Stimulated by Yu et al 2026.[1]
IF – impact factor
PSM – propensity score matching
aHR – adjusted hazard ratio
ECOG PS score – Eastern Cooperative Oncology Group performance status score– key to acronyms
This week we are staying with the theme of cancer care but moving from gastric cancer to lung cancer, so from third on the list (of mortality from cancer in China) to top of the list.
We are also staying in Guangzhou (see links in last week’s post EA for QoL in gastric cancer 2026).
The paper is a large retrospective cohort trial including patients with a new diagnosis of lung cancer presenting at 4 linked hospital sites across Guangzhou over a roughly 10-year period from 2012, when an electronic medical records database was set up.
It is published in the journal Supportive Care in Cancer (IF 3.0), which started out in January 1993 and currently runs a hybrid publishing model.
Nearly 4000 patients were diagnosed with lung cancer between 2012 and 2021, but new diagnoses were 2651. After various exclusions such as an existing diagnosis of insomnia, coma, drowsiness, or delirium, missing records, and insufficient follow-up, the number was reduced to 1295. Of these 586 patients had received acupuncture treatment and 709 had not.
PSM was used to manage covariates and confounding, leaving 459 patients in each group. Pain was not included as a covariate despite it clearly being relevant to the insomnia outcome. The reason for this was that acupuncture reduces pain, which reduces insomnia, so pain is a mediator of the acupuncture – insomnia relationship. If this had been included as a covariate, it could have confounded the results through more pain and thus more insomnia being correlated with a higher number of acupuncture sessions, which would inappropriately influence the results. Because acupuncture would be used most for pain symptoms, by not balancing pain in the PSM, this is likely to disadvantage the acupuncture cohort to some degree, because we would expect a higher percentage of pain and thus insomnia in this cohort compared with the cohort that did not seek or receive acupuncture.
Almost 30% of the patients in the acupuncture cohort received acupuncture for cancer pain. A further ~30% received acupuncture for systemic cancer-related symptoms (fatigue, hot flushes, weight loss), followed by respiratory symptoms (~22%), neurological symptoms (~12%), and digestive symptoms (~10%).
The incidence of insomnia in the acupuncture cohort was 21% and in the non-acupuncture cohort was 42%, which works out to an aHR of 0.31.
There was a dose response relationship, with the lowest aHR (0.15) being associated with daily acupuncture as an inpatient.
Insomnia was associated with age (64 or over – aHR 1.30), ECOG PS score (3-4 – aHR 1.58; 5 = dead), opiate use (aHR 1.39), and mental disorders (aHR 7.59).
Unusually, for this type of study, there were some fancy statistical analyses performed on the points used. Personally, I am uninterested in this, so I am not going to report these results. Only joking! Of course I will report them. I cannot overlook the most common question ever asked at an acupuncture event – what points did you use?
So, they did several different analyses, the veracity of which I cannot judge; however, LI11 and ST36 were the points with the highest ‘importance scores’, and LI11, SP6, and GB20, featured in both analyses of individual points. I should mention that SP6 was associated with the highest non-insomnia rate of 71.63%. That seems a little too accurate an estimate for me.
There were also some analyses of point combinations, but this is rather hard to follow, so I will just quote the authors who state that the acupuncture points SP6, LI11, ST36, and CV15, ‘show a close link to the non-insomnia state’.
References
1 Yu R, Guo X, Zhu Y, et al. Acupuncture reduced incidence of insomnia symptoms in patients with lung cancer: a retrospective cohort study. Support Care Cancer. 2025;34:45. doi: 10.1007/s00520-025-10256-8
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