Insomnia is one of the most frequent unwanted consequences of cancer treatment. While insomnia may initially appear to be a minor symptom in the larger cancer context, it often develops into a debilitating chronic medical condition. In fact, as many as 27% of cancer survivors experience clinically significant insomnia even 10 years after treatment completion and many describe the consequences of poor sleep as more overwhelming than the effects of cancer treatment. In the general population, chronic insomnia is associated with an extensive list of negative physical and psychosocial health outcomes. Given the significant health implications of insomnia for survivors, the National Cancer Institute emphasizes the importance of addressing sleep as part of survivorship care; yet research consistently shows insomnia remains under-recognized and undertreated in cancer populations. Multiple randomized-controlled trials have demonstrated that cognitive- behavioral treatment (CBT) is an effective treatment for insomnia, and published guidelines endorse this approach as the preferred front-line treatment approach. Unfortunately, this empirically validated treatment is largely unavailable to the growing population of cancer survivors who need it. Moreover, even when it is available it often fails to address cancer-related symptoms contributing to survivors' insomnia. The availability and efficacy of behavioral insomnia treatments for cancer survivors is impeded by three factors; 1) Treatment is lengthy-typically 6 to 8 individual sessions; 2) There is a considerable shortage of providers trained in CBT for insomnia; and 3) Current CBT treatments do not target the cancer-related symptoms that contribute to survivors' disrupted sleep. To address these impediments, we have developed a new brief insomnia intervention specifically for cancer survivors-CBT-Insomnia Treatment for Cancer Survivors (CBTI- CS). Based on successful pilot data using the CBTI-CS intervention at our center32 we now propose to further refine the CBTI-CS intervention into a standardized 3-session psychoeducational program, and test its efficacy in a controlled trial. In Phase 1 of the study (now underway), we will conduct focus groups with 12 participants from previously completed CBTI-CS pilot studies to further refine the intervention. In Phase 2, a randomized controlled trial of 50 cancer survivors will compare the efficacy of CBTI-CS to a usual care control group. In Phase 3, a pilot study delivering the CBTI-CS treatment via group-based videoconference will be conducted with 10 cancer survivors. Despite empirical evidence that cognitive-behavioral interventions are the best treatment for insomnia, it remains unavailable to the more than 2 million affected survivors. Our novel CBTI-CS intervention targets the specific needs of cancer survivors with insomnia, and reduces barriers to treatment by consolidating intervention content and incorporating novel delivery methods. The CBTI-CS intervention program has the potential to make insomnia treatment widely available for survivors, and to significantly improve the health and quality of life for the millions of cancer survivors suffering from chronic insomnia.
Chronic insomnia is a significant health problem for as many as 25% of cancer survivors, yet it is commonly undertreated in routine care. To address this need, we propose to test CBTI-CS, a novel behavioral intervention that targets the specific needs of cancer survivors with insomnia, and reduces barriers to treatment by consolidating intervention content and incorporating innovative delivery methods. The CBTI-CS intervention has the potential to make effective insomnia treatment widely available for survivors, and to significantly improve the health and quality of life for the millions of cancer survivors suffering from chronic insomnia.
