Multi-stakeholder perspectives on managing insomnia in cancer survivors: recommendations to reduce barriers and translate patient-centered research into practice

Garland, Sheila N.; Trevino, Kelly M.; Liou, Kevin T; Gehrman, Philip; Spiguel, Eugenie; MacLeod, Jodi; Walker, Desiree; Glosik, Betsy; Seluzicki, Christina; Barg, Frances K.; Mao, Jun J.

doi:10.1007/s11764-021-01001-1

Cited by 14 publications

(10 citation statements)

References 67 publications

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“…They also mentioned that insomnia and the program should be discussed with patients as early as possible in the cancer care trajectory. These ndings are in line with previous studies conducted in cancer patients with sleep di culties and clinicians [10,22].…”

Section: Discussionsupporting

confidence: 92%

Barriers and facilitators to implementing a stepped care cognitive-behavioral therapy for insomnia in cancer patients: a qualitative study

Savard

Filion

Gagnon

et al. 2022

Support Care Cancer

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Purpose: Insomnia affects 30-60% of cancer patients and tends to become chronic when left untreated.While cognitive-behavioral therapy for insomnia (CBT-I) is the recommended rst-line treatment, this intervention is not readily accessible. This qualitative study investigated current practices in the assessment and management of insomnia in ve hospitals offering cancer care and identi ed the barriers and facilitators to the implementation of a stepped care CBT-I (i.e., web-based CBT-I followed, if needed, by 1-3 booster sessions) in these settings.Methods: Nine focus groups composed of a total of 43 clinicians (e.g., physicians, nurses, technologists, psychologists), six administrators, and 10 cancer patients were held. The Consolidated Framework for Implementing Research (CFIR) was used to develop the semi-structured interview and analyze the data.Results: Sleep di culties are not systematically discussed in clinical practice and when a treatment is offered, most often, it is a pharmacological one. Barriers and facilitators to the implementation of a stepped care CBT-I included individual characteristics (e.g., lack of knowledge about CBT-I); intervention characteristics (e.g., increased accessibility offered by a web-based format); inner setting characteristics (e.g., resistance to change); and process factors (e.g., motivation to offer a new service).Conclusions: This qualitative study con rms the need to better address insomnia in routine cancer care and suggests that, while some barriers were mentioned, the implementation of a stepped care CBT-I is feasible. Keys to a successful implementation include accessibility, training, inclusion of stakeholders in the process, and ensuring that they are supported throughout the implementation.

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Section: Discussionsupporting

confidence: 92%

Barriers and facilitators to implementing a stepped care cognitive-behavioral therapy for insomnia in cancer patients: a qualitative study

Savard

Filion

Gagnon

et al. 2022

Support Care Cancer

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“…In addition, appropriate retrospective and prospective cohort studies incorporating validated patient‐reported outcomes and relevant clinical outcomes can inform how these treatments impact populations in real‐world settings and potentially generate more specific testable hypotheses that can then be confirmed in clinical trials 216 . Consistent with patient‐centered outcomes research, engaging patients and relevant clinical and policy stakeholders in defining research questions and facilitating dissemination efforts are key to generating evidence that actually matters to patients in their specific cultural and societal settings 217,218 …”

Section: Challenges and Opportunities In Researchmentioning

confidence: 99%

Integrative oncology: Addressing the global challenges of cancer prevention and treatment

