CBT, Acupuncture Combat Insomnia in Cancer Survivors

John Schieszer

A study led by Dr. Jun Mao of MSKCC found CBT and acupuncture each yielded clinically meaningful and durable sleep-related QOL improvements.

Both cognitive behavioral therapy (CBT) and acupuncture may help cancer patients get a good night’s sleep, according to the results of a randomized clinical trial (abstract 10001) presented at a press conference ahead of the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, to be held June 1–5 in Chicago. These new data suggest that both approaches may yield a clinically meaningful and durable benefit in cancer survivors with insomnia. The researchers found CBT was more effective than acupuncture, especially among patients with mild symptoms of insomnia. They concluded that patients and oncologists can use these findings to inform their choice of insomnia treatment.

CBT attempts to modify emotions, behaviors, and thoughts related to sleep. Results from the randomized clinical trial of cancer survivors showed 8 weeks of either acupuncture or CBT decreased the severity of insomnia among cancer survivors. Lead study author Jun J. Mao, MD, Chief of Memorial Sloan Kettering Cancer Center’s Integrative Medicine Service, in New York City, said that while up to 60% of cancer survivors have some form of insomnia, it is often underdiagnosed and undertreated. Dr. Mao’s investigation included 160 post-treatment cancer survivors with clinically diagnosed insomnia disorder.

The mean age of participants was 61.5 years, and 57% were women. All had completed cancer treatment, and the mean time since cancer diagnosis was about 6 years. The survivors had received treatment for breast, prostate, head and neck, hematologic, and colorectal cancers. In addition, 6% had received treatment for more than one type of cancer.

All trial participants had been clinically diagnosed with insomnia and were randomly assigned to receive either CBT (n = 80) or acupuncture (n = 80) for 8 weeks. The participants who received CBT worked with a therapist to re-establish a restorative sleep schedule by reducing the amount of time in spent in bed and limiting activities performed in bed to only sleep and sexual activity. The therapists also helped dispel unhelpful beliefs about sleep, and they promoted good “sleep hygiene” practices.

Reduction in insomnia severity was the primary study outcome. It was measured by the Insomnia Severity Index (ISI) at study entry through week 8 (end of treatment). Participants were also reassessed 20 weeks after they had started the trial. ISI scores ranged from 0 to 28. Patients with scores of 0–7 were considered as having no clinically significant insomnia, those with scores of 8–14 were classified as having mild insomnia, scores of 15–21 were classified as moderate insomnia, and scores of 22–28 indicated severe insomnia. At the beginning of the trial, based on this scoring system, 33 participants were determined to have mild insomnia, 94 had moderate insomnia, and 33 had severe insomnia.

After 8 weeks, insomnia severity scores fell 10.9 points, from 18.5 to 7.5 for those who received CBT, compared with an ISI score drop of 8.3 points for those treated with acupuncture (range of ISI score decrease, 17.55 to 9.23 points). Among those with mild insomnia at the start of the trial, far more had an improvement with CBT than with acupuncture (85% vs 18%). Among participants who started the trial with moderate to severe insomnia, response rates were somewhat similar for those who received CBT (75%) vs acupuncture (66%). The study showed that participants in both arms had similar improvement in quality of life in terms of physical health (P = .46) and mental health (P = .44). All survivors maintained improvement in their insomnia up to 20 weeks after the start of the trial.

Dr. Mao concluded that both acupuncture and CBT are attractive in this setting because they are nonpharmacologic therapies and appear to provide clinically meaningful and durable benefits.

Editor’s note: Watch for Cancer Network’s exclusive video interview with Dr. Mao during ASCO, to learn more about this study!