Otte, J. L., Carpenter, J. S., Zhong, X., & Johnstone, P. A. (2011). Feasibility study of acupuncture for reducing sleep disturbances and hot flashes in postmenopausal breast cancer survivors. Clinical Nurse Specialist, 25, 228–236.

To evaluate the feasibility of acupuncture as a treatment for concurrent hot flashes (HFs) and sleep disturbances.

• This was an eight-week study using certified community acupuncture providers for three acupuncture treatments over a two-week period per patient.
• Wrist actigraphy and sternal skin conductance was used for measuring HF occurrence and duration.
• Completion of questionnaires was required at baseline and weeks 5 and 8.
• Self-reported symptom data were gathered during treatment and each week at follow-up.

• The sample was comprised of 10 female patients. 
• Patients were 18 years or older; mean age was 53 years.
• Patients had breast cancer stage 1; a possible other stage was not defined.
• Patients were perimenopausal/postmenopausal.
• Patients could not change sleep or HF medication during study.

Patients were included if they

• Reported sleep disturbances over the past month
• Had daily HFs
• Lived within a 100-mile radius of the study site
• Spoke English
• Were diagnosed with nonmetastatic breast cancer
• Had no history of other cancers
• Were at least three months postcompletion of surgery, radiotherapy, and chemotherapy.

• Multisite   
• Outpatient   
• University

• Patients were undergoing the transition phase after initial treatment.
• The study has clinical applicability for late effects and survivorship.

The study used a quasiexperimental, single-group, nonrandomized design.

• Protocol for acupuncture points
• Demographic questionnaire
• Disease and treatment information
• Acupuncture session notes
• 6-item Devilly and Borkovec Outcome/Expectancy Credibility Questionnaire (DBO/ECQ)
• Wrist Actigraphy and Sternal Skin Conductance Monitoring Biolog model 3991
• Sleep diary

Ten breast cancer survivors (BSCs) completed baseline, and two withdrew after the last baseline assessment. The remaining eight BSCs completed all time points. There was no significant difference among acupuncture points used per patient for the three treatments or the four providers. Sessions were mainly conducted at a single clinic. The study described patients as having high outcome expectations for acupuncture effectiveness and its acceptability. Sleep patterns were affected:  sleep latency increased and time spent awake after sleep onset decreased. The average number of HFs decreased.

Expectations for and credibility and acceptability of acupuncture in managing vasomotor and sleep symptoms were high for the BSCs.The study demonstrated minimal improvement in total sleep time and some sleep latency improvement immediately following completion of acupuncture sessions but not at week 8 (not a sustainable effect); waking after sleep onset improved.

• The study had a small sample size, with less than 30 patients.
• The majority of the patients enrolled were not taking a hormone modulator at the time of enrollment; therefore, the authors were unable to extrapolate the results found here to apply to BSCs using aromatase inhibitors or tamoxifen in treating their breast cancer.
• The number of acupuncture treatments was limited to three over two weeks.
• Reproducible results were limited because the study mainly occurred at one site with one acupuncturist.
• No control group was used for comparison to the intervention of acupuncture.

The study showed that women may be amenable, especially highly motivated women, to pursuing acupuncture as a nonpharmacological approach to managing HFs. Further investigations with larger sample sizes are needed to note if there are any correlations with socioeconomic/cultural influences for the acceptability of acupuncture and to compare acupuncture to another intervention for the control of HFs/sleep quality.