Both Mindfulness-Based Stress Reduction and, More So, Cognitive Behavioral Therapy Improve Insomnia in Cancer Patients
In a noninferiority trial reported in the Journal of Clinical Oncology, Garland et al compared the effects of mindfulness-based stress reduction vs cognitive-behavioral therapy for treatment of insomnia in patients with cancer. They found that both techniques improved insomnia, with mindfulness-based stress reduction not being noninferior immediately after the program but achieving noninferiority at 3-month follow-up.
Study Details
In the study, 111 cancer patients with insomnia recruited from a tertiary cancer center in Calgary from September 2008 to March 2011 were randomly assigned to a cognitive-behavioral therapy program consisting of eight weekly 90-minute sessions (n = 47) or a mindfulness-based stress reduction program consisting of eight weekly 90-minute sessions and a 6-hour weekend silent retreat (n = 64). The noninferiority margin was 4 points on the upper 95% confidence (CI) interval of difference in scores measured by the Insomnia Severity Index.
A total of 7 patients in the cognitive behavioral therapy group and 32 in the mindfulness-based program did not complete the study program, with most patients in the latter group withdrawing within the first three sessions. For both treatment groups, subjects who withdrew were less educated and had more severe insomnia severity at baseline vs those who completed the program.
There were no significant differences among the entire population, patients who completed the study, and patients in each of the two study groups who completed the study with regard to sex, age, education, employment status, ethnicity, insomnia duration, cancer duration, type of cancer, previous cancer therapies , or current treatments (including sedatives/hypnotics, anxiolytics, and antidepressants).
Insomnia Improvement
On intent-to-treat analysis, mean Insomnia Severity Index scores improved from 17.87 to 8.28 in the cognitive-behavioral intervention group vs from 18.23 to 12.06 in the mindfulness-based intervention group at the end of the program; the upper 95% confidence interval for the difference in scores was 5.12, indicating absence of noninferiority of the mindfulness-based intervention (P = .39). At 3-month follow-up, mean scores were 9.05 vs 11.07, with the upper 95% confidence interval for the difference in scores of 3.47 indicating noninferiority of the mindfulness-based intervention (P = .01).
On per-protocol analysis including the 40 patients in the cognitive-behavioral intervention group and 32 in the mindfulness-based intervention group who completed the program, mean scores improved from 18.25 to 8.20 vs from 16.34 to 11.86; the upper 95% confidence interval of 5.11 indicated absence of noninferiority of the mindfulness-based intervention (P = .35). At 3-month follow up, however, scores were 8.66 vs 10.73, with the upper 95% confidence interval of 3.47 indicating noninferiority of the mindfulness-based intervention (P = .02).
Sleep onset latency (from subject diaries) was reduced by 22 minutes in the cognitive-behavioral intervention group and 14 minutes in the mindfulness-based intervention group at 3-month follow-up. Wake after sleep onset (ie, the amount of time spent awake after sleep has been initiated and before final awakening) was reduced by 35.84 vs 36.46 minutes. Total sleep time increased by 0.60 vs 0.75 hours. The cognitive-behavioral intervention group had significant improvements in sleep quality (P < .001) and dysfunctional sleep beliefs (P < .001), and both groups had significantly reduced stress (P < .001) and mood disturbance (P < .001).
The investigators concluded, “Although [mindfulness-based stress reduction] produced a clinically significant change in sleep and psychological outcomes, [cognitive-behavioral therapy for insomnia] was associated with rapid and durable improvement and remains the best choice for the nonpharmacologic treatment of insomnia.”
Tavis S. Campbell, PhD, of University of Calgary, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the Canadian Cancer Society Research Institute, the Alberta Cancer Board, and a Francisco J. Varela award from the Mind & Life Institute. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
