Acupuncture for Symptoms Characteristic of the Fatigue-Sleep Disturbance-Depression Symptom Cluster (FSDSC) in Breast Cancer: A Systematic Review and Meta-Analysis

BackgroundThis study aimed to evaluate the effects of acupuncture or acupressure on fatigue, sleep disturbance/insomnia, and depression, the three component symptoms within the fatigue-sleep disturbance-depression symptom-cluster (FSDSC) conceptual framework in patients with breast cancer.MethodsA systematic review was conducted according to PRISMA guidelines. Seven databases (Embase, MEDLINE [Ovid], Cochrane Library [Trials], Scopus, Web of Science Core Collection, CNKI, and Wanfang Data) were searched from inception to June 2025 without language restrictions. Eligible randomized controlled trials evaluated acupuncture or acupressure for at least one prespecified component symptom. Two reviewers independently extracted data and assessed risk of bias. Meta-analyses were conducted using RevMan 5.4. PROSPERO: CRD42024608618.ResultsTwenty-one trials involving 2,153 participants were included. Meta-analysis showed significant improvements in fatigue measured by the Multidimensional Fatigue Inventory (MFI: -9.73; 95% CI, -18.03 to -1.43; p=0.02) and Brief Fatigue Inventory (BFI: -1.13; 95% CI, -1.79 to -0.47; p=0.0008). Sleep quality improved according to the Pittsburgh Sleep Quality Index (PSQI: -2.43; 95% CI, -3.45 to -1.42; p<0.0001) and insomnia severity according to the Insomnia Severity Index (ISI: -1.05; 95% CI, -1.74 to -0.36; p=0.003). Depression (-1.34; 95% CI, -2.08 to -0.60; P = 0.0004) and quality of life measured by FACT-B (8.10; 95% CI, 6.47 to 9.72; P < 0.0001) also significantly improved.ConclusionsAcupuncture or acupressure may improve symptoms related to the FSDSC conceptual framework in patients with breast cancer. These findings support its potential role in managing co-occurring symptoms, although further high-quality trials are warranted.