Acupuncture versus cognitive behavioral therapy for anxiety among cancer survivors with insomnia: An exploratory analysis of a randomized clinical trial

Abstract

Background

Anxiety and insomnia frequently co-occur among cancer survivors and are strongly interconnected, yet no widely accepted intervention simultaneously targets both symptoms.

Methods

Data were drawn from a dual-center, parallel-group, randomized, comparative effectiveness trial evaluating acupuncture versus CBT-I for insomnia. Seventy-six participants with baseline Hospital Anxiety and Depression Scale-Anxiety (HADS-A) scores of ≥8 were included. Both interventions were administered over eight weeks, with follow-up until 20 weeks. Anxiety was assessed at baseline, week 8, and week 20 using HADS-A. A linear mixed-effects model was used to examine mean change in HADS-A scores. Additionally, responder analyses were conducted, with insomnia and anxiety responders defined as patients demonstrating clinically meaningful improvements in either outcome by week 8.

Results

Both CBT-I and acupuncture significantly reduced HADS-A scores at week 8 (CBT-I: -3.75; acupuncture: -3.14) and week 20 (CBT-I: -3.05; acupuncture: -2.66) compared to baseline (all p < 0.001). There was no between-group difference (p=0.85). In responder analyses, CBT-I showed greater anxiety reduction in insomnia responders (-4.62) than non-responders (-0.45), at both time points (week 8: p=0.0046; week 20: p=0.038). In the acupuncture group, the difference in anxiety reduction between insomnia responders (-3.96) and non-responders (-1.58) was not statistically significant.

Conclusion

Both acupuncture and CBT-I effectively manage comorbid anxiety and insomnia in cancer survivors. Acupuncture may address these symptoms independently, while CBT-I may improve them in an interconnected manner.

Trial registration

ClinicalTrials.gov registration (NCT02356575).