Insomnia is common in people undergoing cancer treatment and in cancer survivors. It may involve difficulty falling asleep, waking during the night, early waking, or non-restorative sleep. These symptoms often coexist with fatigue, pain, mood disturbance, and reduced quality of life.
Acupuncture has been studied as a non-pharmacological option in this setting. The randomised controlled trial literature is still limited, but several trials are relevant.
1. Acupuncture versus CBT-I in cancer survivors
One of the better known RCTs compared acupuncture with cognitive behavioural therapy for insomnia (CBT-I) in 160 cancer survivors over 8 weeks. Both groups showed clinically meaningful reductions in insomnia severity, but CBT-I produced a greater improvement overall. Acupuncture was still associated with durable improvement and also showed stronger effects on pain at the end of treatment. This is important because pain and insomnia often overlap in cancer survivorship.
This trial is useful because it compared acupuncture with an active, evidence-based treatment rather than no treatment alone. It does not suggest acupuncture outperformed CBT-I, but it does support acupuncture as a studied non-drug option in this population.
2. Auricular acupuncture in breast cancer survivors
A 2021 randomised controlled trial evaluated auricular acupuncture for insomnia in breast cancer survivors. The study reported improvement in sleep-related outcomes and found the intervention to be feasible and generally well tolerated within the study setting. As this trial focused on breast cancer survivors and used an auricular approach rather than standard body acupuncture, its findings are relevant but should not be generalised too broadly.
This trial adds to the literature by showing that ear-based acupuncture methods have also been investigated in cancer-related insomnia, not only body acupuncture.
3. Acupuncture for chemotherapy-associated insomnia in breast cancer patients
A 2023 assessor-participant blinded, randomised, sham-controlled trial studied acupuncture for chemotherapy-associated insomnia in breast cancer patients. The use of a sham control strengthens the design compared with simple usual-care comparisons. The trial reported that acupuncture improved insomnia symptoms and was considered safe within the study conditions.
This is one of the more clinically relevant recent RCTs because it focused on insomnia associated with chemotherapy, which is a common and difficult problem in breast cancer care.
4. Electroacupuncture pilot trial for cancer-related insomnia
A 2022 multicentre assessor-blinded randomised pilot trial evaluated electroacupuncture for cancer-related insomnia. As a pilot study, its purpose was mainly to assess feasibility and preliminary effectiveness rather than provide definitive evidence. The investigators concluded that electroacupuncture appeared feasible, although recruitment was slow. Pilot studies are useful, but their smaller sample sizes mean they should be interpreted cautiously.
Overall interpretation of the RCT evidence
The RCT literature suggests that acupuncture has been studied in cancer-related insomnia across several designs: comparison with CBT-I, sham-controlled studies, auricular acupuncture studies, and electroacupuncture pilot trials. Across these studies, sleep outcomes such as insomnia severity and sleep quality often improved, but the strength of the evidence varies by design, comparator, and population.
There are also limits to the evidence. Cancer populations are heterogeneous, treatment protocols differ, and not all studies use the same control group. In addition, CBT-I remains the better established first-line non-pharmacological treatment for insomnia, and at least one major comparative trial found it more effective than acupuncture overall.
For this reason, the current literature supports a cautious summary: acupuncture has been investigated as an adjunctive or alternative non-pharmacological option for cancer-related insomnia, but the evidence is not uniform and should not be overstated.
Clinical points
- Acupuncture research in this area has included body acupuncture, auricular acupuncture, and electroacupuncture.
- Outcomes are usually measured with validated sleep tools such as the Insomnia Severity Index and Pittsburgh Sleep Quality Index.
- Treatment schedules in trials commonly involve repeated sessions over several weeks rather than a single treatment.
- Acupuncture is usually studied as part of supportive care, not as a replacement for oncology care or formal sleep medicine assessment.
References
Garland, S. N., Xie, S. X., DuHamel, K., Bao, T., Li, Q. S., Barg, F. K., Song, S., Kantoff, P. W., Gehrman, P. R., Mao, J. J., & Heckler, C. E. (2019). Acupuncture versus cognitive behavioral therapy for insomnia in cancer survivors: A randomized clinical trial. Journal of the National Cancer Institute, 111(12), 1323–1331. https://doi.org/10.1093/jnci/djz050
Höxtermann, M. D., Buner, K., Haller, H., Kohl, W., Dobos, G., Reinisch, M., Kümmel, S., Cramer, H., & Voiss, P. (2021). Efficacy and safety of auricular acupuncture for the treatment of insomnia in breast cancer survivors: A randomized controlled trial. Cancers, 13(16), 4082. https://doi.org/10.3390/cancers13164082
Lee, B., Kim, B.-K., Kim, M., Yang, C., Park, Y.-J., Lee, H. S., Yoon, H.-G., Kim, A. R., & Choi, S.-M. (2022). Electroacupuncture for treating cancer-related insomnia: A multicenter, assessor-blinded, randomized controlled, pilot clinical trial. BMC Complementary Medicine and Therapies, 22, 88. https://doi.org/10.1186/s12906-022-03561-w
Zhang, J., Qin, Z., So, T. H., et al. (2023). Acupuncture for chemotherapy-associated insomnia in breast cancer patients: An assessor-participant blinded, randomized, sham-controlled trial. Breast Cancer Research, 25, 49. https://doi.org/10.1186/s13058-023-01645-0