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Barroso D, Hespanhol L, Siegloch ML, Romeiro P, Silva C, Costa I, Garbacka A, Filho AVT, Kay DB. Effect of minimal cognitive behavioral therapy for patients with acute insomnia: A systematic review and meta-analysis. Sleep Med 2024; 122:171-176. [PMID: 39181023 DOI: 10.1016/j.sleep.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/22/2024] [Accepted: 08/02/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVES The current literature lacks a clear evaluation of the effectiveness of Cognitive Behavioral Therapy for Insomnia (CBT-I) on acute insomnia. Our study aims to address this issue through a systematic review and meta-analysis of Randomized Controlled Trials (RCTs). METHOD We systematically searched PubMed, Embase, and Cochrane Library in April 2024 for RCTs comparing patients with clinically significant insomnia symptoms for less than 6 months (ie, acute insomnia) assigned to 1-6 weeks of CBT-I versus no CBT-I. RESULTS We included four RCTs comprising 327 patients with acute insomnia, of whom 162 (49.5 %) were randomized to CBT-I. CBT-I significantly reduced the Insomnia Severity Index score (MD -5.28; 95 % CI -6.01, -4.56; p < 0.00001; I2 = 18 %), the incidence of chronic insomnia (MD 0.50; 95 % CI 0.35, 0.70; p < 0.0001; I2 = 0 %), and the sleep latency (MD -11.04; 95 % CI -18.46, -3.61; p = 0.004; I2 = 0 %). CONCLUSION These findings provide preliminary evidence that minimal CBT-I may be a feasible and effective preventive measure against chronic insomnia. However, future RCTs and effectiveness trials are necessary to validate, with greater statistical power, the hypothesis that CBT-I can prevent transition from acute to chronic insomnia, given the limited number of studies in our meta-analysis.
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Affiliation(s)
- Douglas Barroso
- Department of Medicine, State University of Santa Cruz, Ilhéus, Bahia, Brazil.
| | - Larissa Hespanhol
- Department of Medicine, Federal University of Campina Grande, Campina Grande, Paraíba, Brazil
| | | | - Pedro Romeiro
- Department of Medicine, Tiradentes University Center, Maceió, Alagoas, Brazil
| | - Caroliny Silva
- Department of Medicine, Federal University of Rio Grande Do Norte, Natal, Rio Grande do Norte, Brazil
| | - Isabela Costa
- Department of Medicine, Federal University of Mineiro Triangle, Uberaba, Minas Gerais, Brazil
| | - Alicja Garbacka
- Child and Adolescent Psychiatry Unit, Rehabilitation Hospital UKZ, Konstancin-Jeziorna, Poland
| | | | - Daniel B Kay
- Department of Psychology, Brigham Young University, Provo, UT, United States
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Nissen ER, Neumann H, Knutzen SM, Henriksen EN, Amidi A, Johansen C, von Heymann A, Christiansen P, Zachariae R. Interventions for insomnia in cancer patients and survivors-a comprehensive systematic review and meta-analysis. JNCI Cancer Spectr 2024; 8:pkae041. [PMID: 38781520 PMCID: PMC11188797 DOI: 10.1093/jncics/pkae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/19/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Considering the persistent nature and higher prevalence of insomnia in cancer patients and survivors compared with the general population, there is a need for effective management strategies. This systematic review and meta-analysis aimed to comprehensively evaluate the available evidence for the efficacy of pharmacological and nonpharmacological interventions for insomnia in adult cancer patients and survivors. METHODS Following the PRISMA guidelines, we analyzed data from 61 randomized controlled trials involving 6528 participants. Interventions included pharmacological, physical, and psychological treatments, with a focus on insomnia severity and secondary sleep and non-sleep outcomes. Frequentist and Bayesian analytical strategies were employed for data synthesis and interpretation. RESULTS Cognitive-Behavioral Therapy for Insomnia (CBT-I) emerged as the most efficacious intervention for reducing insomnia severity in cancer survivors and further demonstrated significant improvements in fatigue, depressive symptoms, and anxiety. CBT-I showed a large postintervention effect (g = 0.86; 95% confidence interval [CI] = 0.57 to 1.15) and a medium effect at follow-up (g = 0.55; 95% CI = 0.18 to 0.92). Other interventions such as bright white light therapy, sleep medication, melatonin, exercise, mind-body therapies, and mindfulness-based therapies showed benefits, but the evidence for their efficacy was less convincing compared with CBT-I. Brief Behavioral Therapy for Insomnia showed promise as a less burdensome alternative for patients in active cancer treatment. CONCLUSIONS CBT-I is supported as a first-line treatment for insomnia in cancer survivors, with significant benefits observed across sleep and non-sleep outcomes. The findings also highlight the potential of less intensive alternatives. The research contributes valuable insights for clinical practice and underscores the need for further exploration into the complexities of sleep disturbances in cancer patients and survivors.
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Affiliation(s)
- Eva Rames Nissen
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Henrike Neumann
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Sofie Møgelberg Knutzen
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Emilie Nørholm Henriksen
- Centre for Involvement of Relatives, Mental Health Services, Region of Southern Denmark, Odense, Denmark
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects (CASTLE) – a Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects (CASTLE) – a Danish Cancer Society National Research Center, Department of Oncology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Peer Christiansen
- Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
| | - Robert Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology Aarhus University Hospital, and Department of Psychology, Aarhus University, Aarhus, Denmark
- Danish Breast Cancer Group Center and Clinic for Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
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Tulk J, Rash JA, Thoms J, Wassersug R, Gonzalez B, Garland SN. Androgen deprivation therapy and radiation for prostate cancer-cognitive impairment, sleep, symptom burden: a prospective study. BMJ Support Palliat Care 2023; 13:e454-e463. [PMID: 34330793 DOI: 10.1136/bmjspcare-2021-003098] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/20/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This paper (1) sought to compare sleep, mood and physical symptom profiles of men with prostate cancer (PCa) who experienced subjective and objective cancer-related cognitive impairment (CRCI) during the first year of treatment and (2) examine if fluctuations in mood and physical symptoms are associated with change in subjective or objective CRCI. METHODS This prospective observational cohort study examined 24 new patients with PCa receiving androgen deprivation therapy (ADT) and radiation therapy (RT) during the first 12 months of treatment. Participants completed subjective and objective assessments of cognition, sleep continuity and self-report measures of insomnia, fatigue, depression and anxiety. Independent sample t-tests, correlations and hierarchical regressions were used to compare groups, explore associations, and assess change over time. Effects are reported as corrected Cohen's d (dc). RESULTS Men with objective CRCI reported worse subjective time asleep (dc=0.47) and more depression (dc=0.55). Men with subjective CRCI reported worse insomnia (dc=0.99), hot flashes (dc=0.76), sleep quality (dc=0.54), subjective total sleep time (dc=0.41), wake after sleep onset (dc=0.71), sleep efficiency (dc=0.49), fatigue (dc=0.67) and objectively estimated sleep latency (dc=0.72) than men without subjective CRCI. Declines in perceived cognition was associated with higher anxiety (p=0.05), fatigue (p≤0.01) and symptoms of insomnia (p=0.01). Finally, subjective time awake during the night (p=0.03) and fatigue (p=0.02) were associated with subjective cognitive decline, controlling for objective change. CONCLUSIONS Subjective concerns of CRCI appear more critical to patient experience than objective measurements in men with PCa who have received RT and ADT. Interventions to improve sleep may result in an improved perception of cognition.
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Affiliation(s)
- Joshua Tulk
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Joshua A Rash
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - John Thoms
- Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Richard Wassersug
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Gonzalez
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida, USA
| | - Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Grassi L, Zachariae R, Caruso R, Palagini L, Campos-Ródenas R, Riba MB, Lloyd-Williams M, Kissane D, Rodin G, McFarland D, Ripamonti CI, Santini D. Insomnia in adult patients with cancer: ESMO Clinical Practice Guideline. ESMO Open 2023; 8:102047. [PMID: 38158225 PMCID: PMC10774975 DOI: 10.1016/j.esmoop.2023.102047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 01/03/2024] Open
Abstract
•Insomnia is common in patients with cancer, with a higher prevalence than observed in the general population. •Insomnia is often under-recognised and inadequately treated in patients with cancer. •Brief validated screening tools are available for the evaluation of insomnia in clinical practice. •First-line therapy should be based on international guidelines recommending cognitive behavioural therapy for insomnia.
