Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients

Abstract

Individuals with cancer are disproportionately affected by sleep disturbance and insomnia relative to the general population. These problems can be a consequence of the psychological, behavioral, and physical effects of a cancer diagnosis and treatment. Insomnia often persists for years and, when combined with already high levels of cancer-related distress, may place cancer survivors at a higher risk of future physical and mental health problems and poorer quality of life. The recommended first-line treatment for insomnia is cognitive behavioral therapy for insomnia (CBT-I), a non-pharmacological treatment that incorporates cognitive and behavior-change techniques and targets dysfunctional attitudes, beliefs, and habits involving sleep. This article presents a comprehensive review of the literature examining the efficacy of CBT-I on sleep and psychological outcomes in cancer patients and survivors. The search revealed 12 studies (four uncontrolled, eight controlled) that evaluated the effects of CBT-I in cancer patients or survivors. Results suggest that CBT-I is associated with statistically and clinically significant improvements in subjective sleep outcomes in patients with cancer. CBT-I may also improve mood, fatigue, and overall quality of life, and can be successfully delivered through a variety of treatment modalities, making it possible to reach a broader range of patients who may not have access to more traditional programs. Future research in this area should focus on the translation of evidence into clinical practice in order to increase awareness and access to effective insomnia treatment in cancer care.

Cognitive behavioral therapy for insomnia, but not armodafinil, improves fatigue in cancer survivors with insomnia: a randomized placebo-controlled trial

“…As shown by our SEM analyses, the reduction in insomnia severity was directly responsible for improving cancer-related fatigue. These findings are consistent with previous studies that have also shown CBT-I to result in decreased levels of cancer-related fatigue [20,21] and support the use of CBT-I as an effective intervention for fatigue related to cancer in survivors who also have insomnia.…”

“…In addition to treating insomnia, CBT-I has also been shown to decrease levels of anxiety and depression related to cancer treatment [20,21]. However, studies examining the efficacy of CBT-I for improving CRF in cancer survivors are conflicting; hence, it is not clear whether the use of sleep management interventions will actually improve CRF [15].…”

Are we sleeping on the job? Insomnia among men with prostate cancer

“…Three randomised controlled trials (RCT) investigating the effect of CBT on insomnia included men with prostate cancer. Of these, Garland et al included 8 men with prostate cancer (7% of total) [59] and Ritterband et al included 4 men [60] , but the cancer site was not identified and neither trial presented results specifically for men with prostate cancer. One RCT encompassed 150 patients with cancer at mixed sites including men with prostate cancer (N = 34; 23%) suffering from insomnia for at least 6 months [53] .…”

Effects of armodafinil and cognitive behavior therapy for insomnia on sleep continuity and daytime sleepiness in cancer survivors

“…A systematic review of these studies concluded that CBT-I is effective in this context with one study showing large effect sizes for sleep latency (SL), wake after sleep onset (WASO), and sleep efficiency (SE). 19 …”