Effects of mindfulness‐based cognitive therapy on breast cancer survivors with insomnia: A randomised controlled trial

Abstract

Sleep disturbance is a widespread public-health problem that has a negative impact on quality of life for individuals and represents a serious economic burden for society (Dragioti, Bernfort, Larsson, Gerdle, & Levin, 2017). Approximately 23%-46% of breast cancer survivors (BCS) suffer from an "insomnia disorder," the most common sleep disorder, which is characterised as persistent difficulty initiating or maintaining sleep with a concomitant waking dysfunction (Fleming et al., 2019). Insomnia has been associated with various factors, such as joint pain, hot flushes, anxiety, depression and fear of recurrence in BCS (Desai et al., 2013; Lowery-Allison et al., 2018). Without supportive management, insomnia symptoms may even increase the risk of breast cancer recurrence (Palesh et al., 2014). Pharmacologic treatment can reduce sleep latency and increase total sleep time (TST) at night, but has limitations due to potential for drug dependency, drug tolerance and side effects (Morin, Gaulier, Barry, & Kowatch, 1992). It has been suggested that non-pharmacologic interventions such as mindfulness-based interventions (MBIs), cognitive behaviour therapy for insomnia (CBT-I) and stress management interventions can also be used to cope with insomnia

Mindfulness-Based Interventions in Cancer Survivors: A Systematic Review of Participants’ Adherence to Home Practice

“…Benefits were maintained at follow-up (4 weeks postintervention). 24 min/day (53% adherence) Zhao et al 2020 38 China 135 breast cancer survivors [average age= 53 years; 50% diploma or university degree; 93% married; average time since treatment completion= 2.3 years] Waitlist RCT MBCT [6 weekly 90-min classes, home practice 20–40 min/day using an audio tape and handouts] Daily log No distress measure was included in this study. No distress measure was included in this study.…”

“… 21 , 22 , 24 , 25 , 28 , 30 , 32 , 33 , 35 , 36 , 39 , 40 Seventeen studies assessed distress as a primary outcome, and four of them screened for distress as part of inclusion criteria. 24 , 26 , 33 , 37 The remaining four studies evaluated fatigue (n=2), 30 , 31 pain (n=1), 35 or sleep disturbance (n=1) 38 as a primary outcome.…”

“… 39 Five dose ranging studies asked participants to practice 15–20 to 40–45 min daily with adherence rates using the upper range limit (40–45 min) of 53%, 37 57%, 29 59%, 38 80% (online asynchronous MBSR program), 29 and 31% (study of advanced cancer patients). 28 Overall, adherence rate was within the range of 40 to 60% in nine studies, 22 , 24 , 26 , 27 , 32 , 34 , 35 , 37 , 38 more than 60% in eight studies, 21 , 23 , 25 , 29–31 , 36 , 39 and less than 40% in one study. 28 Three studies did not specify the length of assigned home practice, which precluded adherence rate calculation; one of them reported actual practice time of 29.6 min/day (MBCT), 33 one 4 min/day (app-based MBI), 40 and one 13.7 min/day (web-based MBI).…”

“… 22 Similarly, a single-arm study (8-week MBCR) of 59 cancer survivors did not find a relationship between stress or cortisol changes and home practice minutes. 23 Two studies 27 , 38 did not evaluate distress changes, either published results separately or did not include a distress measure. All but two 35 , 40 of the remaining studies yielded significant effects on distress, yet none addressed whether findings were related to home practice.…”

“…Studies included were conducted in the USA (n =7), [27][28][29][30][31]39,40 Canada (n = 6), [21][22][23][24][25][26] Australia (n = 2), 32,41 Netherlands (n = 1), 33 United Kingdom (n = 1), 34 Denmark (n = 1), 35 Italy (n = 1), 36 Japan (n = 1), 37 and China (n = 1). 38 The studies included 13 randomized controlled trials, 21,24,27,[30][31][32][33][34][35][37][38][39]41 six single-group studies with pre-post study design, 23,26,28,29,36,40 and two nonrandomized controlled trials. 22,25…”