Acupuncture for Insomnia in Breast Cancer Patients Undergoing Chemotherapy

NCT ID: NCT04144309

Last Updated: 2024-05-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

138 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-11-18

Study Completion Date

2022-07-30

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

The proposed study is a randomized, parallel-group, placebo-controlled, subject- and assessor-blind trial. It is designed according to CONSORT and STRICTA recommendations. The 138 subjects will be randomly assigned to one of the two arms using block randomization in a 1:1 ratio: (I) acupuncture treatment, and (II) sham treatment. In groups (I) and (II), acupuncture or sham acupuncture treatment will be given twice a week for 6 weeks (12 sessions). A maintenance tapering treatment schedule will then be applied once per month for 3 months (3 sessions). The primary outcome will be improvement in sleep quality as measured by the change of ISI after 6 weeks of treatment. Secondary outcome assessment tools will include PSQI, HADS, BPI, BFI, FACT-B, sleep diaries, drug diaries, blinding success questionnaire and reports of adverse events. The subjects will be scheduled for on-site follow-up assessments at 3 and 6 months after the last treatment. An intention to treat (ITT) approach will be used for data analysis.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Insomnia is a frequent and disturbing symptom among cancer patients. Studies have found that cancer treatments, particularly chemotherapy, are a major cause of cancer-related insomnia. However, insomnia is under-treated in most breast cancer patients because effective, safe evidence-based treatments are lacking.

Acupuncture has been used for thousands of years to treat various diseases, including insomnia. Our previous research demonstrated the efficacy and safety of acupuncture as a treatment for insomnia. However, the effect of acupuncture on insomnia in breast cancer patients who undergo chemotherapy has been rarely studied. We propose this randomized controlled trial to examine the feasibility, effect and safety of acupuncture as a treatment for insomnia in breast cancer patients who undergo chemotherapy.

Hypothesis: We hypothesize that acupuncture is a feasible, effective and safe method for the alleviation of insomnia symptoms in breast cancer patients undergoing chemotherapy as compared with a sham control.

Primary Aim: To determine whether the insomnia condition in the acupuncture group is significantly improved when compared to the sham control group, as measured by the ISI after 6 weeks of treatment.

Secondary Aims: 1) To determine whether other sleep-related parameters in the acupuncture group improve more than those of the control group, as measured at different time points by Actiwatch, sleep diary, Pittsburgh Sleep Quality Index (PSQI), Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B), Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI) and Brief Pain Inventory (BPI). 2) To assess by adverse event (AE) analysis whether acupuncture is safe for treatment of insomnia in breast cancer patients undergoing chemotherapy.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Insomnia, Secondary Breast Cancer Female Chemotherapy

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

True acupuncture group

12 sessions of acupuncture treatment (EA+AA) will be given twice a week for 6 weeks after randomization, followed by once a month for 3 months, for a total of 15 sessions of treatments.

Group Type ACTIVE_COMPARATOR

Electroacupuncture (EA) and Auricular Acupressure (AA)

Intervention Type PROCEDURE

EA: Ten points will be used, including GV24 (Shenting), GV20 (Baihui), EX-HN1 (Sishenchong), PC6 (Neiguan), CV12 (Zhongwan), CV4 (Guanyuan), ST25 (Tianshu), ST36 (Zusanli), SP6 (Sanyinjiao), KI3 (Taixi).

AA: Vaccaria seeds will be embedded by acupuncturists on three auricular points (Shenmen, Sympathetic and Heart) and maintained between EA treatments.

Sham acupuncture group

12 sessions of sham acupuncture treatment (SE+SA) will be given twice a week for 6 weeks after randomization, followed by once a month for 3 months, for a total of 15 sessions of treatments.

Group Type PLACEBO_COMPARATOR

Sham Electroacupuncture (SE) and Sham Auricular Acupressure (SA)

Intervention Type PROCEDURE

SE: The sham acupuncture treatment procedure, including the acupoint selection principle, sterilization procedure and treatment schedule, will be the same as in the acupuncture treatment group, except that sham points 1 to 2 cm exterior and inferior to the real points will be used, and no needle penetration or electric stimulation will be performed.

