Acupuncture versus cognitive behavioral therapy for insomnia in cancer survivors: A randomized clinical trial Journal Article

Authors: Garland, S. N.; Xie, S. X.; DuHamel, K.; Bao, T.; Li, Q.; Barg, F. K.; Song, S.; Kantoff, P.; Gehrman, P.; Mao, J. J.
Article Title: Acupuncture versus cognitive behavioral therapy for insomnia in cancer survivors: A randomized clinical trial
Abstract: Background: Insomnia is a common and debilitating disorder experienced by cancer survivors. Although cancer survivors express a preference for using nonpharmacological treatment to manage insomnia, the comparative effectiveness between acupuncture and Cognitive Behavioral Therapy for Insomnia (CBT-I) for this disorder is unknown. Methods: This randomized trial compared 8 weeks of acupuncture (n = 80) and CBT-I (n = 80) in cancer survivors. Acupuncture involved stimulating specific points on the body with needles. CBT-I included sleep restriction, stimulus control, cognitive restructuring, relaxation training, and education. We measured insomnia severity (primary outcome), pain, fatigue, mood, and quality of life posttreatment (8 weeks) with follow-up until 20 weeks. We used linear mixed-effects models for analyses. All statistical tests were two-sided. Results: The mean age was 61.5 years and 56.9% were women. CBT-I was more effective than acupuncture posttreatment (P<.001); however, both acupuncture and CBT-I produced clinically meaningful reductions in insomnia severity (acupuncture: -8.31 points, 95% confidence interval = -9.36 to -7.26; CBT-I: -10.91 points, 95% confidence interval = -11.97 to -9.85) and maintained improvements up to 20 weeks. Acupuncture was more effective for pain at the end of treatment; both groups had similar improvements in fatigue, mood, and quality of life and reduced prescription hypnotic medication use. CBT-I was more effective for those who were male (P<.001), white (P = .003), highly educated (P<.001), and had no pain at baseline (P<.001). Conclusions: Although both treatments producedmeaningful and durable improvements, CBT-I was more effective and should be the first line of therapy. The relative differences in the comparative effectiveness between the two interventions for specific groups should be confirmed in future adequately powered trials to guide more tailored interventions for insomnia.
Keywords: fatigue; management; validation; disorder; severity index
Journal Title: JNCI: Journal of the National Cancer Institute
Volume: 111
Issue: 12
ISSN: 0027-8874
Publisher: Oxford University Press  
Date Published: 2019-12-01
Start Page: 1323
End Page: 1331
Language: English
ACCESSION: WOS:000509549100010
DOI: 10.1093/jnci/djz050
PMCID: PMC6910189
PUBMED: 31081899
Notes: Article -- Source: Wos
Citation Impact
MSK Authors
  1. Katherine N Duhamel
    99 Duhamel
  2. Ting   Bao
    74 Bao
  3. Jun J Mao
    196 Mao
  4. Philip Wayne Kantoff
    188 Kantoff
  5. Qing Susan Li
    68 Li