1
|
O’Keefe K, Chen M, Lesser KJ, DuVall AS, Dils AT. Treating Mental Health and Quality of Life in Older Cancer Patients with Cognitive Behavioral Therapy: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:881. [PMID: 39063458 PMCID: PMC11277493 DOI: 10.3390/ijerph21070881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/21/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) has been successfully utilized in improving mental health (MH) and quality of life (QoL) in the general population, regardless of age. Cancer, which is most frequently diagnosed in older adults, is a debilitating illness that has a detrimental and long-lasting effect on patients' MH and QoL. While numerous studies have demonstrated CBT's efficacy, little evidence exists for its role in older cancer patients. This study, using MH and QoL metrics, evaluates the effectiveness of CBT for older adult cancer patients. METHODS Focusing on MH and QoL and an average age of over 60 years old, a final analysis was performed on 17 clinical trials with a total of 124 effect sizes, including 3073 participants receiving CBT. "Metaphor" and "Robumeta" packages in R Statistical Software (version 4.2.2) were used for analysis, which included robust variance estimation (RVE) in intercept-only meta-regression, and univariate meta-regression for moderator analysis. RESULTS With 17 clinical trials and 124 effect sizes, our results show that CBT moderately improves MH and QoL in cancer patients d = 0.19, 95% CI 0.0166-0.364, p < 0.0399. The delivery format was shown to be a strong moderator of CBT effectiveness with interpersonal technological interventions combined with pre-programmed segments having a very strong treatment effect size (d = 1.7307, 95% CI 1.5244-1.937, p < 0.001). CONCLUSIONS The use of CBT in older adult cancer patients statistically improves MH and QoL, with delivery format and stages of treatment having important roles. Tech-only interpersonal interventions combined with pre-programmed CBT provide an avenue for targeting older adult cancer patients.
Collapse
Affiliation(s)
- Kathryn O’Keefe
- College of Medicine, Central Michigan University, Mt Pleasant, MI 48859, USA; (K.O.)
| | - Meiyan Chen
- School of Social Work, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kevin J. Lesser
- College of Medicine, Central Michigan University, Mt Pleasant, MI 48859, USA; (K.O.)
| | - Adam S. DuVall
- Section of Hematology/Oncology, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Alexander T. Dils
- College of Medicine, Central Michigan University, Mt Pleasant, MI 48859, USA; (K.O.)
| |
Collapse
|
2
|
Drozd C, Curtit E, Gillet V, Jacquinot Q, Meneveau N, Mougin F. Exercise Intervention on Insomnia in Patients with a Cancer: A Systematic Review of the Literature. Cancers (Basel) 2024; 16:2241. [PMID: 38927946 PMCID: PMC11201959 DOI: 10.3390/cancers16122241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/09/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
Cancer is associated with increased muscle weakness, reduced physical functioning, increased fatigue, but also sleep disturbances, including insomnia, that affect quality of life (QoL). Physical activity demonstrated benefits on functional capacity, resilience and cancer-related fatigue, but there is a paucity of available data regarding its effects on insomnia in patients with cancer. This systematic review aims to examine the efficacy of exercise levels with insomnia in cancer patients. A systematic search was performed for articles published in PubMed and Cochrane Library databases from December 2013 to February 2023. Included studies explored insomnia during or after cancer treatment, with various exercise interventions. The search identified nine studies included in this review. Due to substantial heterogeneity in the interventions across studies, meta-analysis was not performed. Three studies reported positive results for insomnia reduction by self-reported outcomes under a supervised aerobic exercise program alone or combined with strength training. The present systematic review establishes the role of exercise interventions for reducing cancer-related insomnia. Further studies are indeed warranted to improve the level of evidence for exercise interventions for implementation in the care of cancer-related insomnia.
Collapse
Affiliation(s)
- Chloé Drozd
- Sports Science Faculty, University of Franche-Comté, 25000 Besançon, France
- Research Unit SINERGIES, University of Franche-Comté, 25000 Besançon, France
- Sleep Medicine Center, Don Du Souffle Association, 25000 Besançon, France
| | - Elsa Curtit
- INSERM U1098 Right, University of Franche-Comté, 25000 Besançon, France
- Department of Medical Oncology, University Hospital, 25000 Besançon, France
| | - Valérie Gillet
- Sleep Medicine Center, Don Du Souffle Association, 25000 Besançon, France
| | - Quentin Jacquinot
- Research Unit SINERGIES, University of Franche-Comté, 25000 Besançon, France
- Regional Federative Cancer Institute of Franche-Comté, 25000 Besançon, France
| | - Nathalie Meneveau
- Department of Medical Oncology, University Hospital, 25000 Besançon, France
| | - Fabienne Mougin
- Sports Science Faculty, University of Franche-Comté, 25000 Besançon, France
- Research Unit SINERGIES, University of Franche-Comté, 25000 Besançon, France
| |
Collapse
|
3
|
Crowther ME, Saunders WJ, Sletten TL, Drummond SPA, Bei B. Tailoring cognitive behavioural therapy for insomnia across contexts, conditions, and individuals: What do we know, where do we go? J Sleep Res 2023; 32:e14023. [PMID: 37641983 DOI: 10.1111/jsr.14023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
Cognitive behavioural therapy for insomnia (CBT-I) is considered the front-line treatment for insomnia. Despite the demonstrated effectiveness of CBT-I, it is necessary to consider how CBT-I may be tailored to different individuals. The purpose of the present review is to provide a summary of literature on tailoring CBT-I to different individuals and provide directions for future research. This review focused on the following domains of adaptation: (i) tailoring CBT-I components to individuals with comorbid mental or physical health conditions such as comorbid depression and pain; (ii) adapting CBT-I delivery for different contexts in which individuals exist, such as inpatient, educational, and different social/cultural settings, (iii) adapting CBT-I to specific individuals via case-formulation in clinical settings. We highlight current gaps in the exploration of tailored CBT-I, including a lack of research methodology to evaluate tailored interventions, a need for the integration of ongoing individualised assessment to inform treatment, and the necessary involvement of consumers and stakeholders throughout the research and treatment development process. Together, this review showed abundant adaptations in CBT-I already exist in the literature. Future research is needed in understanding when and how to apply adaptations in CBT-I and evaluate the benefits of these adaptations.
Collapse
Affiliation(s)
- Meagan E Crowther
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - William J Saunders
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Tracey L Sletten
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Bei Bei
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Block KI, Gyllenhaal C, Grutsch JF, Block PB, Kazlausky T, Blask D, Carome E, Reynolds J, Huff DFQ, Hrushesky W. Advanced cancer patients in a randomized clinical trial of night-simulating eyeglasses observed to have a normal 24-h circadian rhythm during chemotherapy. SAGE Open Med 2022; 10:20503121221100137. [PMID: 35646366 PMCID: PMC9134428 DOI: 10.1177/20503121221100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 04/22/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives: Cancer patients routinely exhibit dysfunctional circadian organization.
Indeed, a dysfunctional circadian organization is a hallmark of advanced
cancer. A cohort of advanced cancer patients undergoing chemotherapy was
recruited to investigate whether manipulating exposure to blue light could
restore or ameliorate their circadian organization. Methods: Thirty advanced metastatic cancer patients participated in a randomized
crossover trial to evaluate whether blue light-blocking night-simulating
eyeglasses could ameliorate a disrupted circadian organization better than
sham eyeglasses. Circadian organization was evaluated by actigraphy and
patients’ self-reports of sleep, fatigue, and quality of life.
Kruskal–Wallis tests compared patients’ outcomes in circadian organization
with a cohort of non-cancer, disease-free individuals with normal sleep as a
negative control, and with advanced cancer patients with disrupted circadian
organization as a positive control. Quality-of-life outcomes of the patients
were compared with population-based controls (negative controls) and with
cohorts of advanced cancer patients (positive controls). Results: Actigraphy measurements, self-reported sleep, fatigue levels, and
quality-of-life outcomes of trial participants were similar to those of
negative controls with a normal circadian organization, in spite of the
trial patients’ concurrent chemotherapy. Night-simulating glasses did not
improve circadian organization. The 24-h correlation of day-to-day rhythms
of rest and activity was 0.455 for the experimental eyeglasses and 0.476 for
the sham eyeglasses (p = 0.258). Actigraphic and
patient-reported outcomes compared favorably to outcomes of positive
controls. Conclusion: The circadian organization of patients in this study unexpectedly resembled
that of healthy controls and was better than comparison populations with
disrupted circadian organization. The study clinic implements
chronomodulated chemotherapy and a systematic, supportive integrative
treatment protocol. Results suggest a need for further research on
interventions for circadian rhythm. Although the study intervention did not
benefit the participants, this work highlights the value of supporting
circadian time structure in advanced cancer patients.
Collapse
Affiliation(s)
- Keith I Block
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
- Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
- Department of Pharmaceutical Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Charlotte Gyllenhaal
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
- Department of Pharmaceutical Sciences, University of Illinois Chicago, Chicago, IL, USA
| | | | - Penny B Block
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
| | | | - David Blask
- Tulane Cancer Center and Louisiana Cancer Research Consortium, Tulane Center for Circadian Biology, Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Justin Reynolds
- Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA
- Wellmont Cancer Institute, Bristol, TN, USA
| | | | - William Hrushesky
- Rhythmalytics, LLC, Columbia, SC, USA
- Ambulatory Monitoring, Inc., Ardsley, NY, USA
- Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
5
|
Alimoradi Z, Jafari E, Broström A, Ohayon MM, Lin CY, Griffiths MD, Blom K, Jernelöv S, Kaldo V, Pakpour AH. Effects of Cognitive Behavioral Therapy for Insomnia (CBT-I) on Quality of Life: A Systematic Review and Meta-Analysis. Sleep Med Rev 2022; 64:101646. [DOI: 10.1016/j.smrv.2022.101646] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/01/2022] [Accepted: 04/29/2022] [Indexed: 12/15/2022]
|
6
|
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]
|
7
|
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: 57] [Impact Index Per Article: 19.0] [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.