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Affiliation(s)
- L Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - R Zachariae
- Unit for Psychooncology and Health Psychology (EPoS), Department of Oncology, Aarhus University Hospital, Aarhus; Danish Center for Breast Cancer Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
| | - R Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - L Palagini
- Sleep Clinic, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - R Campos-Ródenas
- Department of Psychiatry, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | - M B Riba
- Department of Psychiatry, University of Michigan, Ann Arbor; University of Michigan Rogel Cancer Center, University of Michigan, Ann Arbor, USA
| | - M Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool; Department of Supportive and Palliative Care, Liverpool John Moores University, Liverpool, UK
| | - D Kissane
- Department of Psychiatry, Monash University and Monash Medical Centre, Monash Health, Clayton, Australia
| | - G Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - D McFarland
- Department of Psychiatry, University of Rochester, Rochester; Wilmont Cancer Institute, University of Rochester Medical Center, Rochester, USA
| | - C I Ripamonti
- School of Speciality in Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - D Santini
- Medical Oncology A, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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Cathcart-Rake EJ, Tevaarwerk AJ, Haddad TC, D'Andre SD, Ruddy KJ. Advances in the care of breast cancer survivors. BMJ 2023; 382:e071565. [PMID: 37722731 DOI: 10.1136/bmj-2022-071565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Breast cancer survivors may experience significant after effects from diagnoses of breast cancer and cancer directed therapies. This review synthesizes the evidence about optimal management of the sequelae of a diagnosis of breast cancer. It describes the side effects of chemotherapy and endocrine therapy and evidence based strategies for management of such effects, with particular attention to effects of therapies with curative intent. It includes strategies to promote health and wellness among breast cancer survivors, along with data to support the use of integrative oncology strategies. In addition, this review examines models of survivorship care and ways in which digital tools may facilitate communication between clinicians and patients. The strategies outlined in this review are paramount to supporting breast cancer survivors' quality of life.
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Gao Y, Liu M, Yao L, Yang Z, Chen Y, Niu M, Sun Y, Chen J, Hou L, Sun F, Wu S, Zhang Z, Zhang J, Li L, Li J, Zhao Y, Fan J, Ge L, Tian J. Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta-analysis. J Evid Based Med 2022; 15:216-229. [PMID: 35996803 DOI: 10.1111/jebm.12485] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/27/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to examine the most effective delivery format of cognitive behavioral therapy for insomnia (CBT-I) on insomnia in cancer patients. METHODS We searched five databases up to February 2021 for randomized clinical trials that compared CBT-I with inactive or active controls for insomnia in cancer patients. Outcomes were insomnia severity, sleep efficiency, sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Pairwise meta-analyses and frequentist network meta-analyses with the random-effects model were applied for data analyses. RESULTS Sixteen unique trials including 1523 participants met inclusion criteria. Compared with inactive control, CBT-I could significantly reduce insomnia severity (mean differences [MD] = -4.98 points, 95% confidence interval [CI]: -5.82 to -4.14), SOL (MD = -12.29 min, 95%CI: -16.48 to -8.09), and WASO (MD = -16.58 min, 95%CI: -22.00 to -11.15), while increasing sleep efficiency (MD = 7.62%, 95%CI: 5.82% to 9.41%) at postintervention. Compared with active control, CBT-I could significantly reduce insomnia severity (MD = -2.75 points, 95%CI: -4.28 to -1.21), SOL (MD = -13.56 min, 95%CI: -18.93 to -8.18), and WASO (MD = -6.99 min, 95%CI: -11.65 to -2.32) at postintervention. These effects diminished in short-term follow-up and almost disappeared in long-term follow-up. Most of the results were rated as "moderate" to "low" certainty of evidence. Network meta-analysis showed that group CBT-I had an increase in sleep efficiency of 10.61%, an increase in TST of 21.98 min, a reduction in SOL of 14.65 min, and a reduction in WASO of 24.30 min, compared with inactive control at postintervention, with effects sustained at short-term follow-up. CONCLUSIONS CBT-I is effective for the management of insomnia in cancer patients postintervention, with diminished effects in short-term follow-up. Group CBT-I is the preferred choice based on postintervention and short-term effects. The low quality of evidence and limited sample size demonstrate the need for robust evidence from high-quality, large-scale trials providing long-term follow-up data.
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Affiliation(s)
- Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Ming Liu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Zhirong Yang
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Yamin Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Mingming Niu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China
| | - Ji Chen
- Mianyang Hospital of Traditional Chinese Medicine, Mianyang, China
| | - Liangying Hou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shanshan Wu
- National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zeqian Zhang
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lun Li
- Department of Breast Cancer, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhao
- First Clinical Medical College, Lanzhou University, Lanzhou, China
- Departments of Biochemistry and Molecular Biology, Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jingchun Fan
- Epidemiology and Evidence Based-Medicine, School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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Sleight A, Gerber LH, Marshall TF, Livinski A, Alfano CM, Harrington S, Flores AM, Virani A, Hu X, Mitchell SA, Varedi M, Eden M, Hayek S, Reigle B, Kerkman A, Neves R, Jablonoski K, Hacker ED, Sun V, Newman R, McDonnell KK, L'Hotta A, Schoenhals A, Dpt NLS. Systematic Review of Functional Outcomes in Cancer Rehabilitation. Arch Phys Med Rehabil 2022; 103:1807-1826. [PMID: 35104445 PMCID: PMC9339032 DOI: 10.1016/j.apmr.2022.01.142] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains. DATA SOURCES PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019. STUDY SELECTION Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion. DATA EXTRACTION Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV). DATA SYNTHESIS Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome. CONCLUSIONS These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.
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Affiliation(s)
- Alix Sleight
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, United States; Center for Integrated Research in Cancer and Lifestyle (CIRCL), Cedars-Sinai Medical Center, Los Angeles, California, United States; Cedars Sinai Cancer, Los Angeles, California, United States; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States.
