Invasive or noninvasive? A systematic review and network meta-analysis of acupuncture and acupressure to treat sleep disturbance in cancer patients
Corresponding Author
Denise Shuk Ting Cheung BNurs, MPhil, PhD
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
Correspondence
Denise Shuk Ting Cheung, School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR.
Email: [email protected]
Search for more papers by this authorXinyi Xu BNurs, PhD Candidate
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
Search for more papers by this authorRobert Smith BSc, PhD
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
Search for more papers by this authorNaomi Takemura BNurs, PhD
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
Search for more papers by this authorWing Fai Yeung BCM, PhD
School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
Search for more papers by this authorWing-lok Chan MBBS (HK), FRCR, FHKCR, FHKAM (Radiology), Dip Med (CUHK), MSc in Palliative Medicine (Cardiff)
Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
Search for more papers by this authorLixing Lao MD, PhD, LAc
Virginia University of Integrative Medicine, Vienna, Virginia, USA
Search for more papers by this authorChia-Chin Lin BSN (TMU), MSN (UW), PhD (UW), FAAN
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
College of Nursing, Taipei Medical University, Taipei, Taiwan
Search for more papers by this authorCorresponding Author
Denise Shuk Ting Cheung BNurs, MPhil, PhD
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
Correspondence
Denise Shuk Ting Cheung, School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR.
Email: [email protected]
Search for more papers by this authorXinyi Xu BNurs, PhD Candidate
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
Search for more papers by this authorRobert Smith BSc, PhD
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
Search for more papers by this authorNaomi Takemura BNurs, PhD
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
Search for more papers by this authorWing Fai Yeung BCM, PhD
School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
Search for more papers by this authorWing-lok Chan MBBS (HK), FRCR, FHKCR, FHKAM (Radiology), Dip Med (CUHK), MSc in Palliative Medicine (Cardiff)
Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
Search for more papers by this authorLixing Lao MD, PhD, LAc
Virginia University of Integrative Medicine, Vienna, Virginia, USA
Search for more papers by this authorChia-Chin Lin BSN (TMU), MSN (UW), PhD (UW), FAAN
School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
College of Nursing, Taipei Medical University, Taipei, Taiwan
Search for more papers by this authorAbstract
Background
Both acupuncture and acupressure have been suggested beneficial for reducing sleep disturbance in cancer patients. While acupuncture is invasive involving needle insertion, acupressure is noninvasive. Their comparative effectiveness is unclear, hindering clinical recommendations.
Aims
This study aimed to explore the comparative effectiveness of acupuncture and acupressure on sleep in cancer patients.
Methods
This is a systematic review and Bayesian network meta-analysis. Eight key English and Chinese databases were searched. Twenty-four randomized controlled trials involving 2002 cancer patients comparing the effects of six treatments (manual acupuncture, electroacupuncture, acupressure, sham, enhanced usual care, and no treatment) on sleep were found.
Results
Compared with enhanced supportive care, acupressure demonstrated the largest effect size for reducing self-reported sleep disturbance (standardized mean difference [SMD] = −2.67, 95% CrI: −3.46 to −1.90; GRADE = moderate), followed by acupuncture (SMD = −1.87, 95% CrI: −2.94 to −0.81, GRADE = moderate) and electroacupuncture (SMD = −1.60, 95% CrI: −3 to −0.21; GRADE = low). The surface under the cumulative ranking curve indicates that acupressure is most likely to rank highest.
Linking Evidence to Action
Based on available evidence, acupressure can be recommended as the optimal treatment for reducing sleep disturbance in cancer patients. More rigorous trials are warranted to confirm whether different forms of acupuncture or acupressure have different effects on sleep in cancer patients. Particularly, studies examining acupuncture interventions alone instead of in combination with other therapies are needed.
Supporting Information
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