Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia
Background: Fatigue is a troublesome symptom in cancer survivors that often results from disrupted sleep. We sought to assess whether two insomnia-focused non-pharmacological interventions are also effective for improving fatigue. Methods: We analyzed data from a randomized clinical trial comparing...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-03-01
|
| Series: | Integrative Medicine Research |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213422023000021 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850273674626596864 |
|---|---|
| author | Xiaotong Li Kevin T. Liou Susan Chimonas Karolina Bryl Greta Wong Eugenie Spiguel Susan Q. Li Sheila N. Garland Ting Bao Jun J. Mao |
| author_facet | Xiaotong Li Kevin T. Liou Susan Chimonas Karolina Bryl Greta Wong Eugenie Spiguel Susan Q. Li Sheila N. Garland Ting Bao Jun J. Mao |
| author_sort | Xiaotong Li |
| collection | DOAJ |
| description | Background: Fatigue is a troublesome symptom in cancer survivors that often results from disrupted sleep. We sought to assess whether two insomnia-focused non-pharmacological interventions are also effective for improving fatigue. Methods: We analyzed data from a randomized clinical trial comparing cognitive behavioral therapy for insomnia (CBT-I) versus acupuncture for insomnia among cancer survivors. Participants were 109 patients who reported insomnia and moderate or worse fatigue. Interventions were delivered over eight weeks. Fatigue was evaluated at baseline, week 8, and week 20 using the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). We used both mediation analysis and t-tests to explore the extent to which fatigue reduction was attributable to insomnia response. Results: Compared to baseline, both CBT-I and acupuncture produced significant reductions in total MFSI-SF scores at week 8 (−17.1 points; 95% confidence interval [CI]: −21.1 to −13.1, and −13.2 points; 95% CI: -17.2 to -9.2, respectively, all p<0.001) and week 20 (-14.6 points; 95% CI: -18.6 to -10.6, and −14.2 points; 95% CI: -18.1 to -10.3. respectively, all p<0.001), with no significant between-group differences. MFSI-SF total scores at week 8 were significantly associated with sleep improvements in both CBT-I and acupuncture groups (p<0.001 and p=0.011, respectively). Insomnia responders demonstrated significantly greater improvements in mean MFSI-SF total scores compared with non-responders in the CBT-I group (p=0.016) but not in the acupuncture group. Conclusion: CBT-I and acupuncture produced similar, clinically meaningful, and durable fatigue reductions in cancer survivors with insomnia, primarily through improvements in sleep. Acupuncture may also reduce fatigue through additional pathways. Trial registration: ClinicalTrials.gov, identifier: NCT02356575 |
| format | Article |
| id | doaj-art-17d907e78bce40c8b0bb6be55a0d0034 |
| institution | OA Journals |
| issn | 2213-4220 |
| language | English |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Integrative Medicine Research |
| spelling | doaj-art-17d907e78bce40c8b0bb6be55a0d00342025-08-20T01:51:24ZengElsevierIntegrative Medicine Research2213-42202023-03-0112110092210.1016/j.imr.2023.100922Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomniaXiaotong Li0Kevin T. Liou1Susan Chimonas2Karolina Bryl3Greta Wong4Eugenie Spiguel5Susan Q. Li6Sheila N. Garland7Ting Bao8Jun J. Mao9Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United StatesIntegrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United StatesCenter for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United StatesIntegrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United StatesIntegrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United StatesIntegrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Advanced Practice Providers, Memorial Sloan Kettering Cancer Center, New York, NY, United StatesIntegrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United StatesDepartment of Psychology and Oncology, Memorial University of Newfoundland, St. John’s, NL, CanadaIntegrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United StatesIntegrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Corresponding author at: Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, 4th Floor, New York, NY 10065, United States.Background: Fatigue is a troublesome symptom in cancer survivors