Skip to main content
. 2021 Nov 7;18(21):11696. doi: 10.3390/ijerph182111696

Table 5.

Studies on Insomnia Treatment in cancer.

Author Sample Measuring Instrument(s) Measuring Time(s) &
Method(s)		 Results
Barton et al., J Sup-
port Oncol 2011; 9 (1) 24–31 [28]		 227 (202) Cancer patients
 130 Breast
 14 Colon
 4 Prostate
 52 Other		 PSQI;
FOSQ (Functional Outcomes of
 Sleep Questionnaire);
BFI (Brief Fatigue Inventory);
POMS (Profile of Mood States);
TNAS (Toxicity Numeric
 Analogue Scale);
CTCAE (Common Terminology
 Criteria for Adverse Events)		 T1—Baseline
T2—Follow-up (4 weeks)
T3—Follow-up (8 weeks)
  • ❖
    Valerian (Valerian vs. Placebo)
    • -
      ↓ trouble with sleep
    • -
      ↓ drowsiness
    • -
      ↓ fatigue
  • ❖
    not differences in:
    • -
      SQ
    • -
      toxicities
Methods:
- RCT, dopple-blind
- 450 mg Valerian
(Herbal Medicine versus Placebo)
Berger et al., Psycho-oncology 2009; 18 (6): 634–646 [29] 219 Cancer patients/
stages I–III		 Actigraphy;
PSQI;
Sleep Diary
(SOL, WASO, TIB, TST, SE)		 T1—Baseline
T2—Follow-up (within 7 days)
T3—Follow-up (30 days)
  • ❖

    BT group improves:

    (CBT vs. Controls)
    • -
      ↓ Sleep Quality (PSQI)
    • -
      Sleep Diary
      ↓ SOL, ↓ WASO & ↑ SE
  • ❖
    no difference between BT & C:
    • -
      fatigue
Methods:
- RCT
- BT versus Controls
(Behavioural Therapy
[Individualized Sleep
Promotion Plan (ISPP)])
Chen et al., Breast
Cancer Res Treat
2014; 145 (2): 381–388 [30]		 95 Postmenopausal Breast
CA/stages 0–III 		PSQI;
CES-D (Center for
Epidemiologic Studies
– Depression Scale);
NCCTG (North Central
Cancer Treatment Group)		 T1—Baseline
T2—Follow-up (4 months)
  • ❖

    Melatonin

(Melatonin vs. Placebo) - ↑ SQ - ↑ daytime functions
  • ❖

    not differences in:

- depression
Methods:
- RCT, dopple-blind
- 3 mg Melatonin versus
Placebo
Choi et al., Integrative Cancer Therapies 2017; 16 (2) 135–146 [31] A Systematic Review of Randomized Clinical Trials: Acupuncture for Managing Cancer-Related Insomnia
Dupont et al., Health Psychol 2014; 33 (2): 155–163 [32] 558 Mamma CA SF-36 (partly);
IES-R (Revised Impact of
Event Scale);
CES-D (Center for Epidemiologic
Studies—Depression Scale);
PANAS (Positive and Negative
Affect Scale)
FSI (Fatigue Symptom Inventory);
MOS (Medical Outcomes Study);
BCPT (Breast Cancer Prevention
Trial)		 T1—Baseline
T2—Post-Treatment (4 weeks)
T3—Follow-up (2 months)
T4—Follow-up (6 months)
T5—Follow-up (12 months)
  • ❖

    intrusive thoughts were associated with/

    influenced

    (baseline → 12-month assessment)
    • -
      higher levels of all symptoms
    • -
      trajectory of pain
    • -
      depressive symptoms
    • -
      negative affect
    • -
      physical functioning over time
  • ❖
    intrusions were not associated with
    • -
      trajectory of fatigue
    • -
      sleep
    • -
      breast cancer-specific symptoms
    • -
      mental functioning
Methods:
three types of information:
(1) print material
(2) print material & peer-
 modeling videotape
(3) print material, videotape,
 2 education sessions &
information workbook
Epstein & Dirksen, Oncology Nursing
Forum 2007; 34 (5);
51–59 [33]		 81 Mamma CA
- 40 Controls
- 41 CBT-I		 Actigraphy;
Sleep Diary
(SOL, WASO, TIB, TST, SE)
PFS (Piper Fatigue Scale)		 T1—Baseline
T2—Post-CBT-I (6 weeks)
T3—Follow-up (12 weeks)
  • ❖
    both groups improved (CBT vs. Controls)
    • -
      Sleep Diary
      ↓ SOL, ↓ WASO, ↑ SE, ↑ TST & ↑ SQ
    • -
      Aktigraphy
      ↓ SOL, ↓ WASO, ↑ SE & ↑ TST
  • ❖