| | - Lynn H Gerber
- College of Health and Human Services, George Mason University, Fairfax County, Virginia, United States; Inova Health System, Inova Medicine Services, Falls Church, Virginia, United States
| | | | - Alicia Livinski
- National Institutes of Health Library, Office of Research Services, National Institutes of Health, Bethesda, Maryland, United States
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, New York, United States; Center for Personalized Health, Feinstein Institutes for Medical Research, Manhasset, New York, United States; Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, United States
| | - Shana Harrington
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States
| | - Ann Marie Flores
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States; Robert H. Lurie Comprehensive Cancer Center, Cancer Survivorship Institute, Chicago, Illinois, United States
| | - Aneesha Virani
- Rehabilitation Department, Northside Hospital, Atlanta, Georgia, United States
| | - Xiaorong Hu
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Boston, Massachusetts, United States; Rehabilitation Medicine School, Nanjing Medical University, Nanjing, China
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States
| | - Mitra Varedi
- Epidemiology and Cancer Control Department, St Jude Children's Research Hospital, Memphis, Tennessee, United States
| | - Melissa Eden
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, Arizona, United States
| | - Samah Hayek
- Clalit Health Services, Clalit Research Institute, Ramat-Gan, Israel
| | - Beverly Reigle
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, United States
| | - Anya Kerkman
- Lincoln Cancer Rehabilitation, Lincoln, Nebraska, United States; CHI Health St Elizabeth, Lincoln, Nebraska, United States
| | - Raquel Neves
- Czech Rehabilitation Hospital, Al Ain, United Arab Emirates
| | - Kathleen Jablonoski
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States; Department of Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Eileen Danaher Hacker
- Department of Science of Nursing Care, Indiana University School of Nursing, Indianapolis, Indiana, United States
| | - Virginia Sun
- Department of Population Sciences, City of Hope, Duarte, California, United States; Department of Surgery, City of Hope, Duarte, California, United States
| | - Robin Newman
- Department of Occupational Therapy, Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts, United States
| | - Karen Kane McDonnell
- College of Nursing, University of South Carolina, Columbia, South Carolina, United States
| | - Allison L'Hotta
- Department of Occupational Therapy, Washington University in St Louis, St Louis, Missouri, United States
| | - Alana Schoenhals
- Mrs T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, United States
| | - Nicole L Stout Dpt
- West Virginia University Cancer Institute, West Virginia University School of Public Health, Morgantown, West Virginia, United States; Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States
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8
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Liu C, Zhao G, Li T, Guo S, Tang Y, Li B, Zhang B, Li H, Ma Q, Cai Z. Acupuncture for insomnia in people with cancer. Hippokratia 2022. [DOI: 10.1002/14651858.cd015177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Chunyu Liu
- Evidence-Based Pharmacy Center; West China Second University Hospital, Sichuan University; Chengdu China
- Department of Pharmacy; West China Second University Hospital, Sichuan University; Chengdu China
| | - Guozhen Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University; Beijing China
| | - Tianli Li
- Department of Cardiology; Dongzhimen Hospital, Beijing University of Chinese Medicine; Beijing China
| | - Shiqi Guo
- Acupuncture and Tuina College; Beijing University of Chinese Medicine; Beijing China
| | - Yiguo Tang
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy; West China Hospital of Sichuan University; Chengdu, Sichuan China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University; Beijing China
| | - Bo Zhang
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
| | - Hancong Li
- West China School of Medicine; Sichuan University; Chengdu China
| | - Qin Ma
- Division of Gastrointestinal Surgery, Department of General Surgery; West China Hospital, Sichuan University; Chengdu China
| | - Zhaolun Cai
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
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9
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Liu C, Tang Y, Li H, Zhao G, Li B, Zhang B, Zhao Z, Shen C, Cai Z. Cognitive behavioural therapy for insomnia in people with cancer. Hippokratia 2022. [DOI: 10.1002/14651858.cd015176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Chunyu Liu
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
- Evidence-Based Pharmacy Center; West China Second University Hospital, Sichuan University; Chengdu China
- Department of Pharmacy; West China Second University Hospital, Sichuan University; Chengdu China
| | - Yiguo Tang
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy; West China Hospital of Sichuan University; Chengdu, Sichuan China
| | - Hancong Li
- West China School of Medicine, Sichuan University; Chengdu China
| | - Guozhen Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University; Beijing China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University; Beijing China
| | - Bo Zhang
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
| | - Zhou Zhao
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
| | - Chaoyong Shen
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
| | - Zhaolun Cai
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
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Maccora J, Garland SN, Ftanou M, Day D, White M, Lopez VA, Mortimer D, Diggens J, Phillips AJK, Wallace R, Alexander M, Boyle F, Stafford L, Francis PA, Bei B, Wiley JF. The sleep, cancer and rest (SleepCaRe) trial: Rationale and design of a randomized, controlled trial of cognitive behavioral and bright light therapy for insomnia and fatigue in women with breast cancer receiving chemotherapy. Contemp Clin Trials 2022; 120:106877. [PMID: 35961468 DOI: 10.1016/j.cct.2022.106877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Insomnia and fatigue symptoms are common in breast cancer. Active cancer treatment, such as chemotherapy, appears to be particularly disruptive to sleep. Yet, sleep complaints often go unrecognised and under treated within routine cancer care. The abbreviated delivery of cognitive behavioral therapy for Insomnia (CBTI) and bright light therapy (BLT) may offer accessible and cost-effective sleep treatments in women receiving chemotherapy for breast cancer. METHODS The Sleep, Cancer and Rest (SleepCaRe) Trial is a 6-month multicentre, randomized, controlled, 2 × 2 factorial, superiority, parallel group trial. Women receiving cytotoxic chemotherapy for breast cancer at tertiary Australian hospitals will be randomly assigned 1:1:1:1 to one of four, non-pharmacological sleep interventions: (a) Sleep Hygiene and Education (SHE); (b) CBTI; (c) BLT; (d) CBT-I + BLT combined and simultaneously delivered. Each sleep intervention is delivered over 6 weeks, and will comprise an introductory session, a mid-point phone call, and regular emails. The primary (insomnia, fatigue) and secondary (health-related quality of life, rest activity rhythms, sleep-related impairment) outcomes will be assessed via online questionnaires at five time-points: baseline (t0, prior to intervention), mid-point intervention (t2, Week 4), post-intervention (t3, Week 7), 3-months (t4, Week 18), and 6-months follow-up (t5, Week 30). CONCLUSIONS This study will report novel data concerning the comparative and combined efficacy of CBT-I and BLT during chemotherapy. Findings will contribute to the development of evidence-based early sleep and fatigue intervention during chemotherapy for breast cancer. Clinical trial information Registered with the Australian New Zealand Clinical Trials Registry (http://anzctr.org.au/), Registration Number: ACTRN12620001133921.
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Affiliation(s)
- Jordan Maccora
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | | | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Daphne Day
- Department of Oncology Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia.
| | - Michelle White
- Department of Oncology Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia.
| | | | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia.
| | | | - Andrew J K Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | - Rebecca Wallace
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | | | - Lesley Stafford
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | | | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia; Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia.
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11
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Yuan Y, Lin L, Xie C, Lu Y, Liang J, Qi Y, Dong B, Chen Q, Fang Q, Tian L. Effectiveness comparisons of various psychosocial therapies for cancer-related fatigue: A Bayesian network meta-analysis. J Affect Disord 2022; 309:471-481. [PMID: 35504400 DOI: 10.1016/j.jad.2022.04.152] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/09/2022] [Accepted: 04/26/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The purpose of this network meta-analysis (NMA) is to compare the effect of several psychosocial therapies on CRF critically. METHODS We applied systematic strategies based on eight databases, namely the Cochrane Central Register of Controlled Trials, PubMed, Embase, PsycINFO, China Biology Medicine (CBM), Wan Fang database, VIP, and China National Knowledge Infrastructure (CNKI) database to preliminary literature retrieval to identify relevant randomized controlled trials (RCTs). Studies, including adult patients (≥18 years) diagnosed with cancer, were eligible regardless of cancer stage and current treatment. We carried out an expression analysis for comparing the efficacy of various psychosocial therapies using Bayesian NMA. A battery of analyses and assessments, such as conventional meta-analysis and risk of bias, were performed concurrently. RESULTS We identified 41 RCTs including six different psychosocial interventions (4422 participants), namely cognitive-behavioral therapy (CBT), mindfulness-based stress reduction therapy (MBSR), psychoeducational therapy (PE), stress management therapy (SMT), meditation therapy (MT) and comprehensive therapy (CT). Our NMA results showed that three psychosocial intervention therapies were effective for CRF in cancer patients. The most effective psychosocial intervention was MBSR (SMD = -1.23, CrI: -1.88, -0.59, SUCRA = 83.33%), followed by PE (SMD = -0.86, CrI: -1.53, -0.18, SUCRA = 58.51%) and CBT (SMD = -0.84, CrI: -1.31, -0.37, SUCRA = 57.67%). CONCLUSIONS Our study showed that MBSR was most likely to be the best psychosocial intervention to relieve CRF in cancer patients. Medical staff should pay attention to applying MBSR to cancer patients in future clinical care.
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Affiliation(s)
- Yang Yuan
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China; The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China
| | - Lu Lin
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China; The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China
| | - Congyan Xie
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Yang Lu
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Jinghong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Yishu Qi
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Bei Dong
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Qiuyun Chen
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Qian Fang
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Li Tian
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China; The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China.
