Discussion
chemotherapy-associated insomnia, anxiety, breast cancer, chemotherapy-induced cognitive decline, insomnia, electroacupuncture, depression
BREAST CANCER
The main purpose of this trial was to determine whether the active acupuncture regimen could produce superior efficacy over the sham control in improving chemotherapy-associated insomnia in breast cancer patients. Following 12 sessions of treatment, participants on the active acupuncture regimen showed significantly greater improvements than sham control in sleep onset latency, total sleep time and sleep efficiency, which were examined daily with the objective assessment Actiwatch and subjective assessment diary. Likewise, it is evidenced that active acupuncture was markedly associated with improvements in objective sleep parameters, including increases in total sleep time and sleep efficiency [Participants on the active acupuncture regimen achieved better treatment outcomes than those on the sham control in reducing comorbid anxiety and depression and improving quality of life during treatment and follow-up. Similar results have been observed in recent trial that demonstrated the superior efficacy of active acupuncture regimen in improving chemotherapy-induced cognitive decline, distress caused psychological and somatic symptoms and social functions in breast cancer patients [Moreover, in a follow-up period of 18–20 weeks, a much greater proportion of the participants in the active acupuncture group stopped taking sleeping medications than the sham control group. Our previous study, nonetheless, displayed no difference in cessation rate in long-term benzodiazepine users between electroacupuncture and non-invasive placebo control [Similar to previous studies [Several possible mechanisms have been proposed to understand the effect of acupuncture for cancer-related insomnia. First, acupuncture can regulate cerebral neurotransmitters associated with sleep regulation, such as gamma aminobutyric acid, 5-hydroxytryptamine, dopamine, noradrenaline, acetylcholine, histamine and orexin [The efficacy of treatments might be affected by the precipitating or perpetuating factors of chemotherapy-associated insomnia [The sham control produced greater improvement in ISI score after 6-week of intervention than other sham-controlled acupuncture trials [One should consider the following limitations of this study. Firstly, although Streitberger’s retractable placebo needles have been widely used to differentiate specific effects of inserted acupuncture from non-inserted needles, it still could produce widespread modulatory effects at multiple levels of central nervous system by exciting mechanoreceptors underneath skin via pressure from non-inserted needles [