Nakamura, Y., Lipschitz, D. L., Kuhn, R., Kinney, A. Y., & Donaldson, G. W. (2013). Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: a pilot randomized controlled trial. Journal of Cancer Survivorship, 7, 165–182.

To determine the effects of mindfulness meditation (MM) and mind-body bridging (MBB) on self-reported sleep disturbance and quality of life (QOL) in cancer survivors.

All interventions lasted for three consecutive weeks, with weekly two-hour sessions. The sleep hygiene education (SHE) group served as an active control group. No usual care group was included.

• MBB:  MBB is used to learn awareness skills that can help individuals recognize and change dysfunctional mind-body states. Sessions included training on identifying aspects of a mind-body state that might be contributing to poor sleep and learning skills of MBB (stress reduction and increasing self-awareness). Participants were encouraged to practice skills learned on a daily basis.
• MM:  The program content was adapted from a six-week format and included sessions on forms of MM (awareness, body scans, walking meditation, and forgiveness meditation). Concerns about sleep were discussed in the context of MM techniques. Participants were encouraged to practice MM daily and were given mindfulness-based stress reduction (MBSR) meditation CDs and other handouts on MM and stress reduction. No actual homework sheets or practice tracking was required. One expressive writing assignment was completed.
• SHE:  Education was pasted on the Huntsman Online Patient Education (HOPE) Guide and provided information about how to change sleep habits to improve sleep quality. Regular adherence to the guidelines provided was encouraged.

• The sample was comprised of 57 patients (24.5% male, 75.5% female).
• Mean age was 52.6 years.
• Participants were survivors of any type of cancer.
• Participants were included if they had completed therapy at least three months prior to participation and had a report of sleep disturbance indicated by a score of 35 or greater on the Medical Outcomes Study Sleep Scale Index II subscale (MOS-SS, SPI-II).
• Participants with prior experience with MM, MBB, MBSR, or mindfulness-based cognitive therapy were excluded.

• Single site 
• Other
• Cancer Wellness House (nonprofit organization)

Participants were undergoing the late effects and survivorship phase of care.

This was a three-arm, randomized, controlled pilot study.

• MOS-SS, SPI-II
• Functional Assessment of Cancer Therapy–General (FACT-G)
• Perceived Stress Scale (PSS)
• Center for Epidemiologic Studies Depression Scale (CESD)
• Impact of Event Scale (IES)
• Five-Facet Mindfulness Questionnaire
• Self-Compassion Scale (SCS)
• World Health Organization (WHO) Well-Being Index
• Positive and Negative Affect Schedule (PANAS)
• Screening and demographic questionnaire

Baseline measurements of sleep differed significantly across groups at baseline (p = 0.011); adjusted baseline scores were used in the analysis. All intervention groups showed significant improvements in sleep quality from baseline (p < 0.001), although no immediate improvement was seen at  weeks 2 or 3 of any intervention arm. MM and MBB were effective longer after the intervention than SHE. FACT-G scores improved significantly from baseline in all groups (MBB:  p = 0.002; MM:  p = 0.010), although no significant difference was revealed in improvement across groups. Mean PSS scores decreased in all groups from baseline but with no significant difference across groups. All three arms had decreased CESD scores (SHE:  p = 0.001; MMB:  p = 0.008; MM:  p = 0.064), with MBB being more effective than SHE in reducing self-reported symptoms of depression (p = 0.040). MBB, but not MM, was also more effective at increasing mindfulness over SHE. Although scores improved for other secondary outcomes, there were no significant differences between groups.

MBB, SHE, and MM may improve sleep quality in cancer survivors. In addition, MBB may improve depressive symptoms and other comorbidities in this population.

• The study had a small sample size, with less than 100 patients.
• Baseline sample/group differences were of import.
• The study had risks of bias due to no control group, no blinding, and the sample characteristics.
• Key sample group differences could have influenced the results.
• Measurement validity/reliability was questionable.
• Effects of MM may not have been apparent after only three weeks (this is typically a six- to eight-week program).
• The study relied on self-report measures.
• Patients were not evaluated for specific sleep disorders.
• No measurement of intervention fidelity was reported. 
• All groups showed improvement; without comparison to a study group with no intervention, efficacy of any of these interventions cannot be readily determined.

Simple targeted interventions may be effective in improving sleep quality in cancer survivors. Nurses should be aware of and assess for sleep disturbances in cancer survivors. Further study of interventions for sleep disturbance are needed to improve QOL for this population. Findings from this study suggest that the interventions studied here are feasible; however, the effectiveness of these interventions cannot be determined.