ASCO 2018: Alternative Therapies Improve Insomnia Symptoms in Cancer Survivors

Randomised clinical trial investigates non-pharmacologic strategies to control insomnia

Although cognitive behavior therapy for insomnia (CBT-I) and acupuncture both produced clinically meaningful improvements in insomnia severity scores for cancer survivors, CBT-I was more effective overall in reducing the severity of insomnia symptoms, according to findings presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, held 1 to 5 June in Chicago, USA.

Patients with mild insomnia responded significantly more to CBT-I, while those with moderate-to-severe insomnia demonstrated responses that slightly favoured CBT-I. 

Lead author Jun J. Mao, of the Integrative Medicine Service at Memorial Sloan Kettering Cancer Centre in New York noted that up to 60% of cancer survivors have some form of insomnia. Together with colleagues, Dr. Mao recruited 160 cancer survivors who had completed treatment for cancer and had clinically diagnosed insomnia. Eighty participants in each treatment cohort underwent 8 weeks of treatment with CBT-I or acupuncture in the randomised clinical trial ( NCT02356575). Acupuncture consisted of needles being placed at specific axis of the body and patients in the CBT-I groups received cognitive restructuring, education, relaxation training, sleep restriction, and stimulus control. 

Insomnia severity was assessed using the Insomnia Severity Index (ISI), a 28-point questionnaire. The patients rated the severity of their insomnia and the effect that insomnia had on their quality of life (QoL) and daily functioning. Patients with scores of 0 to 7 were considered not to have clinically significant insomnia, scores of 8 to 14 indicated mild insomnia, 15 to 21 showed moderate insomnia, and scores of 22 to 28 indicated severe insomnia. 

The mean participant age was 61.5 years. Women made up 57% of the study population and 29.4% of participants were non-white. Seventy-nine percent of participants had moderate-to-severe insomnia while the rest reported mild insomnia.

Both cognitive behavior therapy and acupuncture lessened insomnia severity 

ISI scores decreased by 10.9 points (95% confidence interval [CI] 9.8, 12.0) during treatment for patients assigned to CBT-I, from 18.5 to 7.5. Participants assigned to acupuncture showed a decline of ISI of 8.3 points (95% CI 7.3, 9.4), from 17.5 to 9.2. 

Response rates at the end of treatment were significantly higher for CBT-I compared with acupuncture in 33 participants with mild insomnia; response rates were 85% versus 18%; p <0.0001. Responses were similar in 127 patients with moderate-to-severe insomnia of 75% with CBT-I compared to 66% with acupuncture (p = 0.26). 

Overall, patients maintained improvements for up to 20 weeks. 

Both groups reported similarly improved QoL for physical health (p = 0.4) and mental health (p = 0.36). Adverse events were mild in both groups.

Conclusions 

The authors concluded that both acupuncture and CBT-I resulted in clinically meaningful, durable effects among cancer survivors with insomnia; however, they found that CBT-I was more effective, especially among patients with mild insomnia symptoms. 

According to the authors, these findings can be used by patients and oncology clinicians to inform their choice of insomnia treatment. 

Disclosure 

No external funding was disclosed. 

Reference 

Mao JJ, Xie S, Duhamel K, et al. The effect of acupuncture versus cognitive behaviour therapy on insomnia in cancer survivors: A randomized clinical trial. J Clin Oncol 36, 2018 (suppl; abstr 10001).