Treating Insomnia in Cancer Survivors

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A Patient-Centered Outcomes Research Institute–supported randomized clinical trial of cancer survivors showed that 8 weeks of either acupuncture or cognitive behavioral therapy for insomnia (CBT-I) decreased the severity of insomnia among cancer survivors, though improvements were greatest among patients receiving CBT-I. The study is being presented at the 2018 ASCO Annual Meeting in Chicago.1

Jun J. Mao, MD

Jun J. Mao, MD

“Up to 60% of cancer survivors have some form of insomnia, but it is often underdiagnosed and undertreated,” said lead study author Jun J. Mao, MD, Chief, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center in New York. “Our trial showed that both CBT-I and acupuncture were effective in treating moderate to severe insomnia, although CBT-I was more effective for those with mild symptoms of insomnia.”

About the Study

CBT-I is a newer form of psychotherapy that attempts to modify emotions, behaviors, and thoughts related to sleep. It has been the gold standard for treatment of insomnia, said Dr. Mao.

To find a therapy to compare with CBT-I, the researchers consulted a group of patient advisors who had cancer and were knowledgeable about how insomnia could impact their health. In addition, a survey of cancer survivors found they preferred a natural, nonmedicinal approach to treating insomnia. Based on this feedback, and results from other sleep studies showing it could be beneficial, acupuncture was deemed a reasonable comparison for this trial.

The survivors in the trial had completed cancer treatment, and the mean time since cancer diagnosis was 6 years. They had received treatment for breast, prostate, head and neck, hematologic, and colorectal cancers; 6% had received treatment for more than one type of cancer.All trial participants had been clinically diagnosed with insomnia by research staff through structured clinical interviews and were randomly assigned to receive either CBT-I or acupuncture for 8 weeks.

The participants who received CBT-I worked with a therapist to reestablish a restorative sleep schedule by reducing the amount of time spent in bed, limiting activities performed in bed to only sleep and sexual activity, modifying unhelpful beliefs about sleep, and promoting good sleep hygiene.

Insomnnia Severity Index (ISI)

  • The ISI is a questionnaire that asks people to rate the severity of insomnia problems, such as difficulty falling asleep and staying asleep, and the impact of insomnia on their daily functioning and quality of life.
  • The ISI score ranges from 0–28, with scores 0–7 considered as no clinically significant insomnia; 8–14, mild insomnia; 15–21, moderate insomnia; and 22–28, severe insomnia.

Reduction in insomnia severity, measured by the Insomnia Severity Index (see inset), from study entry to week 8 (end of treatment), was the primary study outcome. Survivors were also reassessed 20 weeks after having started the trial. At the beginning of the trial, 33 survivors had mild insomnia, 94 had moderate insomnia, and 33, severe insomnia.

Key Findings

CBT-I was the more effective treatment overall. After 8 weeks, insomnia severity scores fell 10.9 points, from 18.5 to 7.5 for those who received CBT-I vs 8.3 points for those who received acupuncture treatments, from 17.55 to 9.23. Among people with mild insomnia at the start of the trial, far more had an improvement with CBT-I than with acupuncture (85% vs 18%). Those who started the trial with moderate to severe insomnia had somewhat similar response rates to CBT-I vs acupuncture (75% vs 66%). All survivors maintained improvement in insomnia up to 20 weeks after the start of the trial.

Future research will focus on how best to deliver effective treatments to more diverse groups of cancer survivors to improve sleep management.

Disclosure: Dr. Mao reported no conflicts of interest.


1. Mao JJ, et al: 2018 ASCO Annual Meeting. Abstract 10001. To be presented June 3, 2018.