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Effectiveness of Cognitive Behavioral Therapy in Improving Functional Health in Cancer Survivors: A Systematic Review and Meta-analysis. Crit Rev Oncol Hematol 2022; 175:103709. [DOI: 10.1016/j.critrevonc.2022.103709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/03/2022] [Accepted: 05/11/2022] [Indexed: 02/07/2023] Open
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13
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Systematic Review and Meta-Analysis of Cognitive-Behavioural Therapy for Insomnia on Subjective and Actigraphy-Measured Sleep and Comorbid Symptoms in Cancer Survivors. Sleep Med Rev 2022; 63:101615. [DOI: 10.1016/j.smrv.2022.101615] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/15/2022] [Accepted: 02/16/2022] [Indexed: 02/03/2023]
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Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev 2021; 60:101556. [PMID: 34607184 PMCID: PMC8651630 DOI: 10.1016/j.smrv.2021.101556] [Citation(s) in RCA: 250] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 02/07/2023]
Abstract
The extent to which sleep is causally related to mental health is unclear. One way to test the causal link is to evaluate the extent to which interventions that improve sleep quality also improve mental health. We conducted a meta-analysis of randomised controlled trials that reported the effects of an intervention that improved sleep on composite mental health, as well as on seven specific mental health difficulties. 65 trials comprising 72 interventions and N = 8608 participants were included. Improving sleep led to a significant medium-sized effect on composite mental health (g+ = -0.53), depression (g+ = -0.63), anxiety (g+ = -0.51), and rumination (g+ = -0.49), as well as significant small-to-medium sized effects on stress (g+ = -0.42), and finally small significant effects on positive psychosis symptoms (g+ = -0.26). We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health. Our findings suggest that sleep is causally related to the experience of mental health difficulties. Future research might consider how interventions that improve sleep could be incorporated into mental health services, as well as the mechanisms of action that explain how sleep exerts an effect on mental health.
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Affiliation(s)
| | - Thomas L Webb
- Department of Psychology, The University of Sheffield, UK
| | | | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, The University of Sheffield, UK
| | - Scott Weich
- School of Health and Related Research (ScHARR), The University of Sheffield, UK
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15
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Sleep Disorders in Cancer-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111696. [PMID: 34770209 PMCID: PMC8583058 DOI: 10.3390/ijerph182111696] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/07/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Sleep disorders, especially insomnia, are very common in different kinds of cancers, but their prevalence and incidence are not well-known. Disturbed sleep in cancer is caused by different reasons and usually appears as a comorbid disorder to different somatic and psychiatric diagnoses, psychological disturbances and treatment methods. There can be many different predictors for sleep disturbances in these vulnerable groups, such as pre-existing sleep disorders, caused by the mental status in cancer or as side effect of the cancer treatment. METHODS A systematic literature review of 8073 studies was conducted on the topic of sleep and sleep disorders in cancer patients. The articles were identified though PubMed, PsycInfo and Web of Knowledge, and a total number of 89 publications were qualified for analysis. RESULTS The identified eighty-nine studies were analyzed on the topic of sleep and sleep disorders in cancer, twenty-six studies on sleep and fatigue in cancer and sixty-one studies on the topic of sleep disorders in cancer. The prevalence of sleep disturbences and/or sleep disorders in cancer was up to 95%. DISCUSSION Sleep disturbances and sleep disorders (such as insomnia, OSAS, narcolepsy and RLS; REM-SBD) in cancer patients can be associated with different conditions. Side effects of cancer treatment and cancer-related psychological dysfunctions can be instigated by sleep disturbances and sleep disorders in these patients, especially insomnia and OSAS are common. An evidence-based treatment is necessary for concomitant mental and/or physical states.
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16
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Staines AC, Broomfield N, Pass L, Orchard F, Bridges J. Do non-pharmacological sleep interventions affect anxiety symptoms? A meta-analysis. J Sleep Res 2021; 31:e13451. [PMID: 34331373 DOI: 10.1111/jsr.13451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022]
Abstract
Research indicates a bidirectional relationship between sleep and anxiety, with findings suggesting anxiety can precede poor sleep and vice versa. Evidence suggests sleep-related thought processes associated with anxiety are involved in the maintenance of insomnia. Previous meta-analyses provide some evidence to suggest cognitive behavioural therapy for insomnia moderately improves anxiety, yet little research has investigated the effect of other sleep interventions on anxiety symptoms. The aim of this meta-analysis was to review whether non-pharmacological sleep interventions have an impact on anxiety symptoms immediately post-intervention. A systematic search of electronic databases was conducted to identify all randomized control trials (RCTs) investigating non-pharmacological sleep interventions that included anxiety symptoms as an outcome. Forty-three RCTs (n = 5945) met full inclusion criteria and were included in a random-effects meta-analysis model. The combined effect size of non-pharmacological sleep interventions on anxiety symptoms was moderate (Hedges' g = -0.38), indicating a reduction in symptoms. Subgroup analyses found a moderate effect for those with additional physical health difficulties (g = -0.46), a moderate effect for those with additional mental health difficulties (g = -0.47) and a moderate effect for those with elevated levels of anxiety at baseline (g = -0.43). A secondary meta-analysis found a large effect of non-pharmacological sleep interventions on sleep-related thought processes (g = -0.92). These findings indicate non-pharmacological sleep interventions are effective in reducing anxiety and sleep-related thought processes, and these effects may be larger in patients with anxiety. This has clinical implications for considering sleep interventions in the treatment of anxiety.
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Affiliation(s)
- Alex Catherine Staines
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Niall Broomfield
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Laura Pass
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Faith Orchard
- School of Psychology, University of Sussex, Brighton, UK
| | - Jessica Bridges
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
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17
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Ma Y, Hall DL, Ngo LH, Liu Q, Bain PA, Yeh GY. Efficacy of cognitive behavioral therapy for insomnia in breast cancer: A meta-analysis. Sleep Med Rev 2021; 55:101376. [PMID: 32987319 PMCID: PMC8210529 DOI: 10.1016/j.smrv.2020.101376] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 12/22/2022]
Abstract
Insomnia is highly prevalent among patients with breast cancer (BC). Although cognitive behavioral therapy for insomnia (CBT-I) is available in integrative oncology settings, it poses unique challenges for BC survivors. Our review aimed to assess the evidence for the therapeutic effects of CBT-I on insomnia in BC. Randomized controlled trials (RCTs) that included patients/survivors with BC and insomnia, and at least one validated self-report measure of sleep quality were included in the review. Of the 14 included RCTs (total N = 1363), the most common components incorporated in CBT-I interventions were sleep hygiene, stimulus control and sleep restriction. Pooled effect sizes favored CBT-I at post-intervention (Hedges' g = -0.779, 95% CI = -0.949, -0.609), short-term follow-up (within six months, Hedges' g = -0.653, 95% CI = -0.808, -0.498), and long-term follow-up (12 mo, Hedges' g = -0.335, 95% CI = -0.532, -0.139). In sub-analyses, CBT-I had similar effect sizes regardless of potential modifiers (comparison design, delivery formats, etc.). As an integrative oncology intervention, CBT-I is efficacious for reducing insomnia and improving sleep quality in women treated for BC, with medium-to-large effect sizes that persist after intervention delivery ends. Given the variability in the CBT-I components tested in RCTs, future studies should investigate the optimal integration of CBT-I components for managing insomnia during BC survivorship.
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Affiliation(s)
- Yan Ma
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Daniel L Hall
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Long H Ngo
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Qingqing Liu
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, Boston, MA, United States
| | - Gloria Y Yeh
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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18
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Sweetman A, Putland S, Lack L, McEvoy RD, Adams R, Grunstein R, Stocks N, Kaambwa B, Van Ryswyk E, Gordon C, Vakulin A, Lovato N. The effect of cognitive behavioural therapy for insomnia on sedative-hypnotic use: A narrative review. Sleep Med Rev 2020; 56:101404. [PMID: 33370637 DOI: 10.1016/j.smrv.2020.101404] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/12/2020] [Accepted: 07/26/2020] [Indexed: 01/09/2023]
Abstract
Although cognitive behavioural therapy for insomnia (CBTi) is the recommended 'first-line' treatment for insomnia, most patients are initially treated with sedative-hypnotic medications. Given the risk of impaired cognitive and psychomotor performance, serious adverse events, and long-term dependence associated with sedative-hypnotics, guidelines recommend that prescriptions should be limited to short-term use and that patients are provided with support for withdrawal where possible. CBTi is an effective insomnia treatment in the presence of sedative-hypnotic use. Furthermore, guidelines recommended that CBTi techniques are utilised to facilitate withdrawal from sedative-hypnotics. However, there is very little research evaluating the effect of CBTi on reduced medication use. The current narrative review integrates 95 studies including over 10,000 participants, investigating the effect of CBTi on reduced sedative-hypnotic use in different populations (e.g., hypnotic-dependent patients, older adults, military personnel), settings (e.g., primary care settings, psychiatric inpatients), CBTi modalities (e.g., self-administered reading/audio materials, digital, and therapist-administered), and in combination with gradual dose reduction programs. Based on this research, we discuss the theoretical mechanistic effects of CBTi in facilitating reduced sedative-hypnotic use, provide clear recommendations for future research, and offer pragmatic clinical suggestions to increase access to CBTi to reduce dependence on sedative-hypnotics as the 'default' treatment for insomnia.
