Approximately 50% of patients with cancer struggle with persistent insomnia, with a predominance of cases observed among women.1 Along with its negative effect on sleep, cancer-related insomnia is associated with reduced compliance with anticancer treatments, impairment functional status and quality of life and increased financial difficulties.1
Complementary and integrative therapies represent an attractive treatment option for cancer-related insomnia because of the lower risk of side effects compared with pharmacologic treatments. Acupuncture and moxibustion, which are sometimes used together, are 2 such approaches that have shown promise in reducing insomnia in patients with cancer.1
In acupuncture, thin needles are inserted into the skin to stimulate specific bodily sites depending on the desired effect, while moxibustion involves burning ground leaves of the mugwort plant near these sites to provide a warming effect.2,3 In electroacupuncture, an electric current is applied to the acupuncture needles for additional stimulation.
“When performed under experienced hands, these therapies are generally safe and effective in treating patients with cancer-related insomnia,” including for patients undergoing multiple types of cancer treatments, said Christina Tian, DACM, CMD, MAOM, LAc, DiplOM, founder of Bethesda Acupuncture & Wellness Medicine in Bethesda, Maryland. In 2020, Dr Tian completed a 5-year tenure as chief acupuncturist at Sibley Memorial Hospital at Johns Hopkins Medicine in Washington, DC. “Some studies suggest that these therapies are just as effective, if not more effective, than conventional medicine, and they also recommend these therapies over conventional medicine because there are no reported long-term adverse effects.”
Dr Tian told Oncology Nurse Advisor that she and her colleagues have observed patient benefits with acupuncture and electroacupuncture for the relief of cancer-related insomnia as well as cancer-related pain, neuropathy, fatigue, hot flashes, nausea, depression, and anxiety. Most patients report lasting improvements in sleep quantity and quality, increased daytime energy, and improved cognitive function after treatment with these interventions.
In a 2022 systematic review and meta-analysis published in Palliative Care and Social Practice, Wang and colleagues examined 14 randomized controlled trials with a total of 1187 participants with various cancers to evaluate the safety and efficacy of acupuncture and moxibustion in the treatment of cancer-related insomnia.1
Overall, the randomized controlled trials consistently demonstrated the superior efficacy of moxibustion, acupuncture with or without moxibustion, and electroacupuncture compared to conventional medicine in the treatment of cancer-related insomnia.
A 2017 study, for example, compared to electroacupuncture to gabapentin in 58 breast cancer survivors with sleep disturbances associated with hot flashes.4 After an 8-week treatment period, the electroacupuncture group showed a greater mean reduction in Pittsburgh Sleep Quality Index (PSQI) scores compared with the gabapentin group (-2.6 vs -0.8; P =.044), as well as improved sleep latency (-0.5 vs 0.1; P =.041) and sleep efficiency (-0.6 vs 0.0, P = .05).
Another trial demonstrated improvement in PSQI scores in patients receiving moxibustion as an add-on to conventional care compared with those receiving conventional care only (P<.05).1
In their meta-analysis of 12 studies (997 patients) that used PSQI scores to evaluate outcomes, Wang and colleagues observed greater efficacy of moxibustion and/or acupuncture compared with conventional medicine and sham treatment in the management of cancer-related insomnia (mean difference , -1.84;95% CI, -2.75 to -0.94; P<.01).1
Of the 4 studies reporting adverse events, the most common of these were mild and moderate soreness, itchiness, and pain at the needling site, which affected 9 patients.1
In contrast to the findings by Wang and colleagues, another systematic review and meta-analysis published in 2022 found no evidence supporting short-term or long-term effects of acupuncture on sleep impairment in cancer survivors.5 The authors stated that these results are inconsistent with other research and underscore the need for larger, more well-designed studies in this area.