ACUPRESSURE THERAPY TO REDUCE CHEMOTHERAPY PATIENT PAIN

Siti Rahmawati
Introduction
Cancer is a disease that begins with the presence of cells whose growth is
uncontrolled and causes damage to healthy cells in the body. Cancer is one of the
leading causes of death worldwide in both developed and developing countries
(Ministry of Data and Information Center, 2015). In Indonesia today cancer has
become a health problem that must be addressed thoroughly, integratedly,
effectively, efficiently, and ecnomisally. Cancer can potentially affect all walks of
life, although in the data it is still dominated by the elderly but the latest data shows
an increase in cancer occurring in the age range of children, adolescents, and adults
(Society &Asco, n.d.). The prevalence of cancer patients in Indonesia is 1.4% with
a total of 347,792 patients (Ministry of Health, 2017). In 2018, approximately 8.2
million deaths were caused by cancer. Global Cancer Observatory 2018 data from
the World Health Organization (WHO) illustrates the most common cancer cases in
Indonesia are cases of breast cancer, namely 58,256 cases or 16.7% of the total
348,809 cases of cancer. Cervical cancer (cervix) is the second most common type
of cancer in Indonesia as many as 32,469 cases or 9.3% of the total cases (Ministry
of Health, 2017). For data on the overall cases of cancer that occur in Indonesia can
be seen in the following figure below.

Cancer is a disease caused by abnormal growth and growth of cells in the

body (Kristanti et al., 2017). The growth and growth of these cancer cells can be
destructive or damage healthy cells by infiltrating other tissues through lymph

vessels or blood vessels. The suppression of cancerous tissue on healthy nerves

and also the side effects of chemotherapy drugs cause patients to experience pain

(Ricevuto et al., 2010).

Pain is an unpleasant experience physically and emotionally due to tissue

damage (Thomas, 1997). Pain in cancer patients is chronic. Chronic pain is a pain

that occurs suddenly or slowly from low intensity to severe that occurs more than

3 months (Munawaroh, 2017). Pain can be affected by several things such as the

type of cancer and the condition of the body, gender, culture and clinical

condition of the patient (Nurmalisa, 2020).

Pain due to chemotherapy drug side effects namely neuropathy with

symptoms of tingling and pain in the hands and feet (Neris et al., 2016). Factors

that resulted in increased pain were climbing stairs (34.8%), walking (30.4%),

lifting (21.7%), heavy work (17.4%), standing (13%), urination (8.7%), sleep

(8.7%), and other things such as diet, stress and weather (39%). The average pain

range of patients is 4-9 or in the moderate to severe pain range (Farastuti

&Windiastuti, 2016).

Cancer pain has an impact on the physical, psychological, social, and

spiritual. Physical impacts include; fatigue, decreased appetite, vomiting,

decreased muscle strength. The psychological impact is; difficulty concentrating,

fear, depression and also anxiety. Social impacts are decreased social

relationships and impaired appearance. The spiritual impact is; increased feelings

of suffering, disruption of meaning and purpose of life, disorders in religious

beliefs (Romdhoni, 2017).

Pain in cancer patients can be overcome by 2 techniques, namely

pharmacological and nonpharmacological techniques. Pharmacological

management guidelines according to the Health Organization (WHO) based on

the pain rate of cancer patients are for mild pain with non-opioids e.g.

acetaminofen, moderate pain with opioids such as codeine, and severe pain with

powerful opioids such as morphine and fentanyl (Jara et al., 2018). In addition to

pharmacological techniques, the use of non-pharmacological techniques to

reduce the patient's pain levels can be done with the use of complementary

therapies. Complementary Alternative Medecine (CAM) can be used as an

alternative option for cancer patients in reducing pain such as music therapy,

massage, acupuncture and guided imagery. The selection of therapy types is

tailored to the patient's choice by considering various aspects such as culture,

duration of administration, therapeutic techniques, and other aspects (Köhler et

al., 2020).

Cancer pain management can effectively be influenced by several things,

among others, pain detection capabilities, proper prescribing, availability of

medications, the ability of patients to perform pain management in daily life, and

the patient's desire to adhere to treatment (Kristanti et al., 2017). The obstacles

to pain management of chemotherapy patients are not optimally influenced in

terms of cognitive, affective and sensory. The cognitive barriers of the patient are

difficulty in communication with the doctor regarding the pain experienced,

knowledge of drug use, and pessimism about the ability to control cancer.

