Langford, D. J., Lee, K., & Miaskowski, C. (2012). Sleep disturbance interventions in oncology patients and family caregivers: a comprehensive review and meta-analysis. Sleep Medicine Reviews, 16, 397–414.

To synthesize findings from intervention studies for sleep disturbance in patients with cancer and their caregivers.

Databases searched were PubMed, CINAHL, and PsycINFO.

Search keywords were sleep, sleep disturbance, insomnia, intervention, cancer, oncology, and caregivers.

Studies dated through 2010 that evaluated sleep disturbance/sleep quality as the primary or secondary outcome were included.

• The total number of references retrieved was not stated.
• The method of study evaluation was described for the type of intervention, mode of delivery, dose, and duration but not for study quality.
• There were only two studies that affected caregivers.

• The final number of studies included was 49 (47 targeting patients and 2 targeting caregivers). 
• Thirteen studies were included in the meta-analysis (total of 1,202 patients with cancer). 
• The total sample across all studies was 3,205 patients.
• The sample range across studies was 9 to 276 patients (including patients with cancer).
• Patients had various cancer types, phases of treatment, and stages of disease. 
• Women with breast cancer were studied most commonly.

Intervention groupings analyzed via meta-analysis included cognitive-behavioral therapy (CBT), education, exercise, and complementary and alternative therapies. Effect sizes appeared to be slightly over 1.0 for CBT, close to 0 for education, slightly over 1.0 for exercise, and slightly over 0 for complementary and alternative therapies. Specific effect sizes were only shown graphically, and actual data were not presented. No separate analysis of caregiver effects could be determined. Modes of delivery of interventions varied widely across studies.

Findings suggest at least moderate effects of CBT and exercise for improvement in sleep disturbances for patients with cancer. No substantial effects of exercise and education were demonstrated.

The review was limited by the lack of any data regarding heterogeneity in the meta-analysis, variability of interventions, and modes of delivery to enable any firm conclusions.

Insufficient evidence was provided to draw any conclusions regarding intervention effects for caregivers.