SA: Three sham auricular points in the helix region (HX7, HX8, HX9) will be selected. Instead of Vaccaria seeds, soft Junci Medulla (1 to 2 mm in length, dyed black) will be used to mimic real AA with no pressure.

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Electroacupuncture (EA) and Auricular Acupressure (AA)

EA: Ten points will be used, including GV24 (Shenting), GV20 (Baihui), EX-HN1 (Sishenchong), PC6 (Neiguan), CV12 (Zhongwan), CV4 (Guanyuan), ST25 (Tianshu), ST36 (Zusanli), SP6 (Sanyinjiao), KI3 (Taixi).

AA: Vaccaria seeds will be embedded by acupuncturists on three auricular points (Shenmen, Sympathetic and Heart) and maintained between EA treatments.

Intervention Type PROCEDURE

Sham Electroacupuncture (SE) and Sham Auricular Acupressure (SA)

SE: The sham acupuncture treatment procedure, including the acupoint selection principle, sterilization procedure and treatment schedule, will be the same as in the acupuncture treatment group, except that sham points 1 to 2 cm exterior and inferior to the real points will be used, and no needle penetration or electric stimulation will be performed.

SA: Three sham auricular points in the helix region (HX7, HX8, HX9) will be selected. Instead of Vaccaria seeds, soft Junci Medulla (1 to 2 mm in length, dyed black) will be used to mimic real AA with no pressure.

Intervention Type PROCEDURE

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Female patients between 18 and 75 years of age.
* Diagnosis of stage (American Joint Committee on Cancer (AJCC) TNM) I-IV breast cancer.
* Currently receiving chemotherapy, or have completed chemotherapy no more than 6 months.
* Insomnia onset after the diagnosis of breast cancer.
* Insomnia occurs at least 3 nights per week, and presents for at least 1 month, with fulfilment of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnostic criteria for brief insomnia disorder Insomnia severity as defined by an ISI score of no less than 10 in the past 2 weeks.
* Expected survival time of more than 6 months.
* Ability to understand the nature of the study and willingness to give informed consent.
* Ability to provide responses during outcome measurement.

Exclusion Criteria

* Other sleep disorder (e.g., obstructive sleep apnoea).
* Shift work or irregular sleep pattern.
* Severe visual, hearing or language defects.
* Severe hematological dysfunction (platelet count \<60,000/μL, haemoglobin \<8 g/dL or absolute neutrophil count \<1000/μL).
* History of acupuncture use in the previous 3 months.
* Participation in other clinical trials with intervention within 3 months of the beginning of the trial.
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

The University of Hong Kong

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Prof. Zhang Zhang-Jin

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Zhang-Jin ZHANG, MMed, PhD

Role: PRINCIPAL_INVESTIGATOR

The University of Hong Kong

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

Department of Clinical Oncology, Queen Mary Hospital

Hong Kong, , Hong Kong

Site Status

Hong Kong Sanatorium & Hospital

Hong Kong, , Hong Kong

Site Status

Countries

Review the countries where the study has at least one active or historical site.

Hong Kong

References

Explore related publications, articles, or registry entries linked to this study.

Savard J, Ivers H, Villa J, Caplette-Gingras A, Morin CM. Natural course of insomnia comorbid with cancer: an 18-month longitudinal study. J Clin Oncol. 2011 Sep 10;29(26):3580-6. doi: 10.1200/JCO.2010.33.2247. Epub 2011 Aug 8.

Reference Type BACKGROUND
PMID: 21825267 (View on PubMed)

Savard J, Villa J, Ivers H, Simard S, Morin CM. Prevalence, natural course, and risk factors of insomnia comorbid with cancer over a 2-month period. J Clin Oncol. 2009 Nov 1;27(31):5233-9. doi: 10.1200/JCO.2008.21.6333. Epub 2009 Sep 8.

Reference Type BACKGROUND
PMID: 19738124 (View on PubMed)

Savard J, Ivers H, Savard MH, Morin CM. Cancer treatments and their side effects are associated with aggravation of insomnia: Results of a longitudinal study. Cancer. 2015 May 15;121(10):1703-11. doi: 10.1002/cncr.29244. Epub 2015 Feb 11.