Affective barriers are closely related to emotional changes in patients such as

anxiety and depression. Sensory barriers are related to the effects of ongoing

analgesic therapy (Nuwa &Kiik, 2020). The patient's inability to cope with pain

causes the patient to have difficulty in carrying out daily activities such as eating,
dressing, bathing and mobilization so as to impact the quality of life of patients

who continue to decline (Romdhoni, 2017).

To reduce the pain level of chemotherapy patients, one of them is by

administering complementary acupressure therapy (Rs &Maris, 2017).

Acupressure is a sicientific method of treatment that maintains balance by doing

some stimulation at some point of focus on the body using needles. This can be

explained by using gate control teory which can stimulate sensory, can be

suppressed by other stimulation (needles) through the nervous system.

Acupressure has the potential to produce analgesic effects quickly and effectively

when the needle is inserted deeply enough (Sinta, 2018). In cancer patients who

experience pain, acupressure administration in addition to the administration of

drugs may increase the effect of analgesia. Acupressure proved effective for

reducing pain in cancer patients undergoing chemotherapy (Mihardja, 2008).

Library Overview

1. Cancer

Cancer or malignant tumors occur due to abnormal growth of body tissue cells,

caused by neoplasia, dysplasia, and hyperplasia. Neoplasia is a condition of

cells found in tissues proliferating abnormally and invasively, dysplasia is a

condition of cells that do not develop normally with indications of changes in

the nucleus (nucleus of cells), hyperplasia is a condition of normal cells in

tissues experiencing excessive growth. Cancer is a disease caused by abnormal

growth of body tissue cells, developing rapidly, not being constrained and

continuing to divide. Cancer is a disease that can attack and arise as a result of

abnormal growth of body tissue cells that turn into cancer cells in their

development (Kristanti et al., 2017).

Types or Locations of Cancer

a. Breast

It is a pathological disorder that begins due to changes in genetic disorders in

a single cell and takes several years to be acquired. Risk factors that affect the

occurrence of breast cancer are gender (women) and old age, the presence of

previous breast cancer, family history: having relatives who have a degree of

breast (mother, sister, daughter) (NARESWARI et al., 2017).

B. Rectal colon

It is the second most visceral neoplasm. Risk factors that affect him over 40

years of age, food (excessive animal fat, especially cows, and low fiber), other

diseases of the gastrointestinal tract (Ministry of Health, 2017).

c. Larynx
Tumors are in the true vocal cords and are less likely to spread due to the

underlying connective tissue lack of lymph nodes, which are characterized by

a rau sound that lasts more than 3 days (Nuwa &Kiik, 2020).

d. Lungs

This cancer usually develops in the wall or epithelium of the bronchial tree.

There is no early stage, while in the advanced stages of chest pain, cough,

fever, parau, shoulder pain, weight loss, shrinking sound (Ricevuto et al.,

2010).

e. Leukemia

It is a malignant polyferation of white blood cell (WBC) of bone marrow and

accumulation of peripheral blood vessels, bone marrow, and body tissues.

f. Pancreas

It is a deadly gastrointestinal disorder that develops rapidly. Caused by

smoking and risk factors that affect diabetes mellitus, acute pangkreatitis,

alkhohol abuse.

g. Prostate

It is the second most common neoplasm found in men aged 50 and over. Most

sarcoma comes from the posterior prostate gland, while others are from the

ureter, which is lined with difficulty urinating, hematuria, anuria, urinary

retention.

h. Prostate

It is the second most common neoplasm found in men aged 50 and over. Most

sarcoma comes from the posterior prostate gland, while others are from the

ureter, which is lined with difficulty urinating, hematuria, anuria, urinary

retention.
i. Gaster

It happened to a man over the age of 40. Caused by gastritis, chronic gastric

inflammation, ulcer gastritis, gastric atrophy. And patched with abdominal

distention, chronic gastric discomfort, dysphagia, blood being pierced, heavy

vomiting, weight gain, anorexia, feeling full after meals, anemia, and fatigue.

j. Ovaries

It is the leading cause of death from gynecological cancer. Risk factors that

affect it are a history of breast cancer, a family history of ovarian cancer, old

age, low perity and obesity. That is preceded by increased abdominal

circumference, pelvic pressure, bloating, back pain, constipation, abdominal

pain, urinary urgency, increased waist size, limb pain, and pelvic pain.

k. Cervix

It is the third most common cancer in the female reproductive system and is

classified as preinvasive or invasive, which is pre-staged in the early stdium,

namely the possibility of abnormal vaginal bleeding, persistent discharge from

the vagina, and pain in the advanced stages of pelvic pain, vaginal leakage in

the form of urine and feces from fistulas, anorexia, weight loss, and anemia.

l. Bladder, etc.

