Light enhanced cognitive behavioral therapy for insomnia and fatigue during chemotherapy for breast cancer: a randomized controlled trial

Abstract

Study Objectives Sleep problems are common during chemotherapy for breast cancer (BC). We evaluated whether combined brief cognitive behavioral and bright light therapy (CBT-I+Light) is superior to treatment as usual with relaxation audio (TAU+) for insomnia symptoms and sleep efficiency (primary outcomes). Methods We randomized women receiving intravenous chemotherapy, stratified by tumor stage and insomnia severity index (ISI), to 6-weeks CBT-I+Light or TAU+. CBT-I+Light included one in-person session, one telephone call, seven emails, and 20 minutes bright light each morning. TAU+ comprised usual treatment and two emails with relaxation audio tracks. Patient-reported outcomes were assessed at baseline, midpoint (week 3), post (week 6) and 3-month follow-up. Results Women (N = 101) were randomly assigned to CBT-I+Light or TAU+. The CBT-I+Light group showed significantly greater improvement in insomnia symptoms than the TAU+ group (-5.06 vs -1.93, P = .009; between-group effect size [ES] = .69). At 3-month follow-up, both groups were lower than baseline but did not differ from each other (between-group ES = .18, P = .56). CBT-I+Light had higher patient-reported sleep efficiency than TAU+ immediately after the start of intervention (P = .05) and significantly greater improvement in fatigue (between-group ES = .59, P = .013) and daytime sleep-related impairment (between-group ES = .61, P = .009) than the TAU+ group. Conclusion CBT-I+Light had a clinically significant impact on insomnia and fatigue with moderate effect sizes. Results support offering cognitive behavioral therapy for insomnia and bright light therapy during chemotherapy for breast cancer to help manage sleep and fatigue.

Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia

“…Our study contributes to a growing body of research reporting the beneficial effects of CBT-I on fatigue in cancer survivors. 51 , 52 , 53 However, to our knowledge, only two studies have evaluated the role of CBT-I on fatigue among cancer patients with insomnia. 27 , 54 Our study is consistent with both in showing that CBT-I produces significant and durable fatigue reduction with moderate to large effects.…”

AYA ‘Can-Sleep’ Program : protocol for a stepped-care, cognitive behavioral therapy based approach to the management of sleep difficulties in adolescents and young adults with cancer

“…The impact of the program will be evaluated on the basis of the number of AYA who report clinically meaningful changes (improvements) in sleep quality as measured by changes in scores of insomnia measures collected at screening, post the CBT Self-Management Resource, and post Individual CBT. Based on a previous study in cancer (41), clinically meaningful changes for the ISI was de ned at 3 or more, a change of 3 represents approximately half a standard deviation on the ISI, or about half a "category" shift based on common cut-offs. Data will be managed through REDCap and quantitative data will be analysed using SPSS.…”

Comparing the effect of emotional freedom technique on sleep quality and happiness of women undergoing breast cancer surgery in military and nonmilitary families: A quasi‐experimental multicenter study

“…However, there are many studies that examined the effect of other nonpharmacological and psychotherapeutic methods on improving sleep quality and treating insomnia in women with breast cancer. For instance, previous studies reported the effectiveness of cognitive‐behavioral therapy (Bean et al, 2021), mindfulness‐based stress reduction (Suh et al, 2021), progressive muscle relaxation (Ashery et al, 2021), electro acupuncture (Zhang et al, 2021), Tai Chi Chih (Irwin et al, 2017), and aerobic and resistance exercises (Dieli‐Conwright et al, 2021). Moreover, review of the literature showed that limited interventions were done to increase the happiness of women with breast cancer.…”

“…However, there are many studies that examined the effect of other nonpharmacological and psychotherapeutic methods on improving sleep quality and treating insomnia in women with breast cancer. For instance, previous studies reported the effectiveness of cognitive-behavioral therapy (Bean et al, 2021), mindfulness-based stress reduction (Suh et al, 2021), progressive muscle relaxation (Ashery et al, 2021), electro acupuncture (Zhang et al, 2021), Tai Chi Chih (Irwin et al, 2017) review of the literature showed that limited interventions were done to increase the happiness of women with breast cancer. For instance, previous studies reported the efficacy of self-management (Ahmadidarrehsima et al, 2016), group positive psychotherapy (Dowlatabadi et al, 2016), hope therapy (Kondori Fard et al, 2021), and compassion-based therapy (Alighanavati et al, 2018) in increasing the happiness of women with breast cancer.…”