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Diggens J, Bullen D, Maccora J, Wiley JF, Ellen S, Goldin J, Jefford M, Hickey M, Ftanou M. Feasibility and efficacy of 'Can-Sleep': effects of a stepped-care approach to cognitive-behavioral therapy for insomnia in cancer. J Cancer Surviv 2023:10.1007/s11764-023-01457-3. [PMID: 37751126 DOI: 10.1007/s11764-023-01457-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/23/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE This study aimed to evaluate the feasibility and clinical efficacy of the Can-Sleep stepped-care intervention for people with cancer-related sleep disturbance. METHODS A total of 147 individuals with cancer were screened. Participants who reported sleep disturbances and were at low-moderate risk for intrinsic sleep abnormalities were given self-managed cognitive behavioral therapy for insomnia (SMCBT-I). Those reporting sleep disturbance and scoring at high risk of intrinsic sleep abnormalities (i.e., restless leg syndrome and obstructive sleep apnoea) were referred to a specialist sleep clinic. In both groups, participants received a stepped-up group CBT-I intervention (GCBT-I) if they continued to report sleep disturbance following SMCBT-I or the specialist sleep clinic. RESULTS Overall, 87 participants reported sleep disturbance or screened at risk for intrinsic sleep abnormality. Thirty-four were referred to a specialist sleep clinic, and of the 17 who declined this referral, 14 were rereferred to SMCBT-I. In total, 62 participants were referred to SMCBT-I, and 56 commenced SMCBT-I. At post-intervention, the SMCBT-I group showed a significant decline in insomnia symptoms (p < .001, d = 1.01). Five participants who reported sleep disturbance after SMCBT-I and/or the specialist sleep clinic, accepted GCBT-I. Those who received the GCBT-I showed a significant reduction in insomnia symptoms (p < .01, d = 3.13). CONCLUSIONS This study demonstrates the feasibility and efficacy of a stepped-care intervention for sleep disturbances in people with cancer. IMPLICATIONS FOR CANCER SURVIVORS A stepped-care intervention for sleep disturbance is a feasible and potentially effective method of addressing a significant and unmet patient need.
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Affiliation(s)
- Justine Diggens
- Peter MacCallum Cancer Centre, 3000, Melbourne, VIC, Australia
| | - Dani Bullen
- Peter MacCallum Cancer Centre, 3000, Melbourne, VIC, Australia
| | - Jordan Maccora
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Joshua F Wiley
- Peter MacCallum Cancer Centre, 3000, Melbourne, VIC, Australia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Steve Ellen
- Peter MacCallum Cancer Centre, 3000, Melbourne, VIC, Australia
| | - Jeremy Goldin
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia
| | - Maria Ftanou
- Peter MacCallum Cancer Centre, 3000, Melbourne, VIC, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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Cathcart-Rake EJ, Tevaarwerk AJ, Haddad TC, D'Andre SD, Ruddy KJ. Advances in the care of breast cancer survivors. BMJ 2023; 382:e071565. [PMID: 37722731 DOI: 10.1136/bmj-2022-071565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Breast cancer survivors may experience significant after effects from diagnoses of breast cancer and cancer directed therapies. This review synthesizes the evidence about optimal management of the sequelae of a diagnosis of breast cancer. It describes the side effects of chemotherapy and endocrine therapy and evidence based strategies for management of such effects, with particular attention to effects of therapies with curative intent. It includes strategies to promote health and wellness among breast cancer survivors, along with data to support the use of integrative oncology strategies. In addition, this review examines models of survivorship care and ways in which digital tools may facilitate communication between clinicians and patients. The strategies outlined in this review are paramount to supporting breast cancer survivors' quality of life.
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Perrier J, Galin M, Denise P, Giffard B, Quarck G. Tackling Insomnia Symptoms through Vestibular Stimulation in Patients with Breast Cancer: A Perspective Paper. Cancers (Basel) 2023; 15:cancers15112904. [PMID: 37296867 DOI: 10.3390/cancers15112904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
Insomnia symptoms are common among patients with breast cancer (BC; 20-70%) and are predictors of cancer progression and quality of life. Studies have highlighted sleep structure modifications, including increased awakenings and reduced sleep efficiency and total sleep time. Such modifications may result from circadian rhythm alterations consistently reported in this pathology and known as carcinogenic factors, including lower melatonin levels, a flattened diurnal cortisol pattern, and lower rest-activity rhythm amplitude and robustness. Cognitive behavioral therapy and physical activity are the most commonly used non-pharmacological interventions to counter insomnia difficulties in patients with BC. However, their effects on sleep structure remain unclear. Moreover, such approaches may be difficult to implement shortly after chemotherapy. Innovatively, vestibular stimulation would be particularly suited to tackling insomnia symptoms. Indeed, recent reports have shown that vestibular stimulation could resynchronize circadian rhythms and improve deep sleep in healthy volunteers. Moreover, vestibular dysfunction has been reported following chemotherapy. This perspective paper aims to support the evidence of using galvanic vestibular stimulation to resynchronize circadian rhythms and reduce insomnia symptoms in patients with BC, with beneficial effects on quality of life and, potentially, survival.
