Abstract
Simple SummarySleep problems impair up to 70% of breast cancer survivors. We studied whether ear acupuncture improves sleep quality in breast cancer survivors with sleeplessness. Fifty-two female breast cancer survivors were randomly distributed to either 10 group ear acupuncture sessions or a onetime psychoeducation group. We found that sleep quality improved over the 5 weeks of the study in the ear acupuncture group in comparison to the psychoeducation group. Stress, anxiety and fatigue improved as well. These effects were lost after 17 and 29 weeks.Among women, breast cancer is the most commonly diagnosed cancer worldwide. Sleep problems impair 40–70% of breast cancer survivors. This randomized controlled trial evaluates the effect of auricular acupuncture on sleep quality in breast cancer survivors suffering from insomnia. Fifty-two female breast cancer survivors with insomnia (mean age 55.73 ± 8.10 years) were randomized either to 10 treatments of auricular acupuncture within five weeks (n = 26), or to a single session of psychoeducation plus an insomnia advice booklet (n = 26). The primary outcome was sleep quality (measured by the Pittsburgh Sleep Quality Index) at week 5. Secondary outcomes were inflammation parameter (interleukin-6), stress, anxiety, depression, quality of life, and fatigue at week 5, and sleep quality, stress, anxiety, depression, quality of life, and fatigue 17 and 29 weeks after randomization. Intention-to-treat analysis showed a significantly stronger increase in sleep quality in the auricular acupuncture group compared to the psychoeducation group (p = 0.031; η2p = 0.094) at week 5. Furthermore, auricular acupuncture improved stress (p = 0.030; η2p = 0.094), anxiety (p = 0.001; η2p = 0.192), and fatigue (p = 0.006; η2p = 0.148) at week 5 compared to psychoeducation. No significant group difference was found concerning the other outcomes at week 5, or in any outcome at week 17 or week 29. No serious adverse events occurred during the study period. In conclusion, a semi-standardized group auricular acupuncture might be an effective and safe intervention in treating insomnia in breast cancer survivors in the short term, and may reduce stress, anxiety, and fatigue as well. Long-term effects remain questionable.
Highlights
Among females, breast cancer is the most commonly diagnosed cancer, with an incidence of 11.6% worldwide in 2018 [1], and a 10-year survival rate exceeding 80% [2]
No serious adverse events occurred during the study period
A total of 93 patients were assessed for eligibility (Figure 2); 52 patients fulfilled the inclusion criteria, and were randomized to either auricular acupuncture (n = 26) or psychoeducation (n = 26)
Summary
Breast cancer is the most commonly diagnosed cancer, with an incidence of 11.6% worldwide in 2018 [1], and a 10-year survival rate exceeding 80% [2]. About 40–70% of breast cancer survivors report sleep problems even years after diagnosis, depending on the applied diagnostic criteria [3,4,5]. A common sleep disorder in breast cancer patients is insomnia [6]. Insomnia leads to impaired psychological and physical health [8,9], and might even increase mortality in breast cancer patients [10,11]. Sleep influences the hypothalamic– pituitary–adrenal axis and the sympathetic nervous system which, in turn, regulate adaptive and innate immune responses [12]. While sleep disturbances seem to induce a downregulation of adaptive immunity, the innate immune responses are upregulated with increases in cellular and genomic markers of inflammation. Circadian control seems to influence the gene expression of cytokines, including IL-6 [14]
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