Mao

Pillai

Andrade

et al. 2021

CA A Cancer J Clinicians

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202

103

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The increase in cancer incidence and mortality is challenging current cancer care delivery globally, disproportionally affecting low‐ and middle‐income countries (LMICs) when it comes to receiving evidence‐based cancer prevention, treatment, and palliative and survivorship care. Patients in LMICs often rely on traditional, complementary, and integrative medicine (TCIM) that is more familiar, less costly, and widely available. However, spheres of influence and tensions between conventional medicine and TCIM can further disrupt efforts in evidence‐based cancer care. Integrative oncology provides a framework to research and integrate safe, effective TCIM alongside conventional cancer treatment and can help bridge health care gaps in delivering evidence‐informed, patient‐centered care. This growing field uses lifestyle modifications, mind and body therapies (eg, acupuncture, massage, meditation, and yoga), and natural products to improve symptom management and quality of life among patients with cancer. On the basis of this review of the global challenges of cancer control and the current status of integrative oncology, the authors recommend: 1) educating and integrating TCIM providers into the cancer control workforce to promote risk reduction and culturally salient healthy life styles; 2) developing and testing TCIM interventions to address cancer symptoms or treatment‐related adverse effects (eg, pain, insomnia, fatigue); and 3) disseminating and implementing evidence‐based TCIM interventions as part of comprehensive palliative and survivorship care so patients from all cultures can live with or beyond cancer with respect, dignity, and vitality. With conventional medicine and TCIM united under a cohesive framework, integrative oncology may provide citizens of the world with access to safe, effective, evidence‐informed, and culturally sensitive cancer care.

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“…In the clinical setting, it is possible the brief format may not be optimal for some survivors (ie, those who prefer to have additional sessions), and stepped care models have emerged as 1 approach to offering progressively more intensive treatment as needed to reduced burden and costs. 41,42 Subclinical insomnia severity was a chief reason cancer survivors were deemed ineligible for this trial, suggesting that this subgroup may have unmet needs for a low-intensity sleep intervention. Alternatively, in exit interviews, some survivors expressed a desire to extend the number of sessions.…”

Section: Discussionmentioning

confidence: 99%

The Survivorship Sleep Program (SSP): A synchronous, virtual cognitive behavioral therapy for insomnia pilot program among cancer survivors

Hall

Gorman

et al. 2021

Cancer

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BACKGROUND: For cancer survivors, insomnia is prevalent, distressing, and persists for years if unmanaged. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment yet can be difficult to access and may require modification to address survivorshipspecific barriers to sleep. In this 2-phase study, the authors adapted and assessed the feasibility, acceptability, and preliminary effects of synchronous, virtual CBT-I adapted for cancer survivors (the Survivorship Sleep Program [SSP]). METHODS: From April to August 2020, cancer survivors with insomnia (N = 10) were interviewed to refine SSP content and delivery. From October 2020 to March 2021, 40 survivors were recruited for a randomized controlled trial comparing 4 weekly SSP sessions with enhanced usual care (EUC) (CBT-I referral plus a sleep hygiene handout). Feasibility and acceptability were assessed by enrollment, retention, attendance, fidelity, survey ratings, and exit interviews. Insomnia severity (secondary outcome), sleep quality, sleep diaries, and fatigue were assessed at baseline, postintervention, and at 1-month follow-up using linear mixed models. RESULTS: The SSP included targeted content and clinician-led, virtual delivery to enhance patient centeredness and access. Benchmarks were met for enrollment (56% enrolled/eligible), retention (SSP, 90%; EUC, 95%), attendance (100%), and fidelity (95%). Compared with EUC, the SSP resulted in large, clinically significant improvements in insomnia severity (Cohen d = 1.19) that were sustained at 1-month follow-up (Cohen d = 1.27). Improvements were observed for all other sleep metrics except sleep diary total sleep time and fatigue. CONCLUSIONS: Synchronous, virtually delivered CBT-I targeted to cancer survivors is feasible, acceptable, and seems to be efficacious for reducing insomnia severity. Further testing in larger and more diverse samples is warranted.

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Multi-stakeholder perspectives on managing insomnia in cancer survivors: recommendations to reduce barriers and translate patient-centered research into practice

Cited by 14 publications

References 67 publications

Barriers and facilitators to implementing a stepped care cognitive-behavioral therapy for insomnia in cancer patients: a qualitative study

Barriers and facilitators to implementing a stepped care cognitive-behavioral therapy for insomnia in cancer patients: a qualitative study

Integrative oncology: Addressing the global challenges of cancer prevention and treatment

The Survivorship Sleep Program (SSP): A synchronous, virtual cognitive behavioral therapy for insomnia pilot program among cancer survivors

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