Effectiveness of Cognitive Behavioral Therapy Treating Insomnia in Patients with Breast Cancer: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 TIAN Lang ¹ , CAO Xiaoyi ²

1. Sichuan Cancer Hospital, Chengdu 610041, China; 2. Department of Nursing, West China Hospital/School of Nursing, West China School of Medicine, Sichuan University, Chengdu 610041, China;

Corresponding author：

TIAN Lang, Email: Langtian1981@126.com

Keywords：

Cognitive behavioral therapy; Breast cancer; Insomnia; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20130014

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objectives 　To evaluate the effectiveness of cognitive behavioral therapy (CBT) treating insomnia in patients with breast cancer.
Methods 　Such databases as CENTRAL (April 2011), The Cochrane Library (2005 to November 2011), MEDLINE (1948 to April 2011), EMbase (Junuary 1966 to April 2011), CINAHL (Cumulative Index to Nursing and Allied Health Literature, 1982 to April 2011), CBM (1978 to 2011) and CNKI (1979 to 2011) were searched to collect the randomized controlled trials (RCTs) about CBT treating insomnia in patients with breast cancer. Literature screening, data extraction and methodological quality assessment of the included studies were conducted according to the inclusion and exclusion criteria. Then RevMan 5.0 software was used for meta-analysis.
Results 　A total of 5 RCTs were included. The results of meta-analysis showed that, compared with the control group, the CBT group was higher in the score of subjective sleep efficiency; however, it was lower in the subjective sleep onset latency. There were no significant differences between the two groups in the sleep efficiency, total sleep time, sleep onset latency and wake time after sleep onset measured by hypnocinematograph.
Conclusion 　Cognitive behavioral therapy may improve the subjective sleep efficiency and sleep quality, and shorten the sleep onset latency in patients with breast cancer. However, its effect of improving objective sleep quality is still unverifiable at present. It suggests the following measures should be taken for providing better evidences: increasing sample size, adopting blind methods, confirming allocation concealment, and using unified hypnocinematograph.

Citation： TIAN Lang,CAO Xiaoyi. Effectiveness of Cognitive Behavioral Therapy Treating Insomnia in Patients with Breast Cancer: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(1): 70-77. doi: 10.7507/1672-2531.20130014 Copy

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2.	Davidson JR, MacLean AW, Brundage MD, et al. Sleep disturbance in cancer patients. Soc Sci Med, 2002, 54(9): 1309-1321.
3.	Savard J, Simard S, Blanchet J, et al. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep, 2001, 24(5): 583-589.
4.	Berger AM, Mitchell SA. Modifying cancer related fatigue by optimizing sleep quality. J Natl Compr Canc Netw, 2008, 6(1): 3-13.
5.	Simon GE, VonKorff M. Prevalence, burden, and treatment of insomnia in primary care. Am J Psychiatr, 1997, 154(10): 1417-1423.
6.	Roscoe JA, Kaufman ME, Matteson-Rusby SE, et al. Cancer-related fatigue and sleep disorders. Oncologist, 2007, 12(1): 35-42.
7.	Currie SR, Wilson KG, Pontefract AJ, et al. Cognitive-behavioral treatment of insomnia secondary to chronic pain. J Consult Clin Psychol, 2000, 68(3): 407-416.
8.	Lichstein KL, Wilson NM, Johnson CT. Psychological treatment of secondary insomnia. Psychol Aging, 2000, 15(2): 232-240.
9.	Rochester, MN. International Classification of Sleep Disorders (ICSD): Diagnostic and Coding Manual. American Sleep Disorders Association, 1997.
10.	American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4ed). APA, Washington, DC, 1994.
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12.	Bootzin RR, Epstein D, Engle-Fnedman M, et al. Sleep disturbances. In Carstensen LL, Edelstein BA, Dombrand L (Eds.), The practical handbook of clinical gerontology. Thousand Oaks. CA: Sage. 1996: 398-420.
13.	Epstein DR, Bootzin RR. Insomnia. Nursing Clinics of North America, 2002, 37: 611-613.
14.	Epstein DR, Dirksen SR. Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors. Oncol Nurs Forum, 2007, 34(5): 51-59.
15.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated March 2011]. The Cochrane Collaboration, 2008. Available from: www. cochrane-handbook. org.
16.	Savard J, Simard S, Ivers H, et al. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects. J Clin Oncol, 2005, 23(25): 6083-6096.
17.	Berger AM, Kuhn BR, Farr LA, et al. Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Psycho Oncol, 2009, 18(6): 634-646.
18.	Berger AM, Kuhn BR, Farr LA, et al. One-year outcomes of a behavioral therapy intervention trial on sleep quality and cancer-related fatigue. J Clin Oncol, 2009, 27(35): 6033-6040.
19.	莫锦萍, 郑婉婷, 林弟. 认知行为疗法对乳腺癌术后化疗患者睡眠质量的影响. 中国现代护理杂志, 2010, 16(36) :4380-4383.
20.	Espie CA, Fleming L, Cassidy J, et al. Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. J Clin Oncol, 2008, 26(28): 4651-4658.
21.	Currie SR, Clark S, Hodgins DC, et al. Randomized controlled trial of brief cognitive-behavioural interventions for insomnia in recovering alcoholics. Addiction, 2004, 99(9): 1121-1132.
22.	Lichstein KL, Stone KC, Donaldson J, et al. Actigraphy validation with insomnia. Sleep, 2005, 29(2): 232-239.
23.	Litlner M, Kushida CA, Anderson WM, et al. Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: An update for 2002. Sleep, 2003, 26(3): 337-341.
24.	Buysse DJ, Ancoli-Israel S, Edinger JD, et al. Recommendations for a standard research assessment of insomnia. Sleep, 2006, 29(9): 1155-1173.

