Cancer Insomnia Research Articles

Feasibility and efficacy of 'Can-Sleep': effects of a stepped-care approach to cognitive-behavioral therapy for insomnia in cancer.

This study aimed to evaluate the feasibility and clinical efficacy of the Can-Sleep stepped-care intervention for people with cancer-related sleep disturbance. 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. 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). This study demonstrates the feasibility and efficacy of a stepped-care intervention for sleep disturbances in people with cancer. A stepped-care intervention for sleep disturbance is a feasible and potentially effective method of addressing a significant and unmet patient need.

Insomnia in cancer patients.

e18657 Background: As new treatments extend patient survival, the quality of their lives (QoL) grows in importance. QoL may differentiate alternative treatments, and QoL assessment has become a standard component of treatment evaluations. Sleep is a key component of QoL. Insomnia can worsen pain, fatigue, depression and cognitive impairments in cancer patients. Inappropriate treatments for insomnia can further worsen these and interact with chemotherapy medications. Recognizing this, in 2019 the American Society of Clinical Oncology identified Insomnia as a key patient-reported outcome performance measure (PRO-PM) for the National Quality Forum to consider. Methods: Through review of the scientific literature the project identified specific cancers and their treatments where treating Insomnia can have a significant impact on patient QoL. PubMed, Pharmapendium, and Science Direct databases were used. Search terms included “insomnia demographics, epidemiology of insomnia in cancer, insomnia in tumor types, cancer insomnia, insomnia associated hormonal treatment, insomnia in patients awaiting cancer diagnosis; insomnia in cancer care-givers, insomnia in cancer survivors, cancers treated with corticosteriods”. Original research articles in English that used human subjects between January 1, 1993 and January 31, 2020 were included. Results: Insomnia is associated with specific tumor types: brain tumors, breast cancer, gastrointestinal cancer, leukemia, lymphoma, multiple myelomaand terminal cancer. Autoimmune causes of insomnia in paraneoplastic syndromes. Insomnia is prevalent in oncology patients being evaluated, awaiting diagnosis and treatment. Age and gender are demographic factors associated with oncology insomnia. Insomnia is associated with specific antineoplastic agents. Corticosteroid use is associated with insomnia, before, during and after cancer treatment. Insomnia in cancer survivors starts during their treatment and may persist for years. Conclusions: Specific demographics, cancers and treatments are associated with insomnia. Insomnia often occurs in patients undergoing evaluations for cancer. Insomnia is often not recognized and not treated in oncology patients. Insomnia that is not addressed during cancer treatment often persists in cancer survivors. There is the need to investigate whether treating insomnia early in cancer patients during their course of treatment can reduce symptoms such as fatigue and improve their QOL.

Insomnia in breast cancer: a prospective observational study.

Insomnia in cancer patients is prevalent, persistent, and confers risk for physical and psychological disorder. We must better understand how insomnia develops in cancer patients and explore the main contributors to its chronicity so that insomnia management protocols can be integrated more effectively within cancer care. This study monitors the etiology of insomnia in breast cancer patients and identifies risk factors for its persistence. One hundred seventy-three females with newly diagnosed, non-metastatic breast cancer were tracked from diagnosis for 12 months. Participants completed monthly sleep assessments using the Insomnia Severity Index (ISI) and 3 monthly health-related quality-of-life assessments using the European Organisation for Research and Treatment of Cancer - Breast (EORTC QLQ-C30-BR23) scale. Clinical data on disease status and treatment regimens were also assessed. Prior to diagnosis, 25% of participants reported sleep disturbance, including 8% with insomnia syndrome (IS). Prevalence increased at cancer diagnosis to 46% (18% IS) and remained stable thereafter at around 50% (21% IS). We also explored sleep status transitions. The most common pattern was to remain a good sleeper (34%-49%) or to persist with insomnia (23%-46%). Seventy-seven percent of good sleepers developed insomnia during the 12-month period and 54% went into insomnia remission. Chemotherapy (odds ratio = 0.08, 95% confidence interval [CI] 0.02-0.29, p < .001) and pre-diagnosis ISI scores (odds ratio = 1.13/unit increase in pre-diagnosis sleep score, 95% CI 1.05-1.21, p = .001) were identified as the main risk factors for persistent insomnia. These data advance our understanding of insomnia etiology in cancer patients and help identify those who should be prioritized for insomnia management protocols.

Cognitive-Behavioral Therapy for Insomnia in Cancer Patients: An Update of Efficacy Evidence and Areas for Future Research

Purpose of Review This study aims to review the empirical evidence on the prevalence, evolution, and etiology of insomnia in cancer as well as on the efficacy of cognitive-behavioral therapy for insomnia (CBT-I) in this population.

