scholarly journals Developing efficient and effective behavioral treatment for insomnia in cancer survivors: Results of a stepped care trial

Cancer ◽  
2019 ◽  
Vol 126 (1) ◽  
pp. 165-173 ◽  
Author(s):  
Eric S. Zhou ◽  
Alexis L. Michaud ◽  
Christopher J. Recklitis
Keyword(s):  
Cancer Survivors ◽  
Behavioral Treatment ◽  
Stepped Care

Behavioral treatment of insomnia in cancer survivors: Early results of a stepped-care trial.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 140-140
Author(s):  
Christopher J. Recklitis ◽  
Ann H. Partridge ◽  
Alexis L. Michaud ◽  
Eric Zhou
Keyword(s):  
Cancer Survivors ◽  
Behavioral Treatment ◽  
Severity Index ◽  
Sleep Hygiene ◽  
Stepped Care ◽  
Education Session ◽  
Low Intensity ◽  
Early Results ◽  
Insomnia Treatment

140 Background: Insomnia is a burdensome late-effect for up to 30% of long-term survivors. Behavioral insomnia treatments are highly effective, but are not available to most affected survivors. Treatment barriers include lack of trained clinicians and resource demands for standard treatment of 6-8 individual sessions. To address these barriers we investigated the efficacy of delivering insomnia treatment in a stepped-care trial (NCT02756390); low intensity treatment was delivered to all participants, and more intense treatment reserved for non-responders. Methods: 43 survivors (91% female; mean ge = 55 yrs; mean time since diagnosis = 11 yrs) participated. They were primarily breast (63%) and blood cancer (26%) survivors, all with clinically elevated ( > 12) Insomnia Severity Index (ISI) scores at baseline. Participants first received a single education session addressing basic sleep hygiene and were reassessed 4 weeks later. Those with an elevated ISI ( > 12) at 4-week follow-up were offered more intense treatment: a 3-session CBT group program developed for cancer survivors. Participants completed the ISI again prior to CBT and 4-weeks post-treatment. Results: Survivors reported significant reductions in insomnia after a single education session; mean ISI scores fell 5.8 points (p < .001), and 23 of 43 survivors (54%) no longer had clinically elevated ISI scores. Of the 20 survivors with persistent insomnia, 9 have received CBT to date and shown similar improvement; their mean ISI scores fell 6.4 points (p = .006), and 6 (67%) no longer had clinically elevated ISI scores. Both treatments had large effect sizes (d = 1.2). Conclusions: Results support a stepped-care approach to treating survivors’ insomnia. A brief sleep hygiene intervention has important dissemination implications, as it may be delivered by non-specialists or as a mobile intervention. For survivors needing more intensive treatment, a short-duration group CBT intervention is effective while requiring fewer resources than standard CBT insomnia treatment. This ongoing trial will investigate how treatment gains in both groups are maintained over three-month follow-up, and explore what factors may predict response to low-intensity treatment. Clinical trial information: NCT02756390.

scholarly journals Nurse-Delivered Brief Behavioral Treatment for Insomnia in Lung Cancer Survivors: A Pilot RCT

2019 ◽  
Vol 18 (6) ◽  
pp. 774-786 ◽  
Author(s):  
Grace E. Dean ◽  
Carleara Weiss ◽  
Carla R. Jungquist ◽  
Michelle L. Klimpt ◽  
Rana Alameri ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cancer Survivors ◽  
Behavioral Treatment ◽  
Pilot Rct

scholarly journals Timing and tailoring of internet‐based cognitive‐behavioral treatment for insomnia for cancer survivors: A qualitative study

2019 ◽  
Vol 28 (9) ◽  
pp. 1934-1937 ◽  
Author(s):  
Kelly Shaffer ◽  
Karen Ingersoll ◽  
Philip Chow ◽  
Frances Thorndike ◽  
Elaine Bailey ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Cancer Survivors ◽  
Behavioral Treatment ◽  
Cognitive Behavioral ◽  
Cognitive Behavioral Treatment

scholarly journals 1051 Level Of Agreement Between Objective And Subjective Sleep Measures In Lung Cancer Survivors With Insomnia

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A399-A399
Author(s):  
C Weiss ◽  
M Kwon ◽  
S Dickerson ◽  
G Dean
Keyword(s):  
Lung Cancer ◽  
Cancer Survivors ◽  
Behavioral Treatment ◽  
Intraclass Correlation ◽  
Individual Variability ◽  
Psychological State ◽  
Sleep Diary ◽  
Sleep State ◽  
Wrist Actigraphy ◽  
Level Of Agreement

