Behavioral Intervention Improves Sleep for Cancer Patient-Caregiver Dyads

A brief cognitive behavioral therapy for insomnia improved sleep over 4 weeks with little to no negative effects on clinic flow.
A brief cognitive behavioral therapy for insomnia improved sleep over 4 weeks with little to no negative effects on clinic flow.

ORLANDO, FL—A brief cognitive behavioral therapy for insomnia (CBT-I) delivered during patient therapy in the infusion room improved sleep over 4 weeks in patients and caregivers, with little to no negative effects on clinic flow, according to a study presented at the ONS 40th Annual Congress.

More than 40% of patients with cancer and 50% of family caregivers experience insomnia. Pharmacologic therapy is the most accessible intervention; however, it treats the symptoms but not the cause of insomnia. 

Behavior therapy is the most effective because it treats the symptoms, but it is the least accessible, Patricia Carter, PhD, RN, CNS, University of Texas at Austin School of Nursing Austin, Texas, explained.

The answer: deliver brief CBT-I—consisting of cognitive therapy, stimulus control, sleep hygiene, relaxation therapies, and goal setting and monitoring—to the patient-caregiver dyad while they are in the oncology clinic infusion room.

Carter and colleagues used a 4-week quasi-experimental study design. Sleep was measured with Actigraphs worn continuously for 4 weeks, and weekly using the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). To assess contextual factors, the Centre for Epidemiologic Studies Depression questionnaire (CESD), Perceived Stress Scale (PSS), and Functional Assessment of Cancer Treatment—General Quality of Life (FACT-G) were used.

Four patient-caregiver dyads, a total of eight people, participated in the study; three dyads were married and one was an adult-daughter/mother. Mean age of the patients (2 male and 2 female) was 71 years (SD 1.2) and the caregivers, 66 years (SD 3.4).

Administering the intervention averaged 70 minutes, with two follow-up sessions of 20-minute conversations. “Infusion room nurses reported no interruption of workflow,” Carter said. “A positive synergistic effect was noted by delivering this brief CBT-I to the patient and caregiver in a joint session.”

Baseline sleep scores for the patients were duration, 6.8 hours (SD 1.4); latency, 27 minutes (SD 2); and efficiency, 79% (SD 7). For the caregivers, baseline sleep scores were duration 5.5 hours (SD 0.15), latency, 27.5 minutes (SD 1.5), and efficiency, 87% (SD 0.5).

“Average PSQI improvement for patients was 2 points and 5 points for caregivers,” Carter said. “Patient-caregiver dyads learning to improve their sleep together may reinforce positive behavior changes that may result in greater improvements than seen with interventions targeting the individual.”

Further work is needed to determine longitudinal effects and wide-scale implementation factors.

Underwriting or funding source was Shivers Foundation for Cancer Research.

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