    CBT > Controls
Methods:
  • ❖

    RCT

  • ❖

    CBT versus no Treatment

Espie et al., J of
Clinical Oncology
2008; 26: 4651–4658 [34]		 150 CA
87 Mamma
34 Prostate
24 Colorectal
5 Gynecological
(110 CBT/50 TAU)		 PSQI; ESS;
Sleep Diary
(SOL, WASO, TST, SE);
HADS;
FSI (Fatigue Symptom Inventory);
CrQoL (Cancer-Related Quality of
Life);
FACT-G (Functional Assessment of
Cancer Therapy Scale – General)		 T1—Baseline
T2—Post-Treatment
T3—Follow-up (6 months)
  • ❖
    CBT was associated with
    • -
      reductions in wakefulness of 55 min. per night
    • -
      moderate to large effect sizes for 5/7 QOL outcomes
    • -
      ↑ SE, ↑ TST, ↓ SOL & ↓ WASO
  • ❖

    TAU no change
Methods:
  • ❖

    RCT

  • ❖

    CBT versus TAU

    (Treatment As Usual)

Fiorentino et al.,
Nature and Science of Sleep 2010; 2: 1–8
[35]		 21 Mamma CA
- 11 IND-CBT-I
- 10 Controls
Actigraphy;
PSQI; Insomnia Severity Index (ISI);
Sleep Diary
(SOL, WASO, TIB, TST, SE)		 T1—Baseline
T2—Post-CBT-I (6 weeks)
T3—Follow-up (12 weeks)
  • ❖
    CBT-I was associated with
    • -
      ↓ ISI
    • -
      Aktigraphy & Sleep Diary
      ↑ SE, ↑ TST & ↓ WASO
Methods:
  • ❖

    RCT

  • ❖

    CBT versus no Treatment

Fleming (Espie) et al.,
Psychooncology 2014;
23 (6): 679–684 [36]		 113 Cancer patients
with Insomnia
- 73 CBT-I
- 40 Controls
PSQI;
Sleep Diary
(SOL, WASO, TIB, TST, SE)
HADS;
FSI (Fatigue Symptom
Inventory)		 T1—Baseline
T2—Post-Treatment
T3—Follow-up (6 months)
  • ❖
    CBT was associated with
    • -
      ↓ clinical insomnia
    • -
      ↓ clinical fatigue
  • ❖
    CBT & TAU
    • -
      no changes in anxiety
  • ❖
    completely symptom free at post-treatment:
    • -
      7 (9.6%) in CBT
    • -
      0 (0.0%) in TAU
Methods:
  • ❖

    RCT

  • ❖

    CBT versus TAU

    (Treatment As Usual)

Garland et al., Contemporary Clinical Trials 2011; 32 (5): 747–754
[37]		 ??? Actigraphy;
Sleep Diary
(SOL, WASO, TST, SE)

???		 T1—Baseline
T2—Post-Treatment (2 months)
T3—Follow-up (3 months)
  • ❖

    high prevalence of distress & sleep distur- bances in cancer population

  • ❖

    MBSR should produce sleep effects comparable to CBT-I
Methods:
CBT-I versus MBSR
(Mindfulness-Based Stress Reduction)
Garland et al., J
Clin Oncol 2014;
32: 1–9 [38]		 327 screened CA
111 randomly assigned
53 Breast
12 Prostate
11 Blood/lymph
10 Female Genitourinary
9 Head & Neck
7 Colon/GI
7 Lung
2 Skin
CBT-I: n = 47
MBSR: n = 64		 Actigraphy;
PSQI; Insomnia Severity Index (ISI);
Sleep Diary
(SOL, WASO, TST, SE)		 T1—Baseline
T2—Post-Treatment (2 months)
T3—Follow-up (5 months)
  • ❖
    CBT-I was associated with
    • -
      ↓ ISI
  • ❖
    Aktigraphy
    • -
      CBT-I: ↑ SE, ↑ TST-, ↓ SOL & ↓ WASO
    • -
      MBSR:
      ↑ SE, ↑ TST+ & ↓ WASO
  • ❖
    Sleep Diary CBT-I & MBSR
    • -
      ↑ SE, ↑ TST, ↓ SOL & ↓ WASO
Methods:
CBT-I versus MBSR
(Mindfulness-Based Stress Reduction)
Garland et al., Neuropsychiatric Disease and Treatment 2014; 10: 1113–1124 [39] Review:
Efficency of CBT-I in cancer
Inclusion of 4 studies
  • ❖

