Power to the Patient

A U-M doc is giving cancer survivors the tools to finally feel healthy again

After a week of treatment, Dawn Ottenbreit had a lower level of fatigue.

Music and dance helped Sandra Hill forget she had breast cancer. During chemo treatments, she put on a wig and danced in her studio’s show. And when she underwent surgery, the music she likes to dance to played in her ears as the anesthesia rendered her unconscious.

But after doctors told her she was cancer-free, Hill found she couldn’t dance the way she used to. The fatigue she experienced during cancer persisted after cancer; she was left “shuffling through” practices.

“Maybe things take you longer to do,” Hill says. “But I had to accept it as my new normal.”

She says her post-cancer fatigue felt like the tail-end of the flu; when your fever breaks and you’re on the mend, you feel better than you really are. She would get up to do the dishes, then have to sit down a few minutes later. Having endured years of surgery, chemo, and now recovery, she couldn’t remember what it felt like to be energized.

“Sometimes you’re so tired that you can’t suppress [your emotions],” she says. “I remember being in the car one day, and tears just started streaming down my face because I was so exhausted.”

While in treatment, Hill signed a registry where researchers could find potential study subjects. And in 2012, after she was cancer-free, she got a call from Dr. Suzie Zick’s team at the University of Michigan Medical School. Zick was studying a new treatment for fatigue in breast cancer survivors, which affects about one third of women diagnosed with cancer. Many experience symptoms for up to a decade.

Zick’s husband had benefited from acupuncture when he was post-cancer. She wanted to see if acupuncture’s cousin — acupressure — could be effective therapy. The practice is guided by many of the same principles as acupuncture, but uses pressure rather than needles to stimulate the body. Zick was also drawn to the therapy because, unlike acupuncture, patients could administer it themselves.

Dr. Suzie Zick is helping cancer survivors learn how to use acupressure.

About 300 women qualified for the study, and Zick’s team split them into three groups: One practiced no acupressure therapy and simply followed recommendations of their doctors; another used a “relaxing” acupressure therapy, which focused on a certain set of body points; the third group practiced “stimulating” acupressure with a different set of points. Hill was assigned to the relaxing group.

Zick’s team spent about 15 minutes teaching the treatment to the two acupressure groups. Every day for six weeks, each person would spend a half hour applying pressure to a series of body points. Some women chose to use their fingers and others used an object like a pencil eraser. The team checked with the patients periodically to make sure they were performing the treatment correctly and talk with them about their symptoms.

Dawn Ottenbreit was also in the relaxing group.

“All I ever wanted to do was sleep,” she says. “But after a week, I would end the day wondering what I could do next instead of wondering when I could go to bed.”

Sandra Hill demonstrates a pressure point to ease anxiety.

Zick’s team found that patients in the relaxing group experienced better sleep quality and reduced fatigue levels than those who just saw their doctors. In addition, the relaxing therapy group saw big improvements in pain and depression levels. After those initial results, Zick decided to create an app to guide users through acupressure sessions — enlisting breast cancer survivors to help.

“The focus group took a lot longer than I thought it would,” Ottenbreit says. “I thought we were going to just tell them what colors would be good and they’d ask about the videos that would go in the app. But it was way more of a process.”

Zick’s team bundled all of he patient input into the app, which is called MeTime Acupressure. Her smiling face greets users as she explains how to use it and the video acupressure tutorials.

“I had a lot of requests from cancer survivors who had heard about the study,” Zick says. “I can give them very simple directions, but how well those simple directions work without any help is what we don’t know. The hope is that [the app] will give them the information to do it on their own.”

Zick’s team is looking for funding to use MeTime to study how acupressure can help survivors of other types of cancer. She’s also investigating how acupressure affects the brain in the hopes of removing doubt that it just generates a placebo effect.

Zick is also teamed up with university colleagues who run their own medical innovation company to create the “AcuWand” (Zick says don’t blame her for the name; that’s on her co-creators.) It’s a device that takes some of the guesswork out of self-treatment.

It has a spring loader and a screen. “It tells you with sound and light if you’re doing too much or too little,” she says. When perfected, she hopes the wand will help anyone who practices acupressure and empower them to do it on their own.

“When you have cancer, all you do is go to the doctor,” Ottenbreit says. “So if you had to go to one to get this done [it] would just feel like more doctor appointments. But you can do this on your own and as you please. That’s such a cool thing.”