Feng, Y., Wang, X. Y., Li, S. D., Zhang, Y., Wang, H. M., Li, M., . . . Zhang, Z. (2011). Clinical research of acupuncture on malignant tumor patients for improving depression and sleep quality. Journal of Traditional Chinese Medicine, 31, 199–202.

To study the effect of acupuncture on depression and insomnia in patients with malignant tumors. 

One time per day for 20 to 30 minutes, over a course of 30 days, patients in the intervention group received acupuncture on these acupoints:  Fenglon (ST-40), Yinlingquan (SP-9), Xuehai (SP-10), Sanyinjiao (SP-6), Yintant (EX-HN3), Baihui (DU-20), Sishencong (EX-HN1), Neiguan (PC-6), and Shenmen (TF-4). Patients in the control group received fluoxetine, 20 mg/day. Depression scores and sleep ratings were collected before and after the three-day treatment.

• The sample was comprised of 80 patients (66% male, 34% female) with malignant tumors:  40 patients were in the treatment group, which received acupuncture, and 40 were in the control group, which received 20 mg of fluoxetine daily.
• Mean age was 63.8 years (standard deviation [SD] = 5.47 years; range 18–75 years).
• All patients had a malignant tumor. Seven types of cancer were represented in the sample:  lung, gastric, breast, colorectal, lymphoma, cervical, and ovarian cancer. 
• Depression was assessed according to the Chinese Classification of Mental Disorders, third edition (CCMD-3).
• Patients with a functional disorder of the heart, liver, kidney, or spinal cord were excluded, as were those currently taking antidepressant medications.

• Single site
• Beijing, China

Patients were undergoing the active treatment phase of care.

The study was a randomized, controlled trial with intervention and control groups.

• Zung Self-Rating Depression Scale (SDS)    
• Hamilton Rating Scale for Depression (HRSD)
• Pittsburgh Sleep Quality Index (PSQI)

Pretreatment SDS scores of the treatment and control groups were 64.12 (SD = 5.34) and 64.24 (SD = 4.98), respectively, with no significant difference (p > 0.05). After treatment, SDS scores of the treatment and control groups were 43.64 (SD = 5.28) and 50.76 (SD = 5.42), which showed significant difference (p < 0.05). HRSD scores of both groups showed no significant difference before treatment (p > 0.05); however, after-treatment scores were 9.88 (SD = 1.27) in the treatment group and 13.72 (SD = 2.05) in the control group (p < 0.05). These results indicate that both acupuncture and fluoxetine were effective in reducing depression scores in these patients, with acupuncture showing greater effectiveness. PSQI scores of the treatment group, before and after treatment, were 14.48 (SD = 1.71) and 7.92 (SD = 1.22), respectively, with a significant difference (p < 0.001). The control group's PSQI scores, 13.92 (SD = 2.59) and 11.44 (SD = 1.89), did not reach significance (p > 0.05). Results indicate that acupuncture improved sleep quality in more patients than did fluoxetine.

Both acupuncture and fluoxetine were associated with reduced depression scores and some improvement in sleep. Due to the lack of a real control group and no control over cancer type and treatment phase, drawing a conclusion about the effectiveness of the intervention is difficult.

• The study had a small sample size, with less than 100 patients.
• The age range was small.
• The study was conducted at a single site, and the measurement tools were self-report instruments.
• Fluoxetine may take more than 30 days to reach therapeutic effectiveness.
• The study compared a fluoxetine-using group to an acupuncture-using group; the study included no real control group.
• The sample included diverse cancer types, and patients were at different phases of treatment. These factors may confound the findings.
• The authors did not analyze the differences between groups in regard to posttreatment PSQI scores. 
• The study did not include an attentional control or consider the possible placebo effect of acupuncture.
   

Acupuncture is a nonpharmacologic intervention that shows promise in reducing depression and improving sleep quality in patients with cancer and depression.