Efficacy of acupuncture therapy on cancer-related insomnia: a systematic review and network meta-analysis

Abstract

Objectives: Cancer-related insomnia (CRI) takes a toll on many cancer survivors, causing distressing symptoms and deteriorating the quality of life. Acupuncture therapy has been used for CRI already. However, it is still uncertain which acupuncture regime is best for CRI. The primary objective of this review is to conduct a comparative evaluation and ranking of the effectiveness of different acupuncture therapies for CRI.

Methods: Randomized controlled trials (RCTs) that were published up to July 31, 2023, from 8 databases (PubMed, Embase, Cochrane library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc) were integrated in this study. Trials that met the inclusion criteria were evaluated the risk of bias. Pittsburgh sleep quality index (PSQI) was used to assess the efficacy of different acupuncture therapies as the primary outcome. Then, STATA 15, R, and OpenBUGS were applied to perform the network meta-analysis. PRISMA statements were followed in this network meta-analysis.

Results: A total of 37 studies were included in this review, involving 16 interventions with 3,246 CRI participants. Auriculotherapy + moxibustion [surface under the cumulative ranking curve (SUCRA) 98.98%] and auriculotherapy (SUCRA 77.47%) came out top of the ranking, which were more effective than control, medicine, usual care and sham acupuncture.

Conclusion: Auriculotherapy + moxibustion and auriculotherapy + acupuncture emerged as the top two acupuncture regimes for CRI and future studies should pay more attention to CRI.

Clinical trial registration: https://clinicaltrials.gov/, identifier INPLASY202210095.

Keywords: acupuncture therapy; cancer-related insomnia; network meta-analysis; non-pharmacological therapy; the complication of cancer.

Figure 1

PRISMA flow diagram of the study selection process. CNKI, China National Knowledge Infrastructure; VIP, China Science and Technology Journal Database.

Figure 2

The risk of bias of included studies. The selection of the reported result constituted the primary source of bias.

Figure 3

The network map of included studies. The size of each node was proportional to the number of participants receiving the respective intervention, while the boldness of the connecting lines corresponded to the number of comparative studies between the interventions. A total of 32 studies with 2,752 participants accepted one of 15 interventions, respectively, reporting the reduction of PSQI. The included studies generated 15 nodes, contributing to 23 pairs of comparisons.

Figure 4

The league figure of included studies. Data with light green background meant significant difference between the comparisons. And compared with medicine, 8 interventions demonstrated significant results.

Figure 5

The SUCRA of included studies. Bigger SUCRA means higher rank, representing better efficacy of the intervention. The rank (SUCRA value) of each intervention in PSQI: auriculotherapy + moxibustion (98.98%) > auriculotherapy (77.47%) > auriculotherapy + acupuncture + acupressure (75.79%) > auriculotherapy + acupoint application (75.27%) > electroacupuncture (74.38%) > acupoint application (69.4%) > acupuncture (60.18%) > moxibustion (47.84%) > auriculotherapy + acupuncture (35.62%) > sham (34.31%) > auriculotherapy + electroacupuncture (27.65%) > usual care (22.35%) > acupuncture + moxibustion (21.57%) > control (21.52%) > medicine (7.67%). And auriculotherapy + moxibustion was the optimal acupuncture regime in reducing the score of PSQI according to SUCRA. AT, auriculotherapy; AC, acupuncture; MO, moxibustion; AP, acupressure; AA, acupoint application; EA, electroacupuncture.

Figure 6

The adjusted funnel plot of included studies of PSQI. Though the distribution was nearly symmetric, some nodes were out of the funnel which showed some heterogeneity or publication bias in those studies. A, control; B, acupuncture; C, auriculotherapy; D, moxibustion; E, electroacupuncture; F, acupoint application; G, auriculotherapy + moxibustion; H, auriculotherapy + acupoint application; I, auriculotherapy + electroacupuncture; J, auriculotherapy + acupuncture + acupressure.