Sleep problems in cancer: effective psychological interventions – a systematic review
Keywords:
oncology, insomnia, cancer, sleep, CBT, MBSR
Abstract
Introduction: Sleep problems are one of the most prevalent complications cancer patients experience. These have been shown to produce harmful effects such as reduced immunity and mood disturbances. While pharmacological agents for sleep problems may be used, psychological therapies should be considered where possible.
Aim: The aim of this review is to evaluate the effectiveness of different psychological interventions for sleep problems in cancer patients.
Methods: A systematic review was conducted. Databases searched included PsychINFO, Embase, MEDLINE, and Web of Science for papers published during the period from January 2003 to December 2013. Combinations of the following terms were used: “sleep disturbance”, “sleep problems”, “insomnia”, “cognitive behavioural therapy”, “CBT”, “non-pharmacological”, “sleep hygiene”, “psychological intervention”, “psychological treatment”, and “cancer”.
Results: 22 papers were selected for analysis. The main finding from this systematic review was that cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR) is the most promising psychological intervention for the treatment of insomnia in cancer patients. Other psychological treatments such as sleep education and multimodal programmes also demonstrate good potential for use in oncology.
Conclusions: Further randomized controlled trials comparing the effectiveness of CBT and MBSR in different types of cancer are required to determine their relative benefits and costs.
References
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23. Espie A, Kelly HL, Fleming L, White CA, Taylor L. Treating insomnia associated with cancer: a randomized, multi-centre trial of cognitive behaviour therapy (CBT) delivered by cancer nurse specialists. Psychooncology. 2006;15(2):S125.
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27. Simeit R, Deck R, Conta-Marx B. Sleep management training for cancer patients with insomnia. Support Care Cancer. 2004;12(3):176-83. DOI: 10.1007/s00520-004-0594-5.
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29. Carlson LE, Garland SN. Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. Int J Behav Med. 2005;12(4):278-85. DOI: 10.1207/s15327558ijbm1204_9.
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31. Berger AM, Kuhn BR, Farr LA, Lynch JC, Agrawal S, Chamberlain J, et al. Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Psychooncology. 2009;18(6):634-46. DOI: 10.1002/pon.1438.
32. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297-307. DOI: 10.1016/S1389-9457(00)00065-4.
33. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index (PSQI): a new instrument for psychiatric research and practice. Psychiatry Res. 1989;28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4.
34. Sadeh A, Hauri PJ, Kripke DF, Lavie P. The role of actigraphy in the evaluation of sleep disorders. Sleep. 1995;18(4):288-302s
35. NHS. Sleeping Pills and the Alternatives. NHS Choices website. March 2012 (reviewed 17 July 2014). http://www.nhs.uk/Livewell/insomnia/Pages/treatment.aspx (accessed 9 December 2013).
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37. Garland SN, Carlson LE, Antle MC, Samuels C, Campbell T. I-CAN SLEEP: Rationale and design of a non-inferiority RCT of mindfulness-based stress reduction and cognitive behavioral therapy for the treatment of insomnia in cancer survivors. Contemp Clin Trials. 2011;32(5):747-54. DOI: 10.1016/j.cct.2011.05.014.
2. Palesh OG, Roscoe JA, Mustian KM, Roth T, Savard J, Ancoli-Israel S, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center–Community Clinical Oncology Program. J Clin Oncol. 2010;28(2):292-8. DOI: 10.1200/JCO.2009.22.5011.
3. Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001;19:895-908.
4. Ritterband LM, Bailey ET, Thorndike FP, Lord HR, Farrell-Carnahan L, Baum LD. Initial evaluation of an internet intervention to improve the sleep of cancer survivors with insomnia. Psychooncology. 2012;21:695-705. DOI: 10.1002/pon.1969.
5. The Royal College of Psychiatrists. Sleeping Well. The Royal College of Psychiatrists website. October 2013 (reviewed July 2014). http://www.rcpsych.ac.uk/mentalhealthinfoforall/problems/sleepproblems/sleepingwell.aspx (accessed 6 December 2013).
6. NHS. Insomnia. NHS Choices website. May 2013 (reviewed 9 December 2013). http://www.nhs.uk/Conditions/Insomnia/Pages/Introduction.aspx (accessed 6th December 2013).
7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revision. Washington, DC, USA: American Psychiatric Association; 2000.
8. National Institute of Health and Care Excellence. Guidance on the Use of Zaleplon, Zolpidem and Zopiclone for the Short-Term Management of Insomnia (TA77). London, UK: National Institute of Health and Care Excellence; April 2004.
9. Joint Formulary Committee. British National Formulary: Hypnotics. Medicines Complete website. London: BMJ Group and Pharmaceutical Press; November 2013. http://www.medicinescomplete.com/mc/bnf/current/PHP2098-hypnotics.htm (accessed 7 December 2013).
10. Mann E, Smith MJ, Hellier J, Balabanovic JA, Hamed H, Grunfeld EA, et al. Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment (MENOS 1): a randomised controlled trial. Lancet Oncol. 2012;13(3):309-18. DOI: 10.1016/S1470-2045(11)70364-3.
11. Lengacher C, Reich R, Jim H, Kip K, Jacobsen P, Kiluk J, et al. The influence of mindfulness based stress reduction on objective sleep among breast cancer survivors. Psychooncology. 2013;22(Suppl. 2):S95.
12. Savard J, Ivers H, Savard MH, Villa J, Morin C. Is a video-based cognitive-behavioral therapy as efficacious as a professionally administered treatment for insomnia comorbid with cancer? Preliminary results of a randomized controlled trial. Psychooncology. 2013;22(Suppl. 2):S15.