    results for

  • ❖

    un-controlled studies (n = 4)

  • ❖

    controlled studies/RCT (n = 8)

CBT-I in cancer is associated with
→ clinically improvements in subjective sleep outcomes
improved sleep → Improvement in:
  • ❖

    mood disturbance

  • ❖

    cancer-related fatigue

  • ❖

    overall quality of life
Garland et al., Explore (N.Y.) 2015; 11 (6): 445–454 [40] 72 Cancer patients
MBCR: n = 32
CBT-I: n = 40		 ??? T1—Baseline
T2—Post-Treatment (? months)
T3—Follow-up (3 months)
  • ❖
    CBT-I & MBCR:
    • -
      ↓ Insomnia severity
  • ❖
    CBT-I > MBCR:
    • -
      ↓ dysfunctional sleep beliefs
Methods:
CBT-I versus MBCR
(Mindfulness-Based Cancer Recovery)
Garland et al.,
Contemporary Clinical Trials 2016; 47: 349-
355 [41]		 160 Cancer patients
with Insomnia
??? T1—Baseline
T2—Mid-Treatment (4 weeks)
T3—Post-Treatment (8 weeks)
T4—Follow-up (3 months) 		???
Methods:
  • ❖

    RCT

  • ❖

    CBT versus Aucupuncture

Garland et al., Sleep Medicine 2016; 20: 18–24 [42] 88 Cancer patients
with Insomnia
 ESS;
Sleep Diary
(SOL, WASO, TST, SE)		 T1—Baseline
T2—Post-Treatment (7 weeks)
T3—Follow-up (3 months)
  • ❖

    CBT-I + A & CBT-I + P:

    → improvement sleep continuity

    → no difference in Daytime Sleepiness

  • ❖

    PLA:

    → absence of improvement of SL & WASO

    → trend to increased TST
Methods: (RCT)
(1) CBT-I + P
(CBT-I and Placebo)
(2) CBT-I + A
(CBT-I and Armodafinil)
(3) ARM (Armodafinil alone)
(4) PLA (Placebo alone)
Heckler (Garland) et al., Supportive Care in Cancer 2016; 24 (5): 2059–2066 [44] 96 Cancer patients
with Insomnia		 Insomnia Severity Index (ISI);
BFI (Brief Fatigue Inventory);
FACIT-Fatigue scale		 T1—Baseline
T2—Post-Treatment (7 weeks)
T3—Follow-up (3 months)
  • ❖

    No sleep results !!!

  • ❖

    CBT-I + A & CBT-I + P:

    → no difference in Fatigue
Methods: (RCT)
(1) CBT-I + P
(CBT-I and Placebo)
(2) CBT-I + A
(CBT-I and Armodafinil)
(3) ARM (Armodafinil alone)
(4) PLA (Placebo alone)
Irwin et al., JNCIM 2014; No. 50; 295–301
[46]		 90 Mamma CA
random subsample
(n = 48)		 Blood samples:
- C-Reactive Protein (CRP)
- Interleukin-6 (IL-6)
- Tumor Necrosis Factor-α (TNF)

subsample analyzed by genome-wide transcriptional profiling		 T1—Baseline
T2—Post-Treatment (3 months)
  • ❖

    Sleep disruption

    → increases in TLR-4-activated production of proinflammatory cytokines

  • ❖

    no change in systemic inflammation (CRP)

  • ❖

    changes in cellular inflammation

    (IL-6 & TNF)

TCC reduced
  • ❖

    cellular inflammatory responses

    (↓ IL-6 & ↓ TNF)

