Title. Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors Aim. This paper is a report of a study to describe the efficacy of cognitive behavioural therapy for insomnia on fatigue, mood and quality of life in breast cancer survivors. Background. Women who receive primary treatment for breast cancer often complain of insomnia. Rarely evaluated in insomnia intervention studies is the effect of cognitive behavioural treatment on the psychosocial outcomes of fatigue, mood and quality of life. Method. Data were collected between December 2002 and March 2004 with 72 women who were at least 3 months post-completion of primary treatment without current evidence of disease. Women were randomly assigned to either the cognitive behavioural therapy for insomnia group, which received stimulus control instructions, sleep restriction therapy and sleep education and hygiene, or the component control group which received sleep education and hygiene only. The 10-week study consisted of 2 weeks of pre-treatment, 6 weeks of treatment and 2 weeks of post-treatment. Fatigue, mood and quality of life were measured at preand post-treatment. Findings. Women receiving cognitive behavioural therapy for insomnia had significant improvements in fatigue, trait anxiety, depression and quality of life. The component control group also had statistically significant increases in quality of life, with a trend suggestive of lower depression at post-treatment. Conclusion. Globally, as the number of survivors in this population continues to grow, it is imperative that nurses continue testing interventions that may positively affect quality of life and the commonly experienced symptoms of fatigue, anxiety and depression.

Breast cancer survivors can benefit from a cognitive-behavioral intervention for chronic insomnia. Sleep education and hygiene, a less complex treatment than a multicomponent intervention, also is effective in treating insomnia.

The purpose of this study was to explore search for meaning in long-term survivors of malignant melanoma and the relationship of this meaning to self-blame and well-being. The sample consisted of 31 long-term melanoma survivors who had been free of disease for 5 years or longer. Measures included the Search for Meaning scale, a single item on self-blame and the Index of Well-Being. Data were analysed by descriptive statistics and t-tests. Findings revealed that 52% (n = 16) of the sample did search for meaning which resulted in an identifiable cause for their cancer and a quiet reassessment of life. Subjects indicating self-responsibility for their cancer expressed a greater meaning search than the group who did not blame self (P < 0.01). Well-being scores were not significantly related to this search for meaning. Results suggest that for some survivors the cancer experience elicits a search for meaning which is significantly associated with self-blame. This study extends developing nursing theory on survivorship by providing insight into the meaning of the cancer experience in long-term survivors.

The purpose of this descriptive study was to test a conceptual model that predicts well-being among women who have survived breast cancer. The model was derived from empirical research findings that identified health care orientation, uncertainty, social support, resourcefulness and self-esteem as significant predictors of well-being in persons diagnosed with cancer. The convenience sample was of 84 women who had completed primary treatment for breast cancer and were currently disease-free. After informed consent was obtained each woman completed six questionnaires which measured the study variables. Multiple regression techniques were used to empirically test the predicted conceptual relationships and to estimate predictive validity for the model. Findings indicated that uncertainty and social support were significant predictors of resourcefulness and explained 12% of the variance in resourcefulness. Resourcefulness and social support were significant predictors of self-esteem and explained 33% of the variance in self-esteem. In combination, social support, resourcefulness, and self-esteem were significant predictors of well-being and explained 42% of the variance in well-being. Health care orientation was not a significant variable. This study confirmed hypotheses and provided insight into the variables that significantly influence well-being in women who have survived breast cancer. Recommendations for practice are given with suggestions made for further research.

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