A Virtual Strategy to Improve Insomnia in Young Cancer Survivors

Adolescent and young adult cancer survivors may suffer from insomnia long after their cancer treatment has completed. One effective treatment option is cognitive‐behavioral therapy for insomnia (CBT‐I). However, the treatment is typically aimed at adults and is not tailored to adolescents and young adults who have survived cancer. Researchers recently tested an internet model of CBT-I designed specifically with this patient population in mind.

“Cognitive-behavioral therapy for insomnia (CBT-I), which helps patients understand the behavioral and thought patterns that lead to long-term troubles with falling or staying asleep, has been shown to be very effective in adult cancer survivors, ” explained study author Eric Zhou, PhD, in a press release. “However, it has not been widely tested in the AYA survivor group. We wanted to explore whether a CBT-I program, specifically tailored to AYA survivors and available online, could be helpful in this population.”

Adolescents and young adults who survive cancer, compared to adults, have different problems and needs when it comes to sleep, said Dr. Zhou—for instance, their sleep schedule may be influenced by parents or roommates. They also tend to go to sleep and wake up earlier than younger children or older adults, in part due to developmental changes in circadian timing.

“Insomnia treatments for AYA cancer survivors need to take account of these factors, as well as addressing their long-term cancer-related issues such as pain or fatigue,” he said.

To address this group specifically, Dr. Zhou and coauthor Christopher Recklitis, PhD, MPH, both of the Dana-Farber Cancer Institute, assessed 22 cancer survivors with insomnia (mean [range] age, 20.4 [14-25] years) who were enrolled in an automated, modified CBT-I program. Survivors had been diagnosed with blood cancer (54.5%) or solid tumors (45.5%) an average 9.7 years previously. Patients were assessed for sleep health, fatigue, and quality of life at baseline, eight weeks, and 16 weeks.

SHUTi Program Tailored to Suit Adolescents, Young Adults Struggling with Insomnia After Cancer

The tailored intervention used was SHUTi, which stands for Sleep Healthy Using the Internet. Dana-Farber researchers modified SHUTi to suit the needs of their patient population. The original SHUTi intervention highlights stories from adult patients with insomnia, while the one used in the present study used ones that young patients would find more relevant.

“SHUTi trains people to recalibrate their sleep so their sleep habits are no longer addressing the problems they experienced during treatment and are, instead, focused on improving long-term sleep,” Dr. Zhou explained.

The modified SHUTi intervention included six sessions, although about a quarter of patients (72.7%) did not complete all of then; the mean completion rate was 3.2 sessions. At eight and 16 weeks, all measured outcomes were improved. Patients who completed at least two sessions outperformed those who did not on the insomnia severity index.

“Our results demonstrate that an internet-delivered CBT-I program targeting AYA cancer survivors reduced their insomnia and improved their quality of life,” said Dr. Recklitis. “Notably, our participants’ insomnia severity continued to get better after the intervention had ended, suggesting that the continued to make sleep-related decisions that helped their sleep even after they had finished using the program.”

Kaitlyn D’Onofrio is a digital medical writer. She is interested in musculoskeletal health, the effect of exercise on health, and mental health awareness. When she’s not writing for DocWire, Kaitlyn is teaching yoga classes in her community, promoting wellness to her students.