Among patients with cancer, different types of sleep disorders represent a highly prevalent symptom.1 These disorders affect 19 %−75 % of cancer patients and significantly impact their mental and physical well-being.2 Insomnia is a common sleep disorder among cancer patients and can occur during the diagnostic process as well as during anticancer treatment. Additionally, many cancer survivors continue to experience these disorders for years, even after completing their cancer treatment.3,4 Unfortunately, in a considerable number of cases, the management of insomnia remains inadequately addressed.

Both pharmacological and non-pharmacological treatments can effectively manage insomnia in cancer patients.5,6 Pharmacological therapy is a typical option for insomnia but is recommended only for short-term use due to the risk of tolerance and dependence. Clinicians must also carefully assess potential interactions with the patient’s cancer drug therapy. Despite the availability of pharmacological options, a significant proportion of cancer patients and survivors prefer non-pharmacological approaches. In an epidemiological trial involving 5000 individuals using sleep medications, 80.3 % expressed a preference for non-pharmacological methods.7

Non-pharmacological methods, including acupressure, acupuncture,8,9 cognitive behavioural therapy (CBT) ,10 and aerobic exercise,11 serve as both primary and adjunctive treatments for cancer patients with insomnia. In recent years, there has been a growing interest in non-pharmacological methods like acupuncture and acupressure due to their minimal side effects, lack of drug interactions, and positive therapeutic effects.12,13

Acupressure has been particularly noted for its effectiveness in enhancing sleep quality among cancer patients. A study by Parizad found that acupressure significantly improved sleep quality in leukemia patients, supporting broader evidence that it may be particularly effective for sleep disturbances in cancer patients.14 Furthermore, a systematic review indicated that acupressure demonstrated a stronger effect size than acupuncture for improving sleep disturbances in cancer patients, although the confidence interval remained broad, indicating variability across studies.15 Additionally, a meta-analysis by Zhang et al. confirmed the positive impact of auricular acupressure on sleep disturbances, emphasizing its simplicity and minimal side effects.16 Most previous reviews have focused on either acupuncture or acupressure in isolation, without directly comparing multiple non-pharmacological interventions. These studies typically examined only a single method for treating insomnia in cancer patients, which leaves an important gap in understanding their comparative effectiveness.8,17,18

The present article investigates various non-pharmacological approaches, including acupuncture, acupressure, electroacupuncture, auricular acupuncture, and auricular acupressure, for managing insomnia in cancer patients. Unlike previous reviews that focused on just one type of intervention, our study takes a more comprehensive approach by comparing multiple acupressure- and acupuncture-based techniques in controlled trials. To ensure a thorough and transparent evaluation, we followed PRISMA guidelines and conducted a detailed bias assessment, providing a clearer picture of how these treatments can help cancer patients with insomnia. The purpose of this meta-analysis is to offer a comprehensive assessment of whether acupuncture or acupressure can be used as non-pharmacological therapies for insomnia in cancer patients by systematically synthesizing the available evidence.