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What makes one respond to acupuncture for insomnia? Perspectives of cancer survivors

Published online by Cambridge University Press:  01 October 2019

Sally A.D. Romero Open the ORCID record for Sally A.D. Romero [Opens in a new window] ,
Eileen Jiang ,
Jason Bussell ,
Whitney Eriksen ,
Katherine N. Duhamel ,
Frances K. Barg  and
Jun J. Mao
Sally A.D. Romero
Affiliation:
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
Eileen Jiang
Affiliation:
School of Medicine, New York University, New York, NY
Jason Bussell
Affiliation:
A Center for Oriental Medicine, Chicago, IL
Whitney Eriksen
Affiliation:
Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Katherine N. Duhamel
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Frances K. Barg
Affiliation:
Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
Jun J. Mao*
Affiliation:
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
*
Author for correspondence: Jun J. Mao, M.D., M.S.C.E., Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY10021. Email: [email protected]
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Abstract

Objective

Like any therapy, acupuncture is effective for some patients, while not helpful for others. Understanding from a patients' perspective what makes one respond or not to acupuncture can help guide further intervention development. This study aimed to identify factors that influence the perception of acupuncture's therapeutic effect among cancer survivors with insomnia.

Method

We conducted post-treatment semi-structured interviews with cancer survivors who were randomized to the acupuncture group in a clinical trial for the treatment of insomnia. Survivors were categorized into Responders and Non-Responders to acupuncture treatment based on the change in the Insomnia Severity Index with a reduction of eight points or greater as the cut-off for the response. An integrated approach to data analysis was utilized by merging an a priori set of codes derived from the key ideas and a set of codes that emerged from the data through a grounded theory approach. Codes were examined for themes and patterns.

Results

Among 28 cancer survivors interviewed, 18 (64%) were classified as Responders. Participants perceived the ability to respond to acupuncture as dependent on treatment that effectively: (1) alleviated co-morbidities contributing to insomnia, (2) supported sleep hygiene practices, and (3) provided a durable therapeutic effect. Acupuncture treatment that did not address one of these themes often detracted from positive treatment outcomes and diminished perceived benefit from acupuncture.

Significance of results

We identified patient-perceived contributors to response to acupuncture, such as co-morbid medical conditions, adequate support for sleep hygiene practices, and temporary therapeutic relief. Addressing these factors may improve the overall effectiveness of acupuncture for insomnia.

Keywords

AcupunctureCancerInsomniaQualitative research
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 3 , June 2020 , pp. 301 - 306
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

Presentation: Accepted for poster presentation at the Society for Integrative Oncology 2018 15th International Conference, Scottsdale, AZ, October 27, 2018.

