapy-
affected suppressing nausea and vomiting associated nausea and vomiting among
due to chemotherapy. adolescents with cancer. Journal of Nursing
Education and Practices, 06, 122–129.
Conclusion Apriany, D. (2010). The influence of Music
Therapy Over Delayed Nausea Vomiting as
Based on the study results, the majority is Chemotherapy Effect on School-Age Who
male respondents; they have a solid tumor Suffer Cancer at RSUP Dr. Hasan Sadikin
type, and previous nausea and vomiting Bandung. Kartika Kesehatan Stikes Jendral
experiences. Also, the study results show Ahmad Yani.
that the control group tends to increase
in the mean of nausea and vomiting, and Aseeri, M., Mukhtar, A., Elimam, N.,
vomiting intervals are faster. The conclusion Jastaniah, W., & Al-Khansa, S. (2012). A
is, the effect of applying acupressure to Retrospective Review of Antiemetic Use
emetogenic chemotherapy-induced nausea for Chemotherapy Induced Nausea and
and vomiting in school-age children with Vomiting in Pediatric Oncology Patients at
cancer is clinically significant, even though a Tertiary Care Centre. Journal of Oncology
statistically not significant. Pharmacy Practice, 19, 138–144. doi:
There are limitations in this study, namely 10.1177/1078155212457966.
taking too many raters can affect the depth of
acupressure suppression, and the intervention Balduci, L. (2008). Cancer Treatment. New
was carried out for two days to obtain data on York: Springer Publishing Company.
the trend of nausea due to the administration
of highly emetogenic chemotherapy and Ball, J. W., Bindler, R. C., & Cowen, K. J.
applying pressure on other acupressure points (2012). Principles of Pediatric Nursing:
given singly or combined. Caring for Children (5 ed.). New Jersey:
For health services: it expects that Pearson Education Inc.
the study results may be input for the
hospital as a service standard in handling Batson, A. S. K., Lu, X., Balsamo, L.,
chemotherapy-induced nausea and vomiting, Graber, K., Devidas, M., Winick, N. J.,
and coordinating with the health promotion dkk. (2016). Prevalence and Predictors of
section to facilitate the creation of leaflets Anxiety and Depression after Completion
and videos on Nei Guan acupressure. Giving of Chemotherapy for Childhood Acute
acupressure can be considered as an option Lymphoblastic Leukemia: A Prospective
for nurses and patient’s parents as adjuvant Longitudinal Study. American Cancer
therapy which is carried out simultaneously Society, 122, 1608–1617. doi: 10.1002/
with the provision of pharmacological cnr.29946.
treatment.
For researchers: it expects that the study Children’s Oncology Group. (2015).

74 Volume 7 Issue 1 Apr 2019

 Triliana Purwadesi Yuliar: Effect of Nei Guan Acupressure Point as Adjuvant Therapy

Guidelines for The Prevention of Nausea and Hosseini, M., Tirgari, B., Forouzi, M.
Vomiting Due to Antineoplastic Medication A., & Jahani, Y. (2016). Guided Imagery
in Pediatric Cancer Patients. Effects on Chemotherapy Induced Nausea
Vomiting in Iranian Breast Cancer
Corwin, E. J. (2009). Buku Patofisiologi Edisi Patients. Complementary Therapies in
3 (E. W. Egi Komara Yudha, Devi Yulianti, Clinical Practice, 25, 8–12. doi: 10.1016/j.
Pamilih Eko Karyuni Ed.). Jakarta: EGC. ctcp.2016.07.002.

