Multi-stakeholder perspectives on managing insomnia in cancer survivors: recommendations to reduce barriers and translate patient-centered research into practice



Insomnia is a debilitating symptom experienced by nearly 60% of cancer survivors. Building on our prior research showing the clinical benefit of cognitive behavioral therapy for insomnia (CBT-I) and acupuncture, we organized a workshop of patient advocates and clinician stakeholders to understand the barriers and develop recommendations for the dissemination and implementation of these interventions.


Participants completed a pre-workshop survey assessing their experiences with insomnia and barriers to insomnia treatment and participated in a workshop facilitated by professionals and patient experts. Responses from the survey were tabulated and the discussions from the workshop were content-analyzed to extract relevant factors that may influence dissemination and implementation.


Multidisciplinary and stakeholder workshop participants (N = 51) identified barriers and proposed solutions and future recommendations for dissemination and implementation of evidence-based interventions to improve sleep health in cancer survivors. Barriers were identified in four categories: patient (e.g., knowledge, time, cost), clinician (e.g., education, time, capacity), institutional (e.g., space, insurance reimbursement, referrals), and societal (e.g., lack of prioritization for sleep issues). Based on these categories, we made six recommendations for dissemination and implementation of research findings to improve clinical sleep management in oncology.


Dissemination and implementation efforts are necessary to translate research into clinical practice to improve patient care.

Implications for Cancer Survivors

Sleep needs to be prioritized in cancer care, but patient, provider, and institutional/societal barriers remain. Dedicated effort and resources at each of these levels are needed to help millions of people affected by cancer manage their insomnia and improve their quality of life.

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Data availability

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.


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This work was partially funded through a Patient-Centered Outcomes Research Institute (PCORI) Engagement Award (EAIN-00059) and a by PCORI award (CER-1403-14292). It was also supported by funding Dr. Mao received from the Translational and Integrative Medicine Research Fund at Memorial Sloan Kettering Cancer Center. Dr. Mao is also supported in part by a National Institutes of Health/National Cancer Institute Cancer Center grant (grant number P30 CA008748).

Author information




All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Sheila N. Garland, Jun J. Mao, Philip Gehrman, Eugenie Spiguel, Jodi MacLeod, Desirée A.H. Walker, Betsy Glosik, Christina Seluzicki, and Frances K. Barg. The first draft of the manuscript was written by Sheila Garland and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sheila N. Garland.

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The Institutional Review Board of Memorial Sloan Kettering Cancer Center designated this study as exempt.


The content does not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or Methodology Committee.

Conflict of interest

Dr. Mao reports grants from Tibet Cheezheng Tibetan Medicine Co., Ltd. and Zhongke Health International LLC outside the submitted work.

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Garland, S.N., Trevino, K., Liou, K.T. et al. Multi-stakeholder perspectives on managing insomnia in cancer survivors: recommendations to reduce barriers and translate patient-centered research into practice. J Cancer Surviv (2021).

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  • Acupuncture
  • Cognitive behavioral therapy
  • CBT
  • Insomnia
  • Patient-centered
  • Dissemination
  • Implementation
  • Cancer
  • Integrative oncology