The Effect of Acupuncture for Insomnia in Breast Cancer Patients Undergoing Chemotherapy

Hypothesis:

Acupuncture is a feasible, effective and safe method for alleviation of insomnia symptoms in breast cancer patients undergoing chemotherapy as compared with a wait-list control.

Objective:

To determine whether the insomnia condition in the acupuncture group is significantly improved when compared to the wait-list control group.

Design and strategy:

This is a randomized, wait-list controlled, assessor-blinded trial. 30 subjects will be recruited and randomized (in 1:1 ratio) to receive either acupuncture treatment or wait-list control. All patients in the 2 groups will receive routine Western medical care for symptom management.

Study instrument:

Insomnia Severity Index (ISI) will be employed as a primary outcome assessment.

Intervention:

In the treatment group, 12 sessions acupuncture treatment (electroacupuncture & auricular acupressure) will be given twice a week for 6 weeks after randomization. In the wait-list control group, no treatment except routine care will be given at the first 6 weeks, followed by 12 sessions treatment as treatment group.

Main outcome measures:

Primary outcome: ISI scores will be measured at week 0, 3, 6, 10, 14.

Secondary outcomes:

Pittsburgh Sleep Quality Index, Sleep diary, Actiwatch, Functional Assessment of Cancer Therapy-Breast Cancer, and adverse events will be documented and compared between groups.

Data analysis: The primary endpoint will be the continuous ISI score. For the primary analysis, if normality of the ISI or its transformation can be achieved, a two-sample t-test on the average ISI score will be performed to access the significance of the treatment effects; otherwise, a nonparametric approach will be taken.

Expected outcome: ISI score of the acupuncture group is expected to be significantly lower than wait-list control group after 6 weeks of treatment.

Inclusion criteria

• Female patients between 18 and 75 years of age;
• Diagnosis of stage (American Joint Committee on Cancer (AJCC) TNM) I-IV breast cancer;
• Currently receiving chemotherapy, or have completed chemotherapy no more than 6 months;
• Insomnia onset after the diagnosis of breast cancer;
• Insomnia occurs at least 3 nights per week, and presents for at least 1 month, with fulfilment of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnostic criteria for brief insomnia disorder;
• Insomnia severity as defined by an ISI score of no less than 10 in the past 2 weeks;
• Expected survival time of more than 6 months;
• Ability to understand the nature of the study and willingness to give informed consent;
• Ability to provide responses during outcome measurement.

Exclusion criteria

• Insomnia before the diagnosis of breast cancer;
• Other sleep disorder (e.g., obstructive sleep apnoea);
• Shift work or irregular sleep pattern;
• Severe visual, hearing or language defects;
• Severe hematological dysfunction (platelet count <60,000/μL, haemoglobin <8 g/dL or absolute neutrophil count <1000/μL);
• With pacemakers or other electronic implants that could interfere with electroacupuncture;
• History of acupuncture use in the previous 3 months;
• Participation in other clinical trials with intervention within 3 months of the beginning of the trial.