Randomised controlled clinical effectiveness trial of cognitive behaviour therapy (CBT) versus treatment as usual (TAU) for insomnia in cancer patients

Introduction : Epidemiologic studies have shown that insomnia is particularly common amongst cancer patients, with many continuing to report sleeping difficulties one year after completion of cancer treatment. Conventional wisdom on the natural history of insomnia has recently been applied in the context of cancer, suggesting the appropriateness of a biopsychosocial treatment model. There is emerging evidence that intervening at the psychosocial level using cognitive behavioural therapies (CBT) can be effective for insomnia associated with cancer. We aim therefore to assess the benefits of CBT for insomnia in a cancer population. Methods : 150 individuals from four cancer groups (breast, prostate, colorectal and gynaecological) participated in the study. All had completed anti-cancer treatment and satisfied the diagnostic criteria for chronic insomnia. The mean age of the sample was 61 years and the mean duration of their insomnia was 53 months. A 2:1 randomisation process in favour of the intervention (100 in CBT and 50 in TAU) was in operation. Results : For the CBT group, baseline (BL) and post treatment (PT) comparisons yielded statistically significant differences (p<0.05) on all subjectively assessed sleep variables [sleep onset latency (SOL), wake time after sleep onset (WASO), total sleep time (TST), time in bed (TIB) and sleep efficiency (SE)]. SOL reduced from 49mins at BL to 21mins at PT; WASO reduced from 80mins (BL) to 38mins (PT); TST increased from 389mins (BL) to 416mins (PT); TIB reduced from 517mins (BL) to 475mins (PT) and SE increased from 75% (BL) to 87% (PT). Analyses on measures of psychopathology and fatigue also generated significant results for the CBT group. Comparisons on the same variables within the TAU group produced no significant differences. Conclusion : These findings demonstrate the effectiveness of using CBT to treat severe and persistent insomnia in cancer populations. This effectiveness does not diminish due to the existence of physical symptoms such as pain or treatment side effects.