In a Canadian study reported in the Journal of Clinical Oncology, Sheila N. Garland, PhD, and colleagues found that virtually delivered cognitive behavioral therapy for insomnia (CBT-I) improved perceived cancer-related cognitive impairment (CRCI) vs waiting list controls in cancer survivors.
Study Details
In the multicenter study, 132 Atlantic Canadian cancer survivors with insomnia and CRCI enrolled between October 2019 and July 2022 were randomly assigned to receive 7 weekly virtual CBT-I sessions (intervention group; n = 63) or to a waitlist control group (n = 69). The CBT-I sessions covered sleep restriction, stimulus control, relaxation training, cognitive restructuring, and psychoeducation. Breast cancer was the most common diagnosis among the survivors (41%).
Sheila N. Garland, PhD
The Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) instrument was used to assess perceived cognitive impairment, perceived cognitive abilities, and impact on quality-of-life subscales, with the perceived cognitive impairment scale used as the main outcome measure (0–72 points, higher score = better function). The Insomnia Severity Index was used to assess insomnia (0–28 points, higher score = worse insomnia). Patients completed assessments at baseline, 1 month (midtreatment), and 2 months (posttreatment); follow-up assessments were performed at 3 and 6 months.
Key Findings
At 2 months, the intervention group exhibited an 11.35-point reduction in insomnia severity (exceeding the clinically meaningful change threshold of 8.4 points), compared with a 2.67-point reduction in the waitlist control group (P < .001). The intervention group had a significant improvement vs the waitlist group in perceived cognitive impairment; scores improved from 39.3 at baseline to 53.5 at 2 months (exceeding the clinically meaningful change of 5.9 points) vs 38.3 to 42.5 (P < .001). Significant improvements were also observed in perceived cognitive abilities (P < .001) and quality of life (P < .001).
Improvements in the intervention group were maintained through 6-month follow-up for perceived cognitive impairment (P < .001), perceived cognitive abilities (P < .001), and quality of life (P < .001).
At 2 months, 74.6% of patients in the intervention group reported significant improvements in perceived cognitive impairment, indicated by the clinically meaningful change of ≥ 5.9 points, compared with 43.3% of the waitlist group (P < .001). Receipt of the intervention was a significant predictor of change in perceived cognitive impairment (P < .001). Receipt of the intervention was also associated with change in perceived cognitive impairment through its effect on change in insomnia severity (P < .001); for every 1-unit decrease in insomnia, there was a 0.92-point improvement in perceived cognitive impairment. Receipt of the intervention was not associated with change in perceived cognitive impairment, independent of its association with change in insomnia (P = .34).
The investigators concluded, “Treating insomnia with CBT-I produces clinically meaningful and durable improvements in CRCI. There is an urgent need increase access to evidence-based treatment for insomnia in cancer centers and the community.”
Dr. Garland, of the Discipline of Oncology, Department of Psychology, Faculty of Science, Memorial University, St. John’s, Newfoundland, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Canadian Institutes of Health Research and others. For full disclosures of the study authors, visit ascopubs.org.
