A randomised, partially-blinded, three-arm, sham-controlled randomised control trial by Li et al, which has been useful in proving the utility of self-acupressure in the management of fatigue- sleep disturbance- depression cluster in breast cancer survivors provides useful insights into the progress that research in supportive care and especially non-pharmacological measures has been able to make.

Background – Multiple guidelines support the use of non-pharmacological measures in the management of symptom clusters in the cancer survivor population. The relative paucity of evidence vis-à-vis pharmacological interventions and the possibility of drug-drug interactions are often cited as the primary reasons for preferring non-pharmacological measures in this setting.
The following non-pharmacological interventions have been proposed to provide some benefit in this setting – cognitive behavioural therapy, acupressure, acupuncture, and physical exercise, by affecting the underlying inflammation-cytokine driven pathways that are involved in the etiopathogenesis of this symptom cluster.
Acupressure has been labelled as a relatively non-invasive intervention with distinct advantages when compared to other modalities. Somatic self-acupressure used in this study, allows the participants to practice independently at any time with minimal prior training. Soft tissue infection as well as ecchymosis constitute known contraindications to the use of acupuncture in this setting. It is also postulated that the presence of persistent fatigue might adversely impact the performance of physical exercise such as dance or resistive exercise programs. The requirement of multiple sessions and its costs are potential disadvantages to the use of cognitive behavioural therapy in this setting.

Methodology
A novel methodological approach outlined below represents a key feature of this trial.  

This trial was developed as a three-phase research program in line with the framework laid down by the Medical Research Council Framework for developing and evaluating complex interventions.

Phase 1 involved development and validation of the protocol, while Phase 2 involved a pilot-randomised control trial with sham acupressure added as a control arm.

The authors also included brief fatigue inventory as the preferred assessment tool in place of the multidemsional fatigue inventory given its ease of administration.

The trial also demonstrates effective use of a large social-media platform for follow-up and a cost-effectiveness evaluation.

The findings of the phase 2 RCT were also used to refine the original hypothesis.

Results
Provides evidence for sustained effects of self-accupressure in managing the FSDSC and QoL in breast cancer survivors.

Critique

The authors point out that the use of self-reported measures only is a potential disadvantage and advocate for the inclusion of objective measures such as biomarkers and actigraphy in future studies.

They also point towards practical difficulties in using the NRS scale in measuring the severity of a symptom cluster consisting of three separate but possibly interrelated symptoms.
Assessment of declining cytokine levels as a measure of improvement in symptoms has also been proposed in future studies.

Companion Reads
A Cochrane review on the effectiveness of home-based multidimensional survivorship interventions in Breast Cancer survivors demonstrated a short term improvement in breast cancer-specific quality of life and global quality of life as measured by the FACT-B and EORTC-C30.

A reduction in anxiety, fatigue and insomnia were also shown immediately following the intervention.

The interventions were classified into various combinations of physical, educational and psychological with routine medical services used as comparators.

Reference

Li, M., Kwok, W. H., Wang, T., Deng, R., Wang, H., Yao, L., Deravin, L., Yang, L., Tian, X., & Tan, J. B. (2026). Effects of self-acupressure on the fatigue-sleep disturbance-depression symptom cluster in breast cancer survivors: a phase III randomised controlled trial. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 34(10), 981. https://doi.org/10.1007/s00520-026-11155-2
Cheng, K. K. F., Lim, Y. T. E., Koh, Z. M., & Tam, W. W. S. (2017). Home-based multidimensional survivorship programmes for breast cancer survivors. The Cochrane database of systematic reviews, 8(8), CD011152. https://doi.org/10.1002/14651858.CD011152.pub2