Originally published as JCO Early Release 10.1200/JCO.2007.13.9006 on June 30 2008

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Espie, C. A. Articles by Paul, J. Search for Related Content PubMed PubMed Citation Articles by Espie, C. A. Articles by Paul, J. Social Bookmarking                            What's this?

Randomized Controlled Clinical Effectiveness Trial of Cognitive Behavior Therapy Compared With Treatment As Usual for Persistent Insomnia in Patients With Cancer

Colin A. Espie, Leanne Fleming, James Cassidy, Leslie Samuel, Lynne M. Taylor, Craig A. White, Neil J. Douglas, Heather M. Engleman, Heidi-Louise Kelly, James Paul

From the University of Glasgow Sleep Centre, Southern General Hospital; Beatson Oncology Centre, Western Infirmary, Glasgow; Anchor Unit, Aberdeen Royal Infirmary, Aberdeen; School of Health, University Campus Ayr, Beech Grove, Ayr; Edinburgh Sleep Centre, Edinburgh Royal Infirmary, Edinburgh, United Kingdom

Corresponding author: Colin A. Espie, PhD, FBPsS, University of Glasgow Sleep Centre, Southern General Hospital, Glasgow, G51 4TF United Kingdom; e-mail: C.Espie{at}clinmed.gla.ac.uk

Purpose Persistent insomnia is a common complaint in cancer survivors, but is seldom satisfactorily addressed. The adaptation to cancer care of a validated, cost-effective intervention may offer a practicable solution. The aim of this study was to investigate the clinical effectiveness of protocol-driven cognitive behavior therapy (CBT) for insomnia, delivered by oncology nurses.

Patients and Methods Randomized, controlled, pragmatic, two-center trial of CBT versus treatment as usual (TAU) in 150 patients (103 females; mean age, 61 years.) who had completed active therapy for breast, prostate, colorectal, or gynecological cancer. The study conformed to CONSORT guidelines. Primary outcomes were sleep diary measures at baseline, post-treatment, and 6-month follow-up. Actigraphic sleep, health-related quality of life (QOL), psychopathology, and fatigue were secondary measures. CBT comprised five, small group sessions across consecutive weeks, after a manualized protocol. TAU represented normal clinical practice; the appropriate control for a clinical effectiveness study.

Results CBT was associated with mean reductions in wakefulness of 55 minutes per night compared with no change in TAU. These outcomes were sustained 6 months after treatment. Standardized relative effect sizes were large for complaints of difficulty initiating sleep, waking from sleep during the night, and for sleep efficiency (percentage of time in bed spent asleep). CBT was associated with moderate to large effect sizes for five of seven QOL outcomes, including significant reduction in daytime fatigue. There was no significant interaction effect between any of these outcomes and baseline demographic, clinical, or sleep characteristics.

Conclusion CBT for insomnia may be both clinically effective and feasible to deliver in real world practice.

published online ahead of print at www.jco.org on June 30, 2008.

Supported by Cancer Research UK (Grant No. C8265/A3036) and from the Dr Mortimer and Theresa Sackler Foundation.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				C. M. Morin, A. Vallieres, B. Guay, H. Ivers, J. Savard, C. Merette, C. Bastien, and L. Baillargeon Cognitive Behavioral Therapy, Singly and Combined With Medication, for Persistent Insomnia: A Randomized Controlled Trial JAMA, May 20, 2009; 301(19): 2005 - 2015. [Abstract] [Full Text] [PDF]