References

REFERENCES

American Psychiatric Association (2014) Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, London: American Psychiatric Publishing.Google Scholar
Bokmand, S and Flyger, H (2013) Acupuncture relieves menopausal discomfort in breast cancer patients: A prospective, double blinded, randomized study. Breast 22(3), 320–323.CrossRefGoogle ScholarPubMed
Carney, CE, Buysse, DJ, Ancoli-Israel, S, et al. (2012) The consensus sleep diary: Standardizing prospective sleep self-monitoring. Sleep 35(2), 287–302.CrossRefGoogle ScholarPubMed
Chapman, AL, Hadfield, M and Chapman, CJ (2015) Qualitative research in healthcare: An introduction to grounded theory using thematic analysis. The Journal of the Royal College of Physicians of Edinburgh 45(3), 201–205.CrossRefGoogle ScholarPubMed
Choi, TY, Kim, JI, Lim, HJ, et al. (2017) Acupuncture for managing cancer-related insomnia: A systematic review of randomized clinical trials. Integrative Cancer Therapies 16(2), 135–146.CrossRefGoogle ScholarPubMed
Conroy, DA and Ebben, MR (2015) Referral practices for cognitive behavioral therapy for insomnia: A survey study. Behavioural Neurology 2015, 819402.CrossRefGoogle ScholarPubMed
Curry, LA, Nembhard, IM and Bradley, EH (2009) Qualitative and mixed methods provide unique contributions to outcomes research. Circulation 119(10), 1442–1452.CrossRefGoogle ScholarPubMed
Davidson, JR, MacLean, AW, Brundage, MD, et al. (2002) Sleep disturbance in cancer patients. Social Science & Medicine 54(9), 1309–1321.CrossRefGoogle ScholarPubMed
Davis, MP and Goforth, HW (2014) Long-term and short-term effects of insomnia in cancer and effective interventions. The Cancer Journal 20(5), 330–344.CrossRefGoogle ScholarPubMed
Evans, M, Paterson, C, Wye, L, et al. (2011) Lifestyle and self-care advice within traditional acupuncture consultations: A qualitative observational study nested in a co-operative inquiry. Journal of Alternative and Complementary Medicine 17(6), 519–529.CrossRefGoogle Scholar
Fleming, L, Gillespie, S and Espie, CA (2010) The development and impact of insomnia on cancer survivors: A qualitative analysis. Psychooncology 19(9), 991–996.CrossRefGoogle ScholarPubMed
Garland, SN, Gehrman, P, Barg, FK, et al. (2016) Choosing Options for Insomnia in Cancer Effectively (CHOICE): Design of a patient centered comparative effectiveness trial of acupuncture and cognitive behavior therapy for insomnia. Contemporary Clinical Trials 47, 349–355.CrossRefGoogle ScholarPubMed
Garland, SN, Eriksen, W, Song, S, et al. (2018) Factors that shape preference for acupuncture or cognitive behavioral therapy for the treatment of insomnia in cancer patients. Supportive Care in Cancer 26(7), 2407–2415.CrossRefGoogle ScholarPubMed
Garland, SN, Xie, SX, DuHamel, K, et al. (2019) Acupuncture versus cognitive behavioral therapy for insomnia in cancer survivors: A randomized clinical trial. Journal of the National Cancer Institute. doi: 10.1093/jnci/djz050.CrossRefGoogle ScholarPubMed
Haddad, NE and Palesh, O (2014) Acupuncture in the treatment of cancer-related psychological symptoms. Integrative Cancer Therapies 13(5), 371–385.CrossRefGoogle ScholarPubMed
Hao, XA, Xue, CC, Dong, L, et al. (2013) Factors associated with conflicting findings on acupuncture for tension-type headache: Qualitative and quantitative analyses. Journal of Alternative and Complementary Medicine 19(4), 285–297.CrossRefGoogle ScholarPubMed
Induru, RR and Walsh, D (2014) Cancer-related insomnia. The American Journal of Hospice & Palliative Medicine 31(7), 777–785.CrossRefGoogle ScholarPubMed
Irwin, MR (2013) Depression and insomnia in cancer: Prevalence, risk factors, and effects on cancer outcomes. Current Psychiatry Reports 15(11), 404.CrossRefGoogle ScholarPubMed
Johnson, JA, Rash, JA, Campbell, TS, et al. (2016) A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Medicine Reviews 27, 20–28.CrossRefGoogle Scholar
Kvale, EA and Shuster, JL (2006) Sleep disturbance in supportive care of cancer: A review. Journal of Palliative Medicine 9(2), 437–450.CrossRefGoogle ScholarPubMed
Lesi, G, Razzini, G, Musti, MA, et al. (2016) Acupuncture as an integrative approach for the treatment of hot flashes in women with breast cancer: A prospective multicenter randomized controlled trial (AcCliMaT). Journal of Clinical Oncology 34(15), 1795–1802.CrossRefGoogle Scholar
MacPherson, H, Thorpe, L and Thomas, K (2006) Beyond needling–therapeutic processes in acupuncture care: A qualitative study nested within a low-back pain trial. Journal of Alternative and Complementary Medicine 12(9), 873–880.CrossRefGoogle ScholarPubMed
