Acceptability and impact of weight management interventions for adults with intellectual disability: protocol for a systematic review and meta-analysis.

Patients living with advanced cancer frequently experience a high burden of co-occurring symptoms, with insomnia symptoms and pain among the most prevalent and debilitating.[] Insomnia affects approximately 40–60% of this population,[, ] while pain is reported in 35% to 96% of cases.[, ] Notably, these symptoms often co-occur. For example, among patients requiring strong opioid treatment (WHO Step III) for cancer pain management, 78% reported clinically significant insomnia-related sleep disturbance, including difficulty initiating and maintaining sleep.[] The detrimental effects of these symptom clusters on quality of life [-] and, in some cases, survival [, ] are further magnified in patients with advanced cancer, who tend to have higher medical complexity, greater vulnerability to adverse drug effects, and fewer safe and effective therapeutic options for symptom management. Additionally, polypharmacy is highly prevalent in this population, with studies reporting rates ranging from approximately 61% to 88% in patients with advanced cancer.[, ] Polypharmacy is associated with an increased risk of drug-drug interactions and treatment-related toxicity, making it particularly important to avoid adding pharmacologic agents when possible.[, ] Given the high prevalence, clinical burden, and pharmacologic challenges associated with comorbid pain and insomnia symptoms in this population,[, ] there is a critical need to identify safe and effective non-pharmacological interventions that can address these symptoms simultaneously. Acupuncture and massage therapy have shown promise in managing cancer-related symptoms, particularly pain and insomnia symptoms. Acupuncture is recommended by the ASCO-SIO clinical guidelines for cancer pain management and has demonstrated long-term effectiveness for joint pain associated with aromatase inhibitors in breast cancer survivors, as well as for musculoskeletal pain in survivors of various cancer types.[-] However, existing evidence is largely based on early-stage cancer populations, with limited research focused specifically on individuals with advanced cancer, who may respond differently due to their greater clinical complexity.[-] Regarding insomnia symptoms, acupuncture has been shown to improve sleep quality in cancer patients, both among those with comorbid pain and those with insomnia alone, though as with pain, studies in advanced cancer populations remain scarce.[-]