Adolescents and young adults (AYA) who have survived cancer may continue to suffer from insomnia long after treatment ends, interfering with a range of daily activities. In Pediatric Blood & Cancer, Eric S. Zhou, PhD, and Christopher J. Recklitis, PhD, MPH, of Dana-Farber Cancer Institute, showed that an online program developed specifically for AYA cancer survivors could significantly alleviate insomnia and improve overall quality of life.1
Cognitive Behavioral Therapy for Insomnia
Sleep habits that may help patients cope with their intensive cancer treatments can become obstacles to healthy sleep as survivors move beyond treatment. The online program, which consists of six sessions, each 20 to 30 minutes long, is particularly well suited to the moment, as telehealth and online programs are becoming even more widely used as a result of the COVID-19 crisis.
“People who survive cancer as adolescents or young adults face a variety of sleep-related issues unique to their age group.”— Eric S. Zhou, PhD
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“Cognitive-behavioral therapy for insomnia [CBT-I], which helps patients understand the behavioral and thought patterns that lead to long-term troubles with falling or staying asleep, has been shown to be effective in adult cancer survivors. However, it has not been widely tested in the AYA survivor group. We wanted to explore whether a CBT-I program, specifically tailored to AYA survivors and available online, could be helpful in this population,” said Dr. Zhou.
“People who survive cancer as adolescents or young adults face a variety of sleep-related issues unique to their age group,” Dr. Zhou commented. “They include the constraints placed on young people’s sleep schedules by their parents or disruptive roommates. Teens and young adults also undergo normal developmental changes in circadian timing, naturally going to bed later and sleeping later than younger children and older adults. Insomnia treatments for AYA cancer survivors should take into account these factors, as well as address their long-term cancer-related issues such as pain or fatigue.”
The insomnia intervention tested in the study is known as SHUTi (Sleep Healthy Using the Internet) and was developed by researchers at the University of Virginia. Drs. Zhou and Recklitis adapted the program for AYA cancer survivors. The interactive program uses text, images, and video to explain how insomnia develops and how it can be overcome. In adapting the program, the two researchers replaced vignettes of individuals struggling with insomnia from the original version with ones more relatable to young people.
The program discusses how sleep behaviors that helped patients weather cancer treatment can become maladaptive when they return to normal life. “During treatment, people may stay in bed because they’re not feeling well or haven’t gotten enough sleep. They may take naps, and their sleep at night can be fragmented,” said Dr. Zhou. As people move into recovery, these habits can make it difficult to resume healthy sleep patterns.
“SHUTi trains people to recalibrate their sleep, so their sleep habits are no longer addressing the problems they experienced during treatment and are, instead, focused on improving long-term sleep,” Dr. Zhou remarked.
Reduced Insomnia, Improved Quality of Life
In the study, 22 AYA cancer survivors, with a mean age 20.4 years, who had insomnia enrolled to use the specially adapted intervention. As part of the program, participants kept a sleep diary, tracking when they slept, and entered the information into SHUTi, which adjusted its sleep recommendations accordingly.
At 8 and 16 weeks after starting to use the intervention, participants reported a significant lessening in insomnia severity, daytime sleepiness, and fatigue, as well as an overall improvement in quality of life.
“Our results demonstrate that an Internet-delivered CBT-I program targeting AYA cancer survivors reduced their insomnia and improved their quality of life.”— Christopher J. Recklitis, PhD, MPH
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“Our results demonstrate that an Internet-delivered CBT-I program targeting AYA cancer survivors reduced their insomnia and improved their quality of life,” Dr. Recklitis said. “Notably, our participants’ insomnia severity continued to get better after the intervention had ended, suggesting that they continued to make sleep-related decisions that helped their sleep even after they had finished using the program.”
DISCLOSURE: Support for the study was provided by a Psychosocial Launch Grant from Alex’s Lemonade Stand Foundation. Drs. Zhou and Recklitis reported no conflicts of interest.
1. Zhou ES, Recklitis CH: Internet-delivered insomnia intervention improves sleep and quality of life for adolescent and young adult cancer survivors. Pediatr Blood Cancer. June 22, 2020 (early release online).