Abstract Introduction Lung cancer survivors (LCS) have the second-highest incidence of impaired sleep among cancer population. Clinical studies use self-reported and objective measures to assess insomnia in LCS. However, negative beliefs of sleep patterns may impair sleep perception, impact psychological state, and influence insomnia treatment and survivorship outcomes. This study aims to assess the level of agreement between subjective and objective sleep measures in LCS. Methods Forty-four non-small cell lung cancer survivors, stage I-III, at least 6 weeks after treatment completion, with Insomnia Severity Index &gt;7, were recruited from two sites from 2014-2016. Individuals with sleep apnea, menopause, rotating shift work, uncontrolled substance abuse, or unstable medical/psychiatric illnesses were excluded from the study. Agreement between total sleep time (TST), sleep latency (SL) and sleep efficiency (SE) from Sleep Diary and wrist-actigraphy (i.e. CamNtech) were assessed with Intraclass Correlation (ICC) and Bland-Altman plots. Analysis of ICC, mean difference, standard deviation (SD) and 95% confidence interval (CI) were conducted using SPSS 24. Results LCS were male (63.6%), 60-69 years old (52.3%), married or living with a partner (50%). Self-reported measurements underestimated TST (-68.2 minutes, ICC 0.45, CI 95%, SD 108.1) and SL (-25.9 minutes, ICC 95%, ICC -0.54, DS 17.5). Objective and self-reported measurements largely overlapped for SE, with a small actigraphy-based overestimation (9.2, ICC 0.2, CI95%, SD 7.3). Bland-Altman plots revealed that the agreement increased with lower SE values. Conclusion LCS tended to underestimate TST and SL. An apparent agreement between objective and self-reported measures for SE may indicate sleep state misperception. Differences in various sleep parameters and potential covariates should be investigated for contribution to the unexplained considerable individual variability in behavioral treatment response among cancer survivors in larger sample sizes. Support 1R01NR018215-01 (GED); T32GM099607(CW).

The Future of Cognitive Behavioral Interventions Within Behavioral Medicine

2010 ◽  
Vol 24 (4) ◽  
pp. 344-353 ◽  
Author(s):  
Stacey L. Hart ◽  
Trevor A. Hart
Keyword(s):  
Behavioral Medicine ◽  
Behavioral Interventions ◽  
Behavioral Treatment ◽  
Stepped Care ◽  
Cognitive Behavioral ◽  
Future Research ◽  
Cognitive Behavioral Treatment ◽  
Future Directions ◽  
Cognitive Behavioral Interventions ◽  
Behavioral Trials

There is a growing body of evidence supporting the use of cognitive behavioral treatment within behavioral medicine. There are several limitations to the current body of literature, including external validity of findings from randomized controlled trials, dissemination of findings, and the use of CBT when patients are unmotivated to make behavior change. The current paper proposes several future directions to address these limitations. Solutions to be explored in future research include practical behavioral trials, stepped care approaches, remote technology approaches such as telephone and Internet-based treatments, and the integration of motivational interviewing into cognitive behavioral treatment.

scholarly journals 0360 Goldilocks's Insomnia: Finding the ‘Just Right’ Treatment for Cancer Survivors in a Stepped Care Program

SLEEP ◽  
2019 ◽  
Vol 42 (Supplement_1) ◽  
pp. A147-A147
Author(s):  
Eric S Zhou ◽  
Alexis L Michaud ◽  
Christopher J Recklitis
Keyword(s):  
Cancer Survivors ◽  
Care Program ◽  
Stepped Care ◽  
Just Right

scholarly journals Psychosocial mechanisms of a behavioral treatment for urinary incontinence of prostate cancer survivors

2019 ◽  
Vol 38 (2) ◽  
pp. 210-227
Author(s):  
Amy Y. Zhang ◽  
Christopher Burant ◽  
Alex Z. Fu ◽  
Gerald Strauss ◽  
Donald R. Bodner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Urinary Incontinence ◽  
Cancer Survivors ◽  
Behavioral Treatment ◽  
Prostate Cancer Survivors

scholarly journals 658 Adjusting Fire - Piloting an Online Sleep Class in a U.S. Air Force Population in Response to COVID-19 Patient Care Restrictions

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A257-A257
Author(s):  
Marc Patience ◽  
Rosemary Estevez Burns ◽  
Daniel Cassidy
Keyword(s):  
Behavioral Treatment ◽  
Sleep Problems ◽  
Severity Index ◽  
Stepped Care ◽  
Service Members ◽  
Military Population ◽  
Sleep Difficulty ◽  
Related Services ◽  
Care Approach

