The Survivorship Sleep Program (SSP): A synchronous, virtual cognitive behavioral therapy for insomnia pilot program among cancer survivors

Daniel L. Hall, Kimberly A. Arditte Hall, Mark J. Gorman, Amy Comander, Michael R. Goldstein, Tony J. Cunningham, Sarah Wieman, Helen R. Mizrach, Brooke C. Juhel, Raissa Li, Alexandros Markowitz, Michael Grandner, Elyse R. Park

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: For cancer survivors, insomnia is prevalent, distressing, and persists for years if unmanaged. Cognitive behavioral therapy for insomnia (CBT-I) is an effective treatment yet can be difficult to access and may require modification to address survivorship-specific barriers to sleep. In this 2-phase study, the authors adapted and assessed the feasibility, acceptability, and preliminary effects of synchronous, virtual CBT-I adapted for cancer survivors (the Survivorship Sleep Program [SSP]). Methods: From April to August 2020, cancer survivors with insomnia (N = 10) were interviewed to refine SSP content and delivery. From October 2020 to March 2021, 40 survivors were recruited for a randomized controlled trial comparing 4 weekly SSP sessions with enhanced usual care (EUC) (CBT-I referral plus a sleep hygiene handout). Feasibility and acceptability were assessed by enrollment, retention, attendance, fidelity, survey ratings, and exit interviews. Insomnia severity (secondary outcome), sleep quality, sleep diaries, and fatigue were assessed at baseline, postintervention, and at 1-month follow-up using linear mixed models. Results: The SSP included targeted content and clinician-led, virtual delivery to enhance patient centeredness and access. Benchmarks were met for enrollment (56% enrolled/eligible), retention (SSP, 90%; EUC, 95%), attendance (100%), and fidelity (95%). Compared with EUC, the SSP resulted in large, clinically significant improvements in insomnia severity (Cohen d = 1.19) that were sustained at 1-month follow-up (Cohen d = 1.27). Improvements were observed for all other sleep metrics except sleep diary total sleep time and fatigue. Conclusions: Synchronous, virtually delivered CBT-I targeted to cancer survivors is feasible, acceptable, and seems to be efficacious for reducing insomnia severity. Further testing in larger and more diverse samples is warranted.

Original languageEnglish (US)
Pages (from-to)1532-1544
Number of pages13
JournalCancer
Volume128
Issue number7
DOIs
StatePublished - Apr 1 2022

Keywords

  • cancer
  • insomnia
  • randomized controlled trial
  • survivorship
  • virtual interventions

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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