that often results from disrupted sleep. We sought to assess whether two insomnia-focused non-pharmacological interventions are also effective for improving fatigue. Methods: We analyzed data from a randomized clinical trial comparing cognitive behavioral therapy for insomnia (CBT-I) versus acupuncture for insomnia among cancer survivors. Participants were 109 patients who reported insomnia and moderate or worse fatigue. Interventions were delivered over eight weeks. Fatigue was evaluated at baseline, week 8, and week 20 using the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). We used both mediation analysis and t-tests to explore the extent to which fatigue reduction was attributable to insomnia response. Results: Compared to baseline, both CBT-I and acupuncture produced significant reductions in total MFSI-SF scores at week 8 (−17.1 points; 95% confidence interval [CI]: −21.1 to −13.1, and −13.2 points; 95% CI: -17.2 to -9.2, respectively, all p<0.001) and week 20 (-14.6 points; 95% CI: -18.6 to -10.6, and −14.2 points; 95% CI: -18.1 to -10.3. respectively, all p<0.001), with no significant between-group differences. MFSI-SF total scores at week 8 were significantly associated with sleep improvements in both CBT-I and acupuncture groups (p<0.001 and p=0.011, respectively). Insomnia responders demonstrated significantly greater improvements in mean MFSI-SF total scores compared with non-responders in the CBT-I group (p=0.016) but not in the acupuncture group. Conclusion: CBT-I and acupuncture produced similar, clinically meaningful, and durable fatigue reductions in cancer survivors with insomnia, primarily through improvements in sleep. Acupuncture may also reduce fatigue through additional pathways. Trial registration: ClinicalTrials.gov, identifier: NCT02356575http://www.sciencedirect.com/science/article/pii/S2213422023000021FatigueInsomniaAcupunctureCognitive behavioral therapyCancer |
| spellingShingle | Xiaotong Li Kevin T. Liou Susan Chimonas Karolina Bryl Greta Wong Eugenie Spiguel Susan Q. Li Sheila N. Garland Ting Bao Jun J. Mao Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia Integrative Medicine Research Fatigue Insomnia Acupuncture Cognitive behavioral therapy Cancer |
| title | Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia |
| title_full | Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia |
| title_fullStr | Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia |
| title_full_unstemmed | Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia |
| title_short | Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia |
| title_sort | addressing cancer related fatigue through sleep a secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia |
| topic | Fatigue Insomnia Acupuncture Cognitive behavioral therapy Cancer |
| url | http://www.sciencedirect.com/science/article/pii/S2213422023000021 |
| work_keys_str_mv | AT xiaotongli addressingcancerrelatedfatiguethroughsleepasecondaryanalysisofarandomizedtrialcomparingacupunctureandcognitivebehavioraltherapyforinsomnia AT kevintliou addressingcancerrelatedfatiguethroughsleepasecondaryanalysisofarandomizedtrialcomparingacupunctureandcognitivebehavioraltherapyforinsomnia AT susanchimonas addressingcancerrelatedfatiguethroughsleepasecondaryanalysisofarandomizedtrialcomparingacupunctureandcognitivebehavioraltherapyforinsomnia AT karolinabryl addressingcancerrelatedfatiguethroughsleepasecondaryanalysisofarandomizedtrialcomparingacupunctureandcognitivebehavioraltherapyforinsomnia AT gretawong addressingcancerrelatedfatiguethroughsleepasecondaryanalysisofarandomizedtrialcomparingacupunctureandcognitivebehavioraltherapyforinsomnia AT eugeniespiguel addressingcancerrelatedfatiguethroughsleepasecondaryanalysisofarandomizedtrialcomparingacupunctureandcognitivebehavioraltherapyforinsomnia AT susanqli addressingcancerrelatedfatiguethroughsleepasecondaryanalysisofarandomizedtrialcomparingacupunctureandcognitivebehavioraltherapyforinsomnia AT sheilangarland addressingcancerrelatedfatiguethroughsleepasecondaryanalysisofarandomizedtrialcomparingacupunctureandcognitivebehavioraltherapyforinsomnia AT tingbao addressingcancerrelatedfatiguethroughsleepasecondaryanalysisofarandomizedtrialcomparingacupunctureandcognitivebehavioraltherapyforinsomnia AT junjmao addressingcancerrelatedfatiguethroughsleepasecondaryanalysisofarandomizedtrialcomparingacupunctureandcognitivebehavioraltherapyforinsomnia |