“Although behavioral treatments for insomnia are effective, access is limited. Stepped care delivery models may provide insomnia treatment that is more efficient and accessible to cancer survivors,” researchers at the Dana-Farber Cancer Institute wrote. Their findings were published in Cancer.
The study included 51 cancer survivors (mean age, 55 years) who had an Insomnia Severity Index (ISI) score ≥ 12. All patients took part in Sleep Training Education Program (STEP)‐1, a one-time sleep education session. Patients who still had high ISI scores one month later were invited to take part in STEP-2, a group cognitive behavioral treatment taking place over three sessions. Treatment responders were survivors whose ISI score improved by six points or more, and they were considered remitted if their ISI score dropped below 12 points. The Profile of Mood States–Short Form (POMS‐SF) was used to determine mood.
For Survivors, A Little Education Goes a Long Way
The “stepped care” approach yielded a high success rate.
“Our results demonstrate that a stepped care model—in which the first treatment is low-intensity and easily accessible to patients—can be effective for improving insomnia in cancer survivors,” said first study author Eric Zhou, PhD, in a press release. “This represents a tremendous opportunity to treat a problem that can significantly diminish cancer survivors’ health and quality of life when not addressed.”
After STEP-1, 45% of patients were responders and 41% were admitted; ISI scores improved from 17.1 to 11.2 (P < 0.001). There was a correlation between insomnia remission after STEP-1 and lower insomnia severity and shorter baseline duration of sleep problems. Of the 30 patients considered remitted after STEP-1, 14 went on to STEP-2, after which ISI scores improved from 16.9 to 8.8 (P < 0.001); 79% of patients were responders, and 71% were remitted. There was an association between STEP-2 participation and baseline interest in sleep treatment. STEP-1 and STEP-2 both resulted in significantly improved mood (P < 0.001).
The education program was designed to be easily applied and does not require extensive existing knowledge to lead, according to Dr. Zhou, who, along with senior author Christopher Recklitis, PhD, MPH, created the course.
“The content is straightforward, the skills needed to teach it are basic,” Dr. Zhou said. “It could be led by someone with an interest in mental health and sleep, without extensive training in behavioral sleep medicine. In a few hours, they could acquire enough knowledge about sleep and sleep habits to be able to offer this kind of program.”