13. Savard J, Villa J, Simard S, Ivers H, Morin CM. Feasibility of a self-help treatment for insomnia comorbid with cancer. Psychooncology. 2011;20(9):1013-9.
14. Raymond CLC. An evaluation of the effectiveness of psychosocial group programmes for treating insomnia in Chinese cancer patients. Psychooncology 2010;19(Suppl. 2):S123-4. DOI: 10.1002/pon.1818.
15. Casault L, Savard J, Ivers H. Cognitive behavioral therapy for insomnia comorbid with cancer: Efficacy of an early and minimal intervention. Psychooncology. 2009;18(Suppl. 1):S47.
16. Espie CA, Fleming L, Cassidy J, Samuel L, Taylor LM, White CA, et al. Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. J Clin Oncol. 2008;26(28):4651-8. DOI: 10.1200/JCO.2007.13.9006.
17. Savard J, Simard S, Ivers H, Morin CM. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: sleep and psychological effects. J Clin Oncol. 2005;23(25):6083-96. doi: 10.1200/JCO.2005.09.548.
18. Quesnel C, Savard J, Simard S, Ivers H, Morin CM. Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer. J Consult Clin Psychol. 2003;71(1):189-200. DOI: 10.1037/0022-006X.71.1.189.
19. Farrell-Carnahan L, Ritterband LM, Bailey ET, Thorndike FP, Lord HR, Baum LD. Feasibility and preliminary efficacy of a self-hypnosis intervention available on the web for cancer survivors with insomnia. E-J Appl Psychol. 2010;6(2):10-23.
20. Fiorentino L. Cognitive behavioral therapy for insomnia in breast cancer survivors: a randomized controlled crossover study. Dissertation Abstracts International: Section B: The Sciences and Engineering 2008;69(1-B):675.
21. Dirksen SR. Epstein DR. Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. J Adv Nurs. 2008;61(6):664-75. DOI: 10.1111/j.1365-2648.2007.04560.x.
22. Espie CA, Fleming LM, Cassidy J, Samuel L, Paul J. Psychological effects of cognitive behaviour therapy (CBT) for persistent insomnia associated with cancer: randomised controlled trial (RCT). J Sleep Res. 2008;17(Suppl. 1):34.
23. Espie A, Kelly HL, Fleming L, White CA, Taylor L. Treating insomnia associated with cancer: a randomized, multi-centre trial of cognitive behaviour therapy (CBT) delivered by cancer nurse specialists. Psychooncology. 2006;15(2):S125.
24. Nakamura Y, Lipschitz DL, Kuhn R, Donaldson GW, Kinney AY. Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: a pilot randomized controlled trial. J Cancer Surviv. 2013;7(2):165-82. DOI: 10.1007/s11764-012-0252-8.
25. Carney S, Nadler M, Eades M, Jeyaganth S, Bhargava R, Gagnon B. Evaluation of a focused intervention for sleep disturbance in a Cancer Nutrition-Rehabilitation Program. Support Care Cancer. 2010;18(Suppl. 3):S205.
26. Matthews E, Cook PF, McCarthy M, Duffy MA, Aloia MS. CBTI for insomnia after breast cancer treatment: individual improvement in sleep outcomes. Sleep. 2010;33(Suppl.):A304.
27. Simeit R, Deck R, Conta-Marx B. Sleep management training for cancer patients with insomnia. Support Care Cancer. 2004;12(3):176-83. DOI: 10.1007/s00520-004-0594-5.
28. Shapiro SL, Bootzin RR, Figueredo AJ, Schwartz GE, Lopez AM. The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: an exploratory study. J Psychosom Res. 2003;54(1):85-91. DOI: 10.1016/S0022-3999(02)00546-9.
29. Carlson LE, Garland SN. Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. Int J Behav Med. 2005;12(4):278-85. DOI: 10.1207/s15327558ijbm1204_9.
30. Epstein DR, Dirksen SR. Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors. Oncol Nurs Forum. 2007;34(5):51-9. DOI: 10.1188/07.
31. Berger AM, Kuhn BR, Farr LA, Lynch JC, Agrawal S, Chamberlain J, et al. Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Psychooncology. 2009;18(6):634-46. DOI: 10.1002/pon.1438.
32. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297-307. DOI: 10.1016/S1389-9457(00)00065-4.
33. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index (PSQI): a new instrument for psychiatric research and practice. Psychiatry Res. 1989;28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4.
34. Sadeh A, Hauri PJ, Kripke DF, Lavie P. The role of actigraphy in the evaluation of sleep disorders. Sleep. 1995;18(4):288-302s
35. NHS. Sleeping Pills and the Alternatives. NHS Choices website. March 2012 (reviewed 17 July 2014). http://www.nhs.uk/Livewell/insomnia/Pages/treatment.aspx (accessed 9 December 2013).
36. Brantley J. Mindfulness-based stress reduction. In: Orsillo SM, Roemer L, editors. Acceptance and Mindfulness-based Approaches to Anxiety: Conceptualization and Treatment. New York, NY, USA: Springer Science + Business Media; 2005. pp. 131-45.
37. Garland SN, Carlson LE, Antle MC, Samuels C, Campbell T. I-CAN SLEEP: Rationale and design of a non-inferiority RCT of mindfulness-based stress reduction and cognitive behavioral therapy for the treatment of insomnia in cancer survivors. Contemp Clin Trials. 2011;32(5):747-54. DOI: 10.1016/j.cct.2011.05.014.
Published
29-Nov-2014
How to Cite
Venables, H. (2014). Sleep problems in cancer: effective psychological interventions – a systematic review. Res Medica, 22(1), 15-36. https://doi.org/10.2218/resmedica.v22i1.776
Section
Clinical Review Article
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