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Affiliation(s)
- Joy Perrier
- Neuropsychologie et Imagerie de la Mémoire Humaine U1077, EPHE, INSERM, CHU de Caen, GIP Cyceron, PSL Université, Normandie Univ, Université de Caen Normandie, 14000 Caen, France
| | - Melvin Galin
- Neuropsychologie et Imagerie de la Mémoire Humaine U1077, EPHE, INSERM, CHU de Caen, GIP Cyceron, PSL Université, Normandie Univ, Université de Caen Normandie, 14000 Caen, France
- COMETE U1075, INSERM, CYCERON, CHU de Caen, Normandie Univ, Université de Caen Normandie, 14000 Caen, France
| | - Pierre Denise
- COMETE U1075, INSERM, CYCERON, CHU de Caen, Normandie Univ, Université de Caen Normandie, 14000 Caen, France
| | - Bénédicte Giffard
- Neuropsychologie et Imagerie de la Mémoire Humaine U1077, EPHE, INSERM, CHU de Caen, GIP Cyceron, PSL Université, Normandie Univ, Université de Caen Normandie, 14000 Caen, France
| | - Gaëlle Quarck
- COMETE U1075, INSERM, CYCERON, CHU de Caen, Normandie Univ, Université de Caen Normandie, 14000 Caen, France
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Abstract
Cognitive-behavioral therapy for insomnia (CBT-I) is the main recommended treatment for patients presenting with insomnia; however, the treatment is not equally effective for all, and several factors can contribute to a diminished treatment response. The rationale for combining CBT-I treatment with acupuncture is explored, and evidence supporting its use in treating insomnia and related comorbidities is discussed. Practical, regulatory, and logistical issues with implementing a combined treatment are examined, and future directions for research are made. Growing evidence supports the effectiveness of acupuncture in treating insomnia and comorbid conditions, and warrants further investigation of acupuncture as an adjunct to CBT-I.
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Gao Y, Liu M, Yao L, Yang Z, Chen Y, Niu M, Sun Y, Chen J, Hou L, Sun F, Wu S, Zhang Z, Zhang J, Li L, Li J, Zhao Y, Fan J, Ge L, Tian J. Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta-analysis. J Evid Based Med 2022; 15:216-229. [PMID: 35996803 DOI: 10.1111/jebm.12485] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/27/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to examine the most effective delivery format of cognitive behavioral therapy for insomnia (CBT-I) on insomnia in cancer patients. METHODS We searched five databases up to February 2021 for randomized clinical trials that compared CBT-I with inactive or active controls for insomnia in cancer patients. Outcomes were insomnia severity, sleep efficiency, sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Pairwise meta-analyses and frequentist network meta-analyses with the random-effects model were applied for data analyses. RESULTS Sixteen unique trials including 1523 participants met inclusion criteria. Compared with inactive control, CBT-I could significantly reduce insomnia severity (mean differences [MD] = -4.98 points, 95% confidence interval [CI]: -5.82 to -4.14), SOL (MD = -12.29 min, 95%CI: -16.48 to -8.09), and WASO (MD = -16.58 min, 95%CI: -22.00 to -11.15), while increasing sleep efficiency (MD = 7.62%, 95%CI: 5.82% to 9.41%) at postintervention. Compared with active control, CBT-I could significantly reduce insomnia severity (MD = -2.75 points, 95%CI: -4.28 to -1.21), SOL (MD = -13.56 min, 95%CI: -18.93 to -8.18), and WASO (MD = -6.99 min, 95%CI: -11.65 to -2.32) at postintervention. These effects diminished in short-term follow-up and almost disappeared in long-term follow-up. Most of the results were rated as "moderate" to "low" certainty of evidence. Network meta-analysis showed that group CBT-I had an increase in sleep efficiency of 10.61%, an increase in TST of 21.98 min, a reduction in SOL of 14.65 min, and a reduction in WASO of 24.30 min, compared with inactive control at postintervention, with effects sustained at short-term follow-up. CONCLUSIONS CBT-I is effective for the management of insomnia in cancer patients postintervention, with diminished effects in short-term follow-up. Group CBT-I is the preferred choice based on postintervention and short-term effects. The low quality of evidence and limited sample size demonstrate the need for robust evidence from high-quality, large-scale trials providing long-term follow-up data.