Collapse
|
8
|
Hulbert-Williams NJ, Norwood SF, Gillanders D, Finucane AM, Spiller J, Strachan J, Millington S, Kreft J, Swash B. Brief Engagement and Acceptance Coaching for Hospice Settings (the BEACHeS study): results from a Phase I study of acceptability and initial effectiveness in people with non-curative cancer. BMC Palliat Care 2021; 20:96. [PMID: 34172029 PMCID: PMC8235846 DOI: 10.1186/s12904-021-00801-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/11/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives Transitioning into palliative care is psychologically demanding for people with advanced cancer, and there is a need for acceptable and effective interventions to support this. We aimed to develop and pilot test a brief Acceptance and Commitment Therapy (ACT) based intervention to improve quality of life and distress. Methods Our mixed-method design included: (i) quantitative effectiveness testing using Single Case Experimental Design (SCED), (ii) qualitative interviews with participants, and (iii) focus groups with hospice staff. The five-session, in-person intervention was delivered to 10 participants; five completed at least 80%. Results At baseline, participants reported poor quality of life but low distress. Most experienced substantial physical health deterioration during the study. SCED analysis methods did not show conclusively significant effects, but there was some indication that outcome improvement followed changes in expected intervention processes variables. Quantitative and qualitative data together demonstrates acceptability, perceived effectiveness and safety of the intervention. Qualitative interviews and focus groups were also used to gain feedback on intervention content and to make design recommendations to maximise success of later feasibility trials. Conclusions This study adds to the growing evidence base for ACT in people with advanced cancer. A number of potential intervention mechanisms, for example a distress-buffering hypothesis, are raised by our data and these should be addressed in future research using randomised controlled trial designs. Our methodological recommendations—including recruiting non-cancer diagnoses, and earlier in the treatment trajectory—likely apply more broadly to the delivery of psychological intervention in the palliative care setting. This study was pre-registered on the Open Science Framework (Ref: 46,033) and retrospectively registered on the ISRCTN registry (Ref: ISRCTN12084782).
Collapse
Affiliation(s)
| | - Sabrina F Norwood
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | - David Gillanders
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Anne M Finucane
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK.,Marie Curie Hospice, Edinburgh, UK
| | | | | | | | - Joseph Kreft
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| | - Brooke Swash
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Chester, UK
| |
Collapse
|
9
|
Weng YP, Hong RM, Chen VCH, Tsai CJ, Yeh DC, Fang YH. Sleep Quality and Related Factors in Patients with Breast Cancer: A Cross-Sectional Study in Taiwan. Cancer Manag Res 2021; 13:4725-4733. [PMID: 34163247 PMCID: PMC8213945 DOI: 10.2147/cmar.s302966] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
Background Sleep disturbances are common and symptomatic burden in patients with breast cancer, but they are poorly documented and managed in routine clinical practice. This descriptive and cross-sectional study evaluated factors associated with post-treatment sleep disturbances in patients with breast cancer. Patients and Methods Patients with breast cancer who underwent standard treatment were enrolled and surveyed for their basic demographic data and precancerous and cancer treatment-related factors; they were also administered self-report questionnaires including the Family Adaptation, Partnership, Growth, Affection, Resolve questionnaire; Impact of Event Scale; Center for Epidemiologic Studies Depression Scale; and Maudsley Personality Inventory. Their sleep disturbances were evaluated using the Pittsburgh sleep quality index (PSQI). Independent sample t test and chi-square tests were used to compare the variables between patients with or without sleep disturbance, and multivariate logistic regression analyses were conducted to detect the independent factors. Results In total, 448 patients, including 145 with PSQI ≤ 5 and 303 with PSQI > 5, completed the investigation. Multiple logistic regression analysis revealed that significantly more patients with sleep disturbances demonstrated psychological distress, severe pain, depression, and impact of stress events than patients without sleep disturbances (adjusted odds ratios [95% confidence intervals]: 2.83 [1.135–7.067], P = 0.026; 1.14 [1.023–1.280], P = 0.018; 1.08 [1.036–1.133], P < 0.001; and 1.03 [1.002–1.051], P = 0.037, respectively). Conclusion Patients with breast cancer showed 67.6% prevalence of sleep disturbances after treatment. The patients with sleep disturbances were more likely to have previously experienced psychological disturbances, severe pain, depression within 5 years after diagnosis. After diagnosis for more than 5 years, higher distress caused by traumatic events still associated with sleep disturbances.
Collapse
Affiliation(s)
- Yi-Ping Weng
- Department of Nursing, Chia-Yi Chang Gung Memorial Hospital, Chiayi branch, Puzi City, Chiayi County, Taiwan, R.O.C.,Department of Nursing, Chia-Yi Chang Gung University of Science and Technology, Chiayi branch, Puzi City, Chiayi County, Taiwan, R.O.C
| | - Rei-Mei Hong
- Department of Nursing, Chia-Yi Chang Gung University of Science and Technology, Chiayi branch, Puzi City, Chiayi County, Taiwan, R.O.C
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Medical Foundation, Chang Gung Memorial Hospital, Chiayi branch, Puzi City, Chiayi County, Taiwan, R.O.C.,School of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | - Chia-Jui Tsai
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, R.O.C
| | - Dah-Cherng Yeh
- Breast Medical Center, Cheng Ching Hospital, Chung Kang Branch, Taichung City, Taiwan, R.O.C
| | - Yu-Hung Fang
- Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi branch, Puzi City, Chiayi County, 61363, Taiwan, R.O.C
| |
Collapse
|
10
|
Garland SN, Savard J, Dalton K, Walsh NA, Seal M, Rash J, Browne S, Urquhart R, Thoms J, Gadag V, Laing K. Rationale and protocol for a randomized waitlist controlled trial of videoconference delivered cognitive behaviour therapy for insomnia (CBT-I) to improve perceived cognitive impairment (PCI) among cancer survivors. Contemp Clin Trials 2021; 103:106322. [PMID: 33588077 DOI: 10.1016/j.cct.2021.106322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/11/2021] [Accepted: 02/06/2021] [Indexed: 01/17/2023]
Abstract
Perceived cognitive impairment (PCI) and sleep disturbances (such as insomnia) are commonly reported barriers preventing cancer survivors from resuming normal functioning. Cognitive-behaviour therapy for insomnia (CBT-I) is the treatment of choice for insomnia among cancer survivors. Literature suggests that treatment with CBT-I may lead to an improvement in PCI, but this needs to be tested in a sample of patients with PCI at study entry with cognitive impairments as the primary study outcome. Here we describe the design of a clinical trial to evaluate the efficacy of videoconference-delivered CBT-I for the improvement of PCI among cancer survivors. This project is a randomized waitlist-controlled trial with a recruitment target of 124 adult cancer survivors (solid tumors and hematological malignancies) who have completed primary treatment at least 6 months prior, report PCI and meet criteria for insomnia disorder. Participants will complete assessments at baseline, 4 weeks (mid-treatment), 8 weeks (post treatment), and 3 and 6 months post-treatment. The primary outcome is the Functional Assessment of Cancer Therapy - Cognitive Function (FACT-Cog). Treatment of PCI in cancer patients is a priority for clinicians, researchers, and patients. This research will increase our understanding of the mechanisms of cognitive impairment associated with cancer, and potentially expand currently available treatment options.
Collapse
Affiliation(s)
- Sheila N Garland
- Department of Psychology, Faculty of Science, Memorial University, Newfoundland and Labrador, Canada; Discipline of Oncology, Faculty of Medicine, Memorial University, Newfoundland and Labrador, Canada; Beatrice Hunter Cancer Research Institute, Halifax, Nova Scotia, Canada.
| | - Josée Savard
- École de psychologie, Université Laval and CHU de Québec-Université Laval Research Center, Quebec, Canada
| | - Kathryn Dalton
- Department of Psychology, Faculty of Science, Memorial University, Newfoundland and Labrador, Canada
| | - Nyissa A Walsh
- Department of Psychology, Faculty of Science, Memorial University, Newfoundland and Labrador, Canada; Beatrice Hunter Cancer Research Institute, Halifax, Nova Scotia, Canada
| | - Melanie Seal
- Discipline of Oncology, Faculty of Medicine, Memorial University, Newfoundland and Labrador, Canada
| | - Joshua Rash
- Department of Psychology, Faculty of Science, Memorial University, Newfoundland and Labrador, Canada
| | - Sondria Browne
- Department of Psychology, Faculty of Science, Memorial University, Newfoundland and Labrador, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Canada
| | - John Thoms
- Discipline of Oncology, Faculty of Medicine, Memorial University, Newfoundland and Labrador, Canada
| | - Veeresh Gadag
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Newfoundland and Labrador, Canada
| | - Kara Laing
- Discipline of Oncology, Faculty of Medicine, Memorial University, Newfoundland and Labrador, Canada
| |
Collapse
|
11
|
Atoui S, Chevance G, Romain AJ, Kingsbury C, Lachance JP, Bernard P. Daily associations between sleep and physical activity: A systematic review and meta-analysis. Sleep Med Rev 2021; 57:101426. [PMID: 33571893 DOI: 10.1016/j.smrv.2021.101426] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 02/07/2023]
Abstract
The day-to-day variations of sleep and physical activity are associated with various health outcomes in adults, and previous studies suggested a bidirectional association between these behaviors. The daily associations between sleep and physical activity have been examined in observational or interventional contexts. The primary goal of the current systematic review and meta-analysis was to summarize existing evidence about daily associations between sleep and physical activity outcomes at inter- and intra-individual level in adults. A systematic search of records in eight databases from inception to July 2019 identified 33 peer-reviewed empirical publications that examined daily sleep-physical activity association in adults. The qualitative and quantitative analyses of included studies did not support a bidirectional daily association between sleep outcomes and physical activity. Multilevel meta-analyses showed that three sleep parameters were associated with physical activity the following day: sleep quality, sleep efficiency, and wake after sleep onset. However, the associations were small, and varied in terms of direction and level of variability (e.g., inter- or intra-individual). Daytime physical activity was associated with lower total sleep time the following night at an inter-person level with a small effect size. From a clinical perspective, care providers should monitor the effects of better sleep promotion on physical activity behaviors in their patients. Future studies should examine sleep and physical activity during a longer period and perform additional sophisticated statistical analyses. SYSTEMATIC REVIEW REGISTRATION: https://osf.io/w6uy5/.
