Somatic acupressure for the fatigue-sleep disturbance-depression symptom cluster in breast cancer survivors: A phase II randomized controlled trial

The Effectiveness of Acupressure on Sleep Quality in Cancer Patients: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

AIMS

To examine the effectiveness of acupressure on sleep quality in cancer patients and to identify the population-level and intervention-level characteristics associated with the intervention outcome of sleep quality.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, EMBASE, APA PsycInfo, Web of Science, CINAHL, Cochrane Library, China National Knowledge Infrastructure and WanFang were searched for eligible randomised controlled trials from inception to April 2024.

METHODS

Methodological quality was assessed using the Cochrane Risk of Bias Tool for Randomised Trials 2.0. A random-effects model was used for the meta-analysis. Subgroup analyses and the meta-regression aimed to investigate potential heterogeneity and identify characteristics that may be associated with more favourable acupressure outcomes.

RESULTS

In total, 22 randomised controlled trials involving 2113 participants were included in this meta-analysis. Compared with various control groups, acupressure exhibited a significant beneficial effect on sleep quality in cancer patients at post-intervention (SMD = -1.38, 95% CI [-1.81, -0.95], p < 0.001) and at 4-week follow-up (SMD = -0.33, 95% CI [-0.56, -0.10], p = 0.004). Acupressure also showed statistically significant improvements in sleep efficiency (SMD = 0.77, 95% CI [0.27, 1.26], p = 0.002) and total sleep time (SMD = 0.68, 95% CI [0.15, 1.22], p = 0.010) at post-intervention. None of the characteristics significantly affected the overall effect size on sleep quality.

CONCLUSIONS

Acupressure appears to be a promising intervention for enhancing sleep quality among cancer patients. Future studies should elucidate the long-term effects of acupressure on sleep quality, identify effective acupressure characteristics and determine which types of cancer patients benefit from this intervention.

IMPACT

This study provides a comprehensive summary of evidence supporting the use of acupressure to enhance sleep quality in cancer patients and demonstrates its effectiveness in clinical nursing practice.

REPORTING METHOD

PRISMA 2020 statement.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Somatic acupressure for the management of the fatigue-sleep disturbance-depression symptom cluster in breast cancer survivors: a study protocol for a phase III randomised controlled trial

INTRODUCTION

The fatigue-sleep disturbance-depression symptom cluster (FSDSC) is commonly experienced by breast cancer (BC) survivors, leading to a deteriorated quality of life (QoL). Somatic acupressure (SA) has been recommended as a promising non-pharmacological intervention for cancer-related fatigue (the core symptom of the FSDSC) in the guidelines, showing its encouraging role in relieving cancer-related sleep disorders, fatigue and depression. This phase III randomised controlled trial (RCT) is designed to evaluate the effects, safety and cost-effectiveness of SA for managing the FSDSC in BC survivors.

METHODS

This phase III RCT will be a partial-blinded, sham-controlled, three-arm, parallel clinical trial, involving a 7-week SA intervention period and a 12-week follow-up period. 108 BC survivors will be randomly allocated in a ratio of 1:1:1 to either a true SA group (self-administered acupressure plus usual care), a sham SA group (self-administered light acupressure at non-acupoints plus usual care) or a usual care group. The primary outcomes will be the effectiveness of SA on the FSDSC at both the individual symptom level and cluster symptom level. Each individual symptom will be specifically measured by the Brief Fatigue Inventory (fatigue), the Pittsburgh Sleep Quality Index (sleep disturbance) and the Hospital Anxiety and Depression Scale-Depression (depression). The cluster symptom level will be measured by using an FSDSC composite score, an averaging score of three separated 0-10 numeric rating scales for fatigue, depression and sleep disturbance. The secondary outcomes will include QoL (measured by the Functional Assessment of Cancer Therapy-Breast), adverse events and cost-effectiveness. Outcomes will be assessed at baseline (week 0), immediately after intervention (week 7) and follow-up (week 19). All outcomes will be analysed based on the intention-to-treat principle using the Statistical Package for Social Science (SPSS 25) software.

ETHICS AND DISSEMINATION

Ethical approvals of this study have been granted by the Human Research Ethics Committee at Charles Darwin University (H22110) and the Clinical Trial Ethics Committee at the Affiliated Hospital of Zunyi Medical University (KLL-2023-594), and the Second Affiliated Hospital of Zunyi Medical University (KYLL-2023-058). Findings from this trial will be published in peer-reviewed journals and presented at professional conferences.

TRIAL REGISTRATION NUMBER

NCT06412107.

Using Serum Metabolomic Signatures to Investigate Effects of Acupuncture on Pain-Fatigue-Sleep Disturbance in Breast Cancer Survivors

BACKGROUND/OBJECTIVES

Acupuncture is an efficacious integrative therapy for treating pain, fatigue, and sleep disturbance (the psychoneurological symptom cluster) in breast cancer survivors. However, the mechanisms underlying its effects remain unclear, and related metabolomics studies are limited. This study aimed to examine serum metabolite changes after acupuncture and their relationships to symptom improvement.

METHODS

Forty-two breast cancer survivors experiencing pain, fatigue, and sleep disturbance participated in a single-arm acupuncture trial. They received a 10-session acupuncture intervention over 5 weeks. Fasting blood samples and symptom surveys were collected before and after the acupuncture intervention, and untargeted metabolomics profiling was conducted on serum samples. Mixed-effects models adjusting for covariates (age, race, body mass index, and antidepressant use) were applied for analysis.

