Combined Treatment With Cognitive Behavioral Therapy for Insomnia and Acceptance and Commitment Therapy Enhances Objective and Subjective Reports of Sleep in Patients With Advanced Cancer.
Sharla Wells-Di Gregorio, Stacy Flowers, Juan Peng, Donald R Marks, Danielle Probst, Alexandra Zaleta, Don Benson, David E Cohn, Maryam Lustberg, William Carson, Uly Magalang, Sarah Baltimore, Sonia Ancoli-Israel
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Abstract
Background: Sleep difficulties are common for people with advanced cancer and are associated with poorer mood, lower quality of life, and reduced survival. For these patients, insomnia severity ratings are tied to nighttime awakenings, but little is known about the reasons for awakenings.
Aims: This study reports actigraphy sleep outcomes, longitudinal self-reported insomnia severity, and circadian rhythm disruptions from a randomized pilot study comparing a multi-symptom intervention with a wait-list control group for people with advanced cancer.
Methods: Twenty-eight people with advanced cancer completed a brief intervention, Finding Our Center Under Stress (FOCUS), designed to enhance sleep and alleviate worry, depression, and fatigue. Participants completed questionnaires and wore an Actiwatch for 7 consecutive 24-h periods pre- and post-intervention.
Results: There were no significant group × time actigraphy effects. However, sensitivity analyses with the full intervention sample including the wait-list control arm demonstrated significant effects on actigraphy sleep efficiency, minutes awake after sleep onset (WASO), number of awakenings, naps, and activity at rest. Insomnia severity ratings on the Insomnia Severity Index were maintained longitudinally with 61% meeting the cut-off for insomnia at baseline compared to 18% at 1 year. Participants demonstrated reductions in key reasons for awakenings.
Conclusions: Multi-symptom interventions may be necessary for sustained insomnia improvements for people with advanced cancer. The FOCUS intervention is one of the first to demonstrate improvements on self-reported and actigraphic measures of sleep in addition to other symptoms (i.e., worry, uncertainty, depression, fatigue interference, distress) for this population. Future effectiveness studies are warranted given results of this pilot trial.
Trial registration: Cognitive-behavioral intervention for worry, uncertainty, and insomnia for cancer survivors (NCT01929720).
期刊介绍：
Psycho-Oncology is concerned with the psychological, social, behavioral, and ethical aspects of cancer. This subspeciality addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process. Psycho-oncology is an area of multi-disciplinary interest and has boundaries with the major specialities in oncology: the clinical disciplines (surgery, medicine, pediatrics, radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology.
This international journal is published twelve times a year and will consider contributions to research of clinical and theoretical interest. Topics covered are wide-ranging and relate to the psychosocial aspects of cancer and AIDS-related tumors, including: epidemiology, quality of life, palliative and supportive care, psychiatry, psychology, sociology, social work, nursing and educational issues.
Special reviews are offered from time to time. There is a section reviewing recently published books. A society news section is available for the dissemination of information relating to meetings, conferences and other society-related topics. Summary proceedings of important national and international symposia falling within the aims of the journal are presented.
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