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Affiliation(s)
- Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Ming Liu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Zhirong Yang
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Yamin Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Mingming Niu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China
| | - Ji Chen
- Mianyang Hospital of Traditional Chinese Medicine, Mianyang, China
| | - Liangying Hou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shanshan Wu
- National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zeqian Zhang
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lun Li
- Department of Breast Cancer, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhao
- First Clinical Medical College, Lanzhou University, Lanzhou, China
- Departments of Biochemistry and Molecular Biology, Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jingchun Fan
- Epidemiology and Evidence Based-Medicine, School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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Liu C, Tang Y, Li H, Zhao G, Li B, Zhang B, Zhao Z, Shen C, Cai Z. Cognitive behavioural therapy for insomnia in people with cancer. Hippokratia 2022. [DOI: 10.1002/14651858.cd015176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Chunyu Liu
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
- Evidence-Based Pharmacy Center; West China Second University Hospital, Sichuan University; Chengdu China
- Department of Pharmacy; West China Second University Hospital, Sichuan University; Chengdu China
| | - Yiguo Tang
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy; West China Hospital of Sichuan University; Chengdu, Sichuan China
| | - Hancong Li
- West China School of Medicine, Sichuan University; Chengdu China
| | - Guozhen Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University; Beijing China
| | - Bo Li
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University; Beijing China
| | - Bo Zhang
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
| | - Zhou Zhao
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
| | - Chaoyong Shen
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
| | - Zhaolun Cai
- Gastric Cancer Center; West China Hospital, Sichuan University; Chengdu China
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Nourizadeh R, Khanipour S, Zamiri RE, Namin MS, Khalili A, Hakimi S. A Comparison of the Effects of Self-Acupressure and Aerobic Exercises on Sleep Disorders of Breast Cancer Survivors: A Controlled Randomized Clinical Trial. Med Acupunct 2022; 34:131-136. [PMID: 35509876 PMCID: PMC9057882 DOI: 10.1089/acu.2020.1515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Breast cancer is the most widespread cancer type, with more than half of the afflicted women suffering from sleep disorders and fatigue, as common complications of the treatment. This study aimed to evaluate the effects of acupressure and aerobic exercises on such women's sleep disorders. Materials and Methods This study was carried out on 99 women affected by breast cancer. Participants were divided to acupressure, exercise, and control groups. The acupressure group received the treatment 3 days a week for 8 weeks. The exercise group participated in aerobic exercises 3 times a week for 8 weeks. The control group received routine care in the oncology clinic. Sleep quality was assessed by Pittsburg sleep quality index. Result The overall score of sleep quality scale in the acupressure and exercise groups was significantly less than that in the control group at weeks 4 (Medical Doctor: 2.7 with 95% confidence interval [CI]: 1.67 to 1.12) and 8 (MD: 0.07 with 95% CI: -1.21 to 1.03) of intervention. However, there was no significant difference between the acupressure and exercise groups. Conclusion The results of this study indicated that both acupressure and exercise methods can be effective and safe methods in reducing sleep disorders of breast cancer survivors and neither is superior to the other.
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Affiliation(s)
| | - Shadi Khanipour
- Department of Midwifery, Tabriz University of Medical Science, Tabriz, Iran
| | - Reza Eghdam Zamiri
- Department of Radiology, Tabriz University of Medical Science, Tabriz, Iran
| | - Mahsa Salimi Namin
- General Practitioner, Tabriz University of Medical Science, Tabriz, Iran
| | - Assef Khalili
- Department of English Language, Tabriz University of Medical Science, Tabriz, Iran
| | - Sevil Hakimi
- Department of Midwifery, Tabriz University of Medical Science, Tabriz, Iran
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Amidi A, Buskbjerg CD, Damholdt MF, Dahlgaard J, Thorndike FP, Ritterband L, Zachariae R. Changes in sSleep following iInternet-dDelivered cCognitive-bBehavioral tTherapy for iInsomnia in Women tTreated for bBreast cCancer: A 3-year fFollow-up Assessment. Sleep Med 2022; 96:35-41. [DOI: 10.1016/j.sleep.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
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Mellor A, Kavaliotis E, Mascaro L, Drummond SP. Approaches to the assessment of adherence to CBT-I, predictors of adherence, and the association of adherence to outcomes: A systematic review. Sleep Med Rev 2022; 63:101620. [DOI: 10.1016/j.smrv.2022.101620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
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Systematic Review and Meta-Analysis of Cognitive-Behavioural Therapy for Insomnia on Subjective and Actigraphy-Measured Sleep and Comorbid Symptoms in Cancer Survivors. Sleep Med Rev 2022; 63:101615. [DOI: 10.1016/j.smrv.2022.101615] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/15/2022] [Accepted: 02/16/2022] [Indexed: 02/03/2023]
