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Danish University Colleges Internet-delivered cognitive-behavioral therapy for insomnia in women treated for breast cancer: a randomized controlled trial Zachariae,
| Content Provider | Semantic Scholar |
|---|---|
| Author | Amidi, Ali Damholdt, Malene Flensborg Clausen, Cecilie R. Dahlgaard, Jesper Lord, Holly Thorndike, Frances P. Ritterband, Lee M. |
| Copyright Year | 2018 |
| 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 preand 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 1⁄4 133) or waitlist control (n 1⁄4 122). Statistically significant (P .02) time group interactions were found for all sleep-related outcomes from preto postintervention. Effect sizes (Cohen’s d) ranged from 0.33 (95% confidence interval [CI] 1⁄4 0.06 to 0.61) for wake after sleep onset to 1.17 (95% CI 1⁄4 0.87 to 1.47) for insomnia severity. Improvements were maintained for outcomes measured at follow-up (d 1⁄4 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. Insomnia is prevalent in the general population, with an annual prevalence of 10% to 20% (1), and the rates in cancer survivors have been found to be two to three times higher (2). In breast cancer, treatments such as chemotherapy and radiotherapy—and possibly surgery and hormonal therapy—may be partly responsible (3). Although the precise causal pathways are unclear, poor sleep is associated with higher levels of cancer-related fatigue, reduced quality of life (4,5), and perhaps even increased risk of all-cause mortality (6) and cancer recurrence (7). While pharmacotherapy remains the most commonly used option for insomnia (8,9), hypnotics such as benzodiazepine receptor agonists are associated with side effects, dependence, and tolerance over time and are usually not curative, requiring maintenance treatment over many years (10). Cognitive-behavioral therapy for insomnia (CBT-I) (11) is an efficacious nonpharmacological alternative (12,13) and is the recommended first-choice treatment for chronic insomnia (14). Short-term effects are comparable or superior to those found for pharmacotherapy, and long-term effects are maintained for up to three years (15), both A R T IC LE Received: September 20, 2017; Revised: November 23, 2017; Accepted: December 21, 2017 © The Author(s) 2018. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com 880 JNCI J Natl Cancer Inst (2018) 110(8): djx293 doi: 10.1093/jnci/djx293 First published online February 20, 2018 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://www.ucviden.dk/portal/files/70440200/Internet_Delivered_Cognitive_Behavioral_Therapy_for_Insomnia.pdf |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
