Garland, S.N., Johnson, J.A., Savard, J., Gehrman, P., Perlis, M., Carlson, L., & Campbell, T. (2014). Sleeping well with cancer: A systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatric Disease and Treatment, 10, 1113–1124. 

DOI Link

Purpose

STUDY PURPOSE: To review the efficacy of cognitive behavioral therapy (CBT) on sleep and psychological outcomes in patients with cancer and cancer survivors

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: PubMed, MEDLINE, PsycINFO
 
KEYWORDS: insomnia; cancer; sleep disturbances; cognitive; cognitive behavioral therapy
 
INCLUSION CRITERIA: CBT tailored for insomnia was used as the intervention; the target population was patients with cancer; measure of sleep was included as a treatment outcome.
 
EXCLUSION CRITERIA: Not described

Literature Evaluated

TOTAL REFERENCES RETRIEVED: Not reported
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Not reported

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 12
  • SAMPLE RANGE ACROSS STUDIES = 10–260
  • TOTAL PATIENTS INCLUDED IN REVIEW = 1,153
  • KEY SAMPLE CHARACTERISTICS: Most studies in breast cancer, but a few in mixed diseases

Phase of Care and Clinical Applications

  • PHASE OF CARE: Multiple phases of care
  • APPLICATIONS: Palliative care

Results

Four of four uncontrolled trials showed a positive significant effect of CBT on sleep problems. Of eight RCTs, five showed a positive significant effect and three showed no difference between groups. One of these compared CBT to mindfulness-based stress reduction rather than usual care. One study showed no long-term effectiveness. Review of the evidence shows overall efficacy of CBT in patients without cancer. The intervention has been delivered effectively in person, individually or in groups, telephonically, and via the internet or videos.

Conclusions

The majority of evidence shows that CBT has a positive effect on sleep-wake disturbance in patients with cancer. The most effective duration, timing, and “dose” is unclear, but this approach appears to be effective when delivered with varied methods.

Limitations

  • This review does not provide a full report of search results or any method of quality evaluation of the studies included.  
  • Reports individual study findings, but does not really synthesize and draw conclusions across studies

Nursing Implications

Evidence supports the effectiveness of CBT for sleep problems in patients with cancer, and this approach appears to be provided effectively in very practical ways, such as through videos and websites. At present, as reported in this review, CBT is seen as the treatment of choice for insomnia in patients with cancer. Future research for comparative effectiveness of various interventions for sleep disturbances is needed.

Legacy ID

4365