MacPherson, H, Maschino, AC, Lewith, G, et al. (2013) Characteristics of acupuncture treatment associated with outcome: An individual patient meta-analysis of 17,922 patients with chronic pain in randomised controlled trials. PLoS One 8(10), e77438.CrossRefGoogle ScholarPubMed
MacPherson, H, Vertosick, EA, Foster, NE, et al. (2017) The persistence of the effects of acupuncture after a course of treatment: A meta-analysis of patients with chronic pain. Pain 158(5), 784–793.CrossRefGoogle ScholarPubMed
Mao, JJ, Armstrong, K, Bowman, MA, et al. (2007) Symptom burden among cancer survivors: Impact of age and comorbidity. Journal of the American Board of Family Medicine 20(5), 434–443.CrossRefGoogle ScholarPubMed
Mao, JJ, Palmer, CS, Healy, KE, et al. (2011) Complementary and alternative medicine use among cancer survivors: A population-based study. Journal of Cancer Survivorship 5(1), 8–17.CrossRefGoogle ScholarPubMed
Mao, JJ, Bowman, MA, Xie, SX, et al. (2015) Electroacupuncture versus gabapentin for hot flashes among breast cancer survivors: A randomized placebo-controlled trial. Journal of Clinical Oncology 33(31), 3615–3620.CrossRefGoogle ScholarPubMed
Morgenthaler, T, Kramer, M, Alessi, C, et al. (2006) Practice parameters for the psychological and behavioral treatment of insomnia: An update. An American academy of sleep medicine report. Sleep 29(11), 1415–1419.Google ScholarPubMed
Morin, CM, Belleville, G, Belanger, L, et al. (2011) The Insomnia Severity Index: Psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 34(5), 601–608.CrossRefGoogle ScholarPubMed
Murphy, CC, Fullington, HM, Alvarez, CA, et al. (2018) Polypharmacy and patterns of prescription medication use among cancer survivors. Cancer 124(13), 2850–2857.CrossRefGoogle ScholarPubMed
National Institutes of Health (2005) National institutes of health state of the science conference statement on manifestations and management of chronic insomnia in adults. Sleep 28(9), 1049–1057.CrossRefGoogle Scholar
Nishiura, M, Tamura, A, Nagai, H, et al. (2015) Assessment of sleep disturbance in lung cancer patients: Relationship between sleep disturbance and pain, fatigue, quality of life, and psychological distress. Palliative & Supportive Care 13(3), 575–581.CrossRefGoogle ScholarPubMed
Pagel, JF and Parnes, BL (2001) Medications for the treatment of sleep disorders: An overview. The Primary Care Companion to The Journal of Clinical Psychiatry 3(3), 118–125.CrossRefGoogle ScholarPubMed
Paterson, C (2007) Patients’ experiences of Western-style acupuncture: The influence of acupuncture ‘dose’, self-care strategies and integration. The Journal of Health Services Research & Policy 12(Suppl 1), S1-39-45.CrossRefGoogle Scholar
Pigeon, WR, Crabtree, VM and Scherer, MR (2007) The future of behavioral sleep medicine. Journal of Clinical Sleep Medicine 3(1), 73–79.Google ScholarPubMed
Price, S, Long, AF and Godfrey, M (2014) What is traditional acupuncture — exploring goals and processes of treatment in the context of women with early breast cancer. BMC Complementary and Alternative Medicine 14, 201.CrossRefGoogle ScholarPubMed
Qaseem, A, Kansagara, D, Forciea, MA, et al. (2016) Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine 165(2), 125–133.CrossRefGoogle ScholarPubMed
Savard, J and Morin, CM (2001) Insomnia in the context of cancer: A review of a neglected problem. Journal of Clinical Oncology 19(3), 895–908.CrossRefGoogle ScholarPubMed
Savard, MH, Savard, J, Simard, S, et al. (2005) Empirical validation of the Insomnia Severity Index in cancer patients. Psychooncology 14(6), 429–441.CrossRefGoogle ScholarPubMed
Savard, J, Ivers, H, Villa, J, et al. (2011) Natural course of insomnia comorbid with cancer: An 18-month longitudinal study. Journal of Clinical Oncology 29(26), 3580–3586.CrossRefGoogle Scholar
Trauer, JM, Qian, MY, Doyle, JS, et al. (2015) Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine 163(3), 191–204.CrossRefGoogle ScholarPubMed
White, A (2004) A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupuncture in Medicine 22(3), 122–133.CrossRefGoogle ScholarPubMed
Witt, CM, Schutzler, L, Ludtke, R, et al. (2011) Patient characteristics and variation in treatment outcomes: Which patients benefit most from acupuncture for chronic pain? The Clinical Journal of Pain 27(6), 550–555.CrossRefGoogle ScholarPubMed
Yun, H, Sun, L and Mao, JJ (2017) Growth of integrative medicine at leading cancer centers between 2009 and 2016: A systematic analysis of NCI-designated comprehensive cancer center websites. JNCI Monographs 2017(52), lgx004.CrossRefGoogle ScholarPubMed