Occurs in patients over the age of 55 years who are experienced by many men.

It usually appears at the base of the bladder and pierces the ureter hole as well

as the neck of the bladder. The encested hematuria and painless, urinary tract

infections occur and urgency / urge urination, changes in urine, pelvic or back

pain due to the presence of metastases (Malki, 2014).

1. Etiology

a. Environmental, social
B. Physical: radiation, need/ blisters

c. Chemistry: food, industry, pharmaceuticals, cigarettes

d. Genetic: breast, uterus

E. Viruses: common in animals.

The cause of cancer is a healthy body is not able to defend itself against cancer,

this occurs because of the complex interaction between exposure to

carcinogens and mutations that have accumulated in several genes called

oncogenes, thus activating cell division that affects embryonic development.

Another cancer gene is the tumor suppressor gene, this will stop cell division.

The causes of gene damage obtained are: viruses, radiance, environmental

carcinogens as well as food and hormones. Other factors that affect the

occurrence of cancer are age, nutritional status, hormonal balance and

response to stress (Lacy &Becker, 2013).

2. Pathophysiology

Abnormal cells form a group and begin to proliferate abnormally, allowing

growth regulatory signals in the surrounding cell environment. Cells get

invasive characteristics so that changes in surrounding tissues occur. Cells

infiltrate tissues and gain access to kelimfe and blood vessels, which carry

cells to other areas of the body. this event is called metastasis (cancer spread

to other parts of the body) (Galluzzi et al., 2020).

Cancer cells are called malignant neoplasms and are classified and named after

where the tissues grow. The failure of the immune system to destroy abnormal

cells quickly and precisely causes cells to grow into large to be treated using

normal immune system. Certain categories of agents or factors that play a role

in carcinomagenesis (maligna transportation) include viruses and bacteria,

physical agents, chemical agents, genetic or familial factors, dietary factors,

and hormonal agents (Galluzzi et al., 2020).

Neoplasms are new growths. According to an anecdologist from the United

Kingdom, neoplasms are abnormal tissue mass, excess plants, and are not

coordinated with normal tissues, and always grow even if the stimuli that

cause them are gone. Neoplastic proliferation causes a mass of neoplasms

causing swelling or lumps in the body's tissues, resulting in the formation of

tumors. The term tumor is used for swelling by tissue sembaban or bleeding.

Tumors are distinguished into two, namely benign and malignant. If a

malignant tumor is called cancer (McAdam Eccles, 1917).

3. Clinical Manifestations

A. Cancer cells spread from one organ or part of the body to another

through invasion and metastasized. So that the manifestation is as appropriate

as the affected organ or body.

B. Cancer causes anemia, weakness, weight loss (dysphagia (difficulty

swallowing), anorexia, blockages), and pain (often late distadium) (Fan,

2009).

4. Symptoms are caused by tissue destruction and replacement by

nonfunctional cancerous tissue or highly productive tissues (e.g. bone marrow

disorders and anemia or overproduction of adrenal steroids), pressure on

surrounding structures, increased metabolic needs, and impaired production

of blood cells (Oláh, 2005).

5. Cancer Treatment

a. Surgery

It is very effective when done in people with early stage cancer so that it has
a chance of recovery.

b. Combination

The combination treatment combines radiotherapy chemotherapy and surgery.

c. Radiation

Radiation aims to destroy cancerous tissue.

d. Chemotherapy

Chemotherapy treatment aims to reach cancer cells that spread to other parts

of the body by inhibiting and controlling the growth of cancer cells (Smith

&Saiki, 2015).

1. Chemotherapy

a. Understanding

Chemotherapy is a therapy that involves the use of chemicals or drugs in the

use of cancer. Conventional chemotherapy works by destroying the structure

or metabolism of cancer cells (Sataloff et al., n.d.).

Chemotherapy is the treatment of cancer using drugs / hormones.

Chemotherapy can be used effectively in both spreading and localized

diseases. Chemotherapy is a systemic therapy, which means the drug spreads

throughout the body and can reach cancer cells that have spread far or

metastasized elsewhere (Alam, 2018).

