Evidence Explorer · MS-N050

Acupuncture compared with CBT-I for insomnia in cancer survivors

Family: Acupuncture and sleep supportive care
Clinical question: For cancer survivors with insomnia after active treatment, how does acupuncture compare with cognitive behavioral therapy for insomnia (CBT-I)?
Evidence label: Both improved insomnia; CBT-I was superior in the comparative trial.

Evidence at a glance

• Benefit: Both treatments produced clinically meaningful average improvements, but CBT-I improved insomnia more.
• Certainty: One randomized comparative-effectiveness trial; no sham or untreated group, so acupuncture-specific effects cannot be separated from attention and expectancy.
• Risk: Mild needling soreness, itching, or pain occurred; sterile technique and an oncology-aware practitioner matter.
• Cancer control: Not studied.

What was studied

The CHOICE trial randomized 160 cancer survivors with insomnia who had completed active cancer treatment to eight weeks of acupuncture (80) or CBT-I (80), with follow-up through week 20.

What the evidence shows

Insomnia Severity Index scores improved by −8.31 points with acupuncture (95% CI −9.36 to −7.26) and −10.91 with CBT-I (95% CI −11.97 to −9.85). The prespecified clinically meaningful threshold was 8 points, reached on average in both groups; CBT-I was statistically superior (P<.001). Among participants with safety data, 9 of 78 in the acupuncture group reported mild or moderate needling-site symptoms; 5 of 73 in CBT-I reported drowsiness or daytime fatigue. Two cancer progressions were judged unrelated.

What this does not show: The trial does not show that acupuncture treats cancer or improves survival, and it does not isolate a specific needling effect because there was no sham control.

Limits and uncertainty

• Single-center comparative-effectiveness design without a sham or usual-care arm.
• Participants had finished active treatment; results may not transfer to people receiving chemotherapy or radiotherapy.
• Participants and practitioners could not be blinded.
• Treatment availability, cost, and practitioner expertise vary.

Safety and practical context

Use a licensed practitioner experienced with oncology. Discuss low platelets, neutropenia, anticoagulants, lymphedema risk, infection, fragile skin, and implanted devices before needling. CBT-I remains the better-supported first-line behavioral treatment for chronic insomnia when accessible.

Questions for the care team

• Could CBT-I be accessed in person, by telehealth, or through a validated digital program?
• Are there bleeding, infection, or lymphedema concerns that change acupuncture safety?
• Could pain, hot flashes, medication, sleep apnea, depression, or another condition be driving the insomnia?
• How will response be reassessed after eight weeks?

Sources

• CHOICE trial (J Natl Cancer Inst; PMID 31081899)
• CHOICE full text (PMCID PMC6910189)
• ClinicalTrials.gov NCT02356575
• ESMO Clinical Practice Guideline for insomnia in adult cancer patients (PMID 38158225)

Identifiers: PMID 31081899; PMCID PMC6910189; NCT02356575
Last literature search: October 17, 2026
Record appraised: October 17, 2026

Educational information, not personal medical advice. Decisions about symptoms, supplements, movement, or psychological care during cancer treatment should be made with the oncology team.