  • ❖

    expression of genes encoding proinflammatory mediators
Methods:
CBT-I versus TCC
(Tai Chi Chih)
Kim M. et al., BMJ open, 2017; 7 (8): 1-
10 [47]		 45 Cancer patients
 Actigraphy;
Insomnia Severity Inventory (ISI); PSQI;
Sleep Diary
(SOL, WASO, TIB, TST, SE)
BDSS (Blood Deficiency Scoring
System);
EA (Electroacupuncture);
FACT-F (Functional
Assessment of Cancer Therapy-
Fatigue);
MoCA (Montreal Cognitive
Assessment)		 T1—Baseline
T2—Treatment (3 weeks)
T2—Post-Treatment (5 weeks)
T2—Post-Treatment (9 weeks)		 Without results !!!
„The result of this study will be published in peer-reviewed journals or presented at academic conferences.“
Methods: (4 weeks)
EA versus Sham-EA
(Electroaccupuncture)
versus TAU
(Treatment As Usual)
Kim S.W. et al.,
Psychiatry and Clinical Neurosciences 2008; 62: 75–83 [48]		 45 Cancer patients
25 Lung
5 Breast
6 Gastrointestinal tract
3 Hepatobiliary tract
3 Other malignancy		 C-LSEQ (Chonnam National
University Hospital-
Leeds Sleep Evaluation
Questionnaire)
SF-36;
MADRS (Montgomery-Asberg
Depression Rating Scale);
EuroQoL (EQ) -5D		 T1—Baseline
T2—Post-Treatment (4 weeks)		 mirtazapine rapidly improved sleep disturbance, nausea, pain and quality of life, as well as depression in cancer patients
Sleep ↑:
↑ TST, ↓ SOL, ↓ SQ
Methods:
  • -

    prospective, open labeled study

  • -

    15–45 mg mirtazapine

Kröz et al., BMC
cancer 2017; 17 (1),
166: 1–13 [49]		 126 Mamma CA PSQI;
CFS-D (Cancer Fatigue Scale)		 T1—Baseline
T2—Post-Treatment (10 weeks)
T3—Follow-up (6 months)
  • ❖

    T1: MT & CT > AeT

  • ❖

    T2: MT or CT > AeT

  • ❖
    MT & CT improve:
    • -
      sleep (PSQI)
    • -
      fatigue (CSS-D)
  • ❖

    MT/T1: ↓ SOL

  • ❖

    CT/T2: ↑ SQ, ↓ SOL & ↑ TST
Methods: (RCT)
(a) MT (Multimodal Treatment)
(b) CT (MT + AeT)
(Combined Treatment)
(c) AeT (Aerobic Training)
Lengacher et al., Psychooncology 24 (4):
424–432 [50]		 79 Mamma CA
/stages 0-III		 OSP (Objective Sleep Parameters):
- Actigraphy
SSP (Subjective Sleep Parameters):
- PSQI;
- Sleep diary		 T1—Baseline
T2—Treatment (6 weeks)
T2—Post-Treatment (12 weeks)
  • ❖
    positive effect of MBSR(BC) on OSP at 12 weeks on:
    • -
      sleep efficiency:
      78.2% MBSR (BC) vs. 74.6% UC, p = 0.04
    • -
      percent of sleep time:
      81.0% MBSR (BC) vs. 77.4% UC, p = 0.02
    • -
      less number waking bouts:
      93.5 MBSR (BC) vs. 118.6 UC, p < 0.01
  • ❖

    small positive effects in MBSR(BC) on SSP at

    6 weeks - PSQI total score: p = 0.09

  • ❖

    no relationship between min. of MBSR (BC)