B. Various chemotherapy

In conducting chemotherapy, clinically should be considered the following:

1. Determine the purpose of therapy

Chemotherapy has several different purposes, namely curative chemotherapy,

adjuvant chemotherapy, neoadjuvan chemotherapy, investigative

chemotherapy.
2. Rational use of drugs

Under normal circumstances, systemic chemotherapy using intravenous

pathways, according to Hryniuk and Evin the intensity of the drug dose is the

most important factor of the effectiveness of the drug, increased dose intensity

in addition to increasing effectiveness also brings greater toxic effects (such

as: severe vomiting nausea, fever and bleeding).

3. Overcoming drug resistance

Drug resistance is the main cause of chemotherapy, the causes of drug

resistance vary, different drugs have different mechanisms (Pavlidis et al.,

2015).

c. Types of Chemotherapy Therapy

1. Neoadjuvan therapy is chemotherapy given before surgery or radiotherapy,

the goal is to reduce the mass of the tumor so that after the tumor shrinks it

will be easier to deal with radiation. Neoadjuvan therapy is administered in 2-

3 cycles given every 3 weeks provided that there is a response to

chemotherapy. In recent studies, neoadjuvan chemotherapy showed increased

opeative chances for neck head cancer, lung small cell cancer, osteosarcoma,

reduced surgical performance that led to defects in certain cancers (larynx,

bladder, canalist analyst) improved the quality of life of some patients.

2. Primary chemotherapy is used alone in the treatment of tumors, which are

less likely to be treated, and chemotherapy is used to control the symptoms.

3. Investigative chemotherapy is a clinical trial with a new chemotherapy

regimen, to find a new drug or regimen with high effectiveness, low toxicity.

4. Combination chemotherapy using two or more chemotherapy agents.

Chemotherapy as a palliative therapy, which is only controlling the growth of

tumors and not to cure or eradicate cancer cells. This therapy is usually done

in advanced patients where the cancer has spread to other organs in the body.

Palliative chemotherapy is administered to cancer patients in the advanced

stage, and can only play a role in reducing symptoms, prolonging survival

time. In this case the doctor should consider the advantages and disadvantages

that chemotherapy brings to the patient, avoid chemotherapy that is too strong

until the patient's quality of life decreases or worsens the development of the

disease.

5. Curative chemotherapy is given to patients with curative ssensitive tumors

(such as: acute lymphostic leukemia, malignant lymphoma, testicular cancer,

small cell carcinoma of the lungs), curative chemotherapy should use a

combination chemotherapy formula consisting of drugs with different

mechanisms of action, different toxic effects and each effective when used

individually, given with many cycles for each drug in the formula is attempted

using a dose of maksimun that can be tolerated by the body. The interval

period is agreed to be shortened in order to achieve total eradication of cancer

cells in the body (Ruth Hettler, 2011).

d. How to administer chemotherapy

1. Peroral administration

2. Some types of chemotherapy have been packaged for peroral administration

including chlorambucil and etoposide (VP-16).

3. Intramuscular administration

4. Giving in this way is relatively easier and should not be given at the same

location as the administration of 2-3x in a row. Those that can be administered

intramusculu include bleomicin and methotrexate. Intravenous administration

5. Can be given slowly bolus or given by infusion / drip. This method is the

most common and widely used way of administering chemotherapy.

6. Intraarteri administration

This provision is rarely done because it requires a considerable amount of

means, among others: diagnostic radiology tools, machines, or filter tools as

well as their own skills.

7. Intraperitonial Administration (Nature, 2018)

A. This method is rarely done because it requires special equipment /

intraperitoneal catheter as well as the completeness of the operating room

because the installation needs narcose. Chemotherapy is usually given in

cycles, in intervals of 3-4 weeks in a period of 4-6 months. The cell cycle is

simply divided into 5 stages, namely:

1. Phase G0 / rest phase. When the signal to develop, this cell will enter phase

G1.

2. Phase G1, in this phase the cells are ready to divide themselves which is

mediated by several proteins important for reproducing, this phase lasts 18-30

hours.

3. Phase S / synthesis phase. In this phase dna will be copied this phase lasts

18-20 hours.