RESULTS

After acupuncture, there was a significant reduction in the psychoneurological symptom cluster (mean reduction = -6.2, p < 0.001).Bonferroni correction was applied to 40 independent metabolite clusters (α = 0.00125); cysteine-glutathione disulfide (p = 0.0006) significantly increased, and retinal (p = 0.0002) and cis-urocanate (p = 0.0005) were significantly decreased. Dimethyl sulfone (p = 0.00139) showed a trend towards reduction after acupuncture and its change (p = 0.04, β =1.97) was positively associated with reduction in the psychoneurological symptom cluster. Also, increased lauroylcarnitine (p = 0.0009) and decreased cytosine (p = 0.0008) can modulate the therapeutic effects of acupuncture.

CONCLUSIONS

Acupuncture demonstrates beneficial effects on the psychoneurological symptom cluster in breast cancer survivors. Dimethyl sulfone may be a promising mediator in the relationship between acupuncture and psychoneurological symptoms, while acylcarnitine metabolism may modulate the therapeutic effect of acupuncture.

Effect of auricular acupressure on sleep quality in breast cancer patients: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND PURPOSE

Sleep disturbance is a very common problem among breast cancer patients, and auricular acupressure is a non-pharmacologic intervention to improve the sleep quality. This study aimed to investigate the effectiveness and safety of auricular acupressure to improve sleep quality in breast cancer patients.

METHODS

Overall, 8 electronic databases in English and Chinese were systematically searched from inception to August 12, 2023 to identify eligible randomized controlled trials (RCTs). The risk of bias was assessed by version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2.0).

RESULTS

A total of 16 studies with 1199 participants were included. The synthesized results showed that compared with the control group, auricular acupressure had a significant effect on improving the effective rate of sleep quality improvement in patients with breast cancer (risk ratio [RR] 1.56, 95 % confidence interval [CI] 1.14 to 2.14; P < 0.001), and that significantly reduced the Pittsburgh Sleep Quality Index (PSQI) global score (mean difference [MD] -3.47, 95 % CI -4.37 to -2.58; P < 0.001). Subgroup analysis of effective rate and PSQI score showed similar significant effects. Additionally, the improvement of sleep quality was better when auricular acupressure was performed by nurses using Vaccaria seeds. Furthermore, the optimal intervention program was performed 1-2 times a day, 3-5 min each time, and lasted for 2-4 weeks.

CONCLUSION

Auricular acupressure may effectively improve the sleep quality of patients with breast cancer. However, more rigorously designed, large-sample, multi-center RCTs are required to further validate the results.

Effects of nonpharmacological interventions on symptom clusters in breast cancer survivors: A systematic review of randomized controlled trials

Objective

To summarize nonpharmacological interventions and assess their effects on symptom clusters and quality of life (QoL) in breast cancer (BC) survivors.

Methods

Seven English and three Chinese electronic databases and three clinical trial registries were searched from January 2001 to August 2023. A narrative approach was applied to summarize the data. The primary outcome was symptom clusters measured by any patient-reported questionnaires, and the secondary outcomes were QoL and intervention-related adverse events.

Results

Six published articles, one thesis, and one ongoing trial involving 625 BC survivors were included. The fatigue-sleep disturbance-depression symptom cluster was the most frequently reported symptom cluster among BC survivors. The nonpharmacological interventions were potentially positive on symptom clusters and QoL among the BC survivors. However, some of the included studies exhibited methodological concerns (e.g., inadequate blinding and allocation concealment). The intervention protocols in only two studies were developed following a solid evidence-based approach. Adverse events related to the targeted interventions were reported in six included studies, with none performing a causality analysis.

Conclusions

The nonpharmacological interventions could be promising strategies for alleviating symptom clusters in BC survivors. Future studies should adopt rigorously designed, randomized controlled trials to generate robust evidence.

Systematic review registration

INPLASY202380028.

Subgroups of sleep quality and associated risk factors in patients with cancer undergoing radiotherapy: A cross-sectional study based on latent profile analysis

PURPOSE

To identify latent classes of sleep quality among patients with cancer undergoing radiotherapy, and to examine the predictors of different latent classes.

METHODS

This cross-sectional study included 238 cancer patients. The assessment instrument included the Pittsburgh Sleep Quality Index, the sleep hygiene awareness and practice scale, the MD Anderson Symptom Inventory, the Distress Thermometer and the Fear of Cancer Recurrence Questionnaire. Latent profile analysis was used to identify different sleep quality subgroups.

RESULTS

Three latent classes with distinct sleep characteristics were identified: good sleep quality (class 1, 66.8%), moderate sleep disturbance with high hypnotics use (class 2, 9.2%), and high sleep disturbance with low hypnotics use (class 3, 24.0%) classes. Patients who were young (P = 0.022) and diagnosed with cancer stage Ⅲ (P = 0.021) were significantly more likely to be in Class 3 than in Class 1. Patients with a senior middle school were less likely to fall into Class 2, but more likely to fall into Class 1 (P = 0.026). Those with higher sleep hygiene practice scores (P = 0.022; P < 0.001), symptom severity (P < 0.001; P < 0.001), and psychological distress (P = 0.040; P < 0.001) had a significantly higher probability of being classified in Class 2 or Class 3 than in Class 1.

CONCLUSIONS

Our study revealed the heterogeneity of sleep quality in patients with cancer undergoing radiotherapy; moreover, through our findings, targeted interventions may be developed to promote the sleep quality of these patients.