Is Transcranial Magnetic Stimulation Effective for Treating Insomnia in Cancer Patients?

Insomnia is a highly prevalent and debilitating symptom among cancer patients, affecting nearly 60%, which is two to three times higher than in the general population [1].Despite this significant burden, access to effective and tolerable treatments remains limited.Cognitive-behavioral therapy for insomnia (CBT-I) is recommended as the first-line intervention; however, adherence among cancer survivors is often low due to fatigue, psychological distress, logistical challenges, and the chronic nature of sleep disturbances [2].Pharmacological agents, although convenient, present risks of adverse effects, drug interactions, and longterm safety concerns in medically vulnerable populations [3].Consequently, there is an urgent need for novel, non-pharmacological treatment options.The pilot randomized controlled trial conducted by Tian et al.[4] provides preliminary evidence that repetitive transcranial magnetic stimulation (rTMS) may serve as such an alternative treatment of insomnia among cancer patients.In this three-arm trial comparing rTMS, sham-rTMS, and CBT-I, 6 weeks of low-frequency stimulation over the left dorsolateral prefrontal cortex led to significant improvements in both the Insomnia Severity Index and the Pittsburgh Sleep Quality Index compared with sham stimulation.Importantly, the magnitude of improvement was comparable to that observed with CBT-I, indicating that rTMS may be a viable therapeutic option when CBT-I is inaccessible, poorly tolerated, or ineffective.In addition to improving sleep quality, rTMS demonstrated benefits in reducing daytime sleepiness and showed indications of improvement in anxiety and depressive symptoms, which affect up to 30%-40% of cancer survivors [5].Given the bidirectional relationship between mood symptoms and sleep disturbances, these broader rTMS effects may offer a significant clinical advantage.The safety and feasibility findings from Tian et al. [4] were reassuring, with only mild, transient adverse events, such as short-lasting headaches, reported.These outcomes are consistent with the established safety profile of rTMS [6].High satisfaction rates and dropout reasons unrelated primarily to treatment tolerability further support the potential integration of TMS into supportive oncology care pathways.Although the study is limited by a modest sample size, single-center design, and lack of long-term follow-up, its implications are considerable.If validated in larger trials, rTMS could become a valuable addition to the therapeutic options for cancer-related insomnia.As untreated insomnia is associated with reduced quality of life and potentially poorer cancer outcomes [7], effective management may influence overall survivorship trajectories.The work of Tian et al. [4] establishes an important direction for future research.Rather than replacing CBT-I, rTMS may function as a complementary or alternative modality that aligns with the specific needs of oncology patients.rTMS has the potential to address a critical treatment gap by providing a safe, non-pharmacological, and evidence-based option for insomnia in cancer patients.