Emotional freedom techniques for cancer-related sleep disturbance and associated symptoms: A systematic review and meta-analysis

Background Cancer patients frequently experience a debilitating and interconnected symptom cluster comprising pain, fatigue, and sleep disturbance (P-F-S), which negatively impacts their quality of life and treatment outcomes. Emotional Freedom Techniques (EFT), a mind-body intervention combining cognitive exposure with acupoint stimulation, has shown potential for addressing psychological distress, yet its effectiveness on this specific physiological symptom cluster remains underexplored. Objectives This systematic review and meta-analysis aimed to evaluate the efficacy of EFT in alleviating cancer-related sleep disturbance, with narrative syntheses for its effects on pain and fatigue. Methods We searched eight databases, including the Cochrane Library, Embase, PubMed, Web of Science, CBM, WeiPu, CNKI, and WanFang from their inception to February 2026. Randomised controlled trials (RCTs) assessing EFT in adult cancer patients, with sleep disturbance as the primary outcome, were included. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment using the Cochrane tool. A random-effects model meta-analysis was performed for sleep disturbance, with subgroup analyses. Narrative syntheses were conducted for pain and fatigue due to insufficient or heterogeneously measured data. Results Nine RCTs involving 760 patients were included. Six studies using the Pittsburgh Sleep Quality Index (PSQI) were included in the quantitative synthesis. EFT significantly reduced sleep disturbance (MD = −3.00, 95% CI: −4.39 to −1.61, P < 0.01) with high heterogeneity (I² = 97%). Subgroup analyses revealed stronger effects in the 4‑week duration subgroup (MD = −6.50, 95% CI: −7.29 to −5.71, P < 0.01), single sessions ≥ 30 min (MD = −3.23, 95% CI: −4.88 to −1.57, P < 0.01), and intervention frequency ≥ 7 sessions/week (MD = −3.71, 95% CI: −6.24 to −1.18, P < 0.01); EFT alone and combined interventions were equally effective; benefits were significant in breast cancer patients (MD = −2.62, 95% CI: −3.82 to −1.43, P < 0.01) but not in other cancers. Narrative synthesis supported that EFT may relieve fatigue and pain. Sensitivity analysis confirmed robustness, and no publication bias was detected. Conclusion EFT demonstrated beneficial effects on sleep disturbance among cancer patients; however, the statistically significant quantitative evidence was primarily observed in breast cancer populations. The optimal intervention characteristics, including 4-week protocols, single sessions ≥ 30 min, and higher frequency, require further confirmation in diverse cancer populations. Narrative evidence suggests that EFT may also provide potential benefits for fatigue and pain. EFT may represent a promising complementary intervention for managing the pain–fatigue–sleep disturbance symptom cluster in cancer patients; however, further high-quality randomized controlled trials are warranted to strengthen the current evidence. Copyright © 2026. Published by Elsevier Ltd.