CBT intervention for insomnia may help oncology patients

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Emerging research has indicated that cognitive behavioral therapy (CBT) is an effective approach to managing the insomnia experienced by cancer patients. However, the researchers acknowledged that more large-scale, high-quality trials are needed to provide long-term follow-up data.

Although insomnia is ubiquitous in the general population (10% to 20%), it is particularly prevalent in oncology patients. According to the study, 30 to 60 percent of this population suffers from insomnia, which is likely attributable to adverse events associated with cancer treatments such as chemotherapy and radiation therapy.

Consequently, these patients are 2 to 3 times more likely to suffer from sleep disturbances due to the discomfort that accompanies their treatment. In addition, insomnia leads to a higher risk of cancer-related fatigue, depression, pain, memory problems, cardiovascular and mental disorders, impaired immune function, reduced quality of life, all-cause mortality and cancer recurrence.

Review of the severity of insomnia in cancer patients

Ya Gao, Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, and researchers conducted a systematic review to examine which delivery format of cognitive-behavioral therapy for insomnia (CBT-I) would be most effective in this patient population.

Cognitive-behavioral therapy has been shown to be effective in improving insomnia when implemented through reputable methods such as under the guidance of a trained therapist, automated self-help programs, or delivered in individual form. , group, by telephone or computerized. The multimodal CBT-I intervention incorporates various cognitive and behavioral treatment elements consisting of cognitive restructuring, sleep hygiene education, stimulus control strategies, sleep restriction, and relaxation training.

The team searched 5 databases to gather data from randomized clinical trials comparing CBT-I with inactive or active controls for insomnia in cancer patients. Primary outcomes included severity of insomnia, sleep efficiency, sleep onset latency (SOL), wakefulness after falling asleep (WASO), and total sleep time (TST).

Most important effects observed after the intervention

Investigators identified 16 unique trials, including 1523 patients, that met the inclusion criteria. When evaluating the impact of targeted intervention alongside inactive control, CBT-I significantly reduced insomnia severity and increased sleep efficiency after the intervention. The severity of insomnia was significantly affected compared to active control, with wakefulness from falling asleep also reduced after the intervention.

“These effects diminished in short-term follow-up and almost disappeared in long-term follow-up,” the investigators reported. “Most of the results were graded as ‘moderate’ to ‘low’ certainty evidence.

However, compared to the inactive control group, the CBT-I group demonstrated an increase in sleep efficiency (10.61%), total sleep time (21.98 minutes), reduction in latency of falling asleep (14.65 minutes), as well as a reduction in wakefulness after falling asleep (24.30 minutes) after the intervention, with lasting effects during short-term follow-up.

“CBT-I is effective for the management of insomnia in cancer patients post-procedure, with diminished effects in short-term follow-up. The CBT-I group is the preferred choice based on post-procedure effects and short-term,” they concluded. “The low quality of evidence and limited sample size demonstrate the need for strong evidence from large, high-quality trials providing long-term follow-up data. “

The study “Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta-analysis” was published in the Journal of Evidence-Based Medicine.

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