Acupuncture for cancer-related insomnia: A systematic review and meta-analysis

Zhang, Jialing; Zhang, Zhinan; Huang, Shengtao; Qiu, Xiaoke; Lao, Lixing; Zhang, Zhangjin; Zhang, Zhang-Jin

doi:10.1016/j.phymed.2022.154160

Cited by 30 publications

(27 citation statements)

References 44 publications

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“…Similar to previous studies [ 63 , 66 ], this study presented that acupuncture had a high safety profile with well tolerability. There were only few mild adverse events reported from both groups and no participants discontinued treatments due to adverse events.…”

Section: Discussionsupporting

confidence: 87%

Acupuncture for chemotherapy-associated insomnia in breast cancer patients: an assessor-participant blinded, randomized, sham-controlled trial

Zhang

Qin

et al. 2023

Breast Cancer Res

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Background Insomnia is a highly prevalent symptom occurred during and post-chemotherapy. Acupuncture may have beneficial effects in the management of chemotherapy-associated insomnia. This study was conducted to determine the efficacy and safety of acupuncture in improving chemotherapy-associated insomnia in breast cancer patients. Methods This assessor-participant blinded, randomized, sham-controlled trial was conducted from November 2019 to January 2022 (follow-up completed July 2022). Participants were referred by oncologists from two Hong Kong hospitals. Assessments and interventions were conducted at the outpatient clinic of School of Chinese Medicine, the University of Hong Kong. The 138 breast cancer patients with chemotherapy-associated insomnia were randomly assigned to receive either 15 sessions of active acupuncture regimen by combining needling into body acupoints and acupressure on auricular acupoints or sham acupuncture control (69 each) for 18 weeks, followed by 24 weeks of follow-up. The primary outcome was measured using Insomnia Severity Index (ISI). Secondary outcomes included the Pittsburgh Sleep Quality Index, Actiwatch and sleep diary for sleep parameters, depression and anxiety, fatigue and pain, and quality of life. Results There were 87.7% (121/138) participants who completed the primary endpoint (week-6). The active acupuncture regimen was not superior to the sham control in reducing ISI score from baseline to 6 weeks (mean difference: − 0.4, 95% CI − 1.8–1.1; P = 0.609), but produced short-term treatment and long-term follow-up better outcomes in improving sleep onset latency, total sleep time, sleep efficiency, anxiety, depression, and quality of life. Participants of the active acupuncture group had a pronouncedly higher cessation rate of sleeping medications than the sham control (56.5% vs. 14.3%, P = 0.011). All treatment-related adverse events were mild. No participants discontinued treatments due to adverse events. Conclusion The active acupuncture regimen could be considered as an effective option for the management of chemotherapy-associated insomnia. It also could serve as a tapering approach to reduce and even replace the use of sleeping medications in breast cancer patients. Trial registrationClinicaltrials.gov: NCT04144309. Registered 30 October 2019.

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Section: Discussionsupporting

confidence: 87%

Acupuncture for chemotherapy-associated insomnia in breast cancer patients: an assessor-participant blinded, randomized, sham-controlled trial

Zhang

Qin

et al. 2023

Breast Cancer Res

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“…Such treatment could be considered an adjuvant alternative to current CRI management. Additionally, another systematic review ( 14 ) published in 2022 showed that acupuncture has great potential to manage CRI in cancer patients, while the evidence of true acupuncture, PSA, and WM in treating CRI has not been entirely conclusive. Clinicians have encountered difficulties in selecting the most favorable acupuncture treatment for CRI.…”

Section: Introductionmentioning

confidence: 99%

Acupuncture and moxibustion in patients with cancer-related insomnia: A systematic review and network meta-analysis

