Auricular point acupressure for chemotherapy-induced peripheral neuropathy: a randomized controlled trial

PURPOSE: Chemotherapy-induced peripheral neuropathy (CIPN) is common and persistent, with limited management options. This trial primarily examines whether auricular point acupressure (APA) improved CIPN outcomes versus usual care; a secondary pragmatic aim compared in-person mobile support (mAPA) with virtual (vAPA) delivery. METHODS: Two hundred twenty-seven cancer survivors with CIPN were randomized to mAPA (n = 80), vAPA (n = 75), or usual care (n = 72). Both APA arms received the same 4-week auricular point protocol; mAPA received in-person seed placement, and vAPA received video instruction for self-placement, with one coaching session for both. Usual care was standard oncologic and supportive care with no study-delivered APA. Primary outcome was a ≥20% reduction from baseline in an individualized composite outcome (ICO); each participant's highest-rated symptom-by-location item at baseline. Secondary outcomes were neuropathy interference, functional status, and quality of life. Intention-to-treat analyses used generalized estimating equations with multiple imputation and delta-adjusted sensitivity analyses. RESULTS: At Week 1, both APA arms exceeded usual care (mAPA OR = 2.60, 95% CI 1.27-5.33; vAPA OR = 3.22; 95% CI 1.48-7.01; p < 0.01). The mAPA advantage persisted at Week 2 (OR = 2.49, p = 0.02). For neuropathy interference, mAPA benefits exceeded usual care every week (OR = 3.29-4.28, all p < 0.01). Among exploratory domains, anxiety, depression, and pain interference improved only in mAPA. CONCLUSION: APA produced a short-lived advantage in CIPN severity and more consistent improvement in interference, specifically with in-person delivery. Findings are preliminary: no blinding or attention control, differential attrition (52% vAPA versus 96% usual care), and exploratory quality-of-life analyses. TRIAL REGISTRATION: ClinicalTrials.gov, ID NCT04920097 registered on 3 June 2021.