Can Electro-Acupuncture Alleviate Sleep Disturbances in Breast Cancer Survivors?
Electro-acupuncture appears to be comparable to gabapentin for improving sleep in breast cancer survivors who experience hot flashes, according to study results published in Menopause.1
Breast cancer survivors may have a greater risk for hot flashes than women who undergo natural menopause for many reasons, including premature menopause due to chemotherapy and surgery, or estrogen deficiency caused by hormonal treatments like tamoxifen and aromatase inhibitors.2 These hot flashes are a major cause of sleep disturbances in breast cancer survivors, noted Sheila N. Garland, PhD, of Memorial University of Newfoundland in Canada, and colleagues.
With researchers estimating that there will be approximately 6 million breast cancer survivors in the United States by 2020,3 symptom reduction and maintenance is of clinical importance, the researchers wrote.
Although evidence suggests that acupuncture may reduce hot flash frequency in women with breast cancer,4-8 Dr Garland and colleagues noted, sleep is often a secondary outcome of these studies and “little is known about the comparative effects of acupuncture to pharmacological interventions for sleep disturbances in women with hot flashes.”
To learn more, the researchers analyzed data from a randomized, controlled trial that compared the short-term effects of electro-acupuncture with daily gabapentin, sham acupuncture, and a placebo pill for hot flashes in breast cancer survivors. They restricted their analyses to the 2 study arms comparing electro-acupuncture with gabapentin.
“We chose [electro-acupuncture] in particular because it has been shown to affect endorphins and other central neuropeptides offering biological plausibility for addressing hot flashes,” they wrote.
The analysis included 58 breast cancer survivors (mean age: 51.7 years) who were experiencing bothersome hot flashes at least twice daily and had been experiencing hot flashes for at least 1 month. In the study, participants were randomly assigned to receive 8 weeks of treatment with either 900 mg/d of gabapentin or electro-acupuncture, which as administered twice a week for 2 weeks and then weekly for 6 weeks.
Change in the total Pittsburgh Sleep Quality Index (PSQI) score at week 8 served as the primary outcome.
At the end of week 8, PSQI decreased significantly more in the electro-acupuncture group, as compared with the gabapentin group (–2.6 vs –0.8; P =.044), according to the data.1 Additionally, compared with gabapentin, electro-acupuncture was associated with greater improvements in sleep latency (–0.5 vs 0.1; P =.041) and sleep efficiency (–0.6 vs 0.0; P =.05).1
Compared with baseline, participants in the electro-acupuncture group experienced improved sleep duration, less sleep disturbance, shorter sleep latency, decreased daytime dysfunction, improved sleep efficiency, and better sleep quality (P <.05 for all).1 Participants taking gabapentin, however, only experienced improvements in duration and sleep quality from baseline (P <.05 for both).1
Despite their findings, the researchers highlighted several study limitations, including:
- A lack of follow-up after treatment, thereby precluding evaluation of differences in long-term effects of electro-acupuncture vs gabapentin
- Self-reported data on hot flashes and sleep quality
- Sleep was a secondary outcome of the trial, and the researchers did not intentionally select the sample for the presence of disturbed sleep and did not screen for sleep disorders
“This study shows that, for women who need or choose to avoid medications, electro-acupuncture may be an option because it has minimal risks, but blinded controlled trials are needed,” JoAnn Pinkerton, MD, executive director of the North American Menopause Society, said in a press release.9
- Garland SN, Xie SX, Li Q, Seluzicki C, Basal C, Mao JJ. Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial. Menopause. 2016 Nov 21. doi:10.1097/GME.0000000000000779 [Epub ahead of print].
- Bordeleau L, Pritchard KI, Loprinzi CL, et al. Multicenter, randomized, cross-over clinical trial of venlafaxine versus gabapentin for the management of hot flashes in breast cancer survivors. J Clin Oncol. 2010;28:5147-5152.
- Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103:117-128.
- Frisk J, Kallstrom AC, Wall N, Fredrikson M, Hammar M. Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes. Support Care Cancer. 2012;20:715-724.
- Otte JL, Carpenter JS, Zhong X, Johnstone PA. Feasibility study of acupuncture for reducing sleep disturbances and hot flashes in postmenopausal breast cancer survivors. Clin Nurse Spec. 2011;25:228-236.
- de Valois BA, Young TE, Robinson N, McCourt C, Maher EJ. Using traditional acupuncture for breast cancer-related hot flashes and night sweats. J Altern Complement Med. 2010;16:1047-1057.
- Painovich JM, Shufelt CL, Azziz R, et al. A pilot randomized, single-blind, placebo-controlled trial of traditional acupuncture for vasomotor symptoms and mechanistic pathways of menopause. Menopause. 2012;19:54-61.
- Baccetti S, Da Fre M, Becorpi A, et al. Acupuncture and traditional Chinese medicine for hot flushes in menopause: a randomized trial. J Altern Complement Med. 2014;20:550-557.
- Electro-acupuncture for disrupted sleep in women with breast cancer [press release]. Cleveland, OH: North American Menopause Society Press Room; November 28, 2016. http://www.menopause.org/docs/default-source/2016-docs/acupuncture-for-hot-flashes-for-breast-cancer-survivors.pdf. Accessed November 29, 2016.