Collapse
Affiliation(s)
- Sarah Atoui
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montréal, Québec, Canada; Research Center, University Institute of Mental Health at Montreal, Montréal, Quebec, Canada
| | - Guillaume Chevance
- Center for Wireless & Population Health Systems, Department of Family Medicine and Public Health, UC San Diego, San Diego, CA 92093, USA
| | - Ahmed-Jérôme Romain
- Research Center, University Institute of Mental Health at Montreal, Montréal, Quebec, Canada; École de kinésiologie et des sciences de l'activité physique, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Célia Kingsbury
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montréal, Québec, Canada; Research Center, University Institute of Mental Health at Montreal, Montréal, Quebec, Canada
| | - Jean-Philippe Lachance
- Research Center, University Institute of Mental Health at Montreal, Montréal, Quebec, Canada
| | - Paquito Bernard
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montréal, Québec, Canada; Research Center, University Institute of Mental Health at Montreal, Montréal, Quebec, Canada.
| |
Collapse
|
12
|
Marion LP, Ivers H, Savard J. Feasibility of a Preventive Intervention for Insomnia in Women with Breast Cancer Receiving Chemotherapy. Behav Sleep Med 2021; 19:70-82. [PMID: 31873040 DOI: 10.1080/15402002.2019.1707203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective/Background: Breast cancer patients display high rates of insomnia and chemotherapy treatments appear to contribute significantly to the development of sleep disturbances among this population. The efficacy of cognitive-behavioral therapy for insomnia (CBT-I) is now well established for treating insomnia comorbid with cancer but is not widely accessible and is also fairly costly. Its capacity to prevent the onset of insomnia symptoms in cancer patients who are at a high risk of developing these difficulties remains to be demonstrated. The purpose of this study was to assess the feasibility of a brief self-administered preventive intervention of insomnia in breast cancer patients about to undergo chemotherapy. Participants/Methods: A sample of 20 women with breast cancer and with no insomnia were recruited and received the preventive intervention, taking the form of a short booklet, at their first chemotherapy treatment. One month later, a semi-structured phone interview was conducted to assess their satisfaction with different aspects of the booklet (e.g., format, content) and their adherence to the proposed strategies and to collect qualitative information. A 3-month follow-up evaluation was also conducted. Results: Patients reported a higher level of satisfaction than expected (mean score corresponding to "a lot" on the scale) and a moderate level of adherence falling only slightly under the hypothesized level. The open comments collected corroborated the good acceptability of this minimal preventive CBT-I in breast cancer patients initiating chemotherapy. Conclusions: Overall, findings of this study confirm that a self-administered preventive intervention for insomnia is feasible and a promising approach in breast cancer patients about to initiate chemotherapy.
Collapse
Affiliation(s)
- Louis-Philippe Marion
- School of Psychology, Université Laval , Québec, Canada.,CHU de Québec-Université Laval Research Center , Québec, Canada.,Université Laval Cancer Research Center , Québec, Québec, Canada
| | - Hans Ivers
- School of Psychology, Université Laval , Québec, Canada.,CHU de Québec-Université Laval Research Center , Québec, Canada.,Université Laval Cancer Research Center , Québec, Québec, Canada
| | - Josée Savard
- School of Psychology, Université Laval , Québec, Canada.,CHU de Québec-Université Laval Research Center , Québec, Canada.,Université Laval Cancer Research Center , Québec, Québec, Canada
| |
Collapse
|
13
|
Martin E, Zingarello A, Di Meglio A, Baciarello G, Matias M, Charles C, Arvis J, Dumas A, Menvielle G, Vaz-Luis I. A qualitative evaluation of the use of interventions to treat fatigue among cancer survivors: A healthcare provider's view. Eur J Cancer Care (Engl) 2020; 30:e13370. [PMID: 33191520 DOI: 10.1111/ecc.13370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cancer-related fatigue (CRF) is among the most common and distressing side effects of cancer treatment. Different types of interventions, including physical activity (PA), psychosocial and mind-body interventions, have been shown to reduce CRF. We aimed to explore HCPs' practices and barriers to refer patients towards interventions to reduce CRF. METHODS We performed a qualitative study using key informant interviews among a sample of 20 HCPs including medical, surgical and radiation oncologists, pain specialists, nurses, psychologists, psychiatrists and physiotherapists recruited from breast, prostate and colorectal cancer disease groups from a comprehensive cancer centre. RESULTS Most interviewees reported not to address CRF spontaneously during consultations. When the topic of CRF was brought up by patients, all interviewees acknowledged to recommend PA, whereas few would recommend psychosocial or mind-body interventions. Barriers to recommend interventions to manage CRF included: lack of knowledge about CRF and its treatment, lack of time and complexity of the referral due to their accessibility and cost. CONCLUSION In a diverse sample of HCPs, most acknowledged not to address CRF proactively with their patients, but identified several actionable barriers. Specific training on screening and management of CRF and improving the referral network dedicated to interventions need to be implemented.
Collapse
Affiliation(s)
- Elise Martin
- Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Anna Zingarello
- Hôpital Saint-Camille, Unité de Soins Médicaux en Oncologie (USMO), Bry-sur-Marne, France
| | - Antonio Di Meglio
- Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Giulia Baciarello
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Margarida Matias
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Cécile Charles
- Psycho-Oncology Unit, Institut Gustave Roussy, Villejuif, France
| | | | - Agnès Dumas
- Inserm Unit 1123, Unité ECEVE, Université de Paris, Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et Santé Publique (IPLESP), Paris, France
| | - Ines Vaz-Luis
- Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France.,Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| |
Collapse
|
14
|
Getu MA, Chen C, Panpan W, Mboineki JF, Dhakal K, Du R. The effect of cognitive behavioral therapy on the quality of life of breast cancer patients: a systematic review and meta-analysis of randomized controlled trials. Qual Life Res 2020; 30:367-384. [PMID: 33068239 DOI: 10.1007/s11136-020-02665-5] [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] [Accepted: 10/03/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Several lines of clinical research support the efficacy of Cognitive behavioral therapy (CBT) with a large number of population and various disease conditions, however, the true effects of CBT interventions on Quality of Life of breast cancer patients remain unknown. The aim of the study was to evaluate the effect of Cognitive Behavioral Therapy on the Quality of Life of breast cancer patients. METHODS A systematic review of articles published using Web of Science (1950-January 2020); Medline via EBSCO (1992-January 2020); Science direct via ELSEVIER (1996-January 2020); SCOPUS (2004-January 2020); and PubMed (1946-January 2020 excluding Medline from 1992-January 2020) were included. Additional studies were included after checking reference lists of all relevant studies; searching ongoing trials and research registers and manual search. Data extraction was conducted by two independent authors and a third independent author checked the data extraction. The PRISMA statement was adopted. RESULT Eleven Randomized controlled trials (RCT) with 1690 breast cancer patients were included in this review. The overall effect size of cognitive behavioral therapy on QoL of breast cancer patients was medium 0.39 (95% CI 0.12-0.66, P < 0.00001, I2 = 83%). Five studies had shown statistically significant improvement in functional and symptoms scales in the treatment group than the control group. CONCLUSION CBT is effective in improving the Quality of Life of breast cancer patients. In future research, further randomized controlled trials with adequate randomization, allocation concealment, and appropriate blinding may be needed.
Collapse
Affiliation(s)
- Mikiyas Amare Getu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China.
| | - Changying Chen
- The First Affiliated Teaching Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wang Panpan
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | | | - Kamala Dhakal
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Ruofei Du
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
15
|
Savard J, Ivers H, Morin CM, Lacroix G. Video cognitive-behavioral therapy for insomnia in cancer patients: A cost-effective alternative. Psychooncology 2020; 30:44-51. [PMID: 32840955 DOI: 10.1002/pon.5532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Despite its high prevalence, cancer-related insomnia typically remains untreated because of a lack of access to cognitive-behavioral therapy for insomnia (CBT-I), the treatment of choice for this condition. While face-to-face CBT-I appears to be optimal in terms of efficacy, self-administered formats may be more cost-effective. The goal of this secondary analysis of a randomized clinical trial was to compare the cost-effectiveness of a professionally-based CBT-I (PCBT-I) to that of a video-based CBT-I (VCBT-I). METHODS A total of 161 women with breast cancer received six weekly, individual CBT-I sessions (PCBT-I; n = 81) or a 60-minutes animated video +6 short booklets (VCBT-I; n = 80). Participants completed the Insomnia Severity Index (ISI) and provided information to calculate treatment costs. RESULTS Total per patient treatment costs were 5.5 times greater for PCBT-I ($1298.90) than VCBT-I ($234.36; P < .0001). Both at posttreatment and 3-month follow-up, the ISI reduction was greater in PCBT-I than VCBT-I, but these differences were not significant (P = .09 and P = .24, respectively). In contrast, the cost-effectiveness ratio was significantly more advantageous for VCBT-I than PCBT-I. Compared to VCBT-I, each reduction of 1 unit on the ISI produced by PCBT-I was associated with a treatment cost that was significantly greater at posttreatment ($186.95 CAD vs $44.87 CAD; P = .001) and follow-up ($154.76 vs $24.97, P = .005). CONCLUSIONS Although CBT-I is slightly less efficacious when self-administered, it constitutes a much more cost-effective alternative than face-to-face CBT-I and represents an extremely valuable option in settings where monetary and human resources required to administer CBT-I are not available or sufficient.