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Affiliation(s)
- Alexander Sweetman
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia.
| | | | - Leon Lack
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - R Doug McEvoy
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Robert Adams
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville, South Australia, Australia; Respiratory and Sleep Service, Southern Adelaide Local Health Network, Bedford Park, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Ron Grunstein
- Sleep and Chronobiology Research Group, Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- Health Economics, College of Medicine and Public Health, Bedford Park, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Emer Van Ryswyk
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Christopher Gordon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW, Australia; Sleep and Chronobiology Research Group, Woolcock Institute of Medical Research, University of Sydney, New South Wales, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Andrew Vakulin
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
| | - Nicole Lovato
- The Adelaide Institute for Sleep Health: A Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; National Centre for Sleep Health Services Research: A NHMRC Centre of Research Excellence, Flinders University, Adelaide, South Australia, Australia
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The Clinical Effectiveness of Cognitive Behavioral Therapy for Patients with Insomnia and Depression: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:8071821. [PMID: 32733587 PMCID: PMC7378630 DOI: 10.1155/2020/8071821] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/27/2020] [Accepted: 06/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Insomnia and depression often co-occurr. However, there is lack of effective treatment for such comorbidity. CBT-I has been recommended as the first-line treatment for insomnia; whether it is also effective for comorbidity of insomnia and depression is still unknown. Therefore, we conducted this meta-analysis of randomized controlled trials to assess the clinical effectiveness and safety of CBT-I for insomnia comorbid with depression. Data Sources. Seven electronic databases, including China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science Technology Journal Database, SinoMed Database, PubMed, the Cochrane Library, and EMBASE, as well as grey literature, were searched from the beginning of each database to July 1, 2019. Study Eligibility Criteria. Randomized controlled trials that compared CBT-I to no treatment or hypnotics (zopiclone, estazolam, and benzodiazepine agonist) for insomnia comorbid with depression and reported both insomnia scales and depression scales. Study Assessment and Synthesis Methods. Cochrane Reviewer's Handbook was used for evaluating the risk of bias of included studies. Review Manager 5.3 software was used for meta-analysis. Online GRADEpro was used to assess the quality of evidence. RESULTS The pooled data showed that CBT-I was superior to no treatment for insomnia, while it was unsure whether CBT-I was better than no treatment for depression. And the effectiveness of CBT-I was comparable to hypnotics for both insomnia and depression. CBT-I was likely to be safe due to its noninvasive nature. The methodological quality varied across these trials. The evidence quality varied from moderate to very low, and the recommendation level was low. CONCLUSIONS Currently, findings support that CBT-I seems to be effective and safe for insomnia comorbid with depression to improve the insomnia condition, while it is unsure whether CBT-I could improve depression condition. More rigorous trials are needed to confirm our findings.
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20
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Liou KT, Root JC, Garland SN, Green J, Li Y, Li QS, Kantoff PW, Ahles TA, Mao JJ. Effects of acupuncture versus cognitive behavioral therapy on cognitive function in cancer survivors with insomnia: A secondary analysis of a randomized clinical trial. Cancer 2020; 126:3042-3052. [PMID: 32320061 DOI: 10.1002/cncr.32847] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/29/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cancer-related cognitive impairment is a prevalent, disruptive condition potentially exacerbated by sleep disturbances. The current study was performed to evaluate the effects of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on objective and subjective cognitive function in cancer survivors with insomnia. METHODS Using data from a randomized clinical trial (160 survivors) that compared acupuncture versus CBT-I for insomnia occurring in cancer survivors, the authors analyzed cognitive outcomes and their relationship to insomnia symptoms. Analysis was limited to 99 patients who reported baseline cognitive difficulties. Interventions were delivered over 8 weeks. Objective attention, learning, and memory were evaluated using the Buschke Selective Reminding Test. Subjective cognitive function was assessed using the Brown Attention-Deficit Disorder Scales. Insomnia symptoms were assessed using the Insomnia Severity Index. All outcomes were collected at baseline, week 8, and week 20. RESULTS From baseline to week 8, acupuncture produced statistically significant within-group improvements in objective attention (Cohen D, 0.29), learning (Cohen D, 0.31), and memory (Cohen D, 0.33) that persisted to week 20 (all P < .05), whereas CBT-I produced a statistically significant within-group improvement in objective attention from baseline to week 20 (Cohen D, 0.50; P < .05); between-group differences were not statistically significant. Both interventions produced statistically significant within-group improvements in subjective cognitive function at weeks 8 and 20 compared with baseline (all P < .001); between-group differences were not statistically significant. In the acupuncture group, patients with clinically meaningful responses with regard to insomnia symptoms demonstrated a significantly greater improvement in subjective cognitive function compared with those without clinically meaningful insomnia responses (P = .006). CONCLUSIONS Among cancer survivors with insomnia, both acupuncture and CBT-I produced significant improvements in objective and subjective cognitive function. However, the effect sizes varied and only survivors in the acupuncture group demonstrated a significant relationship between cognitive and sleep outcomes. These preliminary findings warrant further investigation to guide the personalized management of patients with cancer-related cognitive impairment.
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Affiliation(s)
- Kevin T Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sheila N Garland
- Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Jamie Green
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Q Susan Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Philip W Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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21
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Reynolds-Cowie P, Fleming L. Living with persistent insomnia after cancer: A qualitative analysis of impact and management. Br J Health Psychol 2020; 26:33-49. [PMID: 32558129 DOI: 10.1111/bjhp.12446] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 05/06/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To conduct a qualitative exploration of the lived experience of insomnia disorder and its management amongst a sample of mixed-diagnoses cancer survivors. METHODS Twenty-seven cancer survivors with persistent insomnia were recruited to this qualitative study following completion of treatment for breast (12), prostate (7), colorectal (7), and gynaecological (1) cancers. Eleven males and 16 females (mean age 62 years), who met DSM-5 criteria for insomnia disorder, contributed to one of four focus group discussions, designed to explore the lived experience of persistent insomnia and its management within cancer care services. RESULTS Poor sleep was a persistently troubling complaint for participants, long after the completion of active cancer treatment. The impact of insomnia was significant for all participants, with six key domains emerging as those most affected: temperament, sociability, physical well-being, cognitive functioning, relationships, and psychological well-being. In terms of insomnia management, participants frequently resorted to unfruitful self-management strategies, due to the lack of professional insomnia expertise within cancer care settings. Three main themes emerged in relation to insomnia management: self-management, seeking professional intervention, and a lack of focus on sleep. A lack of clinician understanding of the importance of sleep health and the poor availability of evidence-based insomnia interventions, such as cognitive behavioural therapy for insomnia (CBT-i), were highlighted as important gaps in cancer care. CONCLUSIONS Insomnia was found to have a detrimental and pervasive impact on cancer survivors' quality of life, which persisted long into survivorship. There is an absence of professional attention to sleep throughout the cancer care trajectory, contributing to its prevalence, persistence, and impact. In order to break this cycle, sleep health should be integrated as a key aspect of cancer treatment and rehabilitation, much like maintaining a healthy diet and appropriate levels of physical activity.