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Padron A, McCrae CS, Robinson ME, Waxenberg LB, Antoni MH, Berry RB, Castagno J, Schultz G, Kacel EL, Ulfig C, Garey S, Patidar S, Sannes T, Trinastic L, Wong S, Pereira DB. Impacts of Cognitive Behavioral Therapy for Insomnia and Pain on Sleep in Women with Gynecologic Malignancies: A Randomized Controlled Trial. Behav Sleep Med 2022; 20:460-476. [PMID: 34124972 PMCID: PMC8669057 DOI: 10.1080/15402002.2021.1932500] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Insomnia is an adverse cancer outcome impacting mood, pain, quality of life, and mortality in cancer patients. Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for diverse psychophysiological disorders, including pain and insomnia. Primarily studied in breast cancer, there is limited research on CBT within gynecology oncology. This study examined CBT effects on subjective and behavioral sleep outcomes: Sleep Efficiency (SE), Sleep Quality (SQ), Total Wake Time (TWT), Sleep Onset Latency (SOL), and Wake After Sleep Onset (WASO). Thirty-five women with insomnia status/post-surgery for gynecologic cancer were randomized to CBT for insomnia and pain (CBTi.p., N = 18) or Psychoeducation (N = 17). Sleep was assessed via sleep diaries and wrist-worn actigraphy at baseline (T1), post-intervention (T2), and two-month follow-up (T3). Intent-to-treat analyses utilizing mixed linear modeling examined longitudinal group differences on sleep controlling for age and advanced cancer. All participants demonstrated improved (1) subjective SE (0.5, p < .01), SOL (-1.2, p < .01), TWT (-1.2, p < .01), and (2) behavioral SE (0.1, p = .02), TWT (-1.2, p = .03), WASO (-0.8, p < .01) across time. Group-level time trends were indicative of higher subjective SE (6.8, p = .02), lower TWT (-40.3, p = .01), and lower SOL (-13.0, p = .05) in CBTi.p. compared to Psychoeducation. Supplemental analyses examining clinical significance and acute treatment effects demonstrated clinical improvements in SE (T1), TWT (T2, T3), and SOL (T3). Remaining effects were not significant. Despite lacking power to detect interaction effects, CBTi.p. clinically improved sleep in women with gynecologic cancers and insomnia during the active treatment phase. Future research will focus on developing larger trials within underserved populations.
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Affiliation(s)
- Adaixa Padron
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Christina S. McCrae
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA,Department of Psychiatry, University of Missouri, Columbia, MO, USA
| | - Michael E. Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Lori B. Waxenberg
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | | | - Richard B. Berry
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Jacqueline Castagno
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL, USA
| | - Gregory Schultz
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, University of Florida, Gainesville, FL, USA
| | - Elizabeth L. Kacel
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Chantel Ulfig
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Stephanie Garey
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Seema Patidar
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Timothy Sannes
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Laura Trinastic
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Shan Wong
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Deidre B. Pereira
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA,Corresponding author: Deidre B. Pereira, PhD, ABPP. Address: Clinical & Health Psychology, University of Florida, 1225 Center Drive, Room 3151, Gainesville, Florida 32611. Phone: (352) 273-6039.
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Savard J, Ivers H, Savard MH, Morin CM, Caplette-Gingras A, Bouchard S, Lacroix G. Efficacy of a stepped care approach to deliver cognitive-behavioral therapy for insomnia in cancer patients: a noninferiority randomized controlled trial. Sleep 2021; 44:zsab166. [PMID: 34228123 PMCID: PMC8598200 DOI: 10.1093/sleep/zsab166] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/05/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for cancer-related insomnia, but its accessibility is very limited in routine care. A stepped care approach has been recommended as a cost-effective way to make CBT-I more widely accessible. However, no controlled study has yet been published about the efficacy of this approach. The goal of this noninferiority randomized controlled trial (RCT) was to compare the short and long-term efficacy of a stepped care CBT-I (StepCBT-I) to a standard face-to-face CBT-I (StanCBT-I). METHODS A total of 177 cancer patients were randomized to: (1) StanCBT-I (6 face-to-face CBT-I sessions; n = 59) or (2) StepCBT-I (n = 118). In the StepCBT-I group, patients with less severe insomnia first received a web-based CBT-I (n = 65), while those with more severe insomnia received 6 face-to-face CBT-I sessions (n = 53). In both cases, patients could receive up to three booster sessions of CBT-I if they still had insomnia symptoms following this first step. RESULTS Results indicated that the Step-CBT-I group showed an Insomnia Severity Index score reduction and a sleep efficiency (on a sleep diary) increase that was not significantly inferior to that of StanCBT-I at all post-treatment time points. Analyses of secondary outcomes indicated significant time effects (ps < .001) and no significant group-by-time interactions (ps from .07 to .91) on other sleep diary parameters, sleep medication use, depression, anxiety, fatigue, and quality of life scores. CONCLUSION(S) The efficacy of stepped care CBT-I is not inferior to that of a standard face-to-face intervention and is a valuable approach to making this treatment more widely accessible to cancer patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01864720 (https://clinicaltrials.gov/ct2/show/NCT01864720?term=Savard&draw=2&rank=6; Stepped Care Model for the Wider Dissemination of Cognitive-Behavioural Therapy for Insomnia Among Cancer Patients).