Collapse
Affiliation(s)
- Josée Savard
- School of Psychology, Université Laval, Quebec City, Quebec, Canada.,CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada.,Université Laval Cancer Research Center, Quebec City, Quebec, Canada
| | - Hans Ivers
- School of Psychology, Université Laval, Quebec City, Quebec, Canada.,CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada.,Université Laval Cancer Research Center, Quebec City, Quebec, Canada
| | - Charles M Morin
- School of Psychology, Université Laval, Quebec City, Quebec, Canada.,CERVO Brain Research Centre, Quebec City, Quebec, Canada
| | - Guy Lacroix
- Department of Economics, Université Laval, Quebec City, Quebec, Canada
| |
Collapse
|
16
|
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: 20] [Impact Index Per Article: 5.0] [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.
Collapse
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
| |
Collapse
|
17
|
Youn S, Kim C, Lee J, Yeo S, Suh S, Chung S. Development of Dysfunctional Beliefs and Attitude about Sleep Scale for Cancer Patients. Behav Sleep Med 2020; 18:287-297. [PMID: 30789064 DOI: 10.1080/15402002.2019.1578773] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Study objectives: This study aimed to develop a scale utilizing the original Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale that measured maladaptive cognitions associated with sleep that is especially sensitive to cancer patients. In addition to the original scale, we added two additional items that reflected cancer-specific dysfunctional beliefs about sleep. Methods: Participants consisted of 337 cancer patients (mean age 54.0 ± 11.8 years, 32.0% men). All participants completed the DBAS-16, two cancer specific items, and the Insomnia Severity Index. Item-to-total-score correlations, internal consistency, item selection, and factor structure were examined. Results: The DBAS-16 was found to be reliable, and internal consistency was also adequate when adding two cancer-specific questions (Cronbach's alpha = 0.89). A total of 14 items were selected, and a four-factor model was selected using exploratory factor analysis (Tucker-Lewis index = 0.86, root mean square error of approximation = 0.08). The four factors were (a) sleep expectations, (b) worry about insomnia, (c) perceived consequences of insomnia and medication, and (d) two cancer-related items. The modified 14 items of the Cancer-related DBAS (C-DBAS-14) well differentiated cancer patients with and without insomnia. Conclusions: The C-DBAS-14 is a promising measure that has adequate internal consistency. It is also sensitive to sleep-related cognitions in cancer patients and can discriminate patients with cancer who are experiencing insomnia from those who are good sleepers. The enhanced utility of the shortened 14-item scale tailored specifically to cancer patients may be useful in both clinical practice and research settings.Abbreviations: CBT: cognitive behavioral therapy; C-DBAS-14: Cancer-Related Dysfunctional Beliefs and Attitude about Sleep; C-DBS: Cancer-Related Dysfunctional Beliefs about Sleep; DBAS-16: Dysfunctional Beliefs and Attitudes about Sleep; ISI: Insomnia Severity Index.
Collapse
Affiliation(s)
- Soyoung Youn
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Changnam Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joohee Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungook Yeo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
18
|
Jung HJ, Yu ES, Kim JH. Combined Program of Cognitive-Behavioral Therapy for Insomnia and Medication Tapering in Cancer Patients: A Clinic-Based Pilot Study. Behav Sleep Med 2020; 18:386-395. [PMID: 30966825 DOI: 10.1080/15402002.2019.1597718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: This preliminary study aimed to evaluate the efficacy of a combined program of group-based cognitive-behavioral therapy for insomnia (CBT-I) and medication tapering for reducing hypnotic use in cancer patients and to identify predictors of medication continuation. Participants: This study has a retrospective design and uses archival data from patient's medical records. Forty cancer patients with chronic insomnia received clinic- and group-based CBT-I alongside a medication tapering program. Methods: Clinical outcomes were collected from 32 patients who completed a six-week program, via their medical records. Medication dosages, Insomnia Severity Index scores, scores on the Korean version of the 16-item Dysfunctional Beliefs and Attitudes About Sleep scale, Symptom Checklist-90-Revised inventory scores, and sleep efficiency were measured pre- and posttreatment and at a follow-up after one month. Results: At posttreatment, 68.8% of patients were drug-free and 25.0% were taking hypnotic medication at a reduced dosage or frequency. Patients who were undergoing anticancer treatment were more likely to discontinue hypnotic use than patients who were off the anticancer treatment. Overall relapse rate for sleep medication at the one-month follow-up was 4.5%. Having more somatic symptoms at baseline was a significant predictor for continuing medication after CBT-I. Conclusions: The preliminary results imply that the combined program of group-based CBT-I and medication tapering may be helpful to reduce hypnotics in cancer patients with insomnia in a clinical setting. Along with combined treatment methods, future studies could explore the effects of added treatments for the reduction of physical pain on the prevention of chronic hypnotic use.
Collapse
Affiliation(s)
- Ho-Jun Jung
- Center for Tobacco Control, National Cancer Center, Gyeonggi-do, Republic of Korea
| | - Eun-Seung Yu
- Mental Health Clinic, National Cancer Center, Gyeonggi-do, Republic of Korea
| | - Jong-Heun Kim
- Mental Health Clinic, National Cancer Center, Gyeonggi-do, Republic of Korea
| |
Collapse
|
19
|
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.
Collapse
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
| | | |
Collapse
|
20
|
Hulbert-Williams NJ, Norwood S, Gillanders D, Finucane A, Spiller J, Strachan J, Millington S, Swash B. Brief Engagement and Acceptance Coaching for Community and Hospice Settings (the BEACHeS Study): Protocol for the development and pilot testing of an evidence-based psychological intervention to enhance wellbeing and aid transition into palliative care. Pilot Feasibility Stud 2019; 5:104. [PMID: 31452926 PMCID: PMC6702709 DOI: 10.1186/s40814-019-0488-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Cancer affects millions of individuals globally, with a mortality rate of over eight million people annually. Although palliative care is often provided outside of specialist services, many people require, at some point in their illness journey, support from specialist palliative care services, for example, those provided in hospice settings. This transition can be a time of uncertainty and fear, and there is a need for effective interventions to meet the psychological and supportive care needs of people with cancer that cannot be cured. Whilst Acceptance and Commitment Therapy (ACT) has been shown to be effective across diverse health problems, robust evidence for its effectiveness in palliative cancer populations is not extensive. Method This mixed-methods study uses a single-case experimental design with embedded qualitative interviews to pilot test a novel intervention for this patient group. Between 14 and 20 patients will be recruited from two hospices in England and Scotland. Participants will receive five face-to-face manualised sessions with a psychological therapist. Sessions are structured around teaching core ACT skills (openness, awareness and engagement) as a way to deal effectively with challenges of transition into specialist palliative care services. Outcome measures include cancer-specific quality of life (primary outcome) and distress (secondary outcome), which are assessed alongside measures of psychological flexibility. Daily diary outcome assessments will be taken for key measures, alongside more detailed weekly self-report, through baseline, intervention and 1-month follow-up phases. After follow-up, participants will be invited to take part in a qualitative interview to understand their experience of taking part and acceptability and perceived effectiveness of the intervention and its components. Discussion This study is the first investigation of using ACT with terminally ill patients at the beginning of their transition into palliative treatment. Using in-depth single-case approaches, we will refine and manualise intervention content by the close of the study for use in follow-up research trials. Our long-term goal is then to test the intervention as delivered by non-psychologist specialist palliative care practitioners thus broadening the potential relevance of the approach. Trial registration Open Science Framework, 46033. Registered 19 April 2018.
Collapse
Affiliation(s)
- Nicholas J Hulbert-Williams
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| | - Sabrina Norwood
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| | - David Gillanders
- 2School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Sue Millington
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| | - Brooke Swash
- 1Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ UK
| |
Collapse
|
21
|
Liou KT, Ahles TA, Garland SN, Li QS, Bao T, Li Y, Root JC, Mao JJ. The Relationship Between Insomnia and Cognitive Impairment in Breast Cancer Survivors. JNCI Cancer Spectr 2019; 3:pkz041. [PMID: 31355357 PMCID: PMC6640530 DOI: 10.1093/jncics/pkz041] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/17/2019] [Accepted: 05/31/2019] [Indexed: 11/14/2022] Open
Abstract
Background Cancer-related cognitive impairment is an emerging public health burden. Growing research suggests that sleep disturbances contribute to poor cognition. Our study aimed to evaluate the association between insomnia and cognitive impairment in breast cancer survivors. Methods We analyzed cross-sectional data from a cohort study of postmenopausal women with stage 0–III hormone receptor-positive breast cancer on aromatase inhibitor therapy. The study was conducted between November 2011 and April 2015 at an academic cancer center (Philadelphia, PA). Insomnia was assessed with the Insomnia Severity Index. Perceived cognitive impairment was assessed with the cognitive subscale of the Breast Cancer Prevention Trial Symptom Checklist. We used linear regression to evaluate the association between insomnia and perceived cognitive impairment. Results Among 1072 patients, 556 (51.9%) reported insomnia and 847 (79.0%) were bothered by cognitive symptoms (forgetfulness, difficulty concentrating, distractibility). Greater perceived cognitive impairment was reported by patients with mild insomnia (regression coefficient [β] = 0.35, 95% confidence interval [CI] = 0.23 to 0.46, P < .001), moderate insomnia (β = 0.51, 95% CI = 0.36 to 0.65, P < .001), and severe insomnia (β = 0.94, 95% CI = 0.67 to 1.21, P < .001), compared with those without insomnia. Greater perceived cognitive impairment was also associated with patients younger than 55 years (β = 0.30, 95% CI = 0.15 to 0.45, P < .001), taxane-based chemotherapy (β = 0.11, 95% CI = 0.004 to 0.22, P = .04), anxiety (β = 0.47, 95% CI = 0.30 to 0.64, P < .001), and depression (β = 0.65, 95% CI = 0.35 to 0.94, P < .001). Conclusions Among postmenopausal breast cancer survivors receiving aromatase inhibitor therapy, insomnia and cognitive impairment are prevalent and characterized by a graded association, in which severity of perceived cognitive impairment increases as insomnia severity increases. Our findings warrant further research to determine whether addressing sleep is a strategy to improve management of cancer-related cognitive impairment.
