Cited by 383Sleep and related disordersCancer survivorship and careSleep and Work-Related Fatigue

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Randomized Controlled Clinical Effectiveness Trial of Cognitive Behavior Therapy Compared With Treatment As Usual for Persistent Insomnia in Patients With Cancer

Espie, Colin A., Fleming, Leanne, Cassidy, James, Samuel, Leslie, Taylor, Lynne M., White, Craig A., Douglas, Neil J., Engleman, Heather M., Kelly, Heidi-Louise, Paul, James·2008·Journal of Clinical Oncology

DOI 10.1200/jco.2007.13.9006

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Abstract

PURPOSE: Persistent insomnia is a common complaint in cancer survivors, but is seldom satisfactorily addressed. The adaptation to cancer care of a validated, cost-effective intervention may offer a practicable solution. The aim of this study was to investigate the clinical effectiveness of protocol-driven cognitive behavior therapy (CBT) for insomnia, delivered by oncology nurses. PATIENTS AND METHODS: Randomized, controlled, pragmatic, two-center trial of CBT versus treatment as usual (TAU) in 150 patients (103 females; mean age, 61 years.) who had completed active therapy for breast, prostate, colorectal, or gynecological cancer. The study conformed to CONSORT guidelines. Primary outcomes were sleep diary measures at baseline, post-treatment, and 6-month follow-up. Actigraphic sleep, health-related quality of life (QOL), psychopathology, and fatigue were secondary measures. CBT comprised five, small group sessions across consecutive weeks, after a manualized protocol. TAU represented normal clinical practice; the appropriate control for a clinical effectiveness study. RESULTS: CBT was associated with mean reductions in wakefulness of 55 minutes per night compared with no change in TAU. These outcomes were sustained 6 months after treatment. Standardized relative effect sizes were large for complaints of difficulty initiating sleep, waking from sleep during the night, and for sleep efficiency (percentage of time in bed spent asleep). CBT was associated with moderate to large effect sizes for five of seven QOL outcomes, including significant reduction in daytime fatigue. There was no significant interaction effect between any of these outcomes and baseline demographic, clinical, or sleep characteristics. CONCLUSION: CBT for insomnia may be both clinically effective and feasible to deliver in real world practice.

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Method
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“However, much higher rates of premature discontinuation have been found in clinical treatment studies for Insomnia Disorder (33% Espie et al., 2008; 53%, Espie et al., 2007; 34%, Morgan, Thompson, Dixon, Tomeny, & Mathers, 2003).”
Background
Sleep disorders
Mystakidou, K., Panagiotou, I. E., Parpa, E., & Tsilika, E. (2015) · doi:10.1093/med/9780199656097.003.0086
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Addressing Insomnia Using Group CBT‐I
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Influential
Behavioral Interventions for Sleep Problems in Cancer Patients: A Primer and Narrative Review of Evidence, Implementation Considerations, and Future Directions
Fisher, H. M., & Stalls, J. M. (2026) · Current Sleep Medicine Reports · doi:10.1007/s40675-026-00386-8
“Importantly, these treatment effects can persist for several months, with some evidence supporting maintenance 3–6 months post-intervention [49–51].”
A small pilot trial of virtual group cognitive behavioral therapy for insomnia in gynecologic oncology patients
Low, A., Cooreman, J., Dossett, M. L., Deventer, K. V., Ponzini, M., Wilson, M., Cole, C., Ruskin, R., Leiserowitz, G. S., Brooks, R., et al. (2026) · Gynecologic Oncology Reports · doi:10.1016/j.gore.2026.102152
“These results met the predefined feasibility criteria and are comparable to the retention, attendance, and engagement rates re-ported in prior CBT-I trials in oncology populations (Savard et al., 2005; Espie et al., 2008; Padron et al., 2022).”
Influential
Management of insomnia in cancer patients after radiotherapy using traditional Chinese medicine techniques: A systematic review and evidence summary
Zhang, Y., Wang, S., & Yang, T. (2026) · International Journal of Radiation Research · doi:10.66224/ijrr.24.2.37
Comparative Effects of Various Delivery Methods of Cognitive Behavioral Therapy for Insomnia Among Patients With Cancers: Systematic Review and Network Meta‐Analysis
Lee, C.-I., Mukminin, M. A., Jan, Y.-W., Wang, T., Huang, T., & Chiu, H. (2026) · Psycho-Oncology · doi:10.1002/pon.70593

Authors: Espie, C. A., Fleming, L., Cassidy, J., Samuel, L., Taylor, L. M., White, C. A., Douglas, N. J., Engleman, H. M., Kelly, H.-L., & Paul, J.
Affiliations: Beatson West of Scotland Cancer Centre (GB)
ORCID: Espie, Colin A.
Fleming, Leanne
Samuel, Leslie
Taylor, Lynne M.
White, Craig A.
Paul, James
Venue: Journal of Clinical Oncology
Publisher: American Society of Clinical Oncology (ASCO)
Published: 2008-10-01
Volume: 26
Issue: 28
Pages: 4651-4658
ISSN: 0732-183X (ISSN-L)
1527-7755
DOI: 10.1200/jco.2007.13.9006
OpenAlex: W2132331779
Cited by: 383
References: 42
Citations by year: 2026: 6 · 2025: 16 · 2024: 16 · 2023: 14 · 2022: 20 · 2021: 22 · 2020: 19 · 2019: 22 · 2018: 20 · 2017: 21 · 2016: 29 · 2015: 28 · 2014: 35 · 2013: 21 · 2012: 28
FWCI: 29.92
Type: journal article
Language: en
Open access: closed
Locations: Journal of Clinical Oncology (publishedVersion)
PubMed (publishedVersion)
ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
Funders: Cancer Research UK (C8265/A3036)
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, insomnia, cancer survivors, oncology nurses, usual care, sleep efficiency, health-related quality of life, daytime fatigue, psychopathology, breast cancer, prostate cancer, gynecologic cancer, colorectal cancer, sleep diary, actigraphy
MeSH terms: Adult, Aged, Aged, 80 and over, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Neoplasms, Psychometrics, Quality of Life, Cognitive Behavioral Therapy, Linear Models, Treatment Outcome

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Randomized Controlled Clinical Effectiveness Trial of Cognitive Behavior Therapy Compared With Treatment As Usual for Persistent Insomnia in Patients With Cancer

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