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Affiliation(s)
- Josée Savard
- School of Psychology, Université Laval, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec, Canada
- Université Laval Cancer Research Center, 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, Canada
| | - Marie-Hélène Savard
- CHU de Québec-Université Laval Research Center, Québec, Canada
- Université Laval Cancer Research Center, Québec, Canada
| | - Charles M Morin
- School of Psychology, Université Laval, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec, Canada
- CERVO Brain Research Centre, Québec, Canada
| | - Aude Caplette-Gingras
- Université Laval Cancer Research Center, Québec, Canada
- Centre des maladies du sein, CHU de Québec-Université Laval, Québec, Canada
| | - Stéphane Bouchard
- Département de psychoéducation et de psychologie, Université du Québec en Outaouais et Centre de santé et services sociaux de l’Outaouais, Québec, Canada
| | - Guy Lacroix
- Département d’économique, Université Laval, Québec, Canada
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Sleep Disorders in Cancer-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111696. [PMID: 34770209 PMCID: PMC8583058 DOI: 10.3390/ijerph182111696] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/07/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Sleep disorders, especially insomnia, are very common in different kinds of cancers, but their prevalence and incidence are not well-known. Disturbed sleep in cancer is caused by different reasons and usually appears as a comorbid disorder to different somatic and psychiatric diagnoses, psychological disturbances and treatment methods. There can be many different predictors for sleep disturbances in these vulnerable groups, such as pre-existing sleep disorders, caused by the mental status in cancer or as side effect of the cancer treatment. METHODS A systematic literature review of 8073 studies was conducted on the topic of sleep and sleep disorders in cancer patients. The articles were identified though PubMed, PsycInfo and Web of Knowledge, and a total number of 89 publications were qualified for analysis. RESULTS The identified eighty-nine studies were analyzed on the topic of sleep and sleep disorders in cancer, twenty-six studies on sleep and fatigue in cancer and sixty-one studies on the topic of sleep disorders in cancer. The prevalence of sleep disturbences and/or sleep disorders in cancer was up to 95%. DISCUSSION Sleep disturbances and sleep disorders (such as insomnia, OSAS, narcolepsy and RLS; REM-SBD) in cancer patients can be associated with different conditions. Side effects of cancer treatment and cancer-related psychological dysfunctions can be instigated by sleep disturbances and sleep disorders in these patients, especially insomnia and OSAS are common. An evidence-based treatment is necessary for concomitant mental and/or physical states.
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Agnew S, Vallières A, Hamilton A, McCrory S, Nikolic M, Kyle SD, Fleming L, Crawford MR. Adherence to Cognitive Behavior Therapy for Insomnia. Sleep Med Clin 2021; 16:155-202. [DOI: 10.1016/j.jsmc.2020.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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15
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Ma Y, Hall DL, Ngo LH, Liu Q, Bain PA, Yeh GY. Efficacy of cognitive behavioral therapy for insomnia in breast cancer: A meta-analysis. Sleep Med Rev 2021; 55:101376. [PMID: 32987319 PMCID: PMC8210529 DOI: 10.1016/j.smrv.2020.101376] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 12/22/2022]
Abstract
Insomnia is highly prevalent among patients with breast cancer (BC). Although cognitive behavioral therapy for insomnia (CBT-I) is available in integrative oncology settings, it poses unique challenges for BC survivors. Our review aimed to assess the evidence for the therapeutic effects of CBT-I on insomnia in BC. Randomized controlled trials (RCTs) that included patients/survivors with BC and insomnia, and at least one validated self-report measure of sleep quality were included in the review. Of the 14 included RCTs (total N = 1363), the most common components incorporated in CBT-I interventions were sleep hygiene, stimulus control and sleep restriction. Pooled effect sizes favored CBT-I at post-intervention (Hedges' g = -0.779, 95% CI = -0.949, -0.609), short-term follow-up (within six months, Hedges' g = -0.653, 95% CI = -0.808, -0.498), and long-term follow-up (12 mo, Hedges' g = -0.335, 95% CI = -0.532, -0.139). In sub-analyses, CBT-I had similar effect sizes regardless of potential modifiers (comparison design, delivery formats, etc.). As an integrative oncology intervention, CBT-I is efficacious for reducing insomnia and improving sleep quality in women treated for BC, with medium-to-large effect sizes that persist after intervention delivery ends. Given the variability in the CBT-I components tested in RCTs, future studies should investigate the optimal integration of CBT-I components for managing insomnia during BC survivorship.
