![]() Johnson et al conducted a meta-analysis to investigate the efficacy of CBT-I specifically in cancer survivors. In addition, breast cancer itself may increase the risk of insomnia and vice versa.Ĭognitive behavioral therapy for insomnia (CBT-I) is the gold standard treatment for insomnia, and its efficacy has been well established for primary insomnia and insomnia with a variety of medical or psychiatric comorbid conditions. It has also been suggested that cancer-related fatigue provides a false cue for sleep extension and this contributes to insomnia. Greater insomnia severity is also linked with worsened depression, pain, deregulated circadian rhythm, fatigue, reduced quality of life, disease progression, and even decreased survival. Patients with breast cancer or survivors with breast cancer history experiencing insomnia are also more likely to endorse high uncertainty about cancer and cancer treatment. Notably, women with breast cancer are prone to insomnia for multiple reasons (e.g., discomfort, pain, hot flashes, endocrine therapy and other hormonal changes associated with the breast cancer treatment, fear of recurrence). prostate, gynecologic, head and neck, urinary or GI, etc.). In fact, prevalence rates of insomnia have shown to be the highest in breast cancer (42% to 69%) compared to other cancer sites (e.g. To date, most of the studies on sleep problems in cancer have been conducted in women with breast cancer. ![]() ![]() The greater rate of insomnia in the cancer population is attributed to the emotional consequences of cancer diagnosis and to the direct effects of cancer treatments and their side effects. Insomnia in patients with cancer is persistent, chronic, and two to three times more prevalent compared to that in the general population (50–60% versus 12–25%). Given the variability in the CBT-I components tested in RCTs, future studies should investigate the optimal integration of CBT-I components for managing insomnia during BC survivorship. As an integrative oncology intervention, CBT-I is efficacious for reducing insomnia and improving sleep quality in women treated for BC, with medium-to-large effect sizes that persist after intervention delivery ends. In sub-analyses, CBT-I had similar effect sizes regardless of potential modifiers (comparison design, delivery formats, etc.). Of the 14 included RCTs (total N=1363), the most common components incorporated in CBT-I interventions were sleep hygiene, stimulus control and sleep restriction. Randomized controlled trials (RCTs) that included patients/survivors with BC andinsomnia, and at least one validated self-report measure of sleep quality were included in the review. Our review aimed to assess the evidence for the therapeutic effects of CBT-I on insomnia in BC. ![]() Although cognitive behavioral therapy for insomnia (CBT-I) is available in integrative oncology settings, it poses unique challenges for BC survivors. In conclusion, internet-delivered CBT-I appears efficacious and can be considered a viable option in the treatment of insomnia.Insomnia is highly prevalent among patients with breast cancer (BC). Moderator analyses showed that longer treatment duration and higher degree of personal clinical support were associated with larger effect sizes, and that larger study dropout in the intervention group was associated with smaller effect sizes. The effects were comparable to those found for face-to-face CBT-I, and were generally maintained at 4-48 wk follow-up. Results showed that eCBT-I improved insomnia severity, sleep efficiency, subjective sleep quality, wake after sleep onset, sleep onset latency, total sleep time, and number of nocturnal awakenings at post-treatment, with effect sizes (Hedges's g) ranging from 0.21 to 1.09. ![]() Eleven randomized controlled trials examining a total of 1460 participants were included. Two researchers independently searched key electronic databases (1991 to June 2015), selected eligible publications, extracted data, and evaluated methodological quality. The objective of this meta-analysis was to evaluate the efficacy of eCBT-I and the moderating influence of various study characteristics. Delivering CBT-I over the internet (eCBT-I) may be one method to overcome this challenge. Cognitive-behavioral therapy for insomnia (CBT-I) has been shown efficacious, but the challenge remains to make it available and accessible in order to meet population needs. ![]()
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