Collapse
Affiliation(s)
- Kevin T Liou
- Integrative Medicine Service
- Correspondence to: Jun J. Mao, MD, MSCE, Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Ave, New York, NY 10021 (e-mail: )
| | - Tim A Ahles
- Department of Psychiatry and Behavioral Sciences
| | - Sheila N Garland
- Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | | | - Ting Bao
- Integrative Medicine Service
- Breast Medicine Service
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences
- Department of Epidemiology and Biostatistics
| | - James C Root
- Department of Psychiatry and Behavioral Sciences
| | | |
Collapse
|
22
|
McCrae CS, Curtis AF, Williams JM, Dautovich ND, McNamara JPH, Stripling A, Dzierzewski JM, Chan WS, Berry RB, McCoy KJM, Marsiske M. Efficacy of brief behavioral treatment for insomnia in older adults: examination of sleep, mood, and cognitive outcomes. Sleep Med 2018; 51:153-166. [PMID: 30195661 PMCID: PMC6513321 DOI: 10.1016/j.sleep.2018.05.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of the present study was to examine the effects of a brief behavioral intervention for insomnia (BBTi) on sleep parameters, mood, and cognitive functioning in older adults. METHODS Older adults (aged 65 years or more) underwent four weekly sessions of BBTi or self-monitoring control (SMC). Participants completed 14 days of sleep diaries and actigraphy measuring sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE), and sleep quality ratings at baseline, post-treatment, and three month follow-up. Participants also completed mood scales (Geriatric Depression Scale [GDS]; Beck Depression Inventory-II; and State Trait Anxiety Inventory) and neuropsychological testing (measuring global cognition, language, memory, attention and processing speed, and executive function) at the three timepoints. RESULTS Significant condition (BBTi vs. SMC) x time (baseline vs. post-treatment vs. follow-up) interactions revealed that BBTi improved relative to baseline in sleep diary-reported SOL, WASO, SE, and sleep quality, and these improvements were maintained at follow-up. SMC showed no change in these measures. A main effect of time showed that actigraphy-measured WASO improved from baseline for both BBTi and SMC at post-treatment. A main effect of time revealed that both BBTi and SMC patients endorsed fewer GDS symptoms relative to baseline at post-treatment and follow-up. We observed no change in performance on neuropsychological measures. CONCLUSIONS A four-week BBTi is an efficacious intervention for reducing insomnia symptoms in older adults. BBTi does not selectively improve mood or cognitive functioning. Future work should examine effects of BBTi on physiological measures of sleep architecture and day-to-day cognition. CLINICAL TRIAL IDENTIFER NCT02967185.
Collapse
Affiliation(s)
- Christina S McCrae
- Department of Psychiatry, University of Missouri-Columbia, Columbia, MO, USA.
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri-Columbia, Columbia, MO, USA
| | | | | | | | - Ashley Stripling
- College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | - Wai Sze Chan
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Richard B Berry
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Karin J M McCoy
- Neuropsychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| |
Collapse
|
23
|
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]
|
24
|
Feasibility of a Cognitive-Behavioral and Environmental Intervention for Sleep-Wake Difficulties in Community-Dwelling Cancer Patients Receiving Palliative Care. Cancer Nurs 2018; 42:396-409. [PMID: 29762213 DOI: 10.1097/ncc.0000000000000603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND High rates of sleep-wake difficulties have been found in patients with cancer receiving palliative care. Pharmacotherapy is the most frequently used treatment option to manage these difficulties despite numerous adverse effects and the absence of empirical evidence of its efficacy and innocuity in palliative care. OBJECTIVE This pilot study aimed to assess the feasibility and acceptability of a cognitive-behavioral and environmental intervention (CBT-E) to improve insomnia and hypersomnolence in patients with a poor functioning level and to collect preliminary data on its effects. METHODS Six patients with cancer receiving palliative care (Eastern Cooperative Oncology Group score 2-3), who had insomnia and/or hypersomnolence, received 1 CBT-E individual session at home. They applied the strategies for 3 weeks. Patients completed the Insomnia Severity Index, the Epworth Sleepiness Scale, a daily sleep diary, and a 24-hour actigraphic recording (7 days) at pretreatment and posttreatment, in addition to a semistructured interview (posttreatment). RESULTS Participants found strategies easy to apply most of the time, and none was rated as impossible to use because of their health condition. However, their adherence and satisfaction toward CBT-E were highly variable. Results on the effects of CBT-E were heterogeneous, but improvements were observed in patients with a persistent insomnia disorder. CONCLUSIONS The CBT-E protocol tested among this highly selected sample was fairly well received and suggested positive outcomes in some patients, particularly those with an insomnia complaint alone. IMPLICATIONS Efforts should be pursued to adapt CBT-E and develop other nonpharmacological interventions, in order to provide an alternative to pharmacotherapy for sleep-wake difficulties in this population.
Collapse
|
25
|
Savard J, Savard MH, Ivers H. Moderators of Treatment Effects of a Video-Based Cognitive-Behavioral Therapy for Insomnia Comorbid With Cancer. Behav Sleep Med 2018; 16:294-309. [PMID: 27494528 DOI: 10.1080/15402002.2016.1210148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the moderating role of demographic and clinical variables on the efficacy of a video-based cognitive behavioral therapy for insomnia (VCBT-I) among breast cancer patients. PATIENTS AND METHODS As part of a randomized controlled trial, 80 women received VCBT-I. RESULTS Patients with a more advanced breast cancer were less likely to show reductions on the Insomnia Severity Index (ISI) and increased sleep efficiency at posttreatment. Patients using an antidepressant medication showed a larger reduction of ISI scores and a higher rate of insomnia remission. Remission of insomnia was also significantly more likely in individuals with a higher annual income. When using a multivariate binary classification tree analysis, the best and unique predictor of insomnia remission was having a less severe baseline ISI score. CONCLUSION Although efficacious in general, VCBT-I does not appear to be an optimal format for everybody.
Collapse
Affiliation(s)
- Josée Savard
- a School of Psychology, Université Laval , Québec , Canada.,b CHU de Québec-Université Laval Research Center , Québec , Canada.,c Université Laval Cancer Research Centre, Québec , Québec , Canada
| | - Marie-Hélène Savard
- b CHU de Québec-Université Laval Research Center , Québec , Canada.,c Université Laval Cancer Research Centre, Québec , Québec , Canada
| | - Hans Ivers
- a School of Psychology, Université Laval , Québec , Canada.,b CHU de Québec-Université Laval Research Center , Québec , Canada.,c Université Laval Cancer Research Centre, Québec , Québec , Canada
| |
Collapse
|
26
|
Taylor DJ, Peterson AL, Pruiksma KE, Hale WJ, Young-McCaughan S, Wilkerson A, Nicholson K, Litz BT, Dondanville KA, Roache JD, Borah EV, Brundige A, Mintz J. Impact of cognitive behavioral therapy for insomnia disorder on sleep and comorbid symptoms in military personnel: a randomized clinical trial. Sleep 2018; 41:4956251. [DOI: 10.1093/sleep/zsy069] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, TX
| | - Alan L Peterson
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX
| | - Kristi E Pruiksma
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Willie J Hale
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX
- Department of Psychology, University of Texas at San Antonio, San Antonio, TX
| | - Stacey Young-McCaughan
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Allison Wilkerson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Karin Nicholson
- Department of Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX
| | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Katherine A Dondanville
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - John D Roache
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Elisa V Borah
- Department of Psychology, University of North Texas, Denton, TX
| | - Antoinette Brundige
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jim Mintz
- Department of Psychiatry, University of Texas Health Science Center at San Antonio, San Antonio, TX
- Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | | |
Collapse
|
27
|
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]
|
28
|
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
|
29
|
Zeichner SB, Zeichner RL, Gogineni K, Shatil S, Ioachimescu O. Cognitive Behavioral Therapy for Insomnia, Mindfulness, and Yoga in Patients With Breast Cancer with Sleep Disturbance: A Literature Review. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2017; 11:1178223417745564. [PMID: 29434470 PMCID: PMC5802619 DOI: 10.1177/1178223417745564] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/23/2017] [Indexed: 11/16/2022]
Abstract
The number of patients with breast cancer diagnosed with sleep disturbance has grown substantially within the United States over the past 20 years. Meanwhile, there have been significant improvements in the psychological treatment of sleep disturbance in patients with breast cancer. More specifically, cognitive behavioral therapy for insomnia (CBT-I), mindfulness, and yoga have shown to be 3 promising treatments with varying degrees of benefit, supporting data, and inherent limitations. In this article, we will outline the treatment approach for sleep disturbance in patients with breast cancer and conduct a comprehensive review of CBT-I, mindfulness, and yoga as they pertain to this patient population.
