PHILADELPHIA — Cancer patients 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 (CBT-I) and mindfulness-based stress reduction (MBSR), Penn Medicine researchers report in a new study published online in the Journal of Clinical Oncology. While CBT-I is the gold standard of care, MBSR 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 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 to 59 percent of patients with cancer experience disturbed sleep and insomnia symptoms during and after the completion of cancer treatment, with up to 28 percent meeting a formal diagnosis of insomnia. While there are effective drugs that can help treat insomnia, 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 cancer patients recruited from a cancer center in Calgary, Alberta, Canada, to one of two randomly assigned interventions for their insomnia, either CBT-I (47) or MBSR (64). In previous research, MBSR has been shown to reduce distress and improve psychological well-being in patients with cancer. This is the first study to directly compare MBSR to CBT for insomnia in cancer patients.
When assessed three months after completing an eight-week treatment protocol, the researchers found that both CBT-I and MBSR reduced insomnia severity across each group. However, the effects in the CBT-I group occurred more rapidly whereas the MBSR 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.
“That MBSR can produce similar improvements to CBT-I 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 include Alisa J. Stephens, PhD, from the Perelman School of Medicine’s Center for Clinical Epidemiology and Biostatistics (CCEB). 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.
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