Light enhanced cognitive behavioral therapy for insomnia and fatigue during chemotherapy for breast cancer: a randomized controlled trial

Helena R Bean; Justine Diggens; Maria Ftanou; Marliese Alexander; Lesley Stafford; Bei Bei; Prudence A Francis; Joshua F Wiley

doi:10.1093/sleep/zsab246

Light enhanced cognitive behavioral therapy for insomnia and fatigue during chemotherapy for breast cancer: a randomized controlled trial

Sleep. 2022 Mar 14;45(3):zsab246. doi: 10.1093/sleep/zsab246.

Authors

Helena R Bean¹, Justine Diggens², Maria Ftanou^{2

3}, Marliese Alexander^{2

4}, Lesley Stafford^{5

6}, Bei Bei^{1

5

6}, Prudence A Francis^{2

4}, Joshua F Wiley^{1

2}

Affiliations

¹ School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.
² Peter MacCallum Cancer Centre, Melbourne, Australia.
³ Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
⁴ Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
⁵ Women's Mental Health Service, Royal Women's Hospital, Melbourne, Australia.
⁶ Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.

PMID: 34618907
DOI: 10.1093/sleep/zsab246

Abstract

Study objectives: Sleep problems are common during chemotherapy for breast cancer (BC). We evaluated whether combined brief cognitive behavioral and bright light therapy (CBT-I + Light) is superior to treatment as usual with relaxation audio (TAU+) for insomnia symptoms and sleep efficiency (primary outcomes).

Methods: We randomized women receiving intravenous chemotherapy, stratified by tumor stage and insomnia severity index, to 6-week CBT-I + Light or TAU+. CBT-I + Light included 1 in-person session, 1 telephone call, 7 emails, and 20 min bright light (BL) each morning. TAU+ comprised usual treatment and two emails with relaxation audio tracks. Patient-reported outcomes were assessed at baseline, midpoint (week 3), post (week 6), and 3-month follow-up.

Results: Women (N = 101) were randomly assigned to CBT-I + Light or TAU+. The CBT-I + Light group showed significantly greater improvement in insomnia symptoms than the TAU+ group (-5.06 vs -1.93, p = .009; between-group effect size [ES] = .69). At 3-month follow-up, both groups were lower than baseline but did not differ from each other (between-group ES = .18, p = .56). CBT-I + Light had higher patient-reported sleep efficiency than TAU+ immediately after the start of intervention (p = .05) and significantly greater improvement in fatigue (between-group ES = .59, p = .013) and daytime sleep-related impairment (between-group ES = .61, p = .009) than the TAU+ group.

Conclusions: CBT-I + Light had a clinically significant impact on insomnia and fatigue with moderate ESs. Results support offering cognitive behavioral therapy for insomnia and BL therapy during chemotherapy for BC to help manage sleep and fatigue.

Clinical trial: Australian New Zealand Clinical Trials Registry (http://anzctr.org.au/). Registration number: ACTRN12618001255279.

Keywords: breast cancer; bright light therapy; chemotherapy; cognitive behavioral therapy; insomnia; sleep.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Australia
Breast Neoplasms* / complications
Breast Neoplasms* / drug therapy
Cognitive Behavioral Therapy* / methods
Fatigue / complications
Fatigue / therapy
Female
Humans
Sleep Initiation and Maintenance Disorders* / complications
Sleep Initiation and Maintenance Disorders* / therapy
Treatment Outcome

Associated data

ANZCTR/ACTRN12618001255279