1. Savard J, Morin CM. Insomnia in the context of cancer: A review of a neglected problem. J Clin Oncol, 2001, 19(3): 895-908.
2. Davidson JR, MacLean AW, Brundage MD, et al. Sleep disturbance in cancer patients. Soc Sci Med, 2002, 54(9): 1309-1321.
3. Savard J, Simard S, Blanchet J, et al. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep, 2001, 24(5): 583-589.
4. Berger AM, Mitchell SA. Modifying cancer related fatigue by optimizing sleep quality. J Natl Compr Canc Netw, 2008, 6(1): 3-13.
5. Simon GE, VonKorff M. Prevalence, burden, and treatment of insomnia in primary care. Am J Psychiatr, 1997, 154(10): 1417-1423.
6. Roscoe JA, Kaufman ME, Matteson-Rusby SE, et al. Cancer-related fatigue and sleep disorders. Oncologist, 2007, 12(1): 35-42.
7. Currie SR, Wilson KG, Pontefract AJ, et al. Cognitive-behavioral treatment of insomnia secondary to chronic pain. J Consult Clin Psychol, 2000, 68(3): 407-416.
8. Lichstein KL, Wilson NM, Johnson CT. Psychological treatment of secondary insomnia. Psychol Aging, 2000, 15(2): 232-240.
9. Rochester, MN. International Classification of Sleep Disorders (ICSD): Diagnostic and Coding Manual. American Sleep Disorders Association, 1997.
10. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4ed). APA, Washington, DC, 1994.
11. Bootzin RR, Epstein D. Stimulus control. In Lichstein KL, Morin CM (Eds.), Treatment of late-life insomnia. Thousand Oaks, CA: Sage. 2000: 167-184.
12. Bootzin RR, Epstein D, Engle-Fnedman M, et al. Sleep disturbances. In Carstensen LL, Edelstein BA, Dombrand L (Eds.), The practical handbook of clinical gerontology. Thousand Oaks. CA: Sage. 1996: 398-420.
13. Epstein DR, Bootzin RR. Insomnia. Nursing Clinics of North America, 2002, 37: 611-613.
14. Epstein DR, Dirksen SR. Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors. Oncol Nurs Forum, 2007, 34(5): 51-59.
15. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated March 2011]. The Cochrane Collaboration, 2008. Available from: www. cochrane-handbook. org.
16. Savard J, Simard S, Ivers H, et al. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects. J Clin Oncol, 2005, 23(25): 6083-6096.
17. Berger AM, Kuhn BR, Farr LA, et al. Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Psycho Oncol, 2009, 18(6): 634-646.
18. Berger AM, Kuhn BR, Farr LA, et al. One-year outcomes of a behavioral therapy intervention trial on sleep quality and cancer-related fatigue. J Clin Oncol, 2009, 27(35): 6033-6040.
19. 莫锦萍, 郑婉婷, 林弟. 认知行为疗法对乳腺癌术后化疗患者睡眠质量的影响. 中国现代护理杂志, 2010, 16(36) :4380-4383.
20. Espie CA, Fleming L, Cassidy J, et al. Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. J Clin Oncol, 2008, 26(28): 4651-4658.
21. Currie SR, Clark S, Hodgins DC, et al. Randomized controlled trial of brief cognitive-behavioural interventions for insomnia in recovering alcoholics. Addiction, 2004, 99(9): 1121-1132.
22. Lichstein KL, Stone KC, Donaldson J, et al. Actigraphy validation with insomnia. Sleep, 2005, 29(2): 232-239.
23. Litlner M, Kushida CA, Anderson WM, et al. Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: An update for 2002. Sleep, 2003, 26(3): 337-341.
24. Buysse DJ, Ancoli-Israel S, Edinger JD, et al. Recommendations for a standard research assessment of insomnia. Sleep, 2006, 29(9): 1155-1173.

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