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Li R, Ma Y, Arditte Hall KA, Johnson C, Philpotts LL, Perez GK, Park ER, Hall DL. Representation of race and ethnicity among cancer survivors in trials of cognitive behavioral therapy for insomnia (CBT-I): A systematic review. Support Care Cancer 2023; 32:23. [PMID: 38095732 PMCID: PMC11346510 DOI: 10.1007/s00520-023-08207-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE For cancer survivors, insomnia is highly prevalent and debilitating. Although cognitive behavioral therapy for insomnia (CBT-I) is recognized as a gold standard treatment, it is unclear whether benefits of treatment generalize to racial and ethnic minorities in the USA. This systematic review characterizes the representation of racial and ethnic diversity among cancer survivors in CBT-I clinical trials and provides recommendations for research in sleep/cancer survivorship. METHODS Literature searches were conducted in five electronic databases (PubMed, Cochrane Library via Ovid, PsycINFO via Ovid, Embase, Web of Science Core Collection) using concepts of CBT, insomnia, and cancer survivors. Information about CBT-I intervention details, sample racial demographics, and whether authors explicitly analyzed race and ethnicity were recorded. RESULTS A total of 1673 citations were retrieved, and 967 citations were uploaded to Covidence. Of these, 135 articles went through full-text review and 13 studies were included. Race and ethnicity were reported in 11/13 trials (84.6%). Of those reporting race and ethnicity, 8/11 (72.7%) trials were comprised of samples that were ≥ 85% non-Hispanic White. Among the trials that explicitly analyzed race and ethnicity, CBT-I was more effective among cancer survivors who were White and highly educated, and non-White cancer survivors were less likely to have private insurance and ability to participate in clinical trials. CONCLUSION Non-Hispanic White cancer survivors are overrepresented in CBT-I trials, the best available treatment for insomnia. Underrepresentation of racial and ethnic minorities likely contributes to barriers in access and uptake. Recommendations include implementing sustained efforts to expand diversity in CBT-I clinical trials for cancer survivors.
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Affiliation(s)
- Raissa Li
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA
- Tufts University School of Medicine, Medford, MA, USA
| | - Yan Ma
- Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Lisa L Philpotts
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Giselle K Perez
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Daniel L Hall
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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