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Affiliation(s)
| | - Leanne Fleming
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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22
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Barton DL, Atherton PJ, Satele DV, Qin R, Dakhil S, Pipe T, Hobday T, Fee-Schroeder K, Loprinzi CL. A randomized phase II trial evaluating two non-pharmacologic interventions in cancer survivors for the treatment of sleep-wake disturbances: NCCTG N07C4 (Alliance). Support Care Cancer 2020; 28:6085-6094. [PMID: 32307658 DOI: 10.1007/s00520-020-05461-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/04/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Sleep disturbance is a prevalent problem for cancer survivors and effective behavioral treatments are not widely used for this population. This study evaluated home-based sleep interventions based on cognitive behavioral therapy for insomnia (CBT-I). METHODS This phase II randomized controlled trial evaluated two manualized interventions over 7 weeks. The intervention group received sleep hygiene information, stimulus control, sleep restriction, and a bedtime imagery audio recording. The control group was similar, but without sleep restriction and used audio recordings of bedtime short stories instead of imagery. Eligibility included adult cancer survivors who had trouble falling asleep or falling back to sleep on 3 of 7 days. Patients with diagnoses of sleep or mental health disorders were excluded. The primary endpoint was change in time to fall asleep or falling back to sleep after awakening, from baseline to week 7. Two-sample T tests evaluated differences between arms for this endpoint. RESULTS Ninety-three of 168 planned participants were enrolled from 20 institutions. The study closed early for poor accrual. Baseline time to sleep was 45 min and 52 min for the intervention and control group, respectively. At 7 weeks, both groups improved, the intervention group to 26 min and control group to 30 min, a non-significant difference between groups (p = 0.85). Secondary outcomes improved in both groups with no significant differences between arms. CONCLUSIONS Improvement in sleep outcomes in both arms was consistent with other CBT-I interventions delivered through alternative approaches to provider-delivered therapy. More research on optimal scalable delivery of CBT-I is needed. CLINICAL RELEVANCE This study supports the effectiveness of CBT-I based behavioral interventions for sleep but also the need for better delivery methods to improve uptake and effect size. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00993928.
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Affiliation(s)
- Debra L Barton
- University of Michigan School of Nursing, 400 N. Ingalls, Room 4320, Ann Arbor, MI, 48109-5482, USA.
| | - Pamela J Atherton
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Daniel V Satele
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Rui Qin
- Janssen Pharmaceuticals, Raritan, NJ, Belgium
| | | | - Teri Pipe
- Arizona State University, Tempe, AZ, USA
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23
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Bean HR, Stafford L, Little R, Diggens J, Ftanou M, Alexander M, Francis PA, Bei B, Wiley JF. Light-enhanced cognitive behavioural therapy for sleep and fatigue: study protocol for a randomised controlled trial during chemotherapy for breast cancer. Trials 2020; 21:295. [PMID: 32216832 PMCID: PMC7099834 DOI: 10.1186/s13063-020-4196-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with breast cancer experience a significantly higher prevalence of sleep disturbance and insomnia than the general population. The experience of persistent sleep disturbance places these women at a higher risk of psychological and physical morbidity and a reduced quality of life. Treatment for sleep in this population is not part of routine care and is often managed inadequately. This randomised controlled trial will examine the combined effects of cognitive behavioural therapy (CBT) and bright light therapy (BLT) on the symptoms of insomnia, fatigue and mental health. METHOD/DESIGN Women diagnosed with breast cancer who receive intravenous chemotherapy treatment at a quaternary referral metropolitan cancer centre in Melbourne, Australia, will be recruited. Recruitment will occur after diagnosis and prior to completion of chemotherapy. Eligible women will be randomised to the combined CBT and BLT intervention (CBT+) or relaxation audio-enhanced treatment as usual (TAU+). The CBT+ group will receive one face-to-face session on sleep strategies, one subsequent telephone call, and seven email packages containing CBT-based information and strategies. CBT+ participants will also wear Luminette® light glasses for 20 min each morning for the 6-week duration of the intervention. Women in TAU+ will receive two relaxation audio tracks via email. Outcomes will be measured at multiple points throughout the 6 weeks. Primary outcomes will be symptoms of insomnia and sleep efficiency, measured using the Insomnia Severity Index and a self-reported sleep diary. Secondary outcomes include objective measures of sleep assessed using the ActiGraph wGT3X-BT, and sleep-related complaints, fatigue and mental health, all assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS). Data will also be collected on potential treatment moderators and mechanisms and adherence to treatment. There will be 3-month follow-up measurements of insomnia symptoms, fatigue, sleep-related impairment, sleep disturbance, depression and anxiety. DISCUSSION This is the first randomised controlled trial to combine CBT and BLT for the treatment of sleep disturbance in women with breast cancer. This novel design addresses the multiple causal factors for sleep complaints in this population. Results from this trial will advance knowledge in this field and may have important clinical implications for how best to treat sleep disturbance and insomnia in this population. If effective, the largely email-based format of the intervention would allow for relatively easy translation. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12618001255279. Retrospectively registered on 25 July 2018.
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Affiliation(s)
- Helena R Bean
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC, 3800, Australia
| | - Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Ruth Little
- Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia
| | | | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marliese Alexander
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | | | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC, 3800, Australia
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC, 3800, Australia.
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24
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Ho FYY, Chan CS, Lo WY, Leung JCY. The effect of self-help cognitive behavioral therapy for insomnia on depressive symptoms: An updated meta-analysis of randomized controlled trials. J Affect Disord 2020; 265:287-304. [PMID: 32090753 DOI: 10.1016/j.jad.2020.01.062] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/05/2020] [Accepted: 01/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sleep disturbances commonly occur in patients with depression. Insomnia is considered not only a symptom of but also a risk factor for depression. Psychological treatments for insomnia have been demonstrated to be efficacious in alleviating depressive symptoms. This meta-analysis examined the effect of self-help cognitive behavioral therapy for insomnia (CBT-I) in treating depressive symptoms. METHODS A systematic review was performed up to April 2019 in 6 major electronic databases. The literature search retrieved 4190 potentially relevant citations; 30 randomized controlled trials (total N = 5945) that compared self-help CBT-I vs. waiting-list (WL), routine care, no treatment, individual cognitive behavioral therapy (CBT), group CBT and placebo were included in the current review. RESULTS Random effects models showed significant reduction in self-report depressive symptoms (Hedges' g = 0.35; 95% CI: -0.47, -0.23) and insomnia symptoms (Hedges' g = 0.79; 95% CI: -0.56, -1.03) in the self-help CBT-I group when compared to the WL/routine care/no treatment/psychoeducation control group. LIMITATIONS The findings should be interpreted with caution due to potential publication bias. CONCLUSIONS CBT-I appears to be efficacious in treating depressive symptoms. Given the current results and study limitations, large-scale, high-quality trials that specifically target individuals with a clinical diagnosis of depression are warranted in the future.
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Affiliation(s)
- Fiona Yan-Yee Ho
- The Public Mental Health Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Christian S Chan
- Department of Psychology, The University of Hong Kong, Hong Kong.
| | - Wing-Ying Lo
- The Public Mental Health Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong
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25
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Youn S, Choi B, Lee S, Kim C, Chung S. Time to Take Sleeping Pills and Subjective Satisfaction among Cancer Patients. Psychiatry Investig 2020; 17:249-255. [PMID: 32126741 PMCID: PMC7113171 DOI: 10.30773/pi.2019.0216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/03/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We investigated the influence of the time to take hypnotics and daytime activity on patient satisfaction with sleeping pills. METHODS Ninety-six cancer patients who were currently taking benzodiazepine or z-drug as hypnotics were grouped into satisfied and dissatisfied groups. The subjects' symptoms, time to take sleeping pills, bedtime, sleep onset time, wake up time, and time in bed within 24 hours (TIB/d) were obtained. RESULTS The satisfied group had significantly late sleeping pill ingestion time (p=0.04); significantly early wake up time (p=0.01); and significantly shorter sleep latency, TIB/d, duration from the administration of pills to sleep onset, and duration from the administration of pills to wake up time (PTW). Logistic regression analysis revealed that the significant predictors of patient satisfaction to hypnotics were less severity of insomnia [odds ratio (OR)=0.91] and the time variables, including late sleeping pill administration time (OR=1.53) and early wake up time (OR=0.57). Among the duration variables, short PTW (OR=0.30) and short TIB/d (OR=0.64) were significantly related with the satisfaction to hypnotics. CONCLUSION Reducing the duration from the administration of hypnotics to wake up time and TIB/d can influence the satisfaction to sleeping pills.