Abstract Introduction Sleep problems remain problematically prevalent among U.S. service members. In 2015 over 60% of sampled service members reported getting less than 7 hours of sleep per night, 31.4% getting 5 hours or less, and nearly 50% reported subthreshold insomnia symptoms on the Pittsburgh Sleep Quality Index. Ongoing COVID-19 service delivery restrictions necessitate a rapid shift to virtual health solutions and illuminate barriers to the delivery of sleep interventions. This process improvement pilot was a proof-of-concept during uncertain times. Methods From September to January 2020, 10 weekly 1-time, 60-min virtual sleep classes were held over Microsoft Teams. Interventions were consistent with Motivational Interviewing and Brief Behavioral Treatment for Insomnia. Participants completed the STOP BANG and Insomnia Severity Index (ISI) before each class, and accomplished the ISI again at a 2-week contact during which they rated progress toward problem resolution and were offered additional clinical services as-needed. Results Forty-six participants attended the class. 67% responded to the post-class survey. 74% responded to the two-week follow-up. A majority (84%) indicated either agreement or strong agreement with the statement ’I plan to CHANGE a behavior or TRY an intervention I learned to better my sleep’, and many proceeded to establish a more consistent sleep schedule (n=14; 45%), remove electronics from the bedroom (n=13; 42%), and/or go to bed only when sleepy (n=11; 35%). 84% would recommend this class to others with similar concerns. Scaled from 1 (‘no change’) to 10 (‘full resolution’), participants reported having derived modest benefit from the intervention (M = 4.1, SD=1.7). Eleven (35%) denied need for additional sleep-related services, and 84% expressed intent to recommend the class to others with similar concerns. Conclusion Results suggest a military population is receptive to a 1-time, virtual sleep class consistent with social distancing strictures. This service provided patients rapid access to care while contemporaneously reducing demand for time-intensive one-to-one appointments. As hypothesized, receipt of the intervention was associated with intention to modify sleep-relevant behavior, and with meaningful progress toward resolution of sleep difficulty as assessed at 2-week follow-up. Broadly disseminated, this intervention could introduce an internet-based, stepped-care approach to management of sleep insufficiency across the DoD. Support (if any):

scholarly journals Cancer-Related Cognitive Impairment: A Mixed-Methods Evaluation of A Standard Factsheet

2021 ◽  
Author(s):  
Chloe Yi Shing Lim ◽  
Sharon He ◽  
Joanne Shaw ◽  
Haryana M Dhillon
Keyword(s):  
Cognitive Impairment ◽  
Cancer Survivors ◽  
Health Beliefs ◽  
Help Seeking ◽  
Management Strategies ◽  
Stepped Care ◽  
Structured Interviews ◽  
Major Barrier ◽  
Framework Approach ◽  
The Impact

Abstract Purpose: To understand the impact of cancer survivors accessing a standard factsheet regarding cancer-related cognitive impairment (CRCI), publicly available to the Australian public via Cancer Council Australia’s websites. Methods: Twenty-three cancer survivors completed a questionnaire assessing pre-factsheet knowledge of CRCI. Semi-structured interviews were conducted to explore participants’ experiences of CRCI and perceptions of the factsheet. Interviews were analysed via thematic analysis using a framework approach. Finally, participants completed another questionnaire assessing post-factsheet change in knowledge of CRCI.Results: Pre- and post-factsheet questionnaire change scores indicated increased knowledge and greater confidence about CRCI. Interview data resulted in five themes: generally positive perceptions of the factsheet’s layout and wording; survivors, regardless of treatments received, experienced CRCI symptoms, with some having strong negative emotional responses to their symptoms; perceptions of the factsheet’s strategies to manage CRCI ranged from relevant and useful, to impractical or unrealistic if symptoms were too severe; interactions with healthcare system influenced survivors’ perceptions of help-seeking, with negative healthcare experiences a major barrier; and, generally positive impacts of the factsheet, with survivors praising the factsheet’s ability to validate the CRCI experience, increase CRCI knowledge, influence health beliefs, and prompt help-seeking.Conclusion: The factsheet presentation and wording were acceptable to participants. Its ability to normalise and raise awareness for CRCI validated participants’ symptoms. The factsheet’s potential as a first-line intervention in a stepped-care approach was identified, with participants finding the suggested self-management strategies practical. The factsheet may overcome barriers to self-reporting by encouraging patients to talk with HCPs about CRCI.

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