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Affiliation(s)
- Yan Ma
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Daniel L Hall
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Long H Ngo
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Qingqing Liu
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, Boston, MA, United States
| | - Gloria Y Yeh
- Osher Center for Integrative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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16
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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.
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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
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Abstract
Insomnia is a significant public health concern. Cognitive behavioral therapy for insomnia (CBT-i) is considered first-line treatment. The use of telemedicine for CBT-i allows for increased access to providers for patients who are geographically remote as well as to self-directed CBT-i modalities that do not require the involvement of a therapist. Tele-CBT-i modalities include video conferencing with a CBT-i therapist in an individual or group setting or use of Web or mobile application-based CBT-i modules with varying levels of support from a therapist. Multiple studies and meta-analyses support the efficacy of tele-CBT-i when compared with face-to-face CBT-i and placebo.
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Affiliation(s)
- Caleb Hsieh
- Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 43-229 CHS, Los Angeles, CA, USA
| | - Talayeh Rezayat
- Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 43-229 CHS, Los Angeles, CA, USA
| | - Michelle R Zeidler
- Pulmonary, Critical Care and Sleep Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, 43-229 CHS, Los Angeles, CA, USA.
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18
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Reynolds-Cowie P, Fleming L. Living with persistent insomnia after cancer: A qualitative analysis of impact and management. Br J Health Psychol 2020; 26:33-49. [PMID: 32558129 DOI: 10.1111/bjhp.12446] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 05/06/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To conduct a qualitative exploration of the lived experience of insomnia disorder and its management amongst a sample of mixed-diagnoses cancer survivors. METHODS Twenty-seven cancer survivors with persistent insomnia were recruited to this qualitative study following completion of treatment for breast (12), prostate (7), colorectal (7), and gynaecological (1) cancers. Eleven males and 16 females (mean age 62 years), who met DSM-5 criteria for insomnia disorder, contributed to one of four focus group discussions, designed to explore the lived experience of persistent insomnia and its management within cancer care services. RESULTS Poor sleep was a persistently troubling complaint for participants, long after the completion of active cancer treatment. The impact of insomnia was significant for all participants, with six key domains emerging as those most affected: temperament, sociability, physical well-being, cognitive functioning, relationships, and psychological well-being. In terms of insomnia management, participants frequently resorted to unfruitful self-management strategies, due to the lack of professional insomnia expertise within cancer care settings. Three main themes emerged in relation to insomnia management: self-management, seeking professional intervention, and a lack of focus on sleep. A lack of clinician understanding of the importance of sleep health and the poor availability of evidence-based insomnia interventions, such as cognitive behavioural therapy for insomnia (CBT-i), were highlighted as important gaps in cancer care. CONCLUSIONS Insomnia was found to have a detrimental and pervasive impact on cancer survivors' quality of life, which persisted long into survivorship. There is an absence of professional attention to sleep throughout the cancer care trajectory, contributing to its prevalence, persistence, and impact. In order to break this cycle, sleep health should be integrated as a key aspect of cancer treatment and rehabilitation, much like maintaining a healthy diet and appropriate levels of physical activity.
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Affiliation(s)
| | - Leanne Fleming
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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19
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Evaluation and management of insomnia in women with breast cancer. Breast Cancer Res Treat 2020; 181:269-277. [PMID: 32314110 DOI: 10.1007/s10549-020-05635-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/07/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Insomnia is a common issue among patients with breast cancer with a potentially devastating impact on quality of life. It can be caused or exacerbated by multiple disease and treatment-related factors. Despite the prevalence and impact of insomnia, it is rarely addressed systematically in the oncology clinic. We conducted a comprehensive review of insomnia to guide clinical care of patient's with breast cancer and insomnia. METHODS This manuscript reviews the prevalence, etiology, emerging science and both non-pharmacologic and pharmacologic options for treatment of insomnia among patients with breast cancer. RESULTS Multiple factors contribute to insomnia among patients with breast cancer including endocrine therapy and hotflashes, pain and discomfort from local therapy, and fear of recurrence. If we do identify insomnia, there are treatment options and strategies available to help patients. In particular, there is now a considerable body of evidence supporting the use of psychosocial interventions and behavioral treatments, such as cognitive behavioral therapy for insomnia (CBT-I), yoga, and mind-body programs. It is also important for oncology providers to be educated regarding available pharmacologic therapies and emerging data for cannabis-based therapy. CONCLUSION This manuscript provides an up-to-date and comprehensive review of the prevalence, etiology, and treatment approaches available for insomnia for clinicians treating patients with breast cancer. We also address strategies and goals for cancer care delivery and future research.