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Affiliation(s)
- Soyoung Youn
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byeongil Choi
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suyeon Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Changnam Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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26
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Thakral M, Von Korff M, McCurry SM, Morin CM, Vitiello MV. Changes in dysfunctional beliefs about sleep after cognitive behavioral therapy for insomnia: A systematic literature review and meta-analysis. Sleep Med Rev 2020; 49:101230. [PMID: 31816582 PMCID: PMC7012685 DOI: 10.1016/j.smrv.2019.101230] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/30/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the preferred treatment for chronic insomnia and sleep-related cognitions are one target of treatment. There has been little systematic investigation of how sleep-related cognitions are being assessed in CBT-I trials and no meta-analysis of the impact of CBT-I on dysfunctional beliefs about sleep, a core cognitive component of treatment. Academic Search Complete, Medline, CINAHL and PsychInfo from 1990 to 2018 were searched to identify randomized controlled trials of CBT-I in adults (≥18 years) reporting some measure of sleep-related cognitions. Sixteen randomized controlled trials were identified comparing 1134 CBT-I and 830 control subjects. The Dysfunctional Beliefs and Attitudes about Sleep Scale was utilized almost exclusively to assess sleep-related cognitions in these trials. Hedge's g at 95% confidence interval (CI) was calculated to assess CBT-I effect size at post-treatment compared to controls. CBT-I significantly reduced dysfunctional beliefs about sleep (g = -0.90, 95% CI -1.19, -0.62) at post-treatment. Three trials contributed data to estimate effect size for long-term effects (g = -1.04, 95% CI -2.07, -0.02) with follow up time ranging from 3 to 18 mo. We concluded that cognitive behavioral therapy for insomnia has moderate to large effects on dysfunctional beliefs about sleep.
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Affiliation(s)
- Manu Thakral
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; University of Washington School of Nursing, Seattle, WA, USA.
| | - Michael Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Susan M McCurry
- University of Washington School of Nursing, Seattle, WA, USA
| | - Charles M Morin
- School of Psychology, Université Laval, Quebec City, Quebec, Canada
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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27
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McCrae CS, Curtis AF, Williams JM, Dautovich ND, McNamara JPH, Stripling A, Dzierzewski JM, Berry RB, McCoy KM, Marsiske M. Effects of Brief Behavioral Treatment for Insomnia on Daily Associations between Self-Reported Sleep and Objective Cognitive Performance in Older Adults. Behav Sleep Med 2020; 18:577-588. [PMID: 31203649 PMCID: PMC7981847 DOI: 10.1080/15402002.2019.1632201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Behavioral treatments for insomnia improve sleep in older adults, but research documenting their effects on cognitive performance is mixed. We explored whether a brief behavioral treatment for insomnia (BBTi) impacts daily associations between sleep parameters and next day cognition. METHODS Sixty-two older adults (Mage = 69.45 years, SD = 7.71) with insomnia completed either 4 weeks of BBTi or self-monitoring control (SMC). At baseline, post-treatment, and 3 month follow-up, participants completed 14 days of diaries measuring sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE), as well as daily cognitive tests measuring processing speed (i.e., symbol digit modalities test, SDMT), and reasoning (i.e., letter series). At each time period, associations between sleep parameters and daily cognition, controlling for age, education, insomnia duration, use of sleep medications, and depression (i.e., Beck Depression Inventory-2nd Edition scores), were examined through multilevel modeling. RESULTS At post-treatment, we observed an interactive fixed effect of treatment condition (i.e., BBTi/SMC) and TST on daily SDMT and letter series performance. For BBTi, longer TST was associated with better letter series performance, and did not predict SDMT performance. For SMC, longer TST was associated with worse SDMT, and was not associated with letter series performance. Greater WASO (regardless of group) was associated with better SDMT performance at post-treatment. Associations were not maintained at follow-up. CONCLUSIONS Sleep duration may play an important role in BBTi-related improvements in daily higher order cognition. Maintenance of these associations may be facilitated by booster sessions following post-treatment. CLINICAL TRIAL IDENTIFIER NCT02967185.
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Affiliation(s)
| | - Ashley F. Curtis
- Department of Psychiatry, University of Missouri-Columbia,
Columbia, MO
| | | | | | | | - Ashley Stripling
- College of Psychology, Nova Southeastern University, Fort
Lauderdale, Florida,Department of Psychiatry, Geisel School of Medicine,
Dartmouth College, Hanover, NH
| | | | | | - Karin M. McCoy
- Neuropsychology Service, South Texas Veterans Health Care
System, San Antonio, TX
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL
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28
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Perdigão MMDM, Rodrigues AB, Magalhães TDL, Freitas FMC, Bravo LG, Oliveira PPD. Educational technology for fatigue management related to antineoplastic chemotherapy. Rev Bras Enferm 2019; 72:1519-1525. [DOI: 10.1590/0034-7167-2018-0505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 04/10/2019] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To construct and validate an educational technology (ET) on fatigue and non-pharmacological strategies for the management of this symptom in people with cancer undergoing outpatient antineoplastic chemotherapy. Method: This is a methodological study composed of three stages: 1) elaboration of the ET using the theoretical-methodological model of Doak, Doak and Root; 2) validation of content and appearance by seven nurses via the content validity index (CVI); and 3) a pilot test with 10 patients. Results: The ET “Knowing and coping with fatigue” contemplates the definition of fatigue, its causes and the interventions of physical exercise practice, sleep hygiene, energy conservation and behavioral intervention. The overall CVI obtained with the judges was 0.95. Conclusion: The ET presented content and appearance validity for health education regarding fatigue related to antineoplastic chemotherapy in outpatient cancer patients.
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29
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30
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van der Zweerde T, Bisdounis L, Kyle SD, Lancee J, van Straten A. Cognitive behavioral therapy for insomnia: A meta-analysis of long-term effects in controlled studies. Sleep Med Rev 2019; 48:101208. [PMID: 31491656 DOI: 10.1016/j.smrv.2019.08.002] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/25/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is a treatment with moderate to large effects. These effects are believed to be sustained long-term, but no systematic meta-analyses of recent evidence exist. In this present meta-analysis, we investigate long-term effects in 30 randomized controlled trials (RCTs) comparing CBT-I to non-active control groups. The primary analyses (n = 29 after excluding one study which was an outlier) showed that CBT-I is effective at 3-, 6- and 12-mo compared to non-active controls: Hedges g for Insomnia severity index: 0.64 (3 m), 0.40 (6 m) and 0.25 (12 m); sleep onset latency: 0.38 (3 m), 0.29 (6 m) and 0.40 (12 m); sleep efficiency: 0.51 (3 m), 0.32 (6 m) and 0.35 (12 m). We demonstrate that although effects decline over time, CBT-I produces clinically significant effects that last up to a year after therapy.
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Affiliation(s)
- Tanja van der Zweerde
- Department of Clinical Psychology, Amsterdam Public Health, VU University, Amsterdam, the Netherlands.
| | - Lampros Bisdounis
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; PsyQ Amsterdam, Amsterdam, the Netherlands
| | - Annemieke van Straten
- Department of Clinical Psychology, Amsterdam Public Health, VU University, Amsterdam, the Netherlands
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31
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Jakobsen G, Engstrøm M, Paulsen Ø, Sjue K, Raj SX, Thronæs M, Hjermstad MJ, Kaasa S, Fayers P, Klepstad P. Zopiclone versus placebo for short-term treatment of insomnia in patients with advanced cancer: study protocol for a double-blind, randomized, placebo-controlled, clinical multicenter trial. Trials 2018; 19:707. [PMID: 30591073 PMCID: PMC6307135 DOI: 10.1186/s13063-018-3088-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/30/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the high prevalence of insomnia in patients with advanced cancer, there are no randomized controlled trials on pharmacological interventions for insomnia in this group of patients. A variety of pharmacological agents is recommended to manage sleep disturbance for insomnia in the general population, but their efficacy and safety in adults with advanced cancer are not established. Thus, there is a need to evaluate the effectiveness of medications for insomnia in order to improve the evidence in patients with advanced cancer. One of the most used sleep medications at present in patients with cancer is zopiclone. METHODS This is a randomized, double-blind, placebo-controlled, parallel-group, multicenter trial. A total of 100 patients with metastatic cancer who report insomnia will be randomly allocated to zopiclone or placebo. The treatment duration with zopiclone/placebo is 6 consecutive nights. The primary endpoint is patient-reported sleep quality during the final study night (night 6) assessed on a numerical rating scale of 0-10, where 0 = Best sleep and 10 = Worst possible sleep. Secondary endpoints include the mean patient-reported total sleep time and sleep onset latency during the final study night (night 6). DISCUSSION Results from this study on treatment of insomnia in advanced cancer will contribute to clinical decision-making and improve the treatment of sleep disturbance in this patient cohort. TRIAL REGISTRATION ClinicalTrials.gov, NCT02807922 . Registered on 21 June 2016.
