With Jun J. Mao, MD, and Kevin T. Liou, MD, of Memorial Sloan Kettering Cancer Center
By Sarah DiGiulio
Cognitive complaints are a common side effect linked to cancer treatment for people with many different types of cancer. These problems are multifactorial; treatments themselves can be a contributing factor, but sleep issues can exacerbate the complaints, too, as disrupted sleep is also known to have an effect on the brain and cognitive functioning.
That's why a group of researchers at Memorial Sloan Kettering Cancer Center (MSKCC) conducted a study to evaluate whether insomnia treatments for cancer survivors with sleep complaints also improved cognitive complaints.
"This study was part of a larger clinical trial that randomized participants to either acupuncture or cognitive behavioral therapy for treatment of their insomnia. Patients were eligible for this study if they were experiencing cognitive problems in addition to their insomnia. To ensure that our findings could be generalized to a broader cancer population, we enrolled patients with any type or stage of cancer, as long as they had completed their primary cancer treatment," Jun J. Mao, MD, Chief of Integrative Medicine Service at MSKCC, told Oncology Times.
The data were published in April in the journal Cancer (2020; doi.org/10.1002/cncr.32847). Both insomnia treatments led to improved outcomes when it came to cognitive function. But there were some nuances to the data that should be noted. Here's what Mao and his fellow researcher, Kevin T. Liou, MD, an integrative medicine specialist at MSKCC, told Oncology Times about the data.
1 What led you to conduct this research now?
MAO: "The number of cancer survivors in the U.S. is rapidly increasing and expected to exceed over 20 million in the next 5 years. Research shows that up to four in five of these survivors may experience cognitive difficulties as a consequence of cancer and its treatments.
"Clinically, we have seen how these cognitive problems can impair recovery and quality of life. Unfortunately, current treatment options are limited. That's why we are so excited to collaborate with our MSKCC colleagues in the Neurocognitive Research Laboratory to try to address this prevalent, debilitating condition. We hope our research can eventually lead to more effective treatments and help cancer survivors lead healthier, more independent lives."
2 What were the key findings from this research?
LIOU: "I would say that both acupuncture and cognitive behavioral therapy for insomnia demonstrated promising effects on objective and subjective measures of cognitive function—and that acupuncture may produce cognitive benefits by improving sleep, whereas cognitive behavioral therapy for insomnia may produce cognitive benefits via other mechanisms. This was a small study embedded in a larger trial, so it was not powered to detect differences between the two treatments.
"However, if we focus on the magnitude of the improvement for each cognitive measure, cognitive behavioral therapy for insomnia seems particularly beneficial for subjective cognitive function, whereas acupuncture appears very promising for objective measures of memory and learning. We still need to conduct further research to confirm these findings and to determine whether the effects of these two treatments on various cognitive measures are truly different."
3 So what's the bottom-line message that practicing oncologists and cancer care providers should know about your work? Should these findings change practice?
LIOU: "We are encouraged by the cognitive effects of acupuncture and cognitive behavioral therapy for insomnia observed in our study, but these findings still need to be confirmed in larger, rigorous clinical trials before they can be incorporated into clinical guidelines.
"Given that treatment options for cancer-related cognitive impairment are currently limited, I do think it is worthwhile for cancer survivors struggling with cognitive symptoms to discuss acupuncture or cognitive behavioral therapy for insomnia with their doctors, particularly because both treatments have a relatively favorable safety profile and may provide some potential benefit. It is important to remember that our study was conducted with cancer survivors who are experiencing both sleep and cognitive problems, so our findings may not be applicable to survivors who are experiencing only cognitive difficulties without any associated problems with sleep.
"Both acupuncture and cognitive behavioral therapy for insomnia demonstrated potential benefit for objective and subjective cognitive function in cancer survivors with insomnia, but the effects may differ between these two interventions and should be further investigated in future rigorous studies to guide evidence-based, personalized treatment of cancer-related cognitive impairment."