Changes in sleep following internet-delivered cognitive-behavioral therapy for insomnia in women treated for breast cancer: a 3-year follow-up assessment
Open accessAbstract
BACKGROUND: Sleep disturbances are common in women treated for breast cancer. We have previously shown that internet-delivered cognitive-behavioral therapy for insomnia (e-CBT-I) is an efficacious, low-cost treatment approach. Furthermore, research has shown that e-CBT-I can result in sustained improvements at 12 months post-treatment. However, given the complexity and long duration of post-treatment symptomatology in breast cancer patients, as well as the recommended use of antihormonal therapy for up to 10 years, it is relevant to investigate long-term (>12 months) changes in sleep following e-CBT-I in this population. In the present study, we report data from a 3-year long-term follow-up assessment after e-CBT-I. METHODS: Women treated for breast cancer with sleep disturbances (Pittsburg Sleep Quality Index [PSQI] global score >5) who had previously been enrolled in a randomized-controlled trial investigating the efficacy of e-CBT-I (n = 255), were invited to participate in a 3-year follow-up study. All women in the initial control group had also been granted access to e-CBT-I. Assessment included self-reported sleep quality (PSQI), insomnia severity (Insomnia Severity Index, ISI), cancer-related fatigue and symptoms of depression. Within-group changes in these outcomes from baseline to the 3-year long-term follow-up assessment were analyzed. RESULTS: A total of 131 women (51%) participated in the 3-year follow-up study of which 77 (59%) were from the initial intervention group and 54 (41%) from the initial control group. For the pooled sample, within-group improvements from baseline to the 3-year follow-up assessment corresponding to large effect sizes were observed in sleep quality (Cohen's d = 1.0 95% CI [0.78, 1.21]) and insomnia severity (Cohen's d = 1.36 CI 95% [1.12, 1.59]). Similar changes were observed in cancer-related fatigue (Cohen's d = 0.48 CI 95% [0.30, 0.66]) and symptoms of depression (Cohen's d = 0.80 CI 95%. [0.60, 0.99]). The proportion of patients with scores above established cut-offs on the PSQI and the ISI were 56.1% and 29.8%, respectively. Within the initial intervention group, 15.6% evidenced relapse at the 3-year assessment. CONCLUSION: Overall, these results indicate that long-term sleep quality and insomnia severity following the use of e-CBT-in women treated for breast cancer is significantly lower than the pre-treatment levels. However, a substantial proportion of participants still evidence sleep disturbances.
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Previous studies on eCBTi efficacy indicate a medium effect (partial eta-squared = 0.08).
“Based on previous studies on the efficacy of eCBTi (86–92), we expect a partial eta-squared of 0.08 (medium effect); alpha: 0.05; Power: 0.95; number of groups: 2; number of measurements: 3; total sample size: 32, that is, 16 per condition.”
From Sleep disturbances and psychological well-being among military medical doctors of the Swiss Armed Forces: study protocol, rationale and development of a cross-sectional and longitudinal interventional study (2024) · cites this paper as [86]
The Introduction and discussion (Table 2 section; pages not supplied) describe positive e-CBT-I sleep outcomes and report small-to-medium effects in a prior meta-analysis. Our copy does not report a partial eta-squared of 0.08 for e-CBT-I efficacy, so it supports the general basis for the sample-size assumption but not that specific value. (LLM, conf=0.83)
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Self-citation
- Authors
- Amidi, A., Buskbjerg, C. R., Damholdt, M. F., Dahlgaard, J., Thorndike, F. P., Ritterband, L., & Zachariae, R.
- Affiliations
- Aarhus University (DK)
- Pear Therapeutics (United States) (US)
- University of Virginia (US)
- Corresponding author
- Amidi, Ali
- ORCID
- Venue
- Sleep Medicine
- Publisher
- Elsevier BV
- Published
- 2022-08
- Volume
- 96
- Pages
- 35-41
- ISSN
- 1389-9457 (ISSN-L)
- OpenAlex
- W4225143859
- Cited by
- 41
- References
- 35
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 14 · 2023: 7 · 2022: 1
- FWCI
- 8.05
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Sleep Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Kræftens Bekæmpelse (R48-A2585-11-S3)
- TrygFonden (7-12.0736)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- insomnia, breast cancer survivors, sleep quality, long-term follow-up, cancer-related fatigue, depression, antihormonal therapy, sleep disorders, women with cancer, sustained treatment effects, Pittsburgh Sleep Quality Index, Insomnia Severity Index, cancer survivorship support services, digital mental health interventions, relapse prevention
- MeSH terms
- Breast Neoplasms, Fatigue, Female, Follow-Up Studies, Humans, Sleep Initiation and Maintenance Disorders, Neoplasm Recurrence, Local, Sleep, Cognitive Behavioral Therapy, Treatment Outcome, Internet
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