IMPROVING ADHERENCE TO COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA IN BREAST CANCER

2.50
Hdl Handle:
http://hdl.handle.net/10755/211630
Type:
Research Study
Title:
IMPROVING ADHERENCE TO COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA IN BREAST CANCER
Abstract:
Rationale/Background: Chronic insomnia is a prevalent and distressing symptom in women with breast cancer. Cognitive behavioral therapy for insomnia (CBTI) is an established behavioral treatment that is safe and effective in improving sleep and other health outcomes, however; adherence to CBTI is not optimal in breast cancer survivors. Lack of adherence can negatively affect insomnia treatment outcomes. Purpose/Aims: This presentation will discuss the feasibility of adding motivational enhancement therapy to CBTI (MET+CBTI) in breast cancer survivors. Preliminary results will be presented relative to the impact of MET+CBTI compared to CBTI alone to improve adherence and outcomes (sleep, mood, quality of life and daily functioning). Methods: Women aged 21-65, between 1-36 months following primary breast cancer treatment who meet the criteria for chronic insomnia, were recruited from two Western U.S. Cancer Centers and community support groups. Sleep parameters, mood, and cognitive functioning, among other characteristics were assessed prior to CBTI and MET+CBTI. Participants completed self-report instruments with established reliability in cancer populations including the Insomnia Severity Index (ISI), European organization for research and treatment of cancer (EORTC) quality of life questionnaire C30 (QLQ-C30),   Hospital Anxiety and Depression Scale (HADS) and Attentional Function Index (AFI). The 7-item ISI using a 0-4 Likert scale, provides a quantitative evaluation of insomnia perception by targeting the symptoms and consequences of insomnia as well as the degree of concern and distress experienced by the respondent. ISI scores range from 0-28 with higher scores representing more severe insomnia. The QLQ-C30  is a cancer-specific measure of QOL and is composed of five multi-item functional scales that evaluate physical, role, emotional, cognitive, and social function and one global health status/QOL scale. The HADS measures anxiety and depression via 7- items subscales. The AFI assesses perceived effectiveness of cognitive functioning in daily life. Respondents rate themselves on 14 items anchored with polar opposite phrases ranging from 0 (not at all) to 100 (extremely well) in response to how well they were functioning in key cognitive activities. Results: Women ranged in age from 35-65 (M = 52.4 years, SD = 6.9). The overall average score of the ISI was > 17 which implies clinical insomnia of moderate severity. Recruitment, withdrawal rate, sleep intervention attendance suggest MET+CBTI is a feasible sleep intervention in breast cancer survivors. Eight participants interviewed at the conclusion of 6 weeks of MET+CBTI suggested that this intervention is well tolerated, acceptable, and helpful. Comments included: “Since sleep was not a problem before breast cancer, I didn’t know how to deal with it, and this treatment really helped me feel confident…a lot of it [treatment] was a joint effort…seeing [sleep] improvements boosted my confidence.” Our preliminary data suggests a trend toward greater subjective adherence. Thus, MET+CBTI may be effective in maximizing adherence, but a larger, longitudinal trial is needed. Implications: Insomnia has a significant impact on the daily lives of women with breast cancer. MET+CBTI has the potential to improve adherence and outcomes. Additional findings and implications will be discussed in greater detail during the presentation.
Keywords:
Breast cancer; Insomnia; Behavioral treatment
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5591
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titleIMPROVING ADHERENCE TO COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA IN BREAST CANCERen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211630-
dc.description.abstractRationale/Background: Chronic insomnia is a prevalent and distressing symptom in women with breast cancer. Cognitive behavioral therapy for insomnia (CBTI) is an established behavioral treatment that is safe and effective in improving sleep and other health outcomes, however; adherence to CBTI is not optimal in breast cancer survivors. Lack of adherence can negatively affect insomnia treatment outcomes. Purpose/Aims: This presentation will discuss the feasibility of adding motivational enhancement therapy to CBTI (MET+CBTI) in breast cancer survivors. Preliminary results will be presented relative to the impact of MET+CBTI compared to CBTI alone to improve adherence and outcomes (sleep, mood, quality of life and daily functioning). Methods: Women aged 21-65, between 1-36 months following primary breast cancer treatment who meet the criteria for chronic insomnia, were recruited from two Western U.S. Cancer Centers and community support groups. Sleep parameters, mood, and cognitive functioning, among other characteristics were assessed prior to CBTI and MET+CBTI. Participants completed self-report instruments with established reliability in cancer populations including the Insomnia Severity Index (ISI), European organization for research and treatment of cancer (EORTC) quality of life questionnaire C30 (QLQ-C30),   Hospital Anxiety and Depression Scale (HADS) and Attentional Function Index (AFI). The 7-item ISI using a 0-4 Likert scale