Photo by Petr Kratochvil
Sleeping woman
Treatment with acupuncture or cognitive behavioral therapy (CBT) can decrease the severity of insomnia among cancer survivors, according to new research.
Overall, improvements in insomnia were greatest in patients treated with CBT, and patients with mild insomnia at baseline had a significantly greater improvement with CBT than with acupuncture.
However, among patients who had moderate to severe insomnia at baseline, there was no significant difference in results with CBT and acupuncture.
Jun J. Mao, MD, of Memorial Sloan Kettering Cancer Center in New York, New York, presented these results in a press briefing in advance of the 2018 ASCO Annual Meeting.
Additional results are scheduled to be presented at the meeting as abstract 10001.
“Up to 60% of cancer survivors have some form of insomnia, but it is often underdiagnosed and undertreated,” Dr Mao said. “Our trial showed that both CBT-I [CBT for insomnia] and acupuncture were effective in treating moderate to severe insomnia, although CBT-I was more effective for those with mild symptoms of insomnia. Now, patients have more choices to manage their insomnia.”
Dr Mao and his colleagues studied 160 individuals who had completed cancer treatment. Their mean time since cancer diagnosis was about 6 years.
The subjects had received treatment for hematologic malignancies (8%) as well as breast (31%), prostate (23%), head and neck (7%), colorectal (6%), gynecological (4%), and other cancers (14%). Six percent of subjects had been treated for more than 1 type of cancer.
All subjects had been clinically diagnosed with insomnia. Seventy-nine percent had moderate (n=94) to severe (n=33) insomnia, and 21% had mild insomnia (n=33).
Interventions
Subjects were randomized to receive CBT or acupuncture for 8 weeks. Those who received CBT worked with a therapist to re-establish a restorative sleep schedule by:
- Reducing the amount of time spent in bed
- Limiting activities performed in bed to sleep and sexual activity
- Modifying unhelpful beliefs about sleep
- Promoting good sleep hygiene (setting a regular sleep schedule and avoiding activities that include light from tablets and cellphones, eating too late, and performing vigorous activities).
The study’s primary outcome was reduction in insomnia severity, as measured by the Insomnia Severity Index (ISI), from study entry to the end of treatment at week 8. Subjects were also reassessed at 20 weeks.
The ISI is a questionnaire that asks people to rate the severity of insomnia problems, such as difficulty falling asleep and staying asleep, and the impact of insomnia on their daily functioning and quality of life.
ISI scoring ranges from 0 to 28. Scores of 0 to 7 denote no clinically significant insomnia, 8 to 14 denote mild insomnia, 15 to 21 denote moderate insomnia, and 22 to 28 denote severe insomnia.
Results
At 8 weeks, the mean ISI score fell 10.9 points (from 18.5 to 7.5) for subjects who received CBT and 8.3 points (from 17.55 to 9.23) for those who received acupuncture (P=0.0007).
Among subjects with mild insomnia at baseline, far more responded to CBT than to acupuncture—85% and 18%, respectively (P<0.0001).
However, response rates were similar in subjects who had moderate to severe insomnia at baseline. Seventy-five percent of those who received CBT achieved a response, as did 66% of those who received acupuncture (P=0.26).
Both treatment groups had few mild adverse events, and all subjects maintained their improvements in insomnia at the 20-week assessment.
This study was funded by the Patient-Centered Outcomes Research Institute. The researchers’ disclosures are listed with the abstract.