Reference Type BACKGROUND
PMID: 25677509 (View on PubMed)

Fakih R, Rahal M, Hilal L, Hamieh L, Dany M, Karam S, Shehab L, El Saghir NS, Tfayli A, Salem Z, Assi H, Temraz S, Shamseddine A, Mukherji D. Prevalence and Severity of Sleep Disturbances among Patients with Early Breast Cancer. Indian J Palliat Care. 2018 Jan-Mar;24(1):35-38. doi: 10.4103/IJPC.IJPC_137_17.

Reference Type BACKGROUND
PMID: 29440804 (View on PubMed)

Dahiya S, Ahluwalia MS, Walia HK. Sleep disturbances in cancer patients: underrecognized and undertreated. Cleve Clin J Med. 2013 Nov;80(11):722-32. doi: 10.3949/ccjm.80a.12170.

Reference Type BACKGROUND
PMID: 24186891 (View on PubMed)

Cash E, Sephton SE, Chagpar AB, Spiegel D, Rebholz WN, Zimmaro LA, Tillie JM, Dhabhar FS. Circadian disruption and biomarkers of tumor progression in breast cancer patients awaiting surgery. Brain Behav Immun. 2015 Aug;48:102-14. doi: 10.1016/j.bbi.2015.02.017. Epub 2015 Feb 26.

Reference Type BACKGROUND
PMID: 25728235 (View on PubMed)

Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001 Feb 1;19(3):895-908. doi: 10.1200/JCO.2001.19.3.895.

Reference Type BACKGROUND
PMID: 11157043 (View on PubMed)

Krystal AD. The changing perspective on chronic insomnia management. J Clin Psychiatry. 2004;65 Suppl 8:20-5.

Reference Type BACKGROUND
PMID: 15153064 (View on PubMed)

Leung GM, Thach TQ, Lam TH, Hedley AJ, Foo W, Fielding R, Yip PS, Lau EM, Wong CM. Trends in breast cancer incidence in Hong Kong between 1973 and 1999: an age-period-cohort analysis. Br J Cancer. 2002 Oct 21;87(9):982-8. doi: 10.1038/sj.bjc.6600583.

Reference Type BACKGROUND
PMID: 12434289 (View on PubMed)

Bergdahl L, Broman JE, Berman AH, Haglund K, von Knorring L, Markstrom A. Sleep patterns in a randomized controlled trial of auricular acupuncture and cognitive behavioral therapy for insomnia. Complement Ther Clin Pract. 2017 Aug;28:220-226. doi: 10.1016/j.ctcp.2017.06.006. Epub 2017 Jun 30.

Reference Type BACKGROUND
PMID: 28779933 (View on PubMed)

Zia FZ, Olaku O, Bao T, Berger A, Deng G, Fan AY, Garcia MK, Herman PM, Kaptchuk TJ, Ladas EJ, Langevin HM, Lao L, Lu W, Napadow V, Niemtzow RC, Vickers AJ, Shelley Wang X, Witt CM, Mao JJ. The National Cancer Institute's Conference on Acupuncture for Symptom Management in Oncology: State of the Science, Evidence, and Research Gaps. J Natl Cancer Inst Monogr. 2017 Nov 1;2017(52):lgx005. doi: 10.1093/jncimonographs/lgx005.

Reference Type BACKGROUND
PMID: 29140486 (View on PubMed)

Garland SN, Gehrman P, Barg FK, Xie SX, Mao JJ. CHoosing Options for Insomnia in Cancer Effectively (CHOICE): Design of a patient centered comparative effectiveness trial of acupuncture and cognitive behavior therapy for insomnia. Contemp Clin Trials. 2016 Mar;47:349-55. doi: 10.1016/j.cct.2016.02.010. Epub 2016 Mar 5.

