Cancer patients undergoing hematopoietic stem cell transplantation (HSCT) after high-dose chemotherapy often experience sleep disturbances. In most cases, these disorders are managed with medications that have side effects such as dependence and withdrawal symptoms, further exacerbating an already troubling problem.
One alternative to pharmacological intervention is acupuncture. Although acupuncture has been shown to improve sleep quality in patients with other diseases, it has not yet been studied in multiple myeloma patients undergoing HSCT. With this in mind, the authors of a new study recently evaluated whether acupuncture can reduce sleep disturbances, both during and after HSCT.1
Research design method
This prospective randomized trial is a secondary analysis of data from an earlier sham-controlled trial published in 2018;2 recruited multiple myeloma patients aged 21 years and older from Memorial Sloan Kettering Cancer Center.1 Patients who received both inpatient and outpatient high-dose chemotherapy and subsequently underwent HSCT were included in the study. Patients who have received acupuncture up to 4 weeks prior to the start of the study and those at high risk for infection (as indicated by an absolute neutrophil count <200/μL) and bleeding (as indicated by a platelet count <20,000/μL) are excluded.
A total of 60 patients participated in the study after screening for eligibility and obtaining consent. 29 people were randomly assigned to the true acupuncture group and 31 received sham acupuncture. Sixteen different acupuncture points were selected based on literature review and input from acupuncturists. The participants who received the sham acupuncture felt a noticeable sensation when they tapped each of these 16 spots with an empty plastic needle guide.
Five-day cycles were repeated until the patient was at increased risk of infection or bleeding. The participant received chemotherapy on day –2, followed by her HSCT on day 0. Real or sham acupuncture treatments lasting 20 minutes were administered on days –1 to 3. Observations were collected on his fourth day and his fifth day.
Is true acupuncture effective?
Sleep quality was assessed over a 24-hour period via a wristband actigraphy-based sleep monitor that collected five measurements.
- Number of awakenings
- Wake-up time after falling asleep (WASO; in minutes)
- Total sleep time (in minutes)
- Sleep efficiency (%)
- -Sleep onset latency time (in minutes) from day 2 to day 5.
These measurements were compared to baseline measurements taken 1 to 2 weeks before chemotherapy was started. The primary outcome was the relationship between acupuncture and the five measures of sleep quality listed above.
What did the investigators find? True acupuncture was found to be statistically significantly associated with improved sleep efficiency (P=.042) versus the sham group, the effect on WASO was nearly significant (P=.055). The number of awakenings, total sleep time, and sleep onset latency were not significantly different between the real and sham acupuncture groups. Participants who received true acupuncture in an inpatient chemotherapy setting had significantly higher sleep efficiency (P=.040). WASO, sleep duration, and wake frequency were not significantly different between the inpatient and outpatient chemotherapy groups.
I need more data from a larger sample
Due to the small sample size of this study, and because this study was designed solely to estimate the direction and strength of the relationship between acupuncture and symptom burden, the authors combined these results with HSCT. They caution against interpreting it as conclusive evidence of the effectiveness of acupuncture in your situation. Additionally, this study did not include a control group receiving usual care, and sleep quality may be confounded by unmeasured variables.
Some of these limitations require larger sample sizes and more data. The authors write: “Future studies with appropriate sample sizes that target specific aspects of sleep quality and patient-reported outcomes will help elucidate the role of acupuncture in improving sleep quality during HSCT and may It has the potential to expand the treatment options available to patients during this difficult time.”1
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Erin Kero is a freelance medical writer. She earned her PhD in biological anthropology with a major in epigenetics from the University of Pittsburgh.