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20
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Ho FYY, Chan CS, Lo WY, Leung JCY. The effect of self-help cognitive behavioral therapy for insomnia on depressive symptoms: An updated meta-analysis of randomized controlled trials. J Affect Disord 2020; 265:287-304. [PMID: 32090753 DOI: 10.1016/j.jad.2020.01.062] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/05/2020] [Accepted: 01/14/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sleep disturbances commonly occur in patients with depression. Insomnia is considered not only a symptom of but also a risk factor for depression. Psychological treatments for insomnia have been demonstrated to be efficacious in alleviating depressive symptoms. This meta-analysis examined the effect of self-help cognitive behavioral therapy for insomnia (CBT-I) in treating depressive symptoms. METHODS A systematic review was performed up to April 2019 in 6 major electronic databases. The literature search retrieved 4190 potentially relevant citations; 30 randomized controlled trials (total N = 5945) that compared self-help CBT-I vs. waiting-list (WL), routine care, no treatment, individual cognitive behavioral therapy (CBT), group CBT and placebo were included in the current review. RESULTS Random effects models showed significant reduction in self-report depressive symptoms (Hedges' g = 0.35; 95% CI: -0.47, -0.23) and insomnia symptoms (Hedges' g = 0.79; 95% CI: -0.56, -1.03) in the self-help CBT-I group when compared to the WL/routine care/no treatment/psychoeducation control group. LIMITATIONS The findings should be interpreted with caution due to potential publication bias. CONCLUSIONS CBT-I appears to be efficacious in treating depressive symptoms. Given the current results and study limitations, large-scale, high-quality trials that specifically target individuals with a clinical diagnosis of depression are warranted in the future.
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Affiliation(s)
- Fiona Yan-Yee Ho
- The Public Mental Health Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Christian S Chan
- Department of Psychology, The University of Hong Kong, Hong Kong.
| | - Wing-Ying Lo
- The Public Mental Health Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong
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22
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van der Zweerde T, Bisdounis L, Kyle SD, Lancee J, van Straten A. Cognitive behavioral therapy for insomnia: A meta-analysis of long-term effects in controlled studies. Sleep Med Rev 2019; 48:101208. [PMID: 31491656 DOI: 10.1016/j.smrv.2019.08.002] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/25/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is a treatment with moderate to large effects. These effects are believed to be sustained long-term, but no systematic meta-analyses of recent evidence exist. In this present meta-analysis, we investigate long-term effects in 30 randomized controlled trials (RCTs) comparing CBT-I to non-active control groups. The primary analyses (n = 29 after excluding one study which was an outlier) showed that CBT-I is effective at 3-, 6- and 12-mo compared to non-active controls: Hedges g for Insomnia severity index: 0.64 (3 m), 0.40 (6 m) and 0.25 (12 m); sleep onset latency: 0.38 (3 m), 0.29 (6 m) and 0.40 (12 m); sleep efficiency: 0.51 (3 m), 0.32 (6 m) and 0.35 (12 m). We demonstrate that although effects decline over time, CBT-I produces clinically significant effects that last up to a year after therapy.
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Affiliation(s)
- Tanja van der Zweerde
- Department of Clinical Psychology, Amsterdam Public Health, VU University, Amsterdam, the Netherlands.
