Meeting NewsPerspective

Cognitive behavioral therapy, acupuncture reduce insomnia among cancer survivors

Jun J. Mao

Moderate to severe insomnia improved among cancer survivors after cognitive behavioral therapy or acupuncture, according to study results scheduled for presentation at the ASCO Annual Meeting.

For mild insomnia, cognitive behavioral therapy appeared more effective than acupuncture, the research showed.

Insomnia occurs in as many as 60% of cancer survivors and can have a deleterious effect on quality of life.

“Cognitive behavioral therapy for insomnia is a highly effective therapy and considered gold standard of treatment; however, not everyone accepts this treatment,” Jun J. Mao, MD, MSCE, chief of Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, said during a press cast. “It is a highly specialized therapy that isn’t quite available in many cancer centers or communities.

“Acupuncture can also improve pain and sleep disturbance,” Mao added. “We set out to do a study to answer a question between the two treatments: ‘Which is more effective for insomnia in individuals with cancer?’”

Mao and colleagues evaluated 160 cancer survivors (mean age, 61.5 years; 57% women; 29.4% non-white) with clinically diagnosed insomnia disorder. Cancer types in the population included breast (31%), prostate (23%), other (14%), hematologic (8%), head and neck (7%), colorectal (6%), more than one type (6%) and gynecologic (4%).

Patients received either acupuncture via stimulation of various body points with needles or cognitive behavioral therapy — which consisted of relaxation training, sleep restriction, stimulus control, cognitive restructuring and education — for an 8-week intervention period.

Severity of insomnia — determined by the Insomnia Severity Index — served as the primary outcome.

Each patient underwent follow-up assessment at 20 weeks.

At baseline, 33 survivors had mild insomnia, 94 had moderate insomnia and 33 had severe insomnia.

Patients who received acupuncture experienced an 8.3-point (95% CI, 7.3-9.4) reduction in insomnia severity compared with a 10.9-point (95% CI, 9.8-12) reduction among patients who underwent cognitive behavioral therapy. Thus, researchers deemed cognitive behavioral therapy the more effective treatment (difference, 2.6 points; 95% CI, 1.1-4.1; P = .0007).

A greater proportion of patients with mild insomnia responded to cognitive behavioral therapy than acupuncture (85% vs. 18%; P < .0001).

Patients with moderate to severe insomnia showed similar response rates to both behavioral cognitive therapy and acupuncture (75% vs. 66%).

Improvements in insomnia severity continued up to 20 weeks.

Both groups of patients experienced similar improvements in quality of life for physical and mental health throughout the study period.

Researchers observed a limited number of mild adverse events among patients.

“Our hope is that by doing this research, we can help patients and clinicians pick the right treatment for patients to manage their sleep,” Mao said. – by Melinda Stevens

 

Reference:

Mao JJ, et al. Abstract 10001. Scheduled for presentation at: ASCO Annual Meeting; June 1-5, 2018; Chicago.

 

Disclosures: Mao reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.

Jun J. Mao

Moderate to severe insomnia improved among cancer survivors after cognitive behavioral therapy or acupuncture, according to study results scheduled for presentation at the ASCO Annual Meeting.

For mild insomnia, cognitive behavioral therapy appeared more effective than acupuncture, the research showed.

Insomnia occurs in as many as 60% of cancer survivors and can have a deleterious effect on quality of life.

“Cognitive behavioral therapy for insomnia is a highly effective therapy and considered gold standard of treatment; however, not everyone accepts this treatment,” Jun J. Mao, MD, MSCE, chief of Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, said during a press cast. “It is a highly specialized therapy that isn’t quite available in many cancer centers or communities.

“Acupuncture can also improve pain and sleep disturbance,” Mao added. “We set out to do a study to answer a question between the two treatments: ‘Which is more effective for insomnia in individuals with cancer?’”

Mao and colleagues evaluated 160 cancer survivors (mean age, 61.5 years; 57% women; 29.4% non-white) with clinically diagnosed insomnia disorder. Cancer types in the population included breast (31%), prostate (23%), other (14%), hematologic (8%), head and neck (7%), colorectal (6%), more than one type (6%) and gynecologic (4%).

Patients received either acupuncture via stimulation of various body points with needles or cognitive behavioral therapy — which consisted of relaxation training, sleep restriction, stimulus control, cognitive restructuring and education — for an 8-week intervention period.

Severity of insomnia — determined by the Insomnia Severity Index — served as the primary outcome.

Each patient underwent follow-up assessment at 20 weeks.

At baseline, 33 survivors had mild insomnia, 94 had moderate insomnia and 33 had severe insomnia.

Patients who received acupuncture experienced an 8.3-point (95% CI, 7.3-9.4) reduction in insomnia severity compared with a 10.9-point (95% CI, 9.8-12) reduction among patients who underwent cognitive behavioral therapy. Thus, researchers deemed cognitive behavioral therapy the more effective treatment (difference, 2.6 points; 95% CI, 1.1-4.1; P = .0007).

A greater proportion of patients with mild insomnia responded to cognitive behavioral therapy than acupuncture (85% vs. 18%; P < .0001).

Patients with moderate to severe insomnia showed similar response rates to both behavioral cognitive therapy and acupuncture (75% vs. 66%).

Improvements in insomnia severity continued up to 20 weeks.

Both groups of patients experienced similar improvements in quality of life for physical and mental health throughout the study period.

Researchers observed a limited number of mild adverse events among patients.

“Our hope is that by doing this research, we can help patients and clinicians pick the right treatment for patients to manage their sleep,” Mao said. – by Melinda Stevens

 

Reference:

Mao JJ, et al. Abstract 10001. Scheduled for presentation at: ASCO Annual Meeting; June 1-5, 2018; Chicago.

 

Disclosures: Mao reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.

    Perspective
    Bruce E. Johnson

    Bruce E. Johnson

    Insomnia is a common problem. The most common way we treat it is pharmacologically with sleeping pills. This study shows two different methods, other than medications, that can help sleep and also improve quality of life. We think this will be useful information to help clinicians know how insomnia severity will influence treatment.

    • Bruce E. Johnson, MD, FASCO
    • Dana-Farber Cancer Institute

    Disclosures: Johnson reports expert testimony with Genentech; stock and ownership interests with KEW Group; honoria from Chugai Pharma and Merck; consultant/advisory roles with AstraZeneca, Amgen, Boehringer Ingelheim, Clovis Oncology, Chugai Pharma, Genentech, KEW Group, Lilly, Merck, Novartis and Transgene; research funding from Novartis; and patents, royalties and other intellectual property with royalties from Dana-Farber Cancer Institute.

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