4. Phase G2, protein synthesis needs to continue this phase lasts 2-10 hours.

5. Phase M is divided into 2 new cells. This phase lasts 30-60 minutes

(Ricevuto et al., 2010).

b. Chemotherapy Side Effects

Side effects of chemotherapy physically and psychologically, include: 1). The

impact of physical chemotherapy:

a). Nausea and vomiting

Trigger factors for nausea and vomiting can be triggered by taste, smell,

thoughts and anxiety associated with chemotherapy.

b). Constipation

Constipation occurs approximately for one week. The causative factors are the

use of opoid analgesics, reduced intake of food and beverages, reduced

mobility, advanced age related to the malignancy of the cancer itself.

c) Peripheral neuropathy

Peripheral neuropathy is a symptom caused by damage to nerves further away

from the brain and spinal cord. Peripheral neuropathy occurs at any time after

treatment begins and gets worse as treatment progresses. Factors that affect

include age, intensity of chemotherapy, dose of drugs, duration of

chemotherapy administration.

d). Skin toxicity

The side effect of administering certain chemotherapy drugs can darken skin

tone along the veins, it can also be erythema or hyperpigmentation lines that

spread along the superficial veins. Skin toxicity is not life-threatening but

worsens the patient's quality of life.

e). Alopecia (hair loss)

Hair loss starts to occur 2 to 4 weeks and will be completed

1 to 2 months after loss, bias loss occurs partially or completely. Other parts

of the body that have been lost are the armpits, eyebrows and pubic.

f). Weight loss

Weight loss occurs due to several factors including decreased appetite, nausea

and vomiting, and mucositis. Most chemotherapy patients lose as much as 5%

of their body weight before undergoing chemotherapy.

g). Decreased appetite

Cancer-related decreased appetite can occur because the hunger signal

originating from the hypothalamus is reduced and the satiety signal produced

by melacortins is amplified. In chemotherapy patients decreased appetite is

also affected by nausea and changes in taste sensations.

h). Fatigue ( fatigue)

Fatigue occurs for 1 to 2 weeks after chemotherapy, fatigue can occur due to

lack of nutritional needs so that the energy needs in the body are not fulfilled,

in chemotherapy patients there is a decrease in appetite so that the need for

energy in the body can not be fulfilled.

i). Change of taste

Chemotherapy patients often complain of changes in taste perception, and

many complain of bitterness or metallic taste. The quality of the taste is also

reduced which is described as bad taste in the mouth or nausea. Influential

factors due to lack of oral care, infection, gastrointestinal reflux.

j). Pain

Pain arises in the lower abdomen and back, occurs in a disappearing arising,

can be exacerbated by heavy physical activity, after chemotherapy is

completed the pain will be reduced (Alam, 2018).

2). Psychological impact of chemotherapy, including:

a. Anxiety

Anxiety in chemotherapy patients is influenced by several factors, either due

to internal or external factors.

(1) External factors include: The threat of fsik and self-esteem, and the
severity of the disease.

(2) Internal factors include: Adaptability, Confidence in the ability to control

the situation, gender and personality, individual experience with the situation

experienced, patient knowledge of various things about cancer and treatment

procedures.

b). Feeling helplessness

In chemotherapy patients helplessness can be an emotional disorder, such as

crying kaena reminded of the disease suffered.

c). Low self-esteem

In chemotherapy patients the psychological impact of self-esteem in the form

of shame and pessimism in living life due to the effects of chemotherapy that

changes the physiological condition of his body.

d). Stress and anger

Stress and anger in chemotherapy patients arise because of a dislike of the

effects of treatment.

e). Depression

A meta-analysis study in America states that about 50% of patients with

advanced cancer meet the criteria for psychiatric disorders, the most common

of which is adjustment disorders (11-35%) and severe depression (5-26%).

Depression experienced by chemotherapy patients is minimal depression and

moderate depression (Rulianti, 2013). From the results of a study conducted

by Sonia (2014), malignant patients who received chemotherapy showed a

higher prevalence of psychological symptoms of depression than ansietas.

According to research in breast cancer patients, depression occurs due to

cancer treatment, which is felt to be very burdensome for patients. This is due
to the side effects of chemotherapy that provide a traumatic aspect in patients

(Fernando &Jones, 2015).

1. Pain

a. The definition of pain is an unpleasant sensory and emotional experience

related to potential tissue damage or disruption of tissue metabolism.

Neuropathic (chronic) pain occurs due to abnormal processing of sensory

inputs by the central or peripheral nervous system. There are a large number

of neuropathic pain syndromes that are often difficult to overcome such as:

cancer pain, lower back pain, diabetic neuropathy, wounds on the spinal cord

(Munawaroh, 2017).

b. Factors That Cause Pain Factors that can be the cause of the onset of cancer

pain in general are

1. Pain caused directly by tumors that cause compression of central and

peripheral nerves.

2. Pain due to cancer treatment such as chemotherapy causes neuropathy and

tissue necrosis to cause pain.

