Choi, T.Y., Kim, J.I., Lim, H.J., & Lee, M.S. (2016). Acupuncture for managing cancer-related insomnia: A systematic review of randomized clinical trials. Integrative Cancer Therapies. Advance online publication. 

DOI Link

Purpose

STUDY PURPOSE: To evaluate the efficacy of acupuncture to relieve cancer-related insomnia

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: PubMed, EMBASE, AMED, the Cochrane Library, seven Korean medical databases, one Chinese medical database; no language restrictions
 
INCLUSION CRITERIA: Randomized, controlled trials (RCTs) and quasi-RCTs that tested any type of invasive acupuncture were included, such as manual acupuncture, electroacupuncture, and auricular acupuncture
 
EXCLUSION CRITERIA: Case studies, case series, qualitative studies, uncontrolled studies, and controlled trials without randomization methods were excluded. Trials testing other forms of acupuncture, such as acupressure, transcutaneous electrical nerve stimulation, point injection, laser irradiation, and cupping were excluded.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 90
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Two reviewers extracted data from the trials and assessed risk of bias using the Cochrane risk of bias tool.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 6
  • TOTAL PATIENTS INCLUDED IN REVIEW = 475
  • SAMPLE RANGE ACROSS STUDIES: 45–120
  • KEY SAMPLE CHARACTERISTICS: Adults with various types and in various stages of cancer

Phase of Care and Clinical Applications

PHASE OF CARE: Not specified or not applicable

Results

Two trials compared acupuncture to sham acupuncture in patients with breast cancer: one trial showed positive effects as reported in a sleep diary, and one trial did not show that acupuncture was beneficial as measured by the Pittsburgh Sleep Quality Index (PSQI). Three trials compared acupuncture to sleeping medications: two trials showed improved sleep with acupuncture as measured by PSQI when compared to drugs, and one trial did not show a benefit. One trial that compared acupuncture to hormone therapy in patients with breast cancer showed improved sleep with acupuncture. Overall, the trials had a low risk of bias, except for participant and personnel blinding, because of the nature of acupuncture. Few adverse events were reported with acupuncture but included fatigue, pruritis, and nausea.

Conclusions

Mixed evidence about the effectiveness of acupuncture to relieve cancer-related insomnia compared to medications exists. In the current review, acupuncture may be superior to sham acupuncture, conventional drug therapy, and hormone therapy for the management of cancer-related insomnia. The level of evidence is low because of a limited number of trials and total sample size.

Limitations

  • Limited number of studies included
  • Details of acupuncture procedures, such as treatment times, duration of sessions, length of follow-up, and practitioner background, varied between trials or were not reported.  
  • Sleep outcomes in all trials were subjective measures.  
  • Half the trials were from China, which may limit generalizability to other countries.

Nursing Implications

Acupuncture has been examined as an intervention to relieve cancer-related insomnia, and a small number of studies show mixed evidence about its effectiveness. Additional trials that report standard acupuncture methodology and use objective sleep outcome measures are needed before nurses can recommend acupuncture as an effective treatment to relieve insomnia.

Legacy ID

6297