Reference Type BACKGROUND
PMID: 26956541 (View on PubMed)

Bao T, Goloubeva O, Pelser C, Porter N, Primrose J, Hester L, Sadowska M, Lapidus R, Medeiros M, Lao L, Dorsey SG, Badros AZ. A pilot study of acupuncture in treating bortezomib-induced peripheral neuropathy in patients with multiple myeloma. Integr Cancer Ther. 2014 Sep;13(5):396-404. doi: 10.1177/1534735414534729. Epub 2014 May 26.

Reference Type BACKGROUND
PMID: 24867959 (View on PubMed)

Yeung WF, Chung KF, Zhang SP, Yap TG, Law AC. Electroacupuncture for primary insomnia: a randomized controlled trial. Sleep. 2009 Aug;32(8):1039-47. doi: 10.1093/sleep/32.8.1039.

Reference Type BACKGROUND
PMID: 19725255 (View on PubMed)

Yeung WF, Chung KF, Leung YK, Zhang SP, Law AC. Traditional needle acupuncture treatment for insomnia: a systematic review of randomized controlled trials. Sleep Med. 2009 Aug;10(7):694-704. doi: 10.1016/j.sleep.2008.08.012. Epub 2009 Mar 19.

Reference Type BACKGROUND
PMID: 19303356 (View on PubMed)

Streitberger K, Kleinhenz J. Introducing a placebo needle into acupuncture research. Lancet. 1998 Aug 1;352(9125):364-5. doi: 10.1016/S0140-6736(97)10471-8.

Reference Type BACKGROUND
PMID: 9717924 (View on PubMed)

Zou C, Yang L, Wu Y, Su G, Chen S, Guo X, Wu X, Liu X, Lin Q. Auricular acupressure on specific points for hemodialysis patients with insomnia: a pilot randomized controlled trial. PLoS One. 2015 Apr 15;10(4):e0122724. doi: 10.1371/journal.pone.0122724. eCollection 2015.

Reference Type BACKGROUND
PMID: 25874938 (View on PubMed)

Suen LK, Wong TK, Leung AW. Effectiveness of auricular therapy on sleep promotion in the elderly. Am J Chin Med. 2002;30(4):429-49. doi: 10.1142/S0192415X0200051X.

Reference Type BACKGROUND
PMID: 12568272 (View on PubMed)

Savard MH, Savard J, Simard S, Ivers H. Empirical validation of the Insomnia Severity Index in cancer patients. Psychooncology. 2005 Jun;14(6):429-41. doi: 10.1002/pon.860.

Reference Type BACKGROUND
PMID: 15376284 (View on PubMed)

Morin CM, Belleville G, Belanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011 May 1;34(5):601-8. doi: 10.1093/sleep/34.5.601.

Reference Type BACKGROUND
PMID: 21532953 (View on PubMed)

Yin X, Gou M, Xu J, Dong B, Yin P, Masquelin F, Wu J, Lao L, Xu S. Efficacy and safety of acupuncture treatment on primary insomnia: a randomized controlled trial. Sleep Med. 2017 Sep;37:193-200. doi: 10.1016/j.sleep.2017.02.012. Epub 2017 Mar 8.

Reference Type RESULT
PMID: 28899535 (View on PubMed)

Mao H, Jin M, Xie L, Mao N, Shen X, Chen J, Chen X, Mao JJ, Shen X. Infrared laser moxibustion for cancer-related fatigue in breast cancer survivors: a randomized controlled trial. Breast Cancer Res. 2024 May 21;26(1):80. doi: 10.1186/s13058-024-01838-1.

Reference Type DERIVED
PMID: 38773552 (View on PubMed)

Zhang J, Qin Z, So TH, Chang TY, Yang S, Chen H, Yeung WF, Chung KF, Chan PY, Huang Y, Xu S, Chiang CY, Lao L, Zhang ZJ. Acupuncture for chemotherapy-associated insomnia in breast cancer patients: an assessor-participant blinded, randomized, sham-controlled trial. Breast Cancer Res. 2023 Apr 26;25(1):49. doi: 10.1186/s13058-023-01645-0.

Reference Type DERIVED
PMID: 37101228 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

UW 19-045

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Acupuncture for Post-Thoracotomy Pain
NCT00142532 COMPLETED PHASE3