3. Pain that is not related to tumors usually depends on the condition of

patients experiencing gastric distention, infection, musculoskeletal pain

(Farastuti &Windiastuti, 2016).

c. Types of Pain

1. Nociceptive Pain. Nociceptive pain is pain stimulated by pain receptors.

This type of pain usually comes from the response that occurs due to damage

to the body. Nociceptive Pain Treatment may use common or common

analgesic groups such as paracetamol, NSAIDs, or the opioid group.

2. Neuropathic Pain. Neuropathic pain is caused by the presence of wounds or

dysfunction of the nervous system. This type of pain cannot be treated with

the usual analgetics, so commonly used medications such as antidepressants,

anticonvulsants, and some other types of drugs. Neuropathic pain is also

commonly caused by nerve pressure or infiltration by cancer (Jara et al.,

2018).

d. Measurement of Pain Levels in Cancer

1. Analog Visual Scale and Numerical Rating Scale.

2. The Face Pain Rating Scale (Neris et al., 2016)

1. Complementary Acupressure Therapy

a. Understanding acupressure

Acupressure is a word derived from the word accus which means needle and

pressure which means to press. At first acupressure is often said to be

acupuncture, this is because the basic theory of acupressure is guided by

acupuncture (NARESWARI et al., 2017). Sedation by sticking a needle in

acupressure science is replaced by the emphasis using fingers or tools in the

form of blunt objects that do not injure or injure the client's body (Ministry of

Data and Information Center, 2015)

Acupressure is one form of traditional medicine skills by pressing acupuncture

points with emphasis using fingers or blunt objects on the surface of the body,

in order to support promotional, preventive, and rehabilitative efforts in the

health service sphere (Shannon et al., 2018). In accordance with its history,

the basis of acupressure philosophy is natural philosophy. The law of balance,

causation, changes in quality and quantity, interdependence, holistic, mutual

influence, become considerations in carrying out acupressure actions (Sinta,

2018). As long as it is not contrary to the rhythm of nature, acupressure can

be done regularly, regularly, directed, harmoniously according to the

conditions and comfort of the client. Acupressure treatment is safe to do,

because it does not injure the body and does not insert certain substances into

the body, in addition it is cheap and easy because it can be done by anyone

who has studied the science and techniques of 18 acupressures properly and

correctly (Mihardja, 2008)

Acupressure is one of the traditional Chinese medicine techniques used to

reduce pain, treat diseases and injuries. Acupressure is done by exerting

physical pressure at several points of the body's surface which is a place of

energy circulation and balance in case of pain symptoms (Shannon et al.,

2018).

b. Steps of acupressure acupressure Tools needed for the administration of

acupressure therapy:

1) Oil

2) Gloves (k/p)

3) Tissue

4) Small Towel

5) Antiseptic

6) Simple massage aids in the form of blunt objects made of wood, and metal

that does not injure the body

Standard operational procedures for acupressure therapy:

1) Prepare the necessary tools

2) Wash your hands

3) Give greetings, ask the client's name and call with his name and introduce
yourself ( for the first meeting)

4) Asking for complaints / client's condition

5) Explain the purpose, procedure, and duration of actions and things that need

to be done by the client during acupressure therapy

6) Give the client or family the opportunity to ask before therapy is performed

7) Conduct an assessment to obtain the necessary complaints and

complementary needs

8) Maintain client privacy by closing the curtains

9) Adjust the client's position by positioning the client on the suptinence,

sitting, sitting with his hands resting on the table, lying on the side, or perched

and giving the base

10) Make sure the client is relaxed and comfortable, and pray together

11) Help remove client clothing or accessories that may impede the

acupressure action to be performed, if necessary

12) Wash your hands and use gloves if necessary 1

3) Find the points of stimulation that exist in the body, pressing it until it enters

the nervous system. When applying acupuncture using needles, acupressure

only uses finger movement and pressure or can use blunt objects that do not

injure or injure the body, i.e. the type of rotary press, press point, and press

straight or swipe (Sinta, 2018).

Acupressure is a traditional medicine that is done by pressing the acupunctur e

points using fingers or blunt objects that do not injure the body. The

advantages of this acupressure are lower risk of side effects, easy to do and

learn, beneficial for pain relief and relaxation. Acupressure is also effective in

eliminating various symptoms that accompany the disease by balancing the

body's energy flow. Acupressure at the acupuncture point will give a local

effect i.e. decreased pain in the area around the point of suppression.

