番茄社区

CHICAGO -- A randomized trial of acupuncture versus cognitive behavior therapy for insomnia (CBT-I) for cancer survivors determined that CBT-I was the more effective of the two modalities, and particularly among those with mild insomnia.

After 8 weeks of treatment, CBT-I patients saw their average Insomnia Severity Index (ISI) score drop by 11 points, while acupuncture patients had an 8.3-point reduction, reported Jun J. Mao, MD, chief of the Integrative Medicine Service at Memorial Sloan Kettering Cancer Center in New York City, and colleagues.

"Our trial showed that both CBT-I and acupuncture were effective in treating moderate to severe insomnia, although CBT-I was more effective for those with mild symptoms," said Mao during a press briefing ahead of the (ASCO) meeting. "Now patients have more choices to manage their insomnia."

Among the mild insomnia patients, 85% reported improvement with CBT-I compared with just 18% with acupuncture. Those who started the trial with moderate to severe insomnia had comparable response rates with CBT-I and acupuncture (75% and 66% respectively).

Up to 60% of cancer survivors suffer from some form of insomnia, which can seriously affect a person's health and quality of life. The use of either acupuncture or CBT-I provides clinicians and patients with effective alternatives to sleeping pills, but a randomized comparison of the two had not been performed until now.

CBT-I is a structured program designed to help patients identify and modify the thoughts, emotions, and behaviors that are causing sleep problems -- it is usually recommended as the first line of treatment for insomnia. However, studies have found that CBT-I is often associated with large attrition rates and poor adherence to treatment, and it is often unavailable in cancer centers and surrounding communities.

Acupuncture provides patients and clinicians with another non-pharmacologic option by modulating regions of the brain involved in cognition and emotion, and is available in a large number of cancer centers in the U.S.

In this trial, 160 cancer survivors were randomized to undergo acupuncture and CBT-I. These survivors had completed cancer treatment -- for breast, prostate, head and neck, hematologic, and colorectal cancer -- and had a mean time since diagnosis of about 6 years. About 6% had been treated for more than one type of cancer.

Of the 160 trial participants, 33 had mild insomnia, 94 moderate insomnia, and 33 severe insomnia. Insomnia severity was measured by ISI, with scores ranging from 0-28:

• 0-7, no clinically significant insomnia
• 8-14, mild insomnia
• 15-21, moderate insomnia
• 22-28, severe insomnia

The treatment for both arms of the trial lasted 8 weeks, with a 12-week follow-up. Acupuncture patients underwent 10 treatment sessions involving the placement of needles at a predetermined set of points on the body shown to influence sleep, pain, and depression.

Patients who received CBT-I worked with a therapist through seven sessions to re-establish a normal sleep schedule by reducing the amount of time spent in bed, limiting activities performed in bed to only sleep and sexual activity, modifying unhelpful beliefs about sleep, and promoting good sleep hygiene by avoiding activities such as looking at cellphones in bed, or eating meals late at night.

At 8 weeks the CBT-I intervention reduced the average ISI score from 18.5 to 7.5, while acupuncture reduced the score from 17.5 to 9.2. The researchers found that all trial participants maintained their improvement up to 20 weeks.

"Our hope is that by doing this type of research we can help patients and clinicians take the right kind of treatment to manage their sleep," Mao said, adding that further research will focus on how best to deliver these treatments to a broader community of cancer patients.

Commenting on the study, ASCO President Bruce Johnson, MD, pointed out that sleep is critical during recovery from cancer treatments, but that insomnia affects a large number of patients. "The most common way we've treated this is with pharmacology -- sleeping pills," he said. "And this shows us two different methods that use something other than medication that can help people with sleep and improve their quality of life."