Fatigue is described by cancer patients as a continuous and subjective feeling of tiredness, lassitude, and lack of energy that is not relieved by resting.1,2 A total 55% of patients undergoing cancer treatment and 66% of those with advanced metastasis suffer moderate to severe pain.3 Analgesics regularly used in palliative care, including sublingual fentanyl, benzodiazepines, antidepressants, and anticonvulsants, can cause fatigue. Moreover, pharmacological interventions have various side effects such as dependence, hypotension, respiratory depression, and vomiting.2,4, 5, 6 Holistic treatments in which pharmacological and non-pharmacological regimens are used together are recommended to treat pain and fatigue in cancer patients.7 Acupressure and Reiki are non-pharmacological interventions for cancer patients that are easy to learn and apply, effective, safe, cheap, relaxing, and non-invasive; they do not require special equipment, can be applied with little effort, and serve to motivate the patient.4, 5, 6,8, 9, 10, 11, 12

Acupressure is a massage technique in which pressure is applied to certain areas of the body with the thumb or index finger, the palm of the hand, the hands, or a stimulator, thus aiding in the regular functioning of the energy canals.2,5,6,12,13 When the meridians—the body's energy canals—are stimulated, the canals open and the flow of qi (life energy) is regulated.5,6 Acupressure increases the secretion of endorphin in the body and relieves pain and fatigue, causing relaxation and greater comfort.12

Reiki, translated as “universal life energy,” is a biofield energy therapy involving light touch.1,4,8,10,14 It relieves fatigue by activating the parasympathetic nervous system, and the results of its painkilling effects reduce pain and the use of analgesics.15,16 The physiological effect of Reiki on pain-killing can be explained by “gate control theory.” According to this theory, skin stimulation suppresses pain signals by stimulating a-beta thick sensory fibers and suppressing small diameter fibers that carry pain messages. When the hypothalamus is stimulated, relief is provided by preventing painful stimuli via naturally secreted endorphins, enkephalins, and dynorphins (morphine derivatives).15

In a recent literature review, Billot et al.17 highlighted the need for further studies to determine the benefits of Reiki therapy on pain and quality of life in palliative care. Many studies have been found that were conducted with cancer patients in oncology clinics, but little information was presented on the effect of Acupressure or Reiki interventions on the pain and fatigue of cancer patients in palliative care clinics. The aim of this study was to determine the effect of Acupressure or Reiki interventions on the levels of pain and fatigue of stage III and IV cancer patients receiving palliative care. The hypotheses of this study were as follows:

Hypothesis 1

Acupressure or Reiki interventions have an effect on pain and fatigue levels in stage III and IV cancer patients receiving palliative care.

Hypothesis 0

Acupressure or Reiki interventions have no effect on pain and fatigue levels in stage III and IV cancer patients receiving palliative care.