Effects of acupuncture versus cognitive behavioral therapy on cognitive function in cancer survivors with insomnia: A secondary analysis of a randomized clinical trial

Abstract

Background: Cancer‐related cognitive impairment is a prevalent, disruptive condition potentially exacerbated by sleep disturbances. The current study was performed to evaluate the effects of acupuncture versus cognitive behavioral therapy for insomnia (CBT‐I) on objective and subjective cognitive function in cancer survivors with insomnia. Methods: Using data from a randomized clinical trial (160 survivors) that compared acupuncture versus CBT‐I for insomnia occurring in cancer survivors, the authors analyzed cognitive outcomes and their relationship to insomnia symptoms. Analysis was limited to 99 patients who reported baseline cognitive difficulties. Interventions were delivered over 8 weeks. Objective attention, learning, and memory were evaluated using the Buschke Selective Reminding Test. Subjective cognitive function was assessed using the Brown Attention‐Deficit Disorder Scales. Insomnia symptoms were assessed using the Insomnia Severity Index. All outcomes were collected at baseline, week 8, and week 20. Results: From baseline to week 8, acupuncture produced statistically significant within‐group improvements in objective attention (Cohen D , 0.29), learning (Cohen D , 0.31), and memory (Cohen D , 0.33) that persisted to week 20 (all P < .05), whereas CBT‐I produced a statistically significant within‐group improvement in objective attention from baseline to week 20 (Cohen D , 0.50; P < .05); between‐group differences were not statistically significant. Both interventions produced statistically significant within‐group improvements in subjective cognitive function at weeks 8 and 20 compared with baseline (all P < .001); between‐group differences were not statistically significant. In the acupuncture group, patients with clinically meaningful responses with regard to insomnia symptoms demonstrated a significantly greater improvement in subjective cognitive function compared with those without clinically meaningful insomnia responses ( P = .006). Conclusions: Among cancer survivors with insomnia, both acupuncture and CBT‐I produced significant improvements in objective and subjective cognitive function. However, the effect sizes varied and only survivors in the acupuncture group demonstrated a significant relationship between cognitive and sleep outcomes. These preliminary findings warrant further investigation to guide the personalized management of patients with cancer‐related cognitive impairment.