| | - Lampros Bisdounis
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands; PsyQ Amsterdam, Amsterdam, the Netherlands
| | - Annemieke van Straten
- Department of Clinical Psychology, Amsterdam Public Health, VU University, Amsterdam, the Netherlands
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23
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Cognitive Behavioral Therapy for Insomnia in Patients with Medical and Psychiatric Comorbidities. Sleep Med Clin 2019; 14:167-175. [DOI: 10.1016/j.jsmc.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Fang HF, Lee TY, Hui KC, Yim HCH, Chi MJ, Chung MH. Association between Sedative-hypnotics and Subsequent Cancer in Patients with and without Insomnia: A 14-year Follow-up Study in Taiwan. J Cancer 2019; 10:2288-2298. [PMID: 31258732 PMCID: PMC6584417 DOI: 10.7150/jca.30680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/21/2019] [Indexed: 12/17/2022] Open
Abstract
Background: The aim of this population-based 14-year historical and prospective study was to determine the relationships between the usage of sedative-hypnotics, including benzodiazepines and nonbenzodiazepines, and the risk of subsequent cancer in patients with or without insomnia among the Taiwanese population. Methods: A total of 43,585 patients were recruited, 21,330 of whom had been diagnosed with insomnia and 8,717 who had been prescribed sedative-hypnotics during this study's following period of 2002 to 2015. Information from the claims data, namely basic demographic details, drug prescriptions, comorbidities, and patients' survival, was extracted from the National Health Insurance Research Database for χ2 analysis. A Cox proportional hazards model was used to compute the 14-year cancer-free survival rates after adjustment for confounding factors. Results: Patients with insomnia who used sedative-hypnotics had an adjusted hazard ratio of 1.49 compared with patients with insomnia who did not use any sedative-hypnotics, and patients without insomnia who used sedative-hypnotics had an adjusted hazard ratio of 1.68 compared with patients without insomnia who did not use any sedative-hypnotics. Regarding site-specific risk, patients with insomnia who used sedative-hypnotics had an increased risk of oral and breast cancers, and patients without insomnia who received sedative-hypnotics prescriptions had an increased risk of liver and breast cancers. The cancer-free survival rate of patients who had used sedative-hypnotics was significantly lower than that of patients who had never used sedative-hypnotics. Conclusions: The use of sedative-hypnotics in patients either with or without insomnia was associated with subsequent cancer development in the Taiwanese population. Increased risks of oral, liver, and breast cancer were found in the patients with the use of sedative-hypnotics. The use of sedative-hypnotics should be discouraged for treating patients with or without insomnia in Taiwan.
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Affiliation(s)
- Hui-Fen Fang
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tzu-Yin Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - King Cheung Hui
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Howard Chi Ho Yim
- Microbiome Research Centre, St George & Sutherland Clinical School, University of New South Wales, Sydney, Australia
| | - Mei-Ju Chi
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Min-Huey Chung
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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McCarthy M, Matthews E, Battaglia C, Meek P. Feasibility of a Telemedicine-Delivered Cognitive Behavioral Therapy for Insomnia in Rural Breast Cancer Survivors. Oncol Nurs Forum 2018; 45:607-618. [DOI: 10.1188/18.onf.607-618] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Palesh O, Scheiber C, Kesler S, Janelsins MC, Guido JJ, Heckler C, Cases MG, Miller J, Chrysson NG, Mustian KM. Feasibility and acceptability of brief behavioral therapy for cancer-related insomnia: effects on insomnia and circadian rhythm during chemotherapy: a phase II randomised multicentre controlled trial. Br J Cancer 2018; 119:274-281. [PMID: 30026614 PMCID: PMC6068121 DOI: 10.1038/s41416-018-0154-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 05/20/2018] [Accepted: 05/31/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This phase II RCT was conducted to determine the feasibility and acceptability of brief behavioral therapy for cancer-related insomnia (BBT-CI) in breast cancer patients undergoing chemotherapy. We also assessed the preliminary effects of BBT-CI on insomnia and circadian rhythm in comparison to a Healthy Eating Education Learning control condition (HEAL). METHODS Of the 71 participants recruited, 34 were randomised to receive BBT-CI and 37 to receive HEAL. Oncology staff was trained to deliver the intervention in four community clinics affiliated with the NCI. Insomnia was assessed with the Insomnia Severity Index (ISI), and circadian rhythm was assessed using a wrist-worn actiwatch. RESULTS Community staff interveners delivered 72% of the intervention components, with a recruitment rate of 77% and an adherence rate of 73%, meeting acceptability and feasibility benchmarks. Those randomised to BBT-CI improved their ISI scores by 6.3 points compared to a 2.5-point improvement in those randomised to HEAL (P = 0.041). Actigraphy data indicated that circadian functioning improved in the BBT-CI arm as compared to the HEAL arm at post-intervention (all P-values <0.05). CONCLUSIONS BBT-CI is an acceptable and feasible intervention that can be delivered directly in the community oncology setting by trained staff. The BBT-CI arm experienced significant improvements in insomnia and circadian rhythm as compared to the control condition.
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Affiliation(s)
- Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
| | - Caroline Scheiber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Shelli Kesler
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle C Janelsins
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Joseph J Guido
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Charles Heckler
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Mallory G Cases
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Jessica Miller
- Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN, USA
| | | | - Karen M Mustian
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
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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.
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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
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Matthews E, Carter P, Page M, Dean G, Berger A. Sleep-Wake Disturbance: A Systematic Review of Evidence-Based Interventions for Management in Patients With Cancer. Clin J Oncol Nurs 2018; 22:37-52. [DOI: 10.1188/18.cjon.37-52] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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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]
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