Collapse
Affiliation(s)
- Simon B Zeichner
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Rachel L Zeichner
- Sleep Medicine Center, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA.,Atlanta VA Clinic, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA
| | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Sharon Shatil
- Sleep Medicine Center, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA
| | - Octavian Ioachimescu
- Sleep Medicine Center, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| |
Collapse
|
30
|
do Carmo TM, Paiva BSR, de Oliveira CZ, Nascimento MSDA, Paiva CE. The feasibility and benefit of a brief psychosocial intervention in addition to early palliative care in patients with advanced cancer to reduce depressive symptoms: a pilot randomized controlled clinical trial. BMC Cancer 2017; 17:564. [PMID: 28836960 PMCID: PMC5569457 DOI: 10.1186/s12885-017-3560-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 08/17/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the feasibility and potential benefit of a brief psychosocial intervention based on cognitive-behavioral therapy performed in addition to early palliative care (PC) in the reduction of depressive symptoms among patients with advanced cancer. METHODS An open-label randomized phase II clinical trial with two intervention arms and one control group. Patients with advanced cancer starting palliative chemotherapy and who met the selection criteria were included. The participants were randomly allocated to three arms: arm A, five weekly sessions of psychosocial intervention combined with early PC; arm B, early PC only; and arm C, standard cancer treatment. Feasibility was investigated by calculating rates (%) of inclusion, attrition, and contamination (% of patients from Arm C that received PC). Scores of depression (primary aim), anxiety, and quality of life were measured at baseline and 45, 90, 120, and 180 days after randomization. RESULTS From the total of 613 screened patients (10.3% inclusion rate), 19, 22, and 22 patients were allocated to arms A, B, and C, respectively. Contamination and attrition rates (180 days) were 31.8% and 38.0%, respectively. No interaction between the arms and treatments were found. Regarding effect sizes, there was a moderate benefit in arm A over arms B and C in emotional functioning (-0.66 and -0.61, respectively) but a negative effect of arm A over arm C in depression (-0.74). CONCLUSIONS Future studies to be conducted with this population group need to revise the eligibility criteria and make them less restrictive. In addition, the need for arm C is questioned due to high contamination rate. The designed psychosocial intervention was not able to reduce depressive symptoms when combined with early PC. Further studies are warrant to evaluate the intervention on-demand and in subgroups of high risk of anxiety/depression. TRIAL REGISTRATION Clinical Trials identifier NCT02133274 . Registered May 6, 2014.
Collapse
Affiliation(s)
| | - Bianca Sakamoto Ribeiro Paiva
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, SP, Brazil.,Center for Research Support (NAP), Barretos Cancer Hospital, Barretos, SP, Brazil
| | | | | | - Carlos Eduardo Paiva
- Health-Related Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, SP, Brazil. .,Center for Research Support (NAP), Barretos Cancer Hospital, Barretos, SP, Brazil. .,Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, SP, Brazil. .,Departamento de Oncologia Clínica, Divisão de Mama e Ginecologia, Rua Antenor Duarte Vilella, 1331, Bairro Dr Paulo Prata, Barretos, SP, CEP: 14784-400, Brazil.
| |
Collapse
|
31
|
Cognitive-Behavioral Therapy for Insomnia in Cancer Patients: An Update of Efficacy Evidence and Areas for Future Research. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0067-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
32
|
Peoples AR, Garland SN, Perlis ML, Savard J, Heckler CE, Kamen CS, Ryan JL, Mustian KM, Janelsins MC, Peppone LJ, Morrow GR, Roscoe JA. Effects of cognitive behavioral therapy for insomnia and armodafinil on quality of life in cancer survivors: a randomized placebo-controlled trial. J Cancer Surviv 2017; 11:401-409. [PMID: 28105576 DOI: 10.1007/s11764-017-0597-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 01/04/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer-related insomnia is associated with diminished quality of life (QOL), suggesting that improvement in insomnia may improve QOL in cancer survivors. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to improve insomnia, but less is known regarding its effect on QOL and whether improvement in insomnia corresponds to improved QOL. The present analysis examines the effects of CBT-I, with and without armodafinil, on QOL both directly and indirectly through improvements of insomnia. METHODS This is an analysis of 95 cancer survivors for a specified secondary aim of a four-arm randomized controlled trial assessing the combined and individual effects of CBT-I and armodafinil to improve insomnia. QOL and insomnia severity were assessed before, during the intervention, at post-intervention, and 3 months later by Functional Assessment of Cancer Therapy-General and Insomnia Severity Index, respectively. RESULTS Mean change in QOL from pre- to post-intervention for CBT-I + placebo, CBT-I + armodafinil, armodafinil, and placebo was 9.6 (SE = 1.8; p < 0.0001), 11.6 (SE = 1.8; p < 0.0001), -0.2 (SE = 3.2; p = 0.964), and 3.3 (SE = 2.0; p = 0.124), respectively. ANCOVA controlling for pre-intervention scores showed that participants receiving CBT-I had significantly improved QOL at post-intervention compared to those not receiving CBT-I (p < 0.0001, effect size = 0.57), with benefits being maintained at the 3-month follow-up. Path analysis revealed that this improvement in QOL was due to improvement in insomnia severity (p = 0.002), and Pearson correlations showed that changes in QOL from pre- to post-intervention were significantly associated with concurrent changes in insomnia severity (r = -0.56; p < 0.0001). Armodafinil had no effect on QOL for those who did or did not receive it (p = 0.976; effect size = -0.004). CONCLUSION In cancer survivors with insomnia, CBT-I resulted in clinically significant improvement in QOL via improvement in insomnia. This improvement in QOL remained stable even 3 months after completing CBT-I. IMPLICATIONS FOR CANCER SURVIVORS Considering the high prevalence of insomnia and its detrimental impact on QOL in cancer survivors and the effectiveness of CBT-I in alleviating insomnia, it is important that evidence-based non-pharmacological sleep interventions such as CBT-I be provided as an integral part of cancer care.
Collapse
Affiliation(s)
- Anita R Peoples
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642-0658, USA.
| | - Sheila N Garland
- Departments of Psychology and Oncology, Memorial University, Newfoundland, Canada
| | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA, 19104, USA
| | - Josée Savard
- School of Psychology, Laval University, Quebec City, QC, Canada
| | - Charles E Heckler
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642-0658, USA
| | - Charles S Kamen
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642-0658, USA
| | - Julie L Ryan
- Department of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Karen M Mustian
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642-0658, USA
| | - Michelle C Janelsins
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642-0658, USA
| | - Luke J Peppone
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642-0658, USA
| | - Gary R Morrow
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642-0658, USA
| | - Joseph A Roscoe
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642-0658, USA
| |
Collapse
|
33
|
Cognitive-behavior therapy singly and combined with medication for persistent insomnia: Impact on psychological and daytime functioning. Behav Res Ther 2016; 87:109-116. [PMID: 27658218 DOI: 10.1016/j.brat.2016.09.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 11/20/2022]
Abstract
While impairment of daytime functioning due to poor sleep is often the main determinant for seeking treatment, few studies have examined the clinical impact of insomnia therapies on daytime outcomes. The main objective of this study was to evaluate the impact of cognitive-behavior therapy (CBT), alone and combined with medication, on various indices of daytime and psychological functioning. Participants were 160 individuals with chronic insomnia who received CBT alone or CBT plus medication (zolpidem) for an initial six-week therapy, followed by an extended six-month therapy. Participants treated with CBT initially received maintenance CBT or no additional treatment and those treated with combined therapy initially continued with CBT plus intermittent medication (prn) or CBT without medication (taper). Measures of anxiety and depressive symptoms, fatigue, quality of life, and perceived impact of sleep difficulties on various indices of daytime functioning were completed at baseline, after each treatment stage, and at six-month follow-up. Following acute treatment, significant improvements of fatigue, quality of life (mental component), anxiety, and depression were obtained in the CBT alone condition but not in the combined CBT plus medication condition. Following extended treatment, further improvements were noted for the subgroup receiving extended CBT relative to that with no additional treatment, and for the subgroup receiving CBT and intermittent medication relative to that with CBT but no medication. Improvements were well maintained at the 6-month follow-up. These findings indicate that insomnia-specific therapy is effective at improving daytime and psychological functioning in the short term, and that maintenance therapy produces an added value to optimize long-term outcomes. TRIAL REGISTRATION www.clinicaltrials.gov (#NCT 00042146).
Collapse
|
34
|
Aricò D, Raggi A, Ferri R. Cognitive Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Review of the Literature. Front Psychol 2016; 7:1162. [PMID: 27536265 PMCID: PMC4971442 DOI: 10.3389/fpsyg.2016.01162] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/20/2016] [Indexed: 12/16/2022] Open
Abstract
Background: Insomnia is a common sleep disorder in patients with breast cancer and studies show a higher frequency than in the general population but it appears to be understudied and the treatment seems to be a neglected problem. There is a growing body of evidence about the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in breast cancer survivors (BCS). The aim of this review is to examine the best available scientific evidence related to CBT-I and insomnia in patients with breast cancer and to assess the effect of CBT-I on their psychosocial functioning, sleep, quality of life, and mood. Methods: Empirical articles published in peer-reviewed journals from the earliest reports available until August 2015 were considered. The research on PubMed generated 18 papers, three of which did not meet the inclusion criteria. Another paper was retrieved by screening the reference list of the previously selected papers. Results: A total of 16 studies were found that evaluated the effects of CBT-I in breast cancer patients. CBT-I appears to be an effective therapy for insomnia in BCS, improving mood, general and physical fatigue, and global and cognitive dimensions of quality of life. CBT-I may also reduce menopausal symptoms, such as hot flushes and night sweat problems, frequency of medicated nights, level of depression, and anxiety. Conclusions: CBT-I seems to be an eligible intervention for improving sleep in BCS. Improvements concerning insomnia and sleep quality are durable (usually up to 12 months) and statistically significant.