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Affiliation(s)
- Gunnhild Jakobsen
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway. .,Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Morten Engstrøm
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs hospital, Trondheim, Norway
| | - Ørnulf Paulsen
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.,Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | - Karin Sjue
- Department of Oncology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Sunil X Raj
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.,Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Morten Thronæs
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.,Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Fayers
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Pål Klepstad
- Department of Anaesthesiology and Intensive Care Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
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32
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Gee B, Orchard F, Clarke E, Joy A, Clarke T, Reynolds S. The effect of non-pharmacological sleep interventions on depression symptoms: A meta-analysis of randomised controlled trials. Sleep Med Rev 2018; 43:118-128. [PMID: 30579141 DOI: 10.1016/j.smrv.2018.09.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/07/2018] [Accepted: 09/20/2018] [Indexed: 01/28/2023]
Abstract
Poor sleep is a significant risk factor for depression across the lifespan and sleep problems have been hypothesised to contribute to the onset and maintenance of depression symptoms. However, sleep problems are usually not a direct target of interventions for depression. A range of non-pharmacological treatments can reduce sleep problems but it is unclear whether these interventions also reduce other depression symptoms. The aim of this review was to examine whether non-pharmacological interventions for sleep problems are effective in reducing symptoms of depression. We carried out a systematic search for randomised controlled trials of non-pharmacological sleep interventions that measured depression symptoms as an outcome. Forty-nine trials (n = 5908) were included in a random effects meta-analysis. The pooled standardised mean difference for depression symptoms after treatment for sleep problems was -0.45 (95% CI: -0.55,-0.36). The size of the effect on depression symptoms was moderated by the size of the effect on subjective sleep quality. In studies of participants with mental health problems, sleep interventions had a large effect on depression symptoms (d = -0.81, 95% CI: -1.13,-0.49). The findings indicate that non-pharmacological sleep interventions are effective in reducing the severity of depression, particularly in clinical populations. This suggests that non-pharmacological sleep interventions could be offered as a treatment for depression, potentially improving access to treatment.
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Affiliation(s)
- Brioney Gee
- Norfolk and Suffolk NHS Foundation Trust, UK; Norwich Medical School, University of East Anglia, UK.
| | - Faith Orchard
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | | | - Ansu Joy
- Norfolk and Suffolk NHS Foundation Trust, UK
| | - Tim Clarke
- Norfolk and Suffolk NHS Foundation Trust, UK; Norwich Medical School, University of East Anglia, UK
| | - Shirley Reynolds
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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33
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Palesh O, Scheiber C, Kesler S, Janelsins MC, Guido JJ, Heckler C, Cases MG, Miller J, Chrysson NG, Mustian KM. Feasibility and acceptability of brief behavioral therapy for cancer-related insomnia: effects on insomnia and circadian rhythm during chemotherapy: a phase II randomised multicentre controlled trial. Br J Cancer 2018; 119:274-281. [PMID: 30026614 PMCID: PMC6068121 DOI: 10.1038/s41416-018-0154-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 05/20/2018] [Accepted: 05/31/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This phase II RCT was conducted to determine the feasibility and acceptability of brief behavioral therapy for cancer-related insomnia (BBT-CI) in breast cancer patients undergoing chemotherapy. We also assessed the preliminary effects of BBT-CI on insomnia and circadian rhythm in comparison to a Healthy Eating Education Learning control condition (HEAL). METHODS Of the 71 participants recruited, 34 were randomised to receive BBT-CI and 37 to receive HEAL. Oncology staff was trained to deliver the intervention in four community clinics affiliated with the NCI. Insomnia was assessed with the Insomnia Severity Index (ISI), and circadian rhythm was assessed using a wrist-worn actiwatch. RESULTS Community staff interveners delivered 72% of the intervention components, with a recruitment rate of 77% and an adherence rate of 73%, meeting acceptability and feasibility benchmarks. Those randomised to BBT-CI improved their ISI scores by 6.3 points compared to a 2.5-point improvement in those randomised to HEAL (P = 0.041). Actigraphy data indicated that circadian functioning improved in the BBT-CI arm as compared to the HEAL arm at post-intervention (all P-values <0.05). CONCLUSIONS BBT-CI is an acceptable and feasible intervention that can be delivered directly in the community oncology setting by trained staff. The BBT-CI arm experienced significant improvements in insomnia and circadian rhythm as compared to the control condition.
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Affiliation(s)
- Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
| | - Caroline Scheiber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Shelli Kesler
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle C Janelsins
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Joseph J Guido
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Charles Heckler
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Mallory G Cases
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Jessica Miller
- Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN, USA
| | | | - Karen M Mustian
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
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Herbert V, Kyle SD, Pratt D. Does cognitive behavioural therapy for insomnia improve cognitive performance? A systematic review and narrative synthesis. Sleep Med Rev 2018; 39:37-51. [DOI: 10.1016/j.smrv.2017.07.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 07/04/2017] [Accepted: 07/04/2017] [Indexed: 01/04/2023]
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Matthews E, Carter P, Page M, Dean G, Berger A. Sleep-Wake Disturbance: A Systematic Review of Evidence-Based Interventions for Management in Patients With Cancer. Clin J Oncol Nurs 2018; 22:37-52. [DOI: 10.1188/18.cjon.37-52] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zhou ES, Suh S, Youn S, Chung S. Adapting Cognitive-Behavior Therapy for Insomnia in Cancer Patients. SLEEP MEDICINE RESEARCH 2017. [DOI: 10.17241/smr.2017.00080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Armstrong TS, Shade MY, Breton G, Gilbert MR, Mahajan A, Scheurer ME, Vera E, Berger AM. Sleep-wake disturbance in patients with brain tumors. Neuro Oncol 2017; 19:323-335. [PMID: 27286798 PMCID: PMC5464298 DOI: 10.1093/neuonc/now119] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023] Open
Abstract
Sleep-wake disturbances are defined as perceived or actual alterations in sleep that result in impaired daytime functioning. Unlike other cancers, there is limited information about sleep-wake disturbances in adults with primary brain tumors throughout the illness trajectory. Sleep-wake disturbance is among the most severe and common symptoms reported by primary brain-tumor patients, particularly those undergoing radiation therapy. As with other cancers and neurologic illness, sleep-wake disturbance may also be clustered or related to other symptoms such as fatigue, depression, and cognitive impairment. There is increasing evidence for a genetic basis of normal sleep and sleep regulation in healthy adults. Specific mutations and single nucleotide variants have been reported to be associated with both fatigue and sleep-wake disorders, and both inflammation and alterations in circadian rhythms have been postulated to have a potential role. Guidelines for assessment and interventions have been developed, with cognitive behavioral therapy, exercise, and sleep hygiene demonstrating benefit in patients with other solid tumors. Further research is needed to identify risk and appropriate treatment in the brain-tumor patient population.
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Affiliation(s)
| | - Marcia Y Shade
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ghislain Breton
- Department of Integrative Biology, UTHealth McGovern Medical School, Houston, Texas, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Anita Mahajan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Elizabeth Vera
- University of Texas Health Science Center, Houston, Texas, USA
| | - Ann M Berger
- University of Nebraska Medical Center, Omaha, Nebraska, USA
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