Mindfulness-based stress reduction with acupressure for sleep quality in breast cancer patients with insomnia undergoing chemotherapy: A randomized controlled trial

Abstract

Purpose: The objective of this randomized controlled trial was to evaluate and compare the effectiveness of mindfulness-based stress reduction (MBSR), acupressure, and MBSR combined with acupressure in improving sleep quality in breast cancer patients with sleep disorders, as well as the potential effects of these interventions on relieving fatigue, anxiety, and depression.

Methods: A four-arm parallel-group randomized controlled trial was conducted in a tertiary hospital in Fujian between July 2019 and January 2021. A total of 147 breast cancer patients were randomly assigned to a usual care group (n = 34), a MBSR group (n = 38), an acupressure group (n = 36), or a combined group (n = 39). We assessed patients' sleep quality (Pittsburgh Sleep Quality Index-PSQI and 6 actigraphy indices), fatigue, anxiety, and depression at baseline and at the mid-intervention (fourth week) and the end of intervention (eighth week).

Results: The ANOVA showed a significant difference (p < 0.05) in PSQI, and all sleep parameters measured by wrist actigraphy, and anxiety between groups. The three active treatments led to better PSQI outcomes (p < 0.001), reduced fatigue (p < 0.001), decreased anxiety (p < 0.05), and improved sleep measured by all actigraphy indices with two exceptions (MBSR did not differ from control on Sleep Latency (p = 0.235) and mean waking by time (MWBT) (p = 0.058)). Both acupressure and the combined intervention outperformed MBSR on four actigraphy indices: Sleep Efficiency (SE), Sleep Latency (SL), Totatl Sleep Time (TST), and Wake after sleep onset (WASO) (p < 0.05), and the combined intervention further outperformed MBSR on PSQI (p = 0.03) and Number of awakings (NOA) (p = 0.003). Moreover, there was no significant difference across all outcomes between acupressure and combined intervention (p ≥ 0.05).

Conclusions: MBSR, acupressure, and combined therapy all show a remarkable advantages in allemiating sleep quality, fatigue, and anxiety. Acupressure and combined therapy outperformed MBSR in improving sleep quality.

Keywords: Acupressure; Breast cancer; Fatigue; Mindfulness-based stress reduction; Sleep disorders.