Skip to main content

Evaluation and treatment of insomnia in adult cancer survivorship programs

Journal of Cancer Survivorship volume 11, pages 74–79 (2017)Cite this article

Abstract

Purpose

Insomnia is commonly experienced by cancer survivors. Chronic insomnia is associated with significant physical and psychosocial consequences if not properly treated. Both the National Cancer Institute (NCI) and the National Comprehensive Cancer Network (NCCN) recommend the evaluation of sleep disturbances and evidence-based treatment of insomnia during routine survivorship care. To better understand current clinical practices, we conducted a survey of major cancer centers across the United States (US).

Methods

Adult survivorship programs at the 25 US cancer centers that are both NCI-designated comprehensive cancer centers and NCCN member institutions were surveyed about the evaluation and treatment of insomnia in their hospital.

Results

All institutions responded to the survey. Thirteen centers (56 %) reported screening <25 % of survivors for sleep disorders, and few clinicians providing survivorship care were well-prepared to conduct a proper sleep evaluation. Insomnia was most commonly treated with sleep hygiene, or pharmacotherapy, rather than cognitive-behavioral therapy. No program reported that >50 % of their survivors were receiving optimal insomnia-related care. A variety of methods to improve insomnia care were endorsed by respondents.

Conclusions

There is a clear need to improve the evaluation and treatment of insomnia for cancer survivors at institutions across the country. Cancer centers deemed a number of modalities relevant for improving provider confidence in addressing sleep challenges.

Implications for cancer survivors

To improve the quality of insomnia care for survivors, systematic interventions to increase standardized screening for sleep disorders, providing additional sleep medicine training for survivorship clinicians, and optimizing the role of sleep medicine specialists in the oncology setting should be considered.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Costa AR, Fontes F, Pereira S, Goncalves M, Azevedo A, Lunet N. Impact of breast cancer treatments on sleep disturbances—a systematic review. Breast. 2014;23(6):697–709. doi:10.1016/j.breast.2014.09.003.

    Article  PubMed  Google Scholar 

  2. Palesh O, Peppone L, Innominato PF, Janelsins M, Jeong M, Sprod L, et al. Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer. Nat Sci Sleep. 2012;4:151–62. doi:10.2147/NSS.S18895.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fleming L, Gillespie S, Espie CA. The development and impact of insomnia on cancer survivors: a qualitative analysis. Psychooncology. 2010;19(9):991–6. doi:10.1002/pon.1652.

    Article  PubMed  Google Scholar 

  4. Savard J, Hervouet S, Ivers H. Prostate cancer treatments and their side effects are associated with increased insomnia. Psychooncology. 2013;22(6):1381–8. doi:10.1002/pon.3150.

    Article  PubMed  Google Scholar 

  5. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition. 5th ed. Washington, DC: American Psychiatric Association; 2013.

    Book  Google Scholar 

  6. Davidson JR, MacLean AW, Brundage MD, Schulze K. Sleep disturbance in cancer patients. Soc Sci Med. 2002;54(9):1309–21.

    Article  PubMed  Google Scholar 

  7. Savard J, Simard S, Hervouet S, Ivers H, Lacombe L, Fradet Y. Insomnia in men treated with radical prostatectomy for prostate cancer. Psychooncology. 2005;14(2):147–56. doi:10.1002/pon.830.

    Article  PubMed  Google Scholar 

  8. Sanford SD, Wagner LI, Beaumont JL, Butt Z, Sweet JJ, Cella D. Longitudinal prospective assessment of sleep quality: before, during, and after adjuvant chemotherapy for breast cancer. Support Care Cancer. 2013;21(4):959–67. doi:10.1007/s00520-012-1612-7.

    Article  PubMed  Google Scholar 

  9. Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001;19(3):895–908.

    CAS  PubMed  Google Scholar 

  10. Savard J, Ivers H, Villa J, Caplette-Gingras A, Morin CM. Natural course of insomnia comorbid with cancer: an 18-month longitudinal study. J Clin Oncol. 2011;29(26):3580–6. doi:10.1200/JCO.2010.33.2247.

    Article  PubMed  Google Scholar 

  11. Morin CM, Belanger L, LeBlanc M, Ivers H, Savard J, Espie CA, et al. The natural history of insomnia: a population-based 3-year longitudinal study. Arch Intern Med. 2009;169(5):447–53. doi:10.1001/archinternmed.2008.610.

