Impacts of cognitive behavioral therapy for insomnia and pain on sleep in women with gynecologic malignancies: a randomized controlled trial
Open accessAbstract
Insomnia is an adverse cancer outcome impacting mood, pain, quality of life, and mortality in cancer patients. Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for diverse psychophysiological disorders, including pain and insomnia. Primarily studied in breast cancer, there is limited research on CBT within gynecology oncology. This study examined CBT effects on subjective and behavioral sleep outcomes: Sleep Efficiency (SE), Sleep Quality (SQ), Total Wake Time (TWT), Sleep Onset Latency (SOL), and Wake After Sleep Onset (WASO). Thirty-five women with insomnia status/post-surgery for gynecologic cancer were randomized to CBT for insomnia and pain (CBTi.p., N = 18) or Psychoeducation (N = 17). Sleep was assessed via sleep diaries and wrist-worn actigraphy at baseline (T1), post-intervention (T2), and two-month follow-up (T3). Intent-to-treat analyses utilizing mixed linear modeling examined longitudinal group differences on sleep controlling for age and advanced cancer. All participants demonstrated improved (1) subjective SE (0.5, p < .01), SOL (−1.2, p < .01), TWT (−1.2, p < .01), and (2) behavioral SE (0.1, p = .02), TWT (−1.2, p = .03), WASO (−0.8, p < .01) across time. Group-level time trends were indicative of higher subjective SE (6.8, p = .02), lower TWT (−40.3, p = .01), and lower SOL (−13.0, p = .05) in CBTi.p. compared to Psychoeducation. Supplemental analyses examining clinical significance and acute treatment effects demonstrated clinical improvements in SE (T1), TWT (T2, T3), and SOL (T3). Remaining effects were not significant. Despite lacking power to detect interaction effects, CBTi.p. clinically improved sleep in women with gynecologic cancers and insomnia during the active treatment phase. Future research will focus on developing larger trials within underserved populations.
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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 [85]
The cited study does not fit the description attached to citation 85. In Materials and Methods (Study participants; page unavailable), subjective sleep complaints were an inclusion criterion, and participants also had to meet specified sleep-diary thresholds before randomization. The Methods further state that patients screening positive for insomnia were invited to participate. (LLM, conf=0.88)
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- Authors
- Padron, A., McCrae, C. S., Robinson, M. E., Waxenberg, L. B., Antoni, M. H., Berry, R. B., Castagno, J., Schultz, G., Kacel, E. L., Ulfig, C., Garey, S., Patidar, S., Sannes, T., Trinastic, L., Wong, S., & Pereira, D. B.
- Affiliations
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
- University of Florida Health (US)
- University of Miami (US)
- University of Florida (US)
- Corresponding author
- Pereira, Deidre B.
- ORCID
- Venue
- Behavioral Sleep Medicine
- Publisher
- Informa UK Limited
- Published
- 2021-06-14
- Volume
- 20
- Issue
- 4
- Pages
- 460-476
- ISSN
- 1540-2002 (ISSN-L)
- 1540-2010
- PMC
- PMC8669057
- OpenAlex
- W3171571982
- Cited by
- 17
- References
- 28
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 4
- FWCI
- 2.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behavioral Sleep Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- the National Institutes of Health (R01 CA138808)
- 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
- cognitive behavioral therapy for insomnia, cancer pain, gynecologic cancer, insomnia, sleep efficiency, sleep quality, sleep latency, wake after sleep onset, psychoeducation, women, actigraphy, sleep diary
- MeSH terms
- Female, Genital Neoplasms, Female, Humans, Sleep Initiation and Maintenance Disorders, Pain, Quality of Life, Sleep, Cognitive Behavioral Therapy, Treatment Outcome
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