Collapse
Affiliation(s)
- Debora Aricò
- Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging Troina, Italy
| | - Alberto Raggi
- Unit of Neurology, G. B. Morgagni- L. Pierantoni Hospital Forlì, Italy
| | - Raffaele Ferri
- Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging Troina, Italy
| |
Collapse
|
35
|
Absolon N, Balneaves L, Truant T, Cashman R, Wong M, Hamm J, Witmans M. A Self-Administered Sleep Intervention for Patients With Cancer Experiencing Insomnia. Clin J Oncol Nurs 2016; 20:289-97. [DOI: 10.1188/16.cjon.289-297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
36
|
Savard J, Ivers H, Savard MH, Morin CM. Long-Term Effects of Two Formats of Cognitive Behavioral Therapy for Insomnia Comorbid with Breast Cancer. Sleep 2016; 39:813-23. [PMID: 26715229 DOI: 10.5665/sleep.5634] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/26/2015] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES The goal of this randomized controlled trial, conducted in breast cancer patients, was to assess the long-term efficacy of a video-based cognitive behavioral therapy for insomnia (VCBT-I), as compared to a professionally administered intervention (PCBT-I) and to a no-treatment group (CTL). An earlier report revealed that, at posttreatment, VCBT-I patients showed significantly greater sleep improvements than CTL, but that PCBT-I produced superior effects than VCBT-I on some sleep and secondary outcomes. In this report, long-term effects are compared. METHODS Two hundred forty-two women with breast cancer and with insomnia symptoms or using hypnotic medications participated to this three-arm randomized controlled trial: (1) PCBT-I (n = 81); (2) VCBT-I (n = 80); or (3) no treatment (CTL; n = 81) group. PCBT-I was composed of six weekly, individual sessions of approximately 50 min, whereas VCBT-I comprised a 60-min animated video and six booklets. RESULTS Study measures (sleep and secondary variables) were administered at pretreatment and posttreatment, and at a 3-, 6-, and 12-mo follow-up. Treatment gains were well sustained at follow-up in both PCBT-I and VCBT-I. As at posttreatment, the remission rate of insomnia at follow-up was greater in PCBT-I than in VCBT-I, which was greater than in CTL. CONCLUSIONS Although face-to-face therapy remains the optimal format to efficaciously administer CBT for insomnia in cancer patients, a minimal intervention, such as the video-based intervention tested in this study, produces significant and sustainable treatment effects. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier NCT00674830.
Collapse
Affiliation(s)
- Josée Savard
- School of Psychology, Université Laval, Québec, Québec, Canada.,CHU de Québec-Université Laval Research Center, Québec, Québec, Canada.,Université Laval Cancer Research Center, Québec, Québec, Canada
| | - Hans Ivers
- School of Psychology, Université Laval, Québec, Québec, Canada.,CHU de Québec-Université Laval Research Center, Québec, Québec, Canada.,Université Laval Cancer Research Center, Québec, Québec, Canada
| | - Marie-Hélène Savard
- CHU de Québec-Université Laval Research Center, Québec, Québec, Canada.,Université Laval Cancer Research Center, Québec, Québec, Canada
| | - Charles M Morin
- School of Psychology, Université Laval, Québec, Québec, Canada
| |
Collapse
|
37
|
Abstract
Insomnia most commonly presents comorbidly in association with medical and psychiatric disorders. Comorbid insomnia, however, remains under treated in the majority of patients. Concerns about drug interactions, adverse events, and dependence as well as the assumption that treating the insomnia as a secondary presentation that will resolve when the primary condition improves are all factors that contribute to the under treatment of comorbid insomnia. This article presents the growing research evidence that highlights the benefits and importance of targeting the insomnia that presents comorbidly with medical and psychiatric conditions utilizing the nonpharmacological and effective treatment of cognitive behavior therapy.
Collapse
Affiliation(s)
- Suma P Chand
- Department of Neurology and Psychiatry, Saint Louis University School of Medicine, Grand Blvd, St. Louis, MO, USA
| |
Collapse
|
38
|
Zhou ES, Partridge AH, Recklitis CJ. A pilot trial of brief group cognitive-behavioral treatment for insomnia in an adult cancer survivorship program. Psychooncology 2016; 26:843-848. [PMID: 26872123 DOI: 10.1002/pon.4096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/17/2015] [Accepted: 01/18/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy for insomnia (CBT-Insomnia) is effective, yet rarely available for cancer survivors. This is unfortunate because survivors are at elevated risk for insomnia, which is associated with significant health consequences in this already at-risk population. Barriers to delivering CBT-Insomnia in oncology settings include a lack of trained providers, distance to cancer centers, and treatment duration. PURPOSE To address insomnia treatment barriers, we adapted standard CBT-Insomnia treatment and evaluated a pilot group-based approach for feasibility and efficacy in an adult cancer survivorship program. METHODS Thirty-eight cancer survivors (mean age = 52.2 years) enrolled in our three-session program delivered over 1 month. They were primarily diagnosed with breast cancer (58.6%) and were an average of 6.0 years post-diagnosis and 3.6 years post-treatment. Participants completed sleep logs throughout the study and measures of sleep at baseline and week 4. RESULTS Participants reported experiencing insomnia symptoms an average of 2.4 years, with 89.7% indicating that the cancer experience had caused/exacerbated symptoms. Significant pre/post-intervention group improvements in sleep efficiency (77.3% to 88.5%), sleep quality, and insomnia symptoms were reported (all ps < .01). Less than 1 in 3 had discussed insomnia symptoms with their oncology providers in the prior year. CONCLUSIONS Pilot data indicate that a brief, group-based CBT-Insomnia intervention in a survivorship setting is both feasible and efficacious. There is a need to increase awareness about insomnia and its treatment among both cancer survivors and oncology providers. If validated in future studies, this novel approach can improve cancer survivors' access to much needed insomnia treatment. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Eric S Zhou
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
39
|
McCrae CS, Roth AJ, Ford J, Crew EC, Conti JB, Berry RB, Sears SF. Sleep, Psychosocial Functioning, and Device-Specific Adjustment in Patients with Implantable Cardioverter Defibrillators (ICDs). Behav Sleep Med 2016; 14:49-66. [PMID: 25174823 PMCID: PMC4345140 DOI: 10.1080/15402002.2014.941064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Rates of sleep disorders and associated adjustment were examined in patients with implantable cardioverter defibrillators (ICDs; n = 42; Mage = 61.57, SD = 12.60). One night of ambulatory polysomnography, 14 days of sleep diaries, and questionnaires (mood, sleepiness, fatigue, device acceptance) were administered. Controlling for ischemia, MANCOVA examined adjustment by sleep diagnosis. Apnea was most common (28.6%), followed by Insomnia (16.7%) and Comorbid Insomnia/Apnea (11.9%). Patients with insomnia reported poorer mood, greater sleepiness, and lower device acceptance than good sleepers; they also demonstrated poorer mood and less ICD device acceptance than patients with sleep apnea. Patients with comorbid insomnia/apnea also exhibited poorer mood and less ICD device acceptance than good sleepers; however, comorbid patients did not significantly differ from insomnia or apnea patients on any measure. Those with disordered sleep (regardless of type) reported greater fatigue than good sleepers. Assessment (and treatment) of difficulties with sleep, mood, fatigue, and device acceptance may be important for the comprehensive clinical management of ICD patients. Further research appears warranted.
Collapse
Affiliation(s)
- Christina S. McCrae
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Alicia J. Roth
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Jessica Ford
- Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC
| | - Earl C. Crew
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Jamie B. Conti
- College of Medicine, University of Florida, Gainesville, FL
| | | | - Samuel F. Sears
- Psychology and Cardiovascular Sciences, East Carolina University, Greenville, NC
| |
Collapse
|
40
|
|
41
|
Wickwire EM, Shaya FT, Scharf SM. Health economics of insomnia treatments: The return on investment for a good night's sleep. Sleep Med Rev 2015; 30:72-82. [PMID: 26874067 DOI: 10.1016/j.smrv.2015.11.004] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 11/20/2015] [Accepted: 11/23/2015] [Indexed: 11/20/2022]
Abstract
Chronic insomnia is the most common sleep disorder among adults and is associated with a wide range of negative outcomes. This article reviews the economic consequences of the disorder and the cost effectiveness of insomnia treatments. First, the total costs of insomnia are reviewed; in aggregate these costs exceed $100 billion USD per year, with the majority being spent on indirect costs such as poorer workplace performance, increased health care utilization, and increased accident risk. Next, the deleterious impact of insomnia on quality of life and the impact of treatment on quality of life are briefly considered. Finally, ten published studies evaluating the cost effectiveness of both pharmacological and behavioral treatments for insomnia are reviewed in detail. A significant majority of studies reviewed found that the cost of treating primary and comorbid insomnia is less than the cost of not treating it. Treatments were generally found to be cost-effective using commonly employed standards, with treatment costs being recouped within 6-12 mo.
