Adapting Cognitive-Behavior Therapy for Insomnia in Cancer Patients

Zhou, Eric S.; Suh, Sooyeon; Youn, Soyoung; Chung, Seockhoon

doi:10.17241/smr.2017.00080

Cited by 20 publications

(19 citation statements)

References 102 publications

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“…This includes developmentally normative delays in when they sleep, different sleep duration requirements, 19‐22 and social and sleep environment constraints (eg, inflexible school start times, disruptive roommates, etc). Further, standard (noncancer specific) CBT‐I protocols typically do not take into account common long‐term sequelae that interfere with sleep (eg, pain and fatigue) 23 . Previously, we demonstrated that CBT‐I tailored to be developmentally and disease‐appropriate for AYA cancer survivors was efficacious at improving insomnia and quality of life 24 .…”

Section: Introductionmentioning

confidence: 99%

Internet‐delivered insomnia intervention improves sleep and quality of life for adolescent and young adult cancer survivors

Zhou

Recklitis

2020

Pediatric Blood & Cancer

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Background Insomnia is common among adolescent and young adult (AYA) cancer survivors. Cognitive‐behavioral therapy for insomnia (CBT‐I) is considered the gold standard treatment. Standard CBT‐I was designed for adults and not adapted to the unique medical, psychosocial, and developmental needs of AYA cancer survivors, which can exacerbate their insomnia. Further, the vast majority of cancer centers do not have a behavioral sleep medicine expert on staff. Our study objective was to examine the efficacy of an Internet‐delivered CBT‐I program that was tailored for AYA cancer survivors (NCT03279055). Procedure Twenty‐two AYA cancer survivors (mean age 20.4; range 14‐25) with insomnia enrolled in an automated CBT‐I program modified for AYA cancer survivors following stakeholder feedback. Participants were blood cancer (54.5%) and solid tumor (45.5%) survivors, an average of 9.7 years postdiagnosis. Sleep health, fatigue, and quality of life were assessed at baseline and at two follow up timepoints (8 and 16 weeks postbaseline). Results Significant improvements in insomnia severity, daytime sleepiness, fatigue, and quality of life were reported at both follow up timepoints. However, most participants (72.7%) did not complete all of the six study sessions, with a mean completion rate of 3.2 sessions. Participants who completed at least two sessions reported better sleep (insomnia severity index total score) than those who did not. Conclusions An Internet‐delivered insomnia intervention adapted for AYA cancer survivors was efficacious. This has important implications for access to evidence‐based clinical care for this growing population. Future efforts should study stepped care models of care and ways to improve treatment adherence.

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Section: Introductionmentioning

confidence: 99%

Internet‐delivered insomnia intervention improves sleep and quality of life for adolescent and young adult cancer survivors

Zhou

Recklitis

2020

Pediatric Blood & Cancer

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“…Patients with cancer can easily feel fatigued and lack physical stamina as a side effect of the cancer treatments or due to the symptoms of the cancer itself, thereby aggravating insomnia [17]. In addition, patients diagnosed with cancer are likely to experience anxiety regarding the adverse effects of insomnia on their immunity or cancer, which may lead them to behave in ways that are maladaptive for sleep [18,19]. However, the cognitive-behavioral approach cannot be applied to patients experiencing poor physical function, even though they may also be experiencing sleep disturbance.…”

Section: Discussionmentioning

confidence: 99%

The Effect of a Sleep Education and Hypnotics Reduction Program on Hypnotics Prescription Rate for the Hospitalized Patients with Cancer at a General Hospital

Youn

Lee

Kim

et al. 2019

Clin Psychopharmacol Neurosci

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ObjectiveWe aimed to investigate whether the sleep education and hypnotics reduction program (the i-sleep program), developed for all hospitalized patients and medical personnel, help reducing the hypnotics prescriptions rate among hospitalized cancer patients in a general hospital.MethodsPatient data such as hypnotics prescribed at the time of admission and discharge during prior to (year of 2014) and after (year of 2015) initiation of the i-sleep program were collected and compared. Also, hypnotics prescription rate at the first day of each month of 2014 and 2015 were estimated and compared.ResultsAll of 12,382 patients in 2014 and 12,313 patients in 2015 were admitted to the Department of Oncology of the hospital. In 2014, 782 (6.3%) of 12,382 inpatients were already taking hypnotics at the time of admission, and 594 (76.0%) of the 782 patients were still taking sleeping pills at the time of discharge. Following initiation of the i-sleep program (2015), 792 (6.4%) of 12,313 inpatients were already taking hypnotics at the time of admission, and 553 (69.8%) of the 792 inpatients were still taking them at the time of discharge (relative risk, 0.92; 95% confidence interval, 0.87–0.98). On the first day of each month of 2014, 7.3% to 12.6% (mean, 10.0%) of inpatients had prescriptions for hypnotics. Following initiation of the program, the rate of hypnotic prescription was significantly reduced (3.2–10.8%; mean, 8.0%; p = 0.03).ConclusionOur date showed that the i-sleep program may help to reduce the hypnotic prescription rate in hospitalized cancer patients.

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“…The onset of insomnia is then precipitated by a stressful life event, such as bereavement, relationship breakdown, or diagnosis of a serious illness (Davis & Goforth, 2014). For cancer patients, reduced daytime activity and the side effects of treatment such as increased fatigue can further elevate the risk of developing persistent insomnia (Zhou, Suh, Youn, & Chung, 2017).…”

Section: Introductionmentioning

confidence: 99%

“…Cognitive behavioural therapy for insomnia is a brief, sleep‐focused, multimodal intervention that targets the aspects of insomnia that are most amenable to change, such as maladaptive sleep behaviours and faulty sleep cognitions (Zhou et al ., 2017). CBT‐i comprises five potential elements, including stimulus control, sleep restriction, sleep hygiene, cognitive restructuring, and relaxation training.…”

Section: Introductionmentioning

confidence: 99%

Living with persistent insomnia after cancer: A qualitative analysis of impact and management

Reynolds-Cowie

Fleming

2020

British J Health Psychol

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ObjectivesTo conduct a qualitative exploration of the lived experience of insomnia disorder and its management amongst a sample of mixed‐diagnoses cancer survivors.MethodsTwenty‐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.ResultsPoor 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.ConclusionsInsomnia 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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Adapting Cognitive-Behavior Therapy for Insomnia in Cancer Patients

Cited by 20 publications

References 102 publications

Internet‐delivered insomnia intervention improves sleep and quality of life for adolescent and young adult cancer survivors

Internet‐delivered insomnia intervention improves sleep and quality of life for adolescent and young adult cancer survivors

The Effect of a Sleep Education and Hypnotics Reduction Program on Hypnotics Prescription Rate for the Hospitalized Patients with Cancer at a General Hospital

Living with persistent insomnia after cancer: A qualitative analysis of impact and management

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