Acupuncture for chemotherapy-associated insomnia in breast cancer patients : systematic review and randomized controlled trials

Abstract

Chemotherapy-associated insomnia is a highly prevalent complaint in breast cancer patients. The central theme of this project was to assess the efficacy and safety of acupuncture for chemotherapy-associated insomnia in breast cancer patients. The project comprised three studies: (1) a systematic review to summarize previous knowledge on acupuncture for cancer-related insomnia; (2) a randomized wait-list controlled trial to determine the feasibility, preliminary efficacy and safety of acupuncture for chemotherapy-associated insomnia; and (3) a randomized sham-controlled trial to evaluate the efficacy and safety of acupuncture for chemotherapy-associated insomnia.

(1) A systematic review was performed to evaluate the evidence on the efficacy of acupuncture for cancer-related insomnia in previous randomized controlled trials (RCTs). Nineteen RCTs were included for detailed analysis. Possible positive or equivalent benefits of acupuncture were found when compared with benzodiazepine, non-benzodiazepines, antidepressants, sham acupuncture or usual care. However, the included studies had high probability of bias and were of suboptimal methodological quality. Hence, additional evidence supporting the use of acupuncture for insomnia in cancer patients is warranted.

(2) A two-arm, wait-list controlled, assessor and data analyst-blinded trial was performed to examine the feasibility, preliminary efficacy and safety of acupuncture for chemotherapy-associated insomnia. Thirty breast cancer patients with chemotherapy-associated insomnia were randomly allocated to the acupuncture group or wait-list control group. Participants in the acupuncture group received 12 sessions of acupuncture treatment twice weekly for 6 weeks. Participants in the wait-list group received the same regimen of treatment after the 6-week of waiting period. At week-6 post-intervention, the Insomnia Severity Index (ISI, primary outcome) score change from baseline showed statistically significant between-group difference favoring the acupuncture group. The acupuncture group had greater improvements in sleep diary derived total sleep time, depression and quality of life compared with the wait-list control.

(3) A two-arm, sham controlled, subject, assessor and analyst-blinded clinical trial was further performed to determine the efficacy and safety of acupuncture for chemotherapy-associated insomnia as compared with the sham acupuncture control group. Ninety breast cancer patients with chemotherapy-associated insomnia were randomly allocated to the acupuncture group or sham control group. Participants in the acupuncture group received electroacupuncture plus auricular acupressure treatment, while participants in the sham control group received non-invasive sham electroacupuncture plus sham auricular acupressure at non-acupoints. Treatments were given twice weekly for 6 weeks, followed by maintenance treatments once every 4 weeks for 12 weeks (15 sessions in total). The acupuncture group showed a statistically significant decrease in objective actiwatch derived sleep onset latency compared with the sham control. However, the acupuncture group did not show statistically significant difference from the sham control group in the predefined primary outcome—ISI change from baseline to week-6 post-treatment—and other secondary measures. Both groups displayed similar significant improvements in sleep quality, depression, anxiety, fatigue, pain and quality of life as compared with pre-treatment. The 6-week twice-weekly followed by a once every 4 weeks maintenance treatment course was well-tolerated and safe.

In conclusion, the findings suggest that acupuncture is effective for chemotherapy-associated insomnia in breast cancer patients, with minimal side effects.