This study suggests that we should not apply a ‘one-size-fits-all’ model to the treatment of insomnia and emphasizes the need to individualize treatment based on patient characteristics and preferences.
—Sheila N. Garland, MD
Patients with cancer who are struggling with sleep troubles, due in part to pain or side effects of treatment, can count on two behavioral interventions for relief—cognitive behavioral therapy for insomnia and mindfulness-based stress reduction—Penn Medicine researchers reported in a recent study published online in the Journal of Clinical Oncology.1 While cognitive behavioral therapy for insomnia is the gold standard of care, mindfulness-based stress reduction is an additional treatment approach that can also help improve sleep for cancer patients, the study found.
“Insomnia and disturbed sleep are significant problems that can affect approximately half of all cancer patients,” said lead study author Sheila N. Garland, PhD, a Clinical Psychology Post-Doctoral Fellow at Penn’s Abramson Cancer Center in Integrative Oncology and Behavioral Sleep Medicine. “If not properly addressed, sleep disturbances can negatively influence therapeutic and supportive care measures for these patients, so it’s critical that clinicians can offer patients reliable, effective, and tailored interventions.”
Estimates suggest that anywhere between 36% and 59% of patients with cancer experience disturbed sleep and insomnia symptoms during and after the completion of cancer treatment, with up to 28% meeting a formal diagnosis of insomnia. While there are effective drugs that can help treat insomnia, Dr. Garland says that many cancer patients express a desire not to take additional medications due to concerns about side effects and the possibility of developing a dependence on the medication.
The new study involved 111 patients with cancer recruited from a cancer center in Calgary, Alberta, Canada, to one of two randomly assigned interventions for their insomnia, either cognitive behavioral therapy for insomnia (n = 47) or mindfulness-based stress reduction (n = 64). In previous research, mindfulness-based stress reduction has been shown to reduce distress and improve psychological well-being in patients with cancer. This is the first study to directly compare mindfulness-based stress reduction to cognitive behavioral therapy for insomnia in cancer patients.
When assessed 3 months after completing an 8-week treatment protocol, the researchers found that both cognitive behavioral therapy for insomnia and mindfulness-based stress reduction reduced insomnia severity across each group. However, the effects in the cognitive behavioral therapy group occurred more rapidly whereas the mindfulness-based stress reduction group tended to show more gradual improvement over time. Both groups significantly increased their total sleep time and reduced the amount of time it took them to fall asleep or return to sleep during the night. Both groups also experienced improvements in mood and stress-related symptoms following the interventions.
Expanding Treatment Options
“That [mindfulness-based stress reduction] can produce similar improvements to [cognitive behavioral therapy for insomnia] and that both groups can effectively reduce stress and mood disturbance expands the available treatment options for insomnia in cancer patients,” said Dr. Garland. “This study suggests that we should not apply a ‘one-size-fits-all’ model to the treatment of insomnia and emphasizes the need to individualize treatment based on patient characteristics and preferences.”
In addition to Dr. Garland, other Penn authors included Alisa J. Stephens, PhD, from the Perelman School of Medicine’s Center for Clinical Epidemiology and Biostatistics. Penn authors collaborated with researchers at the University of Calgary, and the study was supported by the Canadian Cancer Society Research Institute and the Alberta Cancer Board. ■
Disclosure: The study authors reported no potential conflicts of interest.
1. Garland SN, Carlson LE, Stephens AJ, et al: Mindfulness-based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: A randomized, partially blinded, noninferiority trial. J Clin Oncol. January 6, 2014 (early release online).