Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
Cancer. 2022 Apr 1;128(7):1532-1544. doi: 10.1002/cncr.34066. Epub 2021 Dec 16.
For cancer survivors, insomnia is prevalent, distressing, and persists for years if unmanaged. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment yet can be difficult to access and may require modification to address survivorship-specific barriers to sleep. In this 2-phase study, the authors adapted and assessed the feasibility, acceptability, and preliminary effects of synchronous, virtual CBT-I adapted for cancer survivors (the Survivorship Sleep Program [SSP]).
From April to August 2020, cancer survivors with insomnia (N = 10) were interviewed to refine SSP content and delivery. From October 2020 to March 2021, 40 survivors were recruited for a randomized controlled trial comparing 4 weekly SSP sessions with enhanced usual care (EUC) (CBT-I referral plus a sleep hygiene handout). Feasibility and acceptability were assessed by enrollment, retention, attendance, fidelity, survey ratings, and exit interviews. Insomnia severity (secondary outcome), sleep quality, sleep diaries, and fatigue were assessed at baseline, postintervention, and at 1-month follow-up using linear mixed models.
The SSP included targeted content and clinician-led, virtual delivery to enhance patient centeredness and access. Benchmarks were met for enrollment (56% enrolled/eligible), retention (SSP, 90%; EUC, 95%), attendance (100%), and fidelity (95%). Compared with EUC, the SSP resulted in large, clinically significant improvements in insomnia severity (Cohen d = 1.19) that were sustained at 1-month follow-up (Cohen d = 1.27). Improvements were observed for all other sleep metrics except sleep diary total sleep time and fatigue.
Synchronous, virtually delivered CBT-I targeted to cancer survivors is feasible, acceptable, and seems to be efficacious for reducing insomnia severity. Further testing in larger and more diverse samples is warranted.
对于癌症幸存者来说，失眠普遍存在，令人痛苦，如果不加以管理，失眠会持续多年。认知行为疗法治疗失眠（CBT-I）是一种有效的治疗方法，但难以获得，并且可能需要进行修改以解决与生存相关的睡眠障碍。在这项两阶段研究中，作者改编并评估了针对癌症幸存者的同步、虚拟 CBT-I 的可行性、可接受性和初步效果（生存睡眠计划[SSP]）。
从 2020 年 4 月到 8 月，失眠的癌症幸存者（N=10）接受了采访，以完善 SSP 的内容和交付方式。从 2020 年 10 月到 2021 年 3 月，招募了 40 名幸存者参加一项随机对照试验，比较每周 4 次 SSP 疗程与增强的常规护理（EUC）（CBT-I 转介加睡眠卫生传单）。通过登记、保留、出勤率、保真度、调查评分和退出访谈评估可行性和可接受性。使用线性混合模型在基线、干预后和 1 个月随访时评估失眠严重程度（次要结果）、睡眠质量、睡眠日记和疲劳。
SSP 包括有针对性的内容和临床医生主导的虚拟交付，以增强以患者为中心和可及性。登记（56%登记/合格）、保留（SSP，90%；EUC，95%）、出勤率（100%）和保真度（95%）都达到了基准。与 EUC 相比，SSP 导致失眠严重程度显著改善（Cohen d=1.19），在 1 个月随访时仍保持（Cohen d=1.27）。除了睡眠日记总睡眠时间和疲劳外，所有其他睡眠指标都有所改善。
针对癌症幸存者的同步、虚拟提供的 CBT-I 是可行的、可接受的，似乎对减轻失眠严重程度有效。需要在更大和更多样化的样本中进一步测试。