Acupressure energy at the acupuncture point will flow through the meridian

stream towards the target organ. This research is in line with research

conducted by Hsieh (2010) on the intensity of pain in students before the

average acupressure of mild, moderate, and severe pain levels after

administration of pain acupressure is reduced and lost.

 Conclusion

Complementary acupressure therapy is the most effective step to improve relaxation and

reduce pain in cancer patients undergoing chemotherapy therapy.

 Daftar Pustaka

Alam, A. (2018). Chemotherapy Treatment And Strategy Schemes: A Review. Open Access

Journal Of Toxicology, 2(5). Https://Doi.Org/10.19080/Oajt.2018.02.555600

Depkes. (2017). Infodatin Pusat Data Dan Informasi Kementerian Kesehatan RI: Situasi

Penyakit Ginjal Kronis. 1–10.

Www.Depkes.Go.Id/Resources/Download/Pusdatin/Infodatin/

Fan, A. M. (2009). Cancer. Information Resources In Toxicology, 103–121.

Https://Doi.Org/10.1016/B978-0-12-373593-5.00011-2

Farastuti, D., & Windiastuti, E. (2016). Penanganan Nyeri Pada Keganasan. Sari Pediatri, 7(3),

153. Https://Doi.Org/10.14238/Sp7.3.2005.153-9

Fernando, J., & Jones, R. (2015). The Principles Of Cancer Treatment By Chemotherapy.

Surgery (United Kingdom), 33(3), 131–135.

Https://Doi.Org/10.1016/J.Mpsur.2015.01.005

Galluzzi, L., Linkermann, A., Kepp, O., & Kroemer, G. (2020). Pathophysiology Of Cancer

Cell Death. In Abeloff’s Clinical Oncology (Sixth Edit). Elsevier Inc.

Https://Doi.Org/10.1016/B978-0-323-47674-4.00005-0

Jara, C., Del Barco, S., Grávalos, C., Hoyos, S., Hernández, B., Muñoz, M., Quintanar, T.,

Meana, J. A., Rodriguez, C., & De Las Peñas, R. (2018). SEOM Clinical Guideline For

Treatment Of Cancer Pain (2017). Clinical And Translational Oncology, 20(1), 97–107.

Https://Doi.Org/10.1007/S12094-017-1791-2

Köhler, F., Martin, Z. S., Hertrampf, R. S., Gäbel, C., Kessler, J., Ditzen, B., & Warth, M.

(2020). Music Therapy In The Psychosocial Treatment Of Adult Cancer Patients: A

Systematic Review And Meta-Analysis. Frontiers In Psychology, 11(April), 1–15.

 Https://Doi.Org/10.3389/Fpsyg.2020.00651

Kristanti, M. S., Setiyarini, S., & Effendy, C. (2017). Enhancing The Quality Of Life For

Palliative Care Cancer Patients In Indonesia Through Family Caregivers: A Pilot Study

Of Basic Skills Training. BMC Palliative Care, 16(1), 1–7.

Https://Doi.Org/10.1186/S12904-016-0178-4

Lacy, S., & Becker, L. (2013). Cancer Notes. Leaving Art, January, 211–221.

Https://Doi.Org/10.1215/9780822391227-026

Malki, A. M. (2014). Theory Of Cancer And Cancer Progression. Cancer Treatment Strategies,

December. Https://Doi.Org/10.4172/978-1-63278--3-040

Mcadam Eccles, W. (1917). The Pathology Of Cancer. British Medical Journal, 1(2923), 33.

Https://Doi.Org/10.1136/Bmj.1.2923.33-A

Mihardja, H. (2008). Peranan Akupuntur Dalam Bidang Kanker. In Indonesian Journal Of

Cancer (Vol. 1, Pp. 24–26).

Munawaroh. (2017). Modifikasi Pro Self Pain Control Untuk Menurunkan Nyeri Dan

Meningkatkan Kemampuan Aktivitas Pada Pasien Kanker Kolorektal Yang Menjalani

Kemoterapi Tesis. In Journal Of Chemical Information And Modeling (Vol. 53, Issue 9).

Nareswari, I., Haryoko, N., & Mihardja, H. (2017). Peran Terapi Akupunktur Pada Kondisi

Leukopenia Kanker Payudara Pasien Kemoterapi. Indonesian Journal Of Cancer, 11(4),

179–188. Https://Doi.Org/10.33371/Ijoc.V11i4.536

Neris, R. R., Magnabosco, P., Do Amaral, P. A., Ribeiro, M. Â., & Dos Anjos, A. C. Y. (2016).