    practice and SSP or OSP
Methods: (RCT)
MBSR (BC) vs. UC
(Mindfulness-Based Stress
Reduction [Breast Cancer])
(Usual Care)
Marshall-McKenna et al., Supportive Care in Cancer 2016; 24 (4): 1821–1829 [51] 74 Mamma CA with
Insomnia
- 68.9 % pre-menopausal
- 31.1% post-menopausal		 HADS;
FACT-B (Functional Assessment of
Cancer Therapy - Breast)
sleep/hot flush diaries (over 2-week periods)		 T1—Baseline
T2—Treatment (x weeks)
T3—Post-Treatment (x weeks)
  • ❖
    CPPT + SC > SC:
    • -
      ↓ hot flushes p = 0.090
    • -
      ↓ HADS depression p = 0.036
  • ❖
    no differences in:
    • -
      FACT-B
    • -
      HADS anxiety
“This study supports the use of the CPPT as an aid to reduce sleep disturbance and the frequen-cy/severity of hot flushes.”
Methods: (RCT)
- Intervention Arm:
CPPT + SC
(Cool Pad Pillow Topper +
Standard Care)
vs.
- Control Arm:
SC (Standard Care)
Mendoza et al., Psychooncology 2017; 26 (11): 1832–1838 [52] 44 Cancer patients MOOS (Medical Outcomes Survey
Sleep);
PROMIS (Fatigue)
(Problem Index Patient-reported
Outcomes Measurement
Information System);
NRS (Pain intensity)
(Numerical Rating Scales) 		T1—Baseline
T2—Treatment (3 weeks)
T3—Post-Treatment (3 months)		 VMWH-CBT vs. Controls
→ beneficial effects of the VMWH-CBT
- sleep problems
- fatigue
- average pain intensity
Methods:
- RCT, cross-over
- VMWH-CBT vs. Controls
(Valencia model of Waking Hypnosis with Cognitive-Behavioural Therapy)
Peoples (Garland) et al., Journal of Cancer Survivorship 2017;
11 (3): 401–409 [55]		 95 Cancer patients
with Insomnia		 Insomnia Severity Index (ISI);
FACT-G (QoL)
(Functional Assessment of
Cancer Therapy - General)
 T1—Baseline
T2—Post-Treatment (7 weeks)
T3—Follow-up (3 months)
  • ❖

    No sleep results !!!

  • ❖
    CBT-I + A & CBT-I + P:
    • → CBT-I improves QoL
    • → Armodafinil no effect on QoL
Methods: (RCT)
(1) CBT-I + P
(CBT-I and Placebo)
(2) CBT-I + A
(CBT-I and Armodafinil)
(3) ARM (Armodafinil alone)
(4) PLA (Placebo alone)
Ritterband et al., Psychooncology 2012; 21 (7): 695–705 [56] 28 Cancer patients
with Insomnia		 Insomnia Severity Index (ISI);
Sleep Diary
(SOL, WASO, TIB, TST, SE)
MFSI-SF (Multidimensional
Fatigue Symptom Inventory -
Short Form);
UQ (Internet Intervention Utility
Questionnaire);
HADS; SF-12		 T1—Baseline
T2—Post-Treatment (3 months)		 SHUTi vs. Controls
→ beneficial effects of the SHUTi
- ↓ ISI
- ↓ HADS
- ↑ SF-12
- Sleep Diary:
↑ SE, ↑ TST, ↓ SOL & ↓ WASO
(Controls improved a little too: SE & WASO)
Methods:
  • ❖

    RCT

  • ❖

    Internet CBT-I/SHUTi (Sleep

     Healthy Using the Internet)

    versus

    WLC (Waiting-List Control)

Roscoe, J.A., (Garland, Sh.N.) et al., Journal of Clinical Oncology 2015; 33 (2): 165–171 [57] 96 Cancer patients
with Insomnia		 PSQI; Insomnia Severity Index (ISI) T1—Baseline
T2—Post-Treatment (7 weeks)
T3—Follow-up (3 months)		 CBT-I + A & CBT-I + P:
→ CBT-I improves Insomnia Severity (ISI)
→ CBT-I improves Sleep Quality (PSQI)
→ Armodafinil no effect on Insomnia & SQ
Methods: (RCT)
(1) CBT-I + P
(CBT-I and Placebo)
(2) CBT-I + A
(CBT-I and Armodafinil)
(3) ARM (Armodafinil alone)
(4) PLA (Placebo alone)
Savard (Quesnel) et al., JCCP 2003; 71 (1): 189–200 [59] 10 Mamma CA PSG;
Insomnia Severity Inventory (ISI);
Sleep Diary
(SOL, WASO, TIB, TST, SE)
MFI (Multidimensional Fatigue
Inventory);
BDI & STAI;
QLQ-C30+ 3
(European Organization
for Research & Treatment
of Ca. Quality of Life
Questionnaire)		 T1—Baseline
T2—Post-Treatment (3 months)
T3—Follow-up (6 months)
 CBT was associated with
- ↓ ISI:
= ↓ Insomnia severity
- ↑ PSG & ↑ Sleep Diary:
= ↑ SE, ↑ TST, ↓ SOL & ↓ WASO
Savard et al., Journal
of Pain and Symptom Management 2004;
27 (6): 513–522 [60]		 24 Mamma CA PSG;
Skin conductance		 ???
  • ❖
    nightly hot flashes
    • -
      ↑ wake time
    • -
      ↓ Stage 2 sleep
    • -
      ↑ REM latency
  • ❖

