Internet-Delivered Cognitive-Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Randomized Controlled Trial

Zachariae, Robert; Amidi, Ali; Damholdt, Malene F; Clausen, Cecilie D R; Dahlgaard, Jesper; Lord, Holly; Thorndike, Frances P; Ritterband, Lee M

doi:10.1093/jnci/djx293

Cited by 212Sleep and related disordersDigital Mental Health InterventionsCancer survivorship and care

Internet-Delivered Cognitive-Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Randomized Controlled Trial

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Zachariae, Robert, Amidi, Ali, Damholdt, Malene F, Clausen, Cecilie D R, Dahlgaard, Jesper, Lord, Holly, Thorndike, Frances P, Ritterband, Lee M·2018·JNCI: Journal of the National Cancer Institute

DOI 10.1093/jnci/djx293PMC PMC6093474

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Abstract

Background: Insomnia is two to three times more prevalent in cancer survivors than in the general population, where it is estimated to be 10% to 20%. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended treatment for chronic insomnia, but meeting survivor needs remains a challenge. Internet-delivered CBT-I (iCBT-I) has been shown efficacious in otherwise healthy adults. We tested the efficacy of iCBT-I in breast cancer survivors with clinically significant sleep disturbance. Methods: Women from a national sample of Danish breast cancer survivors who experienced clinically significant sleep disturbance were randomly allocated to iCBT-I or waitlist control (55:45). The fully automated iCBT-I program consisted of six cores. Online measures of insomnia severity, sleep quality, and fatigue were collected at baseline, postintervention (nine weeks), and follow-up (15 weeks). Online sleep diaries were completed over two-week periods pre- and postintervention. Intention-to-treat analyses (time × group interactions) were conducted with mixed linear models and corrected for multiple outcomes. All statistical tests were two-sided. Results: A total of 255 women were randomly allocated to iCBT-I (n = 133) or waitlist control (n = 122). Statistically significant (P ≤ .02) time × group interactions were found for all sleep-related outcomes from pre- to postintervention. Effect sizes (Cohen's d) ranged from 0.33 (95% confidence interval [CI] = 0.06 to 0.61) for wake after sleep onset to 1.17 (95% CI = 0.87 to 1.47) for insomnia severity. Improvements were maintained for outcomes measured at follow-up (d = 0.66-1.10). Conclusions: iCBT-I appears to be effective in breast cancer survivors, with additional benefit in terms of reduced fatigue. This low-cost treatment could be incorporated in cancer rehabilitation programs.

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Randomized clinical studies have demonstrated that digital health may play an important role in improving symptom management in survivors of BC.
“Randomized clinical studies have demonstrated that digital health may play an important role in facilitating patient empowerment and improving symptom management in survivors of BC.49-54”
From Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer (2023) · cites this paper as [53]
Randomized clinical studies have demonstrated that digital health may play an important role in facilitating patient empowerment in survivors of BC.
“Randomized clinical studies have demonstrated that digital health may play an important role in facilitating patient empowerment and improving symptom management in survivors of BC.49-54”
From Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer (2023) · cites this paper as [53]

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Does Cognitive-Behavioral Therapy for Insomnia Improve Self-reported Cognitive Functioning in Breast Cancer Survivors Experiencing Sleep Disturbances?
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Authors: Zachariae, R., Amidi, A., Damholdt, M. F., Clausen, C. D. R., Dahlgaard, J., Lord, H., Thorndike, F. P., & Ritterband, L. M.
Affiliations: Aarhus University (DK)
Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital and Department of Psychology, Aarhus University, Aarhus, Denmark
VIA University College (DK)
University of Virginia (US)
Charlotte School of Law (US)
Corresponding author: Zachariae, Robert
ORCID: Zachariae, Robert
Amidi, Ali
Damholdt, Malene F
Dahlgaard, Jesper
Thorndike, Frances P
Ritterband, Lee M
Venue: JNCI: Journal of the National Cancer Institute
Publisher: Oxford University Press (OUP)
Published: 2018-02-20
Volume: 110
Issue: 8
Pages: 880-887
ISSN: 0027-8874 (ISSN-L)
1460-2105
DOI: 10.1093/jnci/djx293
PMC: PMC6093474
OpenAlex: W2972485842
Cited by: 212
References: 43
Citations by year: 2026: 16 · 2025: 34 · 2024: 31 · 2023: 30 · 2022: 32 · 2021: 30 · 2020: 21 · 2019: 11 · 2018: 6
FWCI: 13.53
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/4.0/ (vor)
Locations: JNCI Journal of the National Cancer Institute (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
Funders: TrygFonden (7-12.0736)
Danish Cancer Society (R48-A2585-11-S3)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords: insomnia, breast cancer survivors, sleep disorders, fatigue, wake after sleep onset, sleep quality, cancer rehabilitation
MeSH terms: Cancer Survivors, Adolescent, Adult, Aged, Breast Neoplasms, Denmark, Female, Humans, Sleep Initiation and Maintenance Disorders, Middle Aged, Sleep, Waiting Lists, Cognitive Behavioral Therapy, Treatment Outcome, Telemedicine, Internet, Young Adult, Intention to Treat Analysis

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Internet-Delivered Cognitive-Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Randomized Controlled Trial

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