Collapse
Affiliation(s)
- Emerson M Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, 100 N Greene St, 2nd Floor Baltimore, MD 21201, USA; Sleep Disorders Center, Division of Pulmonary and Critical Care, University of Maryland School of Medicine, 100 N Greene St, 2nd Floor Baltimore, MD 21201, USA
| | | | - Steven M Scharf
- Department of Medicine, Division of Pulmonary and Critical Care, University of Maryland School of Pharmacy, USA
| |
Collapse
|
42
|
Morin CM, Drake CL, Harvey AG, Krystal AD, Manber R, Riemann D, Spiegelhalder K. Insomnia disorder. Nat Rev Dis Primers 2015; 1:15026. [PMID: 27189779 DOI: 10.1038/nrdp.2015.26] [Citation(s) in RCA: 342] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Insomnia disorder affects a large proportion of the population on a situational, recurrent or chronic basis and is among the most common complaints in medical practice. The disorder is predominantly characterized by dissatisfaction with sleep duration or quality and difficulties initiating or maintaining sleep, along with substantial distress and impairments of daytime functioning. It can present as the chief complaint or, more often, co-occurs with other medical or psychiatric disorders, such as pain and depression. Persistent insomnia has been linked with adverse long-term health outcomes, including diminished quality of life and physical and psychological morbidity. Despite its high prevalence and burden, the aetiology and pathophysiology of insomnia is poorly understood. In the past decade, important changes in classification and diagnostic paradigms have instigated a move from a purely symptom-based conceptualization to the recognition of insomnia as a disorder in its own right. These changes have been paralleled by key advances in therapy, with generic pharmacological and psychological interventions being increasingly replaced by approaches that have sleep-specific and insomnia-specific therapeutic targets. Psychological and pharmacological therapies effectively reduce the time it takes to fall asleep and the time spent awake after sleep onset, and produce a modest increase in total sleep time; these are outcomes that correlate with improvements in daytime functioning. Despite this progress, several challenges remain, including the need to improve our knowledge of the mechanisms that underlie insomnia and to develop more cost-effective, efficient and accessible therapies.
Collapse
Affiliation(s)
- Charles M Morin
- Université Laval, École de psychologie, 2325 rue des Bibliothèques, Québec City, Québec G1V 0A6, Canada
| | - Christopher L Drake
- Henry Ford Hospital Sleep Disorders and Research Center, Detroit, Michigan, USA
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology/Sleep Medicine, Center for Mental Disorders, University of Freiburg Medical Center, Freiburg, Germany
| |
Collapse
|
43
|
Garland SN, Rouleau CR, Campbell T, Samuels C, Carlson LE. The Comparative Impact of Mindfulness-Based Cancer Recovery (MBCR) and Cognitive Behavior Therapy for Insomnia (CBT-I) on Sleep and Mindfulness in Cancer Patients. Explore (NY) 2015; 11:445-54. [PMID: 26386748 DOI: 10.1016/j.explore.2015.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Insomnia is an important but often overlooked side effect of cancer. Dysfunctional sleep beliefs have been identified as an important perpetuating factor for insomnia. Mindfulness practice has been demonstrated to improve sleep quality but it is unknown whether these effects relate to changes in dysfunctional sleep beliefs. PURPOSE This study is a secondary analysis of a randomized controlled trial comparing mindfulness-based cancer recovery (MBCR) to cognitive behavior therapy for insomnia (CBT-I) in cancer patients with insomnia. This present analysis compares program impact on mindfulness, dysfunctional sleep beliefs, and insomnia severity clinical cutoffs. METHODS Patients (MBCR, n = 32; CBT-I, n = 40) were assessed at baseline, post-program, and 3-month follow-up. RESULTS Across both groups, patients showed improvements over time in acting with awareness (P = .021) and not judging experiences (P = .023). Changes in dysfunctional sleep beliefs produced by the CBT-I group exceeded those produced by MBCR at post-program and follow-up (P < .001). Acting with awareness, non-judging, and non-reacting were the facets of mindfulness associated with an overall reduction in dysfunctional sleep beliefs. There were no significant differences between the MBCR and CBT-I groups in the percentage of patients exceeding insomnia severity clinical cutoffs at post-program or follow-up. CONCLUSIONS This study supports the use of both CBT-I and MBCR to reduce insomnia severity and suggests the development of mindfulness facets as a method of reducing dysfunctional sleep beliefs.
Collapse
Affiliation(s)
- Sheila N Garland
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, 415 Curie Blvd, Philadelphia, PA 19104.
| | - Codie R Rouleau
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Tavis Campbell
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Charles Samuels
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Linda E Carlson
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
44
|
Suh S. Cognitive Behavioral Therapy for Insomnia: Is it Effective in Treating Symptoms of Comorbid Psychiatric and Medical Disorders? A Review. SLEEP MEDICINE RESEARCH 2015. [DOI: 10.17241/smr.2015.6.1.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
45
|
Smith C, Huey SJ, McDaniel DD. Commitment language and homework completion in a behavioral employment program for gang-affiliated youth. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2015; 59:502-518. [PMID: 24203526 DOI: 10.1177/0306624x13510366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Research with substance-abusing samples suggests that eliciting commitment language during treatment may improve motivation to change, increase treatment engagement, and promote positive treatment outcomes. However, the relationship between in-session client language and treatment success is not well-understood for youth offender populations. This study evaluated the relationship between commitment language, treatment engagement (i.e., homework completion), and weekly employment outcomes for six gang-affiliated juvenile offenders participating in an employment counseling intervention. Weekly counseling sessions were audio-recorded, transcribed, and coded for commitment language strength. Multilevel models were fit to the data to examine the relationship between commitment language and counseling homework or employment outcomes within participants over time. Commitment language strength predicted subsequent homework completion but not weekly employment. These findings imply that gang-affiliated delinquent youth who express motivation to change during employment counseling will be more likely to comply with counselor-initiated homework. Further research on counselor techniques for promoting commitment language among juvenile gang offenders is needed.
Collapse
|
46
|
Casault L, Savard J, Ivers H, Savard MH. A randomized-controlled trial of an early minimal cognitive-behavioural therapy for insomnia comorbid with cancer. Behav Res Ther 2015; 67:45-54. [DOI: 10.1016/j.brat.2015.02.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 01/13/2015] [Accepted: 02/23/2015] [Indexed: 11/28/2022]
|
47
|
Phillips KD, Gunther ME. Sleep and HIV Disease. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
48
|
Matthews EE, Berger AM, Schmiege SJ, Cook PF, McCarthy MS, Moore CM, Aloia MS. Cognitive behavioral therapy for insomnia outcomes in women after primary breast cancer treatment: a randomized, controlled trial. Oncol Nurs Forum 2014; 41:241-53. [PMID: 24650832 DOI: 10.1188/14.onf.41-03ap] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the effect of cognitive-behavioral therapy for insomnia (CBTI) on sleep improvement, daytime symptoms, and quality of life (QOL) in breast cancer survivors (BCSs) after cancer treatment. DESIGN A prospective, longitudinal, randomized, controlled trial. SETTING Oncology clinics, breast cancer support groups, and communities in Colorado. SAMPLE 56 middle-aged BCSs with chronic insomnia. METHODS Women were randomly assigned to CBTI or behavioral placebo treatment (BPT) and completed measures of sleep, QOL, functioning, fatigue, and mood at baseline, postintervention, and at three- and six-month follow-ups. MAIN RESEARCH VARIABLES Sleep outcomes (e.g., sleep efficiency, sleep latency, total sleep time, wake after sleep onset, number of nightly awakenings); secondary variables included sleep medication use, insomnia severity, QOL, physical function, cognitive function, fatigue, depression, anxiety, and sleep attitudes or knowledge. FINDINGS Sleep efficiency and latency improved more in the CBTI group than the BPT group; this difference was maintained during follow-up. Women in the CBTI group had less subjective insomnia, greater improvements in physical and cognitive functioning, positive sleep attitudes, and increased sleep hygiene knowledge. No group differences in improvement were noted relative to QOL, fatigue, or mood. CONCLUSIONS Nurse-delivered CBTI appears to be beneficial for BCSs' sleep latency/efficiency, insomnia severity, functioning, sleep knowledge, and attitudes more than active placebo, with sustained benefit over time. IMPLICATIONS FOR NURSING Oncology nurses are in a unique position to identify insomnia in cancer survivors. When sleep disturbances become chronic, nurses need to make recommendations and referrals.
Collapse
Affiliation(s)
| | - Ann M Berger
- College of Nursing, Omaha Division, University of Nebraska Medical Center
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, School of Public Health
| | - Paul F Cook
- College of Nursing, University of Colorado in Denver
| | | | - Camille M Moore
- Department of Biostatistics and Informatics in the School of Public Health, University of Colorado in Denver
| | | |
Collapse
|
49
|
Otte JL, Carpenter JS, Manchanda S, Rand KL, Skaar TC, Weaver M, Chernyak Y, Zhong X, Igega C, Landis C. Systematic review of sleep disorders in cancer patients: can the prevalence of sleep disorders be ascertained? Cancer Med 2014; 4:183-200. [PMID: 25449319 PMCID: PMC4329003 DOI: 10.1002/cam4.356] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 08/26/2014] [Accepted: 09/07/2014] [Indexed: 11/13/2022] Open
Abstract
Although sleep is vital to all human functioning and poor sleep is a known problem in cancer, it is unclear whether the overall prevalence of the various types of sleep disorders in cancer is known. The purpose of this systematic literature review was to evaluate if the prevalence of sleep disorders could be ascertained from the current body of literature regarding sleep in cancer. This was a critical and systematic review of peer-reviewed, English-language, original articles published from 1980 through 15 October 2013, identified using electronic search engines, a set of key words, and prespecified inclusion and exclusion criteria. Information from 254 full-text, English-language articles was abstracted onto a paper checklist by one reviewer, with a second reviewer randomly verifying 50% (k = 99%). All abstracted data were entered into an electronic database, verified for accuracy, and analyzed using descriptive statistics and frequencies in SPSS (v.20) (North Castle, NY). Studies of sleep and cancer focus on specific types of symptoms of poor sleep, and there are no published prevalence studies that focus on underlying sleep disorders. Challenging the current paradigm of the way sleep is studied in cancer could produce better clinical screening tools for use in oncology clinics leading to better triaging of patients with sleep complaints to sleep specialists, and overall improvement in sleep quality.
Collapse
Affiliation(s)
- Julie L Otte
- Indiana University School of Nursing, Indianapolis, Indiana
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
|