The effect of insomnia treatment on work productivity and related costs among cancer survivors with insomnia and comorbid perceived cognitive impairments: A secondary analysis of a randomized controlled trial.
Joshua Tulk, Lynn Gambin, Sondria Browne, Kara Laing, Joshua A Rash, Josée Savard, Melanie Seal, John Thoms, Robin Urquhart, Sheila N Garland
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Abstract
Purpose: This secondary analysis of a randomized clinical trial aimed to understand the cost-effectiveness of cognitive behavioral therapy for insomnia (CBT-I) in improving absenteeism (i.e., time away from work) and presenteeism (i.e., unproductivity while at work) among cancer survivors.
Methods: A total of 55 currently employed mixed cancer survivors who met DSM-5 criteria for insomnia disorder and self-reported cognitive impairments were randomized to receive seven weekly, individual CBT-I sessions immediately or after a waiting period. Participants completed the Work Productivity and Activity Impairment Questionnaire (WPAI). Information from participants and the Labour Force Survey (LFS) were used to calculate costs. Education-adjusted mixed-effects models using intention-to-treat principles assessed immediate and longer-term effects of treatment on work productivity.
Results: While CBT-I was not associated with significant improvements in absenteeism, the treatment group reported a 23.5-point reduction in presenteeism post-treatment, compared to a 0.45-point decrease in the waitlist control group. Improvements in presenteeism were maintained at 6-month follow-up. The mean cost of total work productivity loss was CAD627.59 per person per week before beginning CBT-I. Treatment resulted in a 48.4%, 44.6%, and 30.5% reduction in lost productivity immediately, 3 and 6 months post-treatment, respectively. Total cost savings for the first year after treatment, adjusting for treatment costs, were estimated at CAD 9478.82.
Conclusions: Intervening upon late and long-term effects of cancer treatment (e.g., sleep, fatigue, cognitive impairment) through CBT-I produces meaningful and durable improvements in work productivity, particularly presenteeism.
Implications for cancer survivors: With appropriate treatment, survivors can address side effects and increase productivity, but additional work is needed to improve access to and coverage for evidence-based interventions.
期刊介绍：
Cancer survivorship is a worldwide concern. The aim of this multidisciplinary journal is to provide a global forum for new knowledge related to cancer survivorship. The journal publishes peer-reviewed papers relevant to improving the understanding, prevention, and management of the multiple areas related to cancer survivorship that can affect quality of care, access to care, longevity, and quality of life. It is a forum for research on humans (both laboratory and clinical), clinical studies, systematic and meta-analytic literature reviews, policy studies, and in rare situations case studies as long as they provide a new observation that should be followed up on to improve outcomes related to cancer survivors. Published articles represent a broad range of fields including oncology, primary care, physical medicine and rehabilitation, many other medical and nursing specialties, nursing, health services research, physical and occupational therapy, public health, behavioral medicine, psychology, social work, evidence-based policy, health economics, biobehavioral mechanisms, and qualitative analyses. The journal focuses exclusively on adult cancer survivors, young adult cancer survivors, and childhood cancer survivors who are young adults. Submissions must target those diagnosed with and treated for cancer.
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