Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue
Abstract
BACKGROUND: To determine whether sleep quality and fatigue associated with breast cancer adjuvant chemotherapy treatments can be improved with behavioral therapy (BT) [Individualized Sleep Promotion Plan (ISPP)] including modified stimulus control, modified sleep restriction, relaxation therapy, and sleep hygiene. METHODS: Randomized-controlled trial based on Piper Integrated Fatigue Model, 219 stages I-IIIA breast cancer patients. Prior to the initial chemotherapy treatment, BT participants developed an ISPP plan that was regularly reinforced and revised. Controls received healthy eating information and attention. Pittsburgh Sleep Quality Index (PSQI), daily diary, actigraph, and Piper Fatigue Scale (PFS) data were collected 2 days prior, during the 7 days after each treatment, and 30 days after the last treatment. Repeated measures analysis of variance was used. RESULTS: Prior to chemotherapy, participants reported mild fatigue and fairly poor sleep quality. All variables changed over time. A group by time interaction was found for sleep quality (PSQI) improving in the BT group. Diary revealed group differences on number of awakenings, minutes awake after sleep onset, and sleep efficiency. Fatigue (PFS) was similar between groups. CONCLUSIONS: The BT group showed improved sleep quality over time and better sleep (diary). Perceptions of improved sleep quality over time are not consistently associated with diary or actigraph, or result in lower fatigue.
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The less convincing effects of CBT-I on sleep quality could be due to negative or smaller effects in studies assessing sleep quality without focusing on insomnia severity, including studies with active controls or studies not using insomnia as an inclusion criterion.
“This result could be due to negative or smaller effects in studies assessing sleep quality without focusing on insomnia severity, including studies with active controls (50, 58) or studies not using insomnia as an inclusion criterion (85).”
From Interventions for insomnia in cancer patients and survivors-a comprehensive systematic review and meta-analysis (2024) · cites this paper as [50]
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- Authors
- Berger, A. M., Kuhn, B. R., Farr, L. A., Lynch, J. C., Agrawal, S., Chamberlain, J., & Von Essen, S. G.
- Affiliations
- University of Nebraska Medical Center (US)
- Corresponding author
- Berger, Ann M.
- Venue
- Psycho-Oncology
- Publisher
- Wiley
- Published
- 2008-12-17
- Volume
- 18
- Issue
- 6
- Pages
- 634-646
- ISSN
- 1057-9249 (ISSN-L)
- 1099-1611
- OpenAlex
- W2149684797
- Cited by
- 161
- References
- 62
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 4 · 2022: 8 · 2021: 7 · 2020: 2 · 2019: 7 · 2018: 12 · 2017: 7 · 2016: 12 · 2015: 14 · 2014: 18 · 2013: 17 · 2012: 12
- FWCI
- 13.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psycho-Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01nr007762-05)
- National Institute of Nursing Research (5R01NR007762-05)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- cancer-related fatigue, sleep quality, breast cancer, adjuvant chemotherapy, behavior therapy, stimulus control, sleep restriction, relaxation training, sleep hygiene, sleep efficiency, awakening
- MeSH terms
- Adult, Aged, Behavior Therapy, Breast Neoplasms, Combined Modality Therapy, Fatigue, Female, Follow-Up Studies, Health Education, Humans, Sleep Initiation and Maintenance Disorders, Middle Aged, Neoplasm Staging, Quality of Life, Mastectomy, Radical, Mastectomy, Segmental, Chemotherapy, Adjuvant
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