Table 1.
Uncontrolled trials of cognitive behavioral therapy for insomnia (CBT-I) in cancer patients
| Study | Year | Sample/sex | Diagnosis/stage | Tx status | Design | Assessment times | Tx description | Intervention details | Outcome measures | Main results |
|---|---|---|---|---|---|---|---|---|---|---|
| Davidson et al61 | 2001 | 12/males and females | Mixed/no active disease | Posttreatment | Single group | T1 – Week 0 T2 – Week 4 T3 – Week 8 |
SC, RT, SH, CR | Group Six session Weekly ×5, then monthly ×160–90 minutes |
SD: SL, NWAK, WASO, TST, SE SII HADS, QLQ-C30 |
↓ NWAK (0.002), WASO (0.001) ↑ TST (0.03), SE (<0.001) ↓ sleep-related impairment (<0.001) No significant ↓ in depression, anxiety or ↑ quality of life at T3 |
| Quesnel et al62 | 2003 | 10/females | Breast/I–III | Posttreatment | Multiple-baseline Single subject | T1 – Week 0 T2 – Week 8 T3 – Week 32 |
SC, SR, CR, SH fatigue management, RP | Group Eight session Weekly 90 minutes |
WASO, TST (PSG) ISI BDI, STAI, MFI, QLQ-C30 |
PSG: ↓ WASO (0.02); ↑ SE (0.04) 86% clinically significant ↓ in ISI at T3 No significant ↓ in depression, anxiety, fatigue or ↑ quality of life at T3 |
| Simeit et al65 | 2004 | 229/males and females | Mixed/no active disease | Posttreatment | Three group (PMR, AT, or UC) |
T1 – Week 0 T2 – Week 4 T3 – Week 10 T4 – Week 34 |
Patients chose PMR or AT. Tx groups were provided with information on SC, SR, CR, SH (not formal CBT-I) | Group Three session Weekly 60 minutes |
PSQI QLQ-C30 |
Both Tx groups: ↓ SL (<0.001), sleep disturbance (<0.001) ↑ sleep duration (<0.001), SE (<0.001), sleep quality (<0.001), daytime function (<0.001) All groups ↑ quality of life at T4 |
| Savard et al64 | 2011 | 11/females | Breast/I–III | Post-radiation | Single group | T1 – Week 0 T2 – Week 6 T3 – Week 18 |
SC, SR, CR, SH, RP | Self-administered DVD/booklet Six modules Weekly 60 minutes |
SD: SL, WASO, TST, SE ISI HADS, MFI, QLQ-C30, DBAS |
↓ SL (0.01), WASO (<0.001) ↑ SE (<0.001), TST (ns) ↓ insomnia severity (<0.001) Significant ↓ depression (0.03), dysfunctional beliefs (0.001) and ↑ quality of life (0.03). No significant ↓ anxiety or fatigue at T3 |
Abbreviations: AT, autogenic training; BDI, Beck Depression Inventory; CR, cognitive restructuring; DBAS, Dysfunctional Beliefs and Attitudes about Sleep; HADS, Hospital Anxiety and Depression Scale; ISI, Insomnia Severity Index; MFI, Multidimensional Fatigue Inventory; NWAK, number of awakenings; PMR, progressive muscle relaxation; PSG, polysomnography; PSQI, Pittsburgh Sleep Quality Index; QLQ-C30, Quality of Life Questionnaire – Cancer; RP, relapse prevention; RT, relaxation training; SC, stimulus control; SE, sleep efficiency; SD, sleep diary; SH, sleep hygiene; SII, Sleep Impairment Index; SL, sleep latency; SR, sleep restriction; STAI, State-Trait Anxiety Inventory; TST, total sleep time; Tx, treatment; UC, usual care; WASO, wake after sleep onset; ns, non-significant; ↑, increase; ↓, decrease.