Espie, C. A., Fleming, L., Cassidy, J., Samuel, L., Taylor, L. M., White, C. A., . . . Paul, J. (2008). Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. Journal of Clinical Oncology, 26, 4651–4658.

DOI Link

Study Purpose

To investigate the clinical effectiveness of cognitive-behavioral therapy (CBT) for insomnia delivered by oncology nurses.

Intervention Characteristics/Basic Study Process

Patients received five 50-minute small group sessions delivered across five consecutive weeks, following a manualized protocol. Sessions included sleep information, sleep hygiene and relaxation, sleep scheduling, cognitive approaches, and developing a strong and natural sleep pattern. Outcomes measured were sleep, health-related quality of life (QOL), psychopathology, and fatigue.
 

Sample Characteristics

  • Of the patients, 100 received the CBT intervention and 50 received treatement as usual (TAU).
  • Of the patients, 103 were female.
  • Mean age was 61 years.
  • Patients had completed active therapy for breast, prostate, colorectal, or gynecologic cancer more than one month prior and had a chronic insomnia diagnosis.

Setting

The study was conducted at two oncology clinics in Scotland.

Phase of Care and Clinical Applications

Patients were undergoing the follow-up phase of care.

Study Design

This was a randomized, controlled trial.

Measurement Instruments/Methods

  • Hospital Anxiety and Depression Scale (HADS)
  • Fatigue Symptom Inventory (FSI)
  • Functional Assessment of Cancer Therapy–General (FACT-G)
  • Pittsburgh Sleep Quality Index (PSQI)
  • Epworth Sleepiness Scale (ESS)
  • Sleep diary
  • Actigraph

Results

CBT was associated with mean reductions in wakefulness of 55 minutes per night compared with no change in the TAU group. Outcomes were sustained six months after the intervention. There was statistically significant improvement in wake-after-sleep onset, sleep onset latency, and sleep efficiency, but not total sleep time. Actigraphy did not show statistically significant changes in sleep outcomes. CBT patients had reduced symptoms of fatigue, anxiety, and depression and increased physical and functional QOL compared to TAU patients.

Limitations

  • Training was required to deliver CBT.
  • Space was required for group meetings.
  • Actigraphs incurred a cost.