    Article  PubMed  Google Scholar 

  12. Berger AM, Mitchell SA. Modifying cancer-related fatigue by optimizing sleep quality. J Natl Compr Cancer Netw. 2008;6(1):3–13.

    Google Scholar 

  13. Byar KL, Berger AM, Bakken SL, Cetak MA, editors. Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life. Oncol Nurs Forum; 2006.

  14. Ho S-Y, Rohan KJ, Parent J, Tager FA, McKinley PS. A longitudinal study of depression, fatigue, and sleep disturbances as a symptom cluster in women with breast cancer. J Pain Symptom Manag. 2015;49(4):707–15.

    Article  Google Scholar 

  15. Palesh O, Aldrige-Gerry A, Zeitzer JM, Koopman C, Neri E, Giese-Davis J, et al. Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep. 2014;37(5):837–42.

    PubMed  PubMed Central  Google Scholar 

  16. Jim HS, Jacobsen PB, Phillips KM, Wenham RM, Roberts W, Small BJ. Lagged relationships among sleep disturbance, fatigue, and depressed mood during chemotherapy. Health Psychol. 2013;32(7):768.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lockefeer J, De Vries J. What is the relationship between trait anxiety and depressive symptoms, fatigue, and low sleep quality following breast cancer surgery? Psychooncology. 2013;22(5):1127–33.

    CAS  Article  PubMed  Google Scholar 

  18. Clanton NR, Klosky JL, Li C, Jain N, Srivastava DK, Mulrooney D, et al. Fatigue, vitality, sleep, and neurocognitive functioning in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer. 2011;117(11):2559–68. doi:10.1002/cncr.25797.

    Article  PubMed  PubMed Central  Google Scholar 

  19. National Cancer Institute. Follow-up care after cancer treatment. National Cancer Institute. 2013. http://www.cancer.gov/cancertopics/factsheet/Therapy/followup. Accessed November 2013.

  20. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: survivorship. 2015.

  21. Savard J, Simard S, Ivers H, Morin CM. 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):6083–96. doi:10.1200/JCO.2005.09.548.

    Article  PubMed  Google Scholar 

  22. Espie CA, Fleming L, Cassidy J, Samuel L, Taylor LM, White CA, 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):4651–8. doi:10.1200/JCO.2007.13.9006.

    Article  PubMed  Google Scholar 

  23. Epstein DR, Dirksen SR. Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors. Oncol Nurs Forum. 2007;34(5):E51–9.

    Article  PubMed  Google Scholar 

  24. Ritterband LM, Bailey ET, Thorndike FP, Lord HR, Farrell-Carnahan L, Baum LD. Initial evaluation of an internet intervention to improve the sleep of cancer survivors with insomnia. Psychooncology. 2012;21(7):695–705. doi:10.1002/pon.1969.

    Article  PubMed  Google Scholar 

  25. Zhou ES, Partridge AH, Recklitis CJ. A pilot trial of brief group cognitive-behavioral treatment for insomnia in an adult cancer survivorship program. Psychooncology. 2016. doi:10.1002/pon.4096.

    Google Scholar 

  26. Garland SN, Johnson JA, Savard J, Gehrman P, Perlis M, Carlson L, et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat. 2014;10:1113–24. doi:10.2147/NDT.S47790.

    PubMed  PubMed Central  Google Scholar 

  27. Qaseem A, Barry MJ, Kansagara D. Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;164(5):350–9.

    Article  PubMed  Google Scholar 

  28. Zhou ES, Recklitis CJ. Insomnia in adult survivors of childhood cancer: a report from project REACH. Support Care Cancer. 2014;22(11):3061–9. doi:10.1007/s00520-014-2316-y.

    Article  PubMed  Google Scholar 

  29. Stepanski EJ, Wyatt JK. Use of sleep hygiene in the treatment of insomnia. Sleep Med Rev. 2003;7(3):215–25.

    Article  PubMed  Google Scholar 

  30. Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev. 2015;22:23–36. doi:10.1016/j.smrv.2014.10.001.

