Internet-delivered cognitive-behavioral therapy for insomnia in women treated for breast cancer: a randomized controlled trial

Robert Hugh Zachariae, Ali Amidi, Malene Damholdt, Cecilie Dorthea Rask Clausen, Jesper Ovesen Dahlgaard, Holly Lord, Frances P. Thorndike, Lee Ritterband

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Abstract

Background
Insomnia is two to three times more prevalent in cancer survivors than in the general population, where it is estimated to be 10% to 20%. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended treatment for chronic insomnia, but meeting survivor needs remains a challenge. Internet-delivered CBT-I (iCBT-I) has been shown efficacious in otherwise healthy adults. We tested the efficacy of iCBT-I in breast cancer survivors with clinically significant sleep disturbance.

Methods
Women from a national sample of Danish breast cancer survivors who experienced clinically significant sleep disturbance were randomly allocated to iCBT-I or waitlist control (55:45). The fully automated iCBT-I program consisted of six cores. Online measures of insomnia severity, sleep quality, and fatigue were collected at baseline, postintervention (nine weeks), and follow-up (15 weeks). Online sleep diaries were completed over two-week periods pre- and postintervention. Intention-to-treat analyses (time × group interactions) were conducted with mixed linear models and corrected for multiple outcomes. All statistical tests were two-sided.

Results
A total of 255 women were randomly allocated to iCBT-I (n = 133) or waitlist control (n = 122). Statistically significant (P ≤ .02) time × group interactions were found for all sleep-related outcomes from pre- to postintervention. Effect sizes (Cohen’s d) ranged from 0.33 (95% confidence interval [CI] = 0.06 to 0.61) for wake after sleep onset to 1.17 (95% CI = 0.87 to 1.47) for insomnia severity. Improvements were maintained for outcomes measured at follow-up (d = 0.66–1.10).

Conclusions
iCBT-I appears to be effective in breast cancer survivors, with additional benefit in terms of reduced fatigue. This low-cost treatment could be incorporated in cancer rehabilitation programs.

OriginalsprogEngelsk
TidsskriftNational Cancer Institute. Journal
Vol/bind110
Udgave nummer8
Sider (fra-til)880-887
Antal sider7
ISSN0027-8874
DOI
StatusUdgivet - 2018

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  • Sygdom, sundhedsvidenskab og sygepleje

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