Ducloux, D., Guisado, H., & Pautex, S. (2013). Promoting sleep for hospitalized patients with advanced cancer with relaxation therapy: experience of a randomized study. The American Journal of Hospice and Palliative Care, 30, 536–540.

To measure the efficacy of relaxation training for hospitalized patients with advanced cancer.

Patients were randomized to receive an immediate or delayed intervention, on day 3 or day 6 of a nine-day study period. The intervention was a one-hour training session delivered by a specially trained registered nurse (RN) in deep breathing and somatic tension release, as well as instruction on maintaining a state of somatic relaxation. Patients were given a CD of the audio training to repeat at night after the training.

• The sample was comprised of 18 patients (33% male, 66% female).
• Mean age was 61 years (standard deviation [SD] = 15 years) in the intervention group and 66 (SD = 12 years) in the delayed intervention group.
• Patients were hospitalized with advanced metastatic cancer, with a life expectancy of less than six months, a diagnosed sleep disorder, and fairly well-controlled pain and dyspnea.
• Multiple cancer diagnoses were included.
• Patients were hospitalized for at least five days.
• Patients had a Mini-Mental State Examination (MMSE) score of 20 or greater.
• Patients spoke French.

• Single site
• Inpatient
• Switzerland

• Patients were undergoing the end of life care phase of care.
• The study has clinical applicability for palliative care.

This was a pilot, randomized, controlled trial.

• Numerical Rating Scale of 1 to 10
• Sleep diary
• Hospital Anxiety and Depression Scale (HADS)

Only 11 patients were able to complete the treatment phase of the study. Both groups improved (not statistically) between the day of inclusion and day 2 of therapy. No improvement occurred between days 2 and 5, which was when the intervention occurred for half of the patients. No change occurred in the use of benzodiazepines during the nine-day study.

The study did not show that a simple relaxation therapy intervention improved satisfaction with sleep in patients with advanced cancer hospitalized on a palliative care unit.

Assessment and management of sleep disturbances should be integrated into patient care early in the disease process.  Further work is needed to identify and test interventions that can be used to improve sleep in patients with advanced cancer. Further work is also needed to determine whether relaxation therapies have an effect on sleep satisfaction.

• The study had a small sample size.  
• The study had risks of bias due to no blinding and no appropriate attentional control condition.
• Unintended interventions or applicable interventions not described would have influenced the results.
• Measurements/methods were not well described.
• Measurement validity/reliability was questionable.

It is critical to assess and manage sleep disturbances in patients with cancer early in the disease process. Ongoing evaluation and research is required into effective interventions to promote sleep in patients with cancer; specifically, further work is needed to look at relaxation therapies and determine if they are effective and a means of improving patient satisfaction with sleep.