    Article  PubMed  Google Scholar 

  31. Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331(7526):1169. doi:10.1136/bmj.38623.768588.47.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kupfer DJ, Reynolds 3rd CF. Management of insomnia. N Engl J Med. 1997;336(5):341–6. doi:10.1056/NEJM199701303360506.

    CAS  Article  PubMed  Google Scholar 

  33. Zhou ES, Manley PE, Marcus KJ, Recklitis CJ. Medical and psychosocial correlates of insomnia symptoms in adult survivors of pediatric brain tumors. J Pediatr Psychol. 2015. doi:10.1093/jpepsy/jsv071.

    PubMed  Google Scholar 

  34. Mindell JA, Bartle A, Wahab NA, Ahn Y, Ramamurthy MB, Huong HT, et al. Sleep education in medical school curriculum: a glimpse across countries. Sleep Med. 2011;12(9):928–31. doi:10.1016/j.sleep.2011.07.001.

    Article  PubMed  Google Scholar 

  35. Rosen RC, Rosekind M, Rosevear C, Cole WE, Dement WC. Physician education in sleep and sleep disorders: a national survey of U.S. medical schools. Sleep. 1993;16(3):249–54.

    CAS  PubMed  Google Scholar 

  36. Zozula R, Rosen RC, Jahn EG, Engel SH. Recognition of sleep disorders in a community-based setting following an educational intervention. Sleep Med. 2005;6(1):55–61. doi:10.1016/j.sleep.2004.09.004.

    Article  PubMed  Google Scholar 

  37. Martinez-Garcia MA, Soler-Cataluna JJ, Roman-Sanchez P, Amoros C, Quiles L, Chiner-Vives E, et al. Efficacy of a training program on sleep apnea-hypopnea syndrome aimed at primary care physicians. Arch Bronconeumol. 2008;44(1):15–21.

    PubMed  Google Scholar 

  38. Valerio TD, Heaton K. The effects of an online educational program on nurse practitioners’ knowledge of obstructive sleep apnea in adults. J Am Assoc Nurse Pract. 2014;26(11):603–11.

    PubMed  Google Scholar 

  39. Savard J, Ivers H, Savard M-H, Villa J, Morin C, editors. Is a video-based cognitive-behavioral therapy as efficacious as a professionally administered treatment for insomnia comorbid with cancer? Preliminary results of a randomized controlled trial. Psychooncology; 2013: Wiley-Blackwell 111 River St, Hoboken 07030–5774, NJ USA.

  40. Savard J, Villa J, Simard S, Ivers H, Morin CM. Feasibility of a self-help treatment for insomnia comorbid with cancer. Psychooncology. 2011;20(9):1013–9. doi:10.1002/pon.1818.

    PubMed  Google Scholar 

  41. Zhou ES, Vrooman LM, Manley PE, Crabtree VM, Recklitis CJ. Adapted delivery of cognitive-behavioral treatment for insomnia in adolescent and young adult cancer survivors: a pilot study. Behav Sleep Med. 2016;1-14.

  42. Dahiya S, Ahluwalia MS, Walia HK. Sleep disturbances in cancer patients: underrecognized and undertreated. Cleve Clin J Med. 2013;80(11):722–32. doi:10.3949/ccjm.80a.12170.

    Article  PubMed  Google Scholar 

  43. Savard J, Savard M-H. Insomnia and cancer: prevalence, nature, and nonpharmacologic treatment. Sleep Med Clin. 2013;8(3):373–87.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Eric S. Zhou, Ann H. Partridge, Alexis L. Michaud & Christopher J. Recklitis

  2. Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA

    Eric S. Zhou, Ann H. Partridge & Christopher J. Recklitis

  3. Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA

    Karen L. Syrjala

Authors
  1. Eric S. Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ann H. Partridge
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karen L. Syrjala
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexis L. Michaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher J. Recklitis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric S. Zhou.

Ethics declarations

Funding

This study was funded by internal support at the Dana-Farber Cancer Institute.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhou, E.S., Partridge, A.H., Syrjala, K.L. et al. Evaluation and treatment of insomnia in adult cancer survivorship programs. J Cancer Surviv 11, 74–79 (2017). https://doi.org/10.1007/s11764-016-0564-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-016-0564-1

Keywords

  • Insomnia
  • Sleep disorders
  • Cancer survivorship
  • Oncology
  • Evaluation and treatment