THM has been reported to modulate 5-hydroxytryptamine and gamma-aminobutyric acid (GABA) receptors ( Cho et al., 2010), and affects brain enzymes associated with the GABA system ( Awad et al., 2007).
Traditional herbal medicine (THM) has been widely used to treat insomnia ( Leach and Page, 2015). However, long-term adherence to CBT-I is difficult for patients with advanced cancer ( Kvale and Shuster, 2006), and hypnotics have limited efficacy with adverse effects including dependence, impairment of memory or movement, and residual effects ( Holbrook et al., 2000). Hypnotics are one of the most prescribed medications for patients with cancer ( Stiefel et al., 1990). Cognitive behavioral therapy for insomnia (CBT-I) is recommended as a first treatment option for insomnia in the cancer population ( Cleeland et al., 2013). Non-pharmacological and pharmacological treatments are commonly used to treat insomnia. Insomnia and subsequent sleep disturbances can lead to fatigue, psychological disorders, and immunosuppression, which can significantly impair the quality of life and even affect the course of the disease ( O’Donnell, 2004 Innominato et al., 2015). In addition, many cancer patients do not appear to report symptoms of insomnia, assuming them to be a minor problem compared to a cancer diagnosis or treatment despite its prevalence and clinical significance, which results in insomnia remaining untreated ( Induru and Walsh, 2014 Howell et al., 2014). The prevalence of insomnia in patients with cancer varies from 30 to 60%, which is considerably higher than that in the general population ( O’Donnell, 2004 Induru and Walsh, 2014 Cleeland et al., 2013). It is defined as difficulty falling asleep, trouble staying asleep, early awakening, or nonrestorative sleep ( Savard and Morin, 2001). Insomnia is one of the most prominent complaints among patients with cancer ( O’Donnell, 2004). Systematic Review Registration:, PROSPERO 2021 However, considering the limited methodological qualities and inconsistent results of the included trials, further rigorous RCTs are required. No serious adverse events were observed.Ĭonclusion: This review suggests that THM may be an effective therapeutic option for insomnia in patients with cancer. The most frequently used herbs were Ziziphus jujuba Mill. Compared to placebo, THM also reduced the PSQI score significantly (MD −2.56, 95% CI −3.81 to −1.31, I 2 = 91%) with moderate quality of evidence. Compared to hypnotics, THM showed a significant improvement in sleep quality by reducing the PSQI score and increasing the total effective rate with low quality of evidence. Results: Fourteen RCTs were included in the systematic review, and 10 RCTs were analyzed quantitatively. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. The included studies were appraised using the Cochrane risk of bias tool and meta-analyzed. The outcome measurements were sleep quality measured by validated questionnaire such as the Pittsburgh Sleep Quality Index (PSQI), total effective rate, and adverse effects. Methods: Randomized controlled trials (RCTs) evaluating orally administered THM in a cancer population with insomnia were searched using nine electronic databases up to November 30, 2020. This study aimed to evaluate the efficacy and safety of traditional herbal medicine (THM) for improving sleep quality in patients with cancer.
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