Dahlan, S. (2010). Besar Sampel dan Cara Hussein, A., H, & Abdel Sadek, B., R (2013).
Pengambilan Sampel dalam Penelitian Acupressure for chemotherapy Induced
Kedokteran dan Kesehatan (3 ed.). Jakarta: Vomiting Among School Age. World Journal
Salemba Medika. of Medical Science. doi: 10.5829/idosi.
wjms.2013.8.4.7581.
Dastgir, F. (1988). Combination
Aromatherapy and Acupressure for Treating Jie, S. K. (2008). Ilmu Terapi Akupunktur
Nausea and Vomiting. Journal of The Royal (d. Prof Subowo, MSc., Ph.D., Trans.).
Society of Medicine. Singapore: TCM Publication.
Enikmawati, A. (2016). Pengaruh Katzung , B., G,Master , S., B, & Trevor ,
Aromaterapi Jahe terhadap Mual Muntah A., J. (2013). Farmakologi Dasar dan Klinik
Akut akibat Kemoterapi pada Penderita (Vol. 2). Jakarta: EGC.
Kanker Payudara di RS PKU.
Kementerian Kesehatan RI. (2015). Situasi
Eunice, E. (2012). The effect of Acupressure Penyakit Kanker. Infodatin.
and Nurse Provided Counseling on
Chemotherapy-Induced Nausea and vomiting Mason, H., DeRubuis, B., Burke, N., Shannon,
in Patients with Breast Cancer. Oncology M., Karsies, D., Wolf, G., dkk. (2016).
Nursing Forum, 39(1). Symptom management during and after
treatment with concurrent chemoradiotherapy
Muhammadiyah Surakarta. Jurnal for oropharyngeal cancer: A Review of the
Kebidanan, 07(02), 115–222. literature and areas for future research. World
Journal of Clinical Oncology, 7(2), 220–226.
Flank, J., Robinson, P. D., Holdsworth,
M., Phillips, R., Portwine, C., Gibson, Miao, J., Liu, X., Wu, C., Kong, H., Xie,
P., dkk. (2016). Guideline for Treatment W., & Liu, K. (2017). Effects of acupressure
of Breakthrough and The Prevention of on Chemotherapy-Induced Nausea and
Refractory Chemotherapy-Induced Nausea Vomiting- a systematic review with Meta-
and Vomiting in Children with Cancer. analyses and Trial Sequential Analysis of
Pediatric Blood Cancer, 63. doi: 10.1002/ Randomized Control Trials. International
pbc.25955. Journal of Nursing Studies, 70, 27–37. doi:
10.1016/j.ijnurstu.2017.02.014.
Gilmore, J. W., Peacock, N. W., Gu, A.,
Szabo, S., Rammage, M., Sharpe, J., dkk. Miladinia, M., Baraz, S., Nourt, E., M, &
(2013). Antiemetic Guideline Consistency Baeis, M., G. (2015). Effects of Slow-Stroke
and Incidence of Chemotherapy-Induced Back Massage on Chemotherapy-Induced
Nausea and Vomiting in US Community Nausea and Vomiting in Pediatrics with
Oncology Practice: INSPIRE Study. Journal Acute Leukemia: a challenge of Controlling
of Oncology Practice, 10(01). Symptoms. International Journal of
Pediatrics, 3.
Hockenberry, M. J., Wilson, D., & Wong, D.
L. (2013). Wong’s Essentials of Paediatric Navari, R. M. (2017). Cancer Patient a High
Nursing (9 ed.). United States of America: Risk for Chemotherapy-Induced Nausea
Elsevier. and Vomiting- Prediction assessment

Volume 7 Issue 1 Apr 2019 75

 Triliana Purwadesi Yuliar: Effect of Nei Guan Acupressure Point as Adjuvant Therapy

