Preliminary descriptive data from a study of the clinical effectiveness of cognitive behaviour therapy (CBT) versus treatment as usual (TAU) for insomnia in cancer patients

Insomnia is a risk factor for psychological disorder and is treatable with cognitive behaviour therapy (CBT). We have evidence from regional and national studies, which indicates that CBT is a clinically effective treatment for insomnia. Both insomnia and psychological disorder are common in cancer patients. The treatment of insomnia in cancer has never been systematically investigated. We aim therefore to assess the benefits of CBT for secondary insomnia in a cancer population. This is the first study of its kind. 204 individuals from three cancer groups (breast, prostate, and colorectal) who have completed treatment and satisfy the diagnostic criteria for chronic insomnia will participate. Participants must score at or above the recognized screening cut-off of 5 on the Pittsburgh Sleep Quality Index (PSQI) and at or below 10 on the Epworth Sleepiness Scale (ESS). A 2 : 1 randomization process in favour of the intervention (136 in CBT and 68 in TAU) is in operation. We currently have data from 31 participants (10 M/21 F, mean age = 63 years). 54.8% are breast cancer patients, 29% have prostate cancer and 16.2% have colorectal cancer. Preliminary analysis shows that 10% of patients score between 5 and 9 on the PSQI, 50% score between 10 and 14, whilst 40% score between 15 and 19. Data from the ESS indicate that 26.2% of patients score within the 0–3 range, 46.2% score within the 4–7 range and 27.6% score within the 8–10 range. Measures of anxiety and depression, measured by the Hospital Anxiety and Depression Scale (HADS) show that the mean score for anxiety is 9.6 and the mean score for depression is 6.1. Of the 31 patients currently recruited, 21 are receiving CBT for their insomnia and 10 have been assigned to receive TAU. It is expected that patients assigned to CBT will show a significantly greater improvement in post-treatment objective (actigraphy) and subjective (sleep diary) measures of sleep pattern and sleep quality, compared with TAU patients. The CBT group is also expected to demonstrate improved end-state functioning using the criteria for clinical sleep outcome, sleep-associated functional outcomes and cancer-related quality of life. These benefits will be maintained at follow-up assessments conducted at 6 months post-intervention. Also the effectiveness of CBT as a treatment for insomnia is not expected to diminish due to the existence of physical symptoms such as pain or treatment side effects. Our presentation will describe the adaptation and implementation of our validated small group CBT intervention. Sleep pattern and sleep quality will improve and be maintained in patients receiving CBT for insomnia.