    ↑ sleep disruption

  • ❖

    ↑ poor sleep
Methods:
CBT
Savard et al., JCO
2005 I & II; 23 (25): 6083–6096 & 6097-
6106 [61]		 57 women with insomnia
caused or aggravated
by breast cancer		 PSG;
Insomnia Severity Inventory (ISI);
Sleep Diary
(SOL, WASO, TIB, TST, SE)
MFI (Multidimensional Fatigue
Inventory);
HADS;
QLQ-C30+ 3
(European Organization
for Research & Treatment
of Ca. Quality of Life
Questionnaire);
Immune measures: enumeration of blood cell counts (i.e., WBCs, monocytes, lymphocytes, CD3, CD4, CD8, CD16/CD56) & cytokine product. (Interleukin-1-beta [IL-1β], Interferon gamma [IFN-γ])		 T0—Pre-Waiting
T1—Baseline
T2—Post-Treatment
T3—Follow-up (3 months)
T4—Follow-up (6 months)
T5—Follow-up (12 months)		 CBT was associated with
(post-treatment vs. control patients)
- ↓ ISI:
= ↓ Insomnia severity
- ↑ PSG & ↑ Sleep Diary:
= ↑ SE, ↑ TST, ↓ SOL & ↓ WASO
- higher secretion and/or level of IFN-γ &
IL-1β
- lower increase of lymphocytes
Methods:
CBT versus WLC
(Waiting-List Control)
Savard (Tremblay) et al., JCCP 2009; 77 (4): 742–750 [62] 57 Mamma CA PSG;
Insomnia Severity Inventory (ISI);
Sleep Diary
(SOL, WASO, TIB, TST, SE)
DBAS (Dysfunctional Beliefs and
Attitudes about Sleep Scale);
ABS (Adherence to Behavioural
Strategies)
TEPCQ (Treatment Expectancies
and Perceived Credibility
Questionnaire);
TAPQ (Therapeutic Alliance
Perception Questionnaire);
HADS		 T1—Baseline
T2—Post-Treatment
(2 months)
T3—Follow-up
(6 months)
  • ❖

    CBT was associated with

    - ↓ ISI:

    = ↓ Insomnia severity

    - ↑ Sleep Diary:

    = ↑ SE, ↑ TST, ↓ SOL & ↓ WASO

  • ❖

    CBT wasn‘t associated with

    - PSG
Methods:
CBT versus WLC
(Waiting-List Control)
Savard et al., Psycho-Oncology 2013; 22 (6): 1381–1388 [65] 60 Prostate CA Insomnia Severity Index (ISI);
PSQ (Physical Symptoms
Questionnaire)		 T1—Baseline
Tx—1, 2, 4, 6, 8 & 12 months
T8—16 months
  • ❖

    ADT

    → risk of Insomnia ↑

  • ❖

    side effects of ADT & RTH

    → development of Insomnia
Methods:
ADT (Androgen Deprivation
Therapy)
RTH (Radiation therapy)
Savard (Casault) et
al., Behaviour Research and Therapy 2013; 67: 45–54 [66]		 83 Cancer patients
 ??? T1—Baseline
T2—Post-Treatment
T3—Follow-up (3 months)
T4—Follow-up (6 months)
  • ❖

    CBT was associated with

    (mCBT vs. Controls)
    • -
      ↑ all sleep parameters
    • -
      ↓ dosage of hypnotics
    • -
      ↓ anxiety & depression
    • -
      ↓ maladaptive sleep habits
    • -
      ↓ erroneous beliefs about sleep
    • -
      ↑ subjective cognitive functioning
  • ❖

    therapeutic gains of mCBT-I well sustained up to 6 months
Methods:
mCBT versus no Treatment
(minimal CBT)
Savard et al., Sleep 2014; 37 (8): 1305-
1314 [68]		 242 Mamma CA Actigraphy;
Insomnia Severity Index (ISI);
Sleep Diary
(SOL, WASO, TIB, TST, SE)
 T1—Baseline
T2—Post-Treatment (6 weeks)
  • ❖

