Researchers at Memorial Sloan Kettering (MSK) reported results highlighted the American Society of Clinical Oncology (ASCO) press cast that found that eight weeks of acupuncture or cognitive behavioral therapy for insomnia (CBT-I) decreased the severity of insomnia in cancer survivors.  While both acupuncture and CBT-I resulted in clinically meaningful and durable effects among cancer survivors with insomnia, CBT-I was more useful — especially among patients with mild insomnia symptoms.

“Insomnia has deleterious effects and occurs in up to 60 percent of cancer survivors,” said Jun J. Mao, MD, Chief of the Integrative Medicine Service at MSK. “The results of this trial found that both acupuncture and CBT-I produced beneficial and durable meaningful results. Patients and oncology clinicians can now use these findings to help inform their choice of insomnia treatment.”

Researchers conducted the randomized clinical trial of acupuncture vs. CBT-I among 160 post-treatment cancer survivors with clinically diagnosed insomnia disorder. Study participants, who were on average about 61 years old and about six years post-treatment, were seen over an eight-week period. They received either traditional Chinese acupuncture designed to treat insomnia with an additional focus on pain, fatigue, and psychological stress, or insomnia-specific cognitive behavioral therapy (CBT-i). CBT-i has two key components: sleep restriction and stimulus control. Sleep restriction limits the amount of time a person is in bed so that he or she can have higher quality and efficiency of sleep, meaning the time in bed is deep sleep rather than toss and turns. Stimulus control helps people remove activities that make sleep difficult, for example, not checking phones or i-PADs before bedtime or not reading a book or watching TV in bed. Over time, the bed is a place for sleep rather than doing all kinds of activities.

Before and after the treatment period, people self-reported the severity of their insomnia on a 28-point index. Dr. Mao and his colleagues saw that overall, CBT-i reduced insomnia by 11 points (from about 19 on the scale to 8) compared with acupuncture, which decreased it by approximately 8 points (from 18 to 10). As both proved successful, Dr. Mao says that giving people options for managing their insomnia is beneficial

Patients with mild insomnia were significantly more likely to respond to CBT-I than acupuncture; however, researchers noted that patients with moderate to severe insomnia had similar response rates to CBT-I and acupuncture. Both groups had few mild adverse events and maintained improvements up to 20 weeks. Both groups also had similar improvement in the quality of life including physical health and mental health during the study.

“We are encouraged by the overall results of this study. CBT-I was overall more effective and a clear winner for people with mild insomnia, acupuncture can be a reasonably good choice for people with moderate to severe insomnia,” said Dr. Mao. “We hope to continue our studies to find out how best personalize treatment to improve sleep for patients and survivors.”

Importance of Patient Reported Outcomes

Although symptom management is a cornerstone of high-quality cancer care, prior research has shown that doctors miss up to half of the patients’ symptoms during cancer treatment.  “Many cancer survivors have some form of insomnia that is often undiagnosed and undertreated,” said Dr. Mao.

Patient-reported outcomes empower patients to report their symptoms actively and allow doctors and nurses to intervene early when necessary, ultimately improving the quality of life for patients.

Acupuncture and CBT-I at MSK

Acupuncture is a component of Traditional Chinese Medicine and involves the use of needles, sometimes with electricity to stimulate points on the body to induce relaxation and restore balance.

There is evidence that acupuncture can reduce symptoms such as pain, nausea and vomiting, fatigue, hot flashes, dry mouth and side effects caused by radiotherapy and/or chemotherapy. It may also assist with lifestyle changes such as smoking cessation.

Acupuncture treatments are generally safe and well tolerated by most patients, including pediatric patients and the elderly. To manage specific symptoms, individuals often need a series of 6-10 treatment initially on a weekly basis. Once responding to treatment, some individuals may not need additional treatment while others may need ongoing maintenance treatment.  MSK believes in caring for the whole person — not just the disease or symptom. Integrative medicine weaves natural treatments such as acupuncture, massage, and yoga into a patient’s overall care plan. All of MSK’s holistic health services and programs are based on the latest scientific evidence.

Cognitive Behavioral Therapy for Insomnia is a newer type of psychotherapy that has been considered the gold standard for the treatment of insomnia. MSK psychiatrists and psychologists provide specialized emotional and mental health support for all patients, no matter their stage or diagnosis.

While this type of CBT-I psychotherapy is not offered widely, MSK has a dedicated staff of clinicians who help in this area and are knowledgeable about how insomnia effects the overall health.

This study was funded by the Patient-Centered Outcomes Research Institute (PCORI).