Efficacy of cognitive behavioral therapy for insomnia in breast cancer: A meta-analysis

Ma, Yan; Hall, Daniel L.; Ngo, Long; Liu, Qingqing; Bain, Paul; Yeh, Gloria Y.

doi:10.1016/j.smrv.2020.101376

Cited by 83 publications

(51 citation statements)

References 53 publications

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“…Thus, the best interventions for insomnia will be those with enduring long‐term effects (e.g., Cognitive Behaviour Therapy for Insomnia; CBT‐I). CBT‐I has demonstrated immediate and long‐lasting effects for reduction of insomnia severity in cancer patients, 47 and has been shown to reduce fatigue over time 48 . As such, CBT‐I might be an important first‐line treatment option for breast cancer patients with a primary insomnia complaint and secondary fatigue symptoms.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with cognitive impairment during the first year of treatment for nonmetastatic breast cancer

et al. 2021

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Background Women with breast cancer are more likely to develop cognitive impairment (CI), insomnia, fatigue, and mood disturbance than individuals with other cancers. The main objectives of this study were to establish the prevalence of CI and examine the relationships between CI, insomnia, fatigue, and mood over the first year of breast cancer treatment. Methods Participants were recruited after diagnosis and completed validated measures of insomnia, objective and perceived CI, fatigue, and mood disturbance at four time points during the first year of treatment. A random intercepts cross‐lagged panel model assessed relationships among symptoms over time. Results The sample included 98 women. Prevalence of objective CI ranged from 3.1% to 8.2% throughout the year, whereas 36.7% demonstrated a clinically meaningful decline in perceived CI from baseline to 4 months, which remained relatively stable. Greater perceived CI was associated with more fatigue (β = −0.78, z = 17.48, p < .01) and symptoms of insomnia (β = −0.58, z = 5.24, p < .01). Short‐term fluctuations in perceived CI (p < .05), but not fatigue or insomnia, predicted future perceived CI. Fatigue (p < .001) was a significant predictor of future reported symptoms of fatigue and insomnia. Conclusion Subjective CI is more prevalent than objective impairments. Fatigue, insomnia, and perceived CI remain stable and are associated during the first year of treatment. Changes in insomnia and fatigue may have little effect on future perceived cognition. Women with breast cancer likely require targeted intervention for these side effects.

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Section: Discussionmentioning

confidence: 99%

Factors associated with cognitive impairment during the first year of treatment for nonmetastatic breast cancer

et al. 2021

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“…Cognitive-behavioral therapy for insomnia (CBT-I) is the "gold standard" nonpharmacologic treatment for insomnia in the general population and in cancer survivors, with medium-tolarge effect sizes for sleep outcomes that persist after intervention delivery ends [17][18][19] . Pain, one of the most common concurrent symptoms of insomnia, is inadequately addressed.…”

Section: Introductionmentioning

confidence: 99%

Acupuncture versus cognitive behavioral therapy for pain among cancer survivors with insomnia: an exploratory analysis of a randomized clinical trial

et al. 2021

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Pain and insomnia often co-occur and impair the quality of life in cancer survivors. This study evaluated the effect of acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) on pain severity among cancer survivors with comorbid pain and insomnia. Using data from the CHOICE trial that compared acupuncture versus CBT-I for insomnia among cancer survivors, we analyzed the effect of interventions on pain outcomes in 70 patients with moderate to severe baseline pain. Interventions were delivered over eight weeks. We assessed average pain severity (primary outcome) and pain interference at baseline, week 8, and week 20. We further defined insomnia and pain responders as patients who achieved clinically meaningful improvement in insomnia and pain outcomes, respectively, at week 8. We found that compared with baseline, the between-group difference (-1.0, 95% CI -1.8 to -0.2) was statistically significant favoring acupuncture for reduced pain severity at week 8 (-1.4, 95% CI -2.0 to -0.8) relative to CBT-I (-0.4, 95% CI-1.0 to 0.2). Responder analysis showed that 1) with acupuncture, insomnia responders reported significantly greater pain reduction from baseline to week 4, compared with insomnia non-responders (-1.5, 95% CI -2.7 to -0.3); 2) with CBT-I, pain responders reported significantly greater insomnia reduction at week 8, compared with pain non-responders (-4.7, 95% CI -8.7 to -1.0). These findings suggest that among cancer survivors with comorbid pain and insomnia, acupuncture led to rapid pain reductions, which contributed to a decrease in insomnia, whereas CBT-I had a delayed effect on pain, possibly achieved by insomnia improvement.

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“…Participants also kept a sleep diary at three time points throughout the trial, and sleep self‐monitoring can lead to improvements in sleep‐related behaviors 32,33 . More intensive behavioral sleep interventions, such as cognitive behavioral therapy for insomnia (CBT‐I), have been found to be efficacious for reducing insomnia and improving sleep quality among cancer survivors 34–36 . Thus, future research should examine the potential impact of CBT‐I on cognition, specifically examining if cognitive function improves through the mechanism of improved sleep among survivors who are at risk for both sleep disturbance and neurocognitive impairments.…”

Section: Discussionmentioning

confidence: 99%

A randomized double‐blind placebo‐controlled trial of the effectiveness of melatonin on neurocognition and sleep in survivors of childhood cancer

Lubas

Mandrell

Greene

et al. 2021

Pediatric Blood & Cancer

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Background Adult survivors of childhood cancer are at risk of developing sleep and neurocognitive problems, yet few efficacious interventions exist targeting these prevalent late effects. Melatonin has known sleep‐promoting effects; however, it has not been well studied among childhood cancer survivors. Method Survivors (n = 580; mean age = 33.5 years; 26 years post‐diagnosis) from the St. Jude Lifetime Cohort were randomized (1:1) to a six‐month double‐blind placebo‐controlled trial of 3 mg time‐release melatonin within three strata (stratum 1: neurocognitive impairment only; stratum 2: neurocognitive and sleep impairment; stratum 3: sleep impairment only). Neurocognitive performance was assessed at baseline and post‐intervention using standardized measures. Sleep was assessed via self‐report and actigraphy. Independent sample t tests compared mean change scores from baseline to six months. Post‐hoc analyses compared the prevalence of clinically significant treatment responders among melatonin and placebo conditions within and across strata. Results Intent‐to‐treat analyses revealed no statistically significant differences in neurocognitive performance or sleep from baseline to post‐intervention. However, among survivors with neurocognitive impairment only, a larger proportion randomized to melatonin versus placebo demonstrated a treatment response for visuomotor speed (63% vs 41%, P = 0.02) and nonverbal reasoning (46% vs 28%, P = 0.04). Among survivors with sleep impairment only, a larger proportion treated with melatonin demonstrated a treatment response for shifting attention (44% vs 28%, P = 0.05), short‐term memory (39% vs 19%, P = 0.01), and actigraphy‐assessed sleep duration (47% vs 29%, P = 0.05). Conclusion Melatonin was not associated with improved neurocognitive performance or sleep in our intent‐to‐treat analyses; however, a subset of survivors demonstrated a clinically significant treatment response.

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Efficacy of cognitive behavioral therapy for insomnia in breast cancer: A meta-analysis

Cited by 83 publications

References 53 publications

Factors associated with cognitive impairment during the first year of treatment for nonmetastatic breast cancer

Factors associated with cognitive impairment during the first year of treatment for nonmetastatic breast cancer

Acupuncture versus cognitive behavioral therapy for pain among cancer survivors with insomnia: an exploratory analysis of a randomized clinical trial

A randomized double‐blind placebo‐controlled trial of the effectiveness of melatonin on neurocognition and sleep in survivors of childhood cancer

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