    PCBT-I & VCBT-I were associated (compared to CTL):

- ↑ sleep
- ↓ Insomnia severity
- ↓ Early Morning Awakenings (EMA)
- ↓ depression
- ↓ fatigue
- ↓ dysfunctional beliefs about sleep
  • ❖

    Remission rates of insomnia (ISI < 8) were

significantly greater in PCBT-I as compared to VCBT-I:
- 71.3% vs. 44.3%, p < 0.005
Methods: (RCT)
(1) Professionally administered
CBT-I
(PCBT-I; n = 81)
(2) Video-based CBT-I
(VCBT-I; n = 80)
(3) no treatment
(CTL; n = 81)
Savard et al., Sleep 2016; 39 (4): 813–823
[69]		 242 Mamma CA Insomnia Severity Index (ISI);
Insomnia Interview Schedule (IIS);
Sleep Diary
(SOL, WASO, TIB, TST, SE)
MFI (Multidimensional Fatigue
Inventory)
EORTC QLQ-C30; HADS;
DBAS-16 (Dysfunctional Beliefs &
Attitudes about Sleep Scale –
Abbreviated version);		 T1—Baseline
T2—Post-Treatment (6 weeks)
T3—Follow-up (3 months)
T4—Follow-up (6 months)
T5—Follow-up (12 months)
  • ❖

    PCBT-I > VCBT-I > CTL:

- ↑ sleep: ↑ SE, ↑ TST, ↓ SOL & ↓ WASO
- ↓ Insomnia severity (ISI, IIS)
- ↓ Early Morning Awakenings (EMA)
- ↓ depression
- ↓ anxiety
- ↓ dysfunctional beliefs about sleep
- ↑ QoL
  • ❖

    remission rates of insomnia (ISI < 8) were

significantly greater in PCBT-I as compared to
VCBT-I and CTL: e.g., 12 month FU
- 67% vs. 59% vs. 48%, p < 0.100
Methods: (RCT)
(1) Professionally administered
CBT-I
(PCBT-I; n = 81)
(2) Video-based CBT-I
(VCBT-I; n = 80)
(3) no treatment
(CTL; n = 81)
Simeit et al., Suppor-tive Care in Cancer 2004; 12 (3): 176–183
[70]		 229 Cancer patients
(breast, kidney or
prostate)		 ??? T1—Baseline
T2—Post-Treatment (3-4 weeks)
T3—Follow-up (6 months)
  • ❖

    PMR & AT vs. CG

 → improvements over time:
  - sleep latency (p < 0.001)
  - sleep duration (p < 0.001)
  - sleep efficiency (p < 0.001)
  - sleep quality (p < 0.001)
  - sleep medication (p < 0.050)
  - daytime dysfunction (p < 0.050)
  - quality-of-life
  • ❖

    indicate a benefit of rehabilitation treatment in

    general

  • ❖

    no evidence between the two intervention

    groups

Methods: (RCT)
(1) Progressive Muscle
Relaxation
(PMR; n = 80)
(2) Autogenic Training
(AT; n = 71)
(3) Control Group
(CG; n = 78)
Zhou et al., Behavioral Sleep Medicine 2017;
15 (4): 288–301 [71]		 10 (12) Cancer patients Insomnia Severity Index (ISI); PSQI;
Sleep logs [SL];
(SOL, WASO, TIB, TST, SE);
SF-12		 T1—Baseline
T2—Post-Treatment (20 days)
T3—Follow-up
(2 months after T2)
  • ❖

    adapted CBT-I improves:

- ↑ Sleep (SL):
 ↑ SE, ↓ SOL, ↓ WASO & ↓ EMA
- ↓ Insomnia severity (ISI)
- ↓ Sleep Quality (PSQI)
  • ❖

    no effect on:

 - TST
 - QoL
Methods:
- Adapted CBT-I
3 x intervention in person (6) and via videoconference (6)

Notes: ???: unclear; ↑: increase; ↓: decrease.