Internet-Delivered Cognitive-Behavioral Therapy for Insomnia in Breast Cancer Survivors


Key Points

  • An Internet-delivered cognitive-behavioral therapy for insomnia was effective in reducing insomnia symptoms.
  • Large treatment effects were observed for insomnia severity, sleep quality, and sleep efficiency.

In a Danish study reported in the Journal of the National Cancer Institute, Zachariae et al found that an Internet-delivered cognitive-behavioral therapy intervention improved insomnia among breast cancer survivors.

Study Details

In the study, 255 patients from a national sample of Danish breast cancer survivors who had clinically significant sleep disturbance were randomized to the Internet-based intervention (n = 133) or wait-list control (n = 122). The intervention was modeled after face-to-face cognitive-behavioral therapy, and consisted of the components of introduction and treatment rationale; sleep restriction and stimulus control; cognitive restructuring; sleep hygiene; and relapse prevention.

Each component took 45 to 60 minutes to complete, with new components becoming available 1 week after completion of the previous component. Online assessments of insomnia severity, sleep quality, and fatigue were collected at baseline, postintervention at 9 weeks, and at follow-up at 15 weeks. Effect sizes were assessed as Cohen’s d, based on absolute between group differences at postintervention and follow-up, with 0.2, 0.5, and 0.8 categorized as thresholds for small, medium, and large effect sizes.

Improvements in Insomnia

Statistically significant (P ≤ .02) time x group interactions were found for all sleep-related outcomes from baseline to postintervention at 9 weeks. Effect sizes ranged from 0.33 for wake after sleep onset to 1.17 for insomnia severity for the intervention vs control group. Changes in the proportion of nights on which patients took sleep medication did not achieve statistical significance (P = .09).

In addition to insomnia severity, large effect sizes favoring the intervention group were found for sleep quality and sleep efficiency; medium effect sizes were found for total sleep time, less time in bed, and fewer early morning awakenings; and small effect sizes were found for shorter sleep onset latency, fewer nightly awakenings, and reductions in fatigue, as well as for less time spent awake after sleep onset.  Improvements were maintained at follow-up at 15 weeks postintervention, with effect sizes ranging from 0.66 to 1.10.

The investigators concluded, “[Internet-delivered cognitive-behavioral therapy for insomnia] appears to be effective in breast cancer survivors, with additional benefit in terms of reduced fatigue. This low-cost treatment could be incorporated in cancer rehabilitation programs.”

The work was funded by TrygFonden and the Danish Cancer Society.

Robert Zachariae, DMSc, of Aarhus University Hospital and Department of Psychology, Aarhus University, is the corresponding author for the Journal of the National Cancer Institute article.

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®.