CHoosing Options for Insomnia in Cancer Effectively (CHOICE): Design of a patient centered comparative effectiveness trial of acupuncture and cognitive behavior therapy for insomnia

Insomnia is a prevalent and persistent side effect of cancer, which if left unaddressed, can be unremitting and negatively influence physical and mental well-being. Acupuncture and Cognitive Behavioral Therapy (CBT) are commonly used non-pharmacological treatments that are efficacious for treating insomnia in cancer patients; however, little is known about the comparative effectiveness of these options. The goal of personalized medicine is to determine which treatments are most effective for which individuals, and patient preference for treatment is a particularly important contributor to adherence and outcomes. Here we describe the design of a clinical trial that begins to determine how best to personalize the treatment of insomnia for cancer survivors. This project is a randomized controlled comparative effectiveness trial with a nested qualitative study comparing acupuncture and CBT for insomnia and co-morbid symptoms in a heterogeneous sample of 160 cancer survivors. The primary aim is to determine which treatment is associated with the largest reduction in insomnia severity. The secondary aim is to examine the demographic, clinical, and psychological characteristics that predict and/or moderate treatment effect. Patients will receive ten treatments of acupuncture or 7 sessions of CBT over eight weeks and complete validated patient-reported outcome measures of sleep and co-morbid symptoms at baseline, mid-treatment, post-treatment, and at three-months to assess durability of effect. The results of the proposed study have the potential to improve healthcare outcomes by helping cancer survivors and their caregivers make informed and evidence-based decisions, leading to patient-centered and personalized care for cancer survivors with insomnia.

Insomnia in Cancer--Associations and Implications.

Insomnia is a common condition in cancer patients. In spite of the high prevalence its associations have not been well studied. Existing data suggests that insomnia is related to depression and pain. However, the impact of ongoing chemotherapy on sleep is not investigated. To study the relationship between insomnia and chemotherapy after analysing confounding variables. Consecutive patients who visited New England Oncology Clinic in Tamworth were recruited. Insomnia was assessed with the Bergen insomnia scale. The Montgomery Asberg Depression rating scale was used to measure depression. Pain was assessed with the Brief Pain inventory. Chronic medical conditions, type of cancer, side effects to chemotherapy, role of steroids and other drugs were studied as confounders. A total of 56 patients participated in the study. Age ranged from 33 to 83 years (mean: 63.6, SD=10.97). There were 29 men and 27 women. 42 patients received at least one form of chemotherapy and 15 were receiving radiotherapy at the time of assessment. Mean insomnia score was significantly higher in those receiving chemotherapy than in those without chemotherapy (8.92 vs 17.2, two tailed p=0.005, 95% CI=2.63-13.71). There was no significant variation in insomnia scores in terms of chronic medical condition, type of cancer, psychiatric history, use of steroids or adverse effects of chemotherapy. However, total insomnia score was correlated with depression rating score (Pearson correlation, r=0.39, p=0.003) and magnitude of pain (r=0.37, p=0.006). On regression analysis only pain was found to be predictive of insomnia. Insomnia in patients with cancer is found to be associated with concurrent chemotherapy and correlated with degree of depression and pain. Identifying factors related to insomnia in cancer population has implications in its management and patient education.

Long-term and short-term effects of insomnia in cancer and effective interventions.

Sleep disorders and insomnia are more prevalent in patients with cancer than in the normal population. Sleep disorders consist of delayed sleep latency, waking episodes after sleep onset, unrefreshing sleep, reduced quality of sleep, and reduced sleep efficiency. Sleep disorders cluster with pain, fatigue, depression, anxiety, and vasomotor symptoms, depending on stage of disease, treatment, and comorbidities. Premorbid sleep problems and shift work have been associated with a higher prevalence of cancer; in fact, shift work has been labeled a carcinogen. Treatment for insomnia includes cognitive behavioral therapy with sleep hygiene, bright-light therapy, exercise, yoga, melatonin, and hypnotic medications. Unfortunately, there are few randomized trials in cancer-related sleep disorders such that most recommendations particularly for hypnotics are based on treatment for primary insomnia. In this article, insomnia is reviewed as a predisposing factor to cancer, prior to and during treatment, in cancer survivorship and in advanced cancer. Recommendations for treatment are based on low-quality evidence but are also reviewed.

Depression and Insomnia in Cancer: Prevalence, Risk Factors, and Effects on Cancer Outcomes

Over two-thirds of the 11.4 million cancer survivors in the United States can expect long-term survival, with many others living with cancer as a chronic disease controlled by ongoing therapy. Behavioral comorbidities often arise during treatment and persist long term to complicate survival and reduce quality of life. This review focuses on depression and insomnia with an emphasis on understanding the role of cancer-specific factors and their contribution to the prevalence of these behavioral comorbidities in cancer patients following cancer diagnosis and treatment. The clinical significance of depression and insomnia for cancer patients is further stressed by epidemiological observations that link depression and insomnia to cancer morbidity and mortality risk.

The curative effects of action treatments and do-it-by-oneself exercises on the digestive tract cancer insomnia patients

目的 为减轻癌症患者心理压力,缓解焦虑程度,达到改善和提高睡眠质量.方法对确诊为消化道癌症(经手术切除)并有失眠症患者54例,采取生物反馈行为训练、自我训练、音乐疗法、说教与心理疏导等.治疗前人格测定与常模比较,治疗前后情绪量表及PSQI睡眠质量自评各分值比较.结果患者的MMPI和16PF粗分分别高于常模,差别有极显著性(P均≤0.01);PSQI分值治疗前后差别极有显著性(P≤0.01).治疗后睡眠改善明显优于治疗前,使治疗前每天平均睡眠由(1.7±1.25)h提高到(6.1±1.5)h.焦虑、紧张量表治疗前后HAMA、SAS分值差别有极显著性(P≤0.01),以治疗后各分值低于治疗前.结论行为疗法与自我训练对缓解患者焦虑、紧张心理压力,改善睡眠质量有较好作用。