Pain Induction By Chemotherapy Medication Docetaxel In Women With Breast Cancer.

Acta Paulista De Enfermagem, 29(4), 397–404. Https://Doi.Org/10.1590/1982-

0194201600055

Nurmalisa, B. E. (2020). Literature Review : Managemen Nyeri Pada Pasien Kanker

Literature Review : Pain Managements In Cancer Patients Baiq Emy Nurmalisa . 1(1),
 20–26.

Nuwa, M. S., & Kiik, S. M. (2020). Spiritual Guided Imagery And Music. 95–106.

Https://Doi.Org/10.26699/V7i1.ART.P095

Oláh, E. (2005). Basic Concepts Of Cancer: Genomic Determination. Ejifcc, 16(2), 10–15.

Pavlidis, N., Izar, B., Ryan, D. P., & Chabner, B. A. (2015). PRINCIPLES OF

CHEMOTHERAPY Nothing To Declare. Clinical Radiation Oncology, July, 171-

185.E2. Http://Dx.Doi.Org/10.1016/B978-0-323-24098-7.00009-5

Pusat Data Dan Informasi Kementerian. (2015). Situasi Penyakit Kanker. Journal Of Chemical

Information And Modeling, 53(9), 1689–1699.

Ricevuto, E., Bruera, G., & Marchetti, P. (2010). General Principles Of Chemotherapy.

European Review For Medical And Pharmacological Sciences, 14(4), 269–271.

Https://Doi.Org/10.1201/9781003108702-2

Romdhoni, A. C. (2017). Manajemen Nyeri Pada Keganasan Kepala Dan Leher. Emergency

On Otorhinolaryngology Head & Neck Surgery : Latest Clinical Update, 53(9), 230–272.

Rs, D. I., & Maris, S. (2017). Evaluasi Pemberian Terapi Akupresur Dalam Meningkatkan

Kualitas Tidur Pasien Gagal Ginjal Tahap Akhir Di Rs. Stella Maris Makassar. Patria

Artha Journal Of Nursing Science, 1(2). Https://Doi.Org/10.33857/Jns.V1i2.73

Ruth Hettler. (2011). Chemotherapy Information For Patients. Oxford University Hospitals

NHS Trust, 4,7-10.

Sataloff, R. T., Johns, M. M., & Kost, K. M. (N.D.). No 主観的健康感を中心とした在宅高

齢者における 健康関連指標に関する共分散構造分析Title. 0–18.

Shannon, C. E., Indira, T., Somakim, S., Susanty, E., Alamiah, U. S., Afriansyah, E. A., R, H.

Y., Waluya, S. B., Rosita, C. D., Nopriana, T., Silvia, I., Shodiqin, A., Zuhri, M. S.,

Lestari, D., Rizqi, A. A., Hodiyanto, H., C.E. Shannon , Vol. 27, Pp. , July, October, " ",

Mahardhikawati, E., Mardiyana, … Rusmawati, R. D. (2018). Analisis Praktik Klinik

 Keperawatan Pada Pasien Chronic Kidney Disiase (Ckd) Dengan Efek Pemberian Terapi

Akupresur Dan Aromaterapi Bunga Lavender Terhadap Penurunan Tingkat Kecemasan

Di Ruang Hemodialisa Rsud Abdul Wahab Sjahranie Samarind. Mathematics Education

Journal, 1(1), 75. Https://Doi.Org/10.29333/Aje.2019.423a

Sinta. (2018). Pengaruh Terapi Akupresur Sanyinjiao Pointterhadap Intensitas Nyeri

Dismenoreprimer Pada Mahasiswi Semester Viiiprogram Studi Ilmu Keperawatan. 1–16.

Https://Sinta.Unud.Ac.Id/Uploads/Wisuda/1002106087-1-BAGIAN DEPAN Scan.Pdf

Smith, T. J., & Saiki, C. B. (2015). Cancer Pain Management. Mayo Clinic Proceedings,

90(10), 1428–1439. Https://Doi.Org/10.1016/J.Mayocp.2015.08.009

Society, A., & Asco, O. (N.D.). Managing Cancer-Related.

Thomas, V. N. (1997). Cancer Pain Relief, 2nd Edn. In International Journal Of Nursing

Studies (Vol. 34, Issue 2, P. 172). Https://Doi.Org/10.1016/S0020-7489(97)84430-6