Tools. Expert Review of Quality of (ToUS) pada Anak yang Mengalami Mual
Life in Cancer Care, 02, 103–108. doi: Akibat Kemoterapi di Ruang Rawat Non
10.1080/23809000.2017.1297204. Infeksi RSCM Jakarta. Jurnal Keperawatan
Muhammadiyah.
Nurhidayah, I., Hendrawati, S., Mediani,
H. S., & Adistie, F. (2016). Kualitas Hidup Shen, C. H., & Yang, L. Y. (2016). The Effect
Anak Dengan Kanker. Jurnal Keperawatan of Acupressure on Meridian energy as Well
Padjadjaran, 04. as nausea and Vomiting in Lung Cancer
Patients Receiving Chemotherapy. Biological
Owen, J. L., Hanson, J. L., Mc.Arthur, J. Research for Nursing.
A., & Mikhailov, T. A. (2013). The Need
for Evidence-Based Nutritional Guidelines Suardi, D. R. (2011). Peran dan Dampak
for Pediatric Acute Lymphoblastic Leukemia Terapi Komplementer/Alternatif bagi Pasien
Patients: Acute and Long-Term Following Kanker. CDK, 38.
Treatment. Nutrients, 5. doi: 10.3390/
nu5114333. Sukanta, P. O. (2008). Pijat Akupresur untuk
Kesehatan (S. Kusumawati Ed. 01 ed.).
Perhimpunan Rumah Sakit Seluruh Indonesia Jakarta: Penebar Plus+.
(PERSI). (2014). Kondisi Pencapaian
Program Kesehatan Anak Indonesia. Syarif, H.,Nurachmah, E., & Gayatri, D.
Infodatin. (2011). Terapi Akupresur dapat menurunkan
keluhan mual muntah akut akibat kemoterapi
Price , S. A., & Wilson , L. M. (2009). pada pasien kanker:Randomized Clinical
Patofisiologi : Konsep Klinis Proses-Proses Trial. Jurnal Keperawatan Indonesia, 14,
Penyakit (Peter, Trans.). Jakarta: EGC. 133–140.

Rahmayanti, N. D., & Agustin, N. (2015). Utami, T. K. (2014). Pengaruh akupresure

Kualitas Tidur Anak Usia Sekolah yang p6 terhadap mual muntah lambat akibat
Menjalani Kemoterapi di Rumah Sakit kemoterapi pada anak Usia Sekolah dengan
Kanker. Jurnal Keperrawatan Indonesia, 18. Leukemia Limfoblastik Akut. COPING
NERS (Community Publishing in Nursing), 2.
Rhodes, V. A., & Mc Daniels, R. W. (2001).
Nausea, Vomiting, and Retching: Complex Wahyuni, D.,Huda, N., & Utami, G. T.
Problem in Palliative Care. Cancer Journal (2015). Studi Fenomenologi : Pengalaman
for Clinicians, 51, 232–248. Kanker Stadium Lanjut yang Menjalani
Kemoterapi. Jurnal Online Mahasiswa, 2(2).
Rithirangsriroj, K.,Manchana, T., &
Akkayagorn, L. (2014). Efficacy of Waqar, S. N., Mann, J., Baggstorm, M. Q.,
Acupuncture in Prevention of Delayed Waqar, M. A., Chitneni, P., William, K.,
Chemotherapy Induced Nausea and Vomiting dkk. (2016). Delayed nausea and vomiting
in Gynecologic Cancer Patients. Elsevier, from carboplatin doublet chemotherapy.
136, 82–86. doi: 10.1016/j.ygyno.10.025. ACTA ONCOLOGICA, 55(6). doi:
10.3109/0284186X.2016.1154603.
Rusdiatin, I. E., & Maulana, D. (2007).
Pengaruh Pemberian Teknik Akupresur WHO. (2016). International Childhood
terhadap Tingkat Nyeri Persalinan Kala I Cancer Day: Much Remains to be Done to
di Rumah Sakit Rajawali Citra Potorono Fight Childhood Cancer. IARC.
Banguntapan Bantul,2007. Seminar Nasional
Teknologi 2007. Wong, Hockenberry, M., J, & David, W.
(2011). Nursing Care of Infants and Children
Sefrina, A.,Nurhaeni, N., & Hayati, H. (2014). (9 ed. Vol. 1). New York: Elsevier.
Aplikasi Theory of Unpleasant Symptoms

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