Berger, A. M., VonEssen, S., Kuhn, B. R., Piper, B. F., Agrawal, S., Lynch, J. C., . . . Higginbotham, P. (2003). Adherence, sleep, and fatigue outcomes after adjuvant breast cancer chemotherapy: results of a feasibility intervention study. Oncology Nursing Forum, 30, 513–522.

To evaluate the outcomes of an intervention designed to promote sleep and modify fatigue after adjuvant breast cancer chemotherapy.

A multicomponent cognitive-behavioral therapy in the form of a four-part intervention consisting of sleep hygiene counseling, relaxation therapy, sleep restriction, and an individualized sleep promotion plan (ISPP) stimulus control was used. It started two days before the first chemotherapy treatment; continued during treatment; was revised 30, 60, and 90 days after the last treatment; and was reinforced seven days later. Sleep and fatigue were the outcomes measured.

• The study was comprised of 21 female Caucasian patients with stage I or II breast cancer following adjuvant chemotherapy.
• Mean patient age was 55.3 years (range 43–66).

The study was conducted in the Midwestern United States in the patients’ homes.

Patients were undergoing the long-term follow-up phase of care.

This was a prospective, repeated measures, quasiexperimental feasibility study.

• Pittsburgh Sleep Quality Index (PSQI)
• Daily diary
• Wrist actigraph

High adherence to the four components of the ISPP was found, except for stimulus control. Sleep latency remained stable. Sleep efficiency ranged from 82% to 92%, and total rest ranged from seven to eight hours per night. The number of night awakenings ranged from 10 to 11 per night.

• The pilot study was not designed to test the effectiveness of the intervention.
• Research RN training was required.
• Actigraphs incurred a cost.