Dong

et al. 2023

Front. Psychiatry

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ObjectivesCancer-related insomnia (CRI) is one of the most common and serious symptoms in patients with cancer. Acupuncture and moxibustion have been widely applied in the treatment of CRI. Nevertheless, the comparative efficacy and safety of different acupuncture and moxibustion techniques remain unclear. This study aimed to evaluate and compare the efficacy and safety of different acupuncture and moxibustion techniques in the treatment of CRI.MethodsEight medical databases were comprehensively searched for relevant randomized controlled trials (RCTs) as of June 2022. Two independent reviewers assessed the risk of bias and conducted the research selection, data extraction, and quality assessment of the included RCTs. A network meta-analysis (NMA) was performed using frequency models, combining all available direct and indirect evidence from RCTs. The Pittsburgh Sleep Quality Index (PSQI) was set as the primary outcome, and adverse events and effective rates were set as the secondary outcomes. The efficacy rate was calculated as the ratio of patients with insomnia symptom relief to the total number of patients.ResultsThirty-one RCTs with 3,046 participants were included, including 16 acupuncture- and moxibustion-related therapies. Transcutaneous electrical acupoint stimulation [surface under the cumulative ranking curve (SUCRA) 85.7%] and acupuncture and moxibustion (SUCRA 79.1%) were more effective than Western medicine, routine care, and placebo-sham acupuncture. Furthermore, Western medicine showed significantly better effects than placebo-sham acupuncture. In the NMA, the acupuncture and moxibustion treatments with the best therapeutic effects for CRI were transcutaneous electrical acupoint stimulation (SUCRA 85.7%), acupuncture and moxibustion (SUCRA 79.1%), auricular acupuncture (SUCRA 62.9%), routine care combined with intradermal needling (SUCRA 55.0%), and intradermal needling alone (SUCRA 53.3%). No serious acupuncture- or moxibustion-related adverse events were reported in the included studies.ConclusionAcupuncture and moxibustion are effective and relatively safe in treating CRI. The relatively conservative recommended order of acupuncture- and moxibustion-related therapies for CRI is as follows: transcutaneous electrical acupoint stimulation, acupuncture and moxibustion, and auricular acupuncture. However, the methodological quality of the included studies was generally poor, and further high-quality RCTs are needed to strengthen the evidence base.

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“…In addition to acupuncture and acupressure, ASRTs have now evolved into numerous treatment techniques driven by clinical need, with acupoint selection varying from practitioner to practitioner. While several clinical common ASRTs for insomnia have been evaluated in previous systematic reviews, [45][46][47][48][49][50][51][52][53] in the face of such a wide range of ASRTs, there is no conclusion on how ASRT clinicians should manage insomnia in clinical practice. To develop guidelines and further drive future clinical practice and research, a more thorough and comprehensive evaluation of all the existing literature is required.…”

Section: Discussionmentioning

confidence: 99%

“…43,44 Numerous systematic reviews have also reported that the efficacies of these common clinical ASRTs for primary insomnia and comorbid insomnia were higher than that of routine care, placebo acupuncture, or waiting list controls. [45][46][47][48][49][50][51][52][53] However, the generalizability of these findings was constrained by the fact that the quality of the available literature is generally poor and these meta-analyses concentrated on a particular form of insomnia and/or a single therapy approach.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis Protocol to Establish How Common Clinical Acupoint Stimulation-Related Therapies Should Be Used for Managing Insomnia

Pei¹,

Xu²,

Pan³

et al. 2023

JPR

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Background Many studies have now investigated the effects of common clinical acupoint stimulation-related therapies (ASRTs) following the meridian theory of traditional Chinese medicine for the management of insomnia. However, ASRT choice is currently based on personal clinical experience or patient preference. This study will review the common ASRTs reported in clinical trials and analyze their efficacy and safety for managing insomnia with or without co-morbidities. Methods English and Chinese databases will be thoroughly searched, and other potentially eligible trials will be obtained by reviewing reference lists of identified studies and previous reviews. Only randomized controlled trials (RCTs) of common clinical ASRTs to manage insomnia published in peer-reviewed journals will be considered. Sleep quality questionnaires or indices will be considered as the main outcome, while the secondary outcomes will include sleep parameters, daytime dysfunction, quality of life, and adverse effects. Two reviewers will independently investigate eligible RCTs, extract information, analyze their methodological quality, and employ Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria to evaluate the strength of the evidence. The treatment impact of various ASRTs will be calculated using meta-analysis techniques, and the degree of study heterogeneity will be assessed using Cochrane’s Q and I-squared statistics. Subgroup and sensitivity analyses will be used to evaluate the reliability of the results. Results Our systematic review and meta-analysis will present up-to-date evidence on: 1) which common clinical ASRTs are beneficial for the management of insomnia; and 2) whether the effects of common clinical ASRTs on insomnia vary depending on clinical, participant, and treatment characteristics. Conclusion The results of our review should help decision-makers make educated choices regarding evidence-based non-pharmacological management options for insomnia. Study Registration The International Platform of Registered Systematic Review and Meta-analysis (INPLASY), record INPLASY2021120137.

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Acupuncture for cancer-related insomnia: A systematic review and meta-analysis

Cited by 30 publications

References 44 publications

Acupuncture for chemotherapy-associated insomnia in breast cancer patients: an assessor-participant blinded, randomized, sham-controlled trial

Acupuncture for chemotherapy-associated insomnia in breast cancer patients: an assessor-participant blinded, randomized, sham-controlled trial

Acupuncture and moxibustion in patients with cancer-related insomnia: A systematic review and network meta-analysis

A Systematic Review and Meta-Analysis Protocol to Establish How Common Clinical Acupoint Stimulation-Related Therapies Should Be Used for Managing Insomnia

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