Behavioral treatment of insomnia in cancer survivors: Early results of a stepped-care trial.

Abstract

140 Background: Insomnia is a burdensome late-effect for up to 30% of long-term survivors. Behavioral insomnia treatments are highly effective, but are not available to most affected survivors. Treatment barriers include lack of trained clinicians and resource demands for standard treatment of 6-8 individual sessions. To address these barriers we investigated the efficacy of delivering insomnia treatment in a stepped-care trial (NCT02756390); low intensity treatment was delivered to all participants, and more intense treatment reserved for non-responders. Methods: 43 survivors (91% female; mean ge = 55 yrs; mean time since diagnosis = 11 yrs) participated. They were primarily breast (63%) and blood cancer (26%) survivors, all with clinically elevated ( > 12) Insomnia Severity Index (ISI) scores at baseline. Participants first received a single education session addressing basic sleep hygiene and were reassessed 4 weeks later. Those with an elevated ISI ( > 12) at 4-week follow-up were offered more intense treatment: a 3-session CBT group program developed for cancer survivors. Participants completed the ISI again prior to CBT and 4-weeks post-treatment. Results: Survivors reported significant reductions in insomnia after a single education session; mean ISI scores fell 5.8 points (p < .001), and 23 of 43 survivors (54%) no longer had clinically elevated ISI scores. Of the 20 survivors with persistent insomnia, 9 have received CBT to date and shown similar improvement; their mean ISI scores fell 6.4 points (p = .006), and 6 (67%) no longer had clinically elevated ISI scores. Both treatments had large effect sizes (d = 1.2). Conclusions: Results support a stepped-care approach to treating survivors’ insomnia. A brief sleep hygiene intervention has important dissemination implications, as it may be delivered by non-specialists or as a mobile intervention. For survivors needing more intensive treatment, a short-duration group CBT intervention is effective while requiring fewer resources than standard CBT insomnia treatment. This ongoing trial will investigate how treatment gains in both groups are maintained over three-month follow-up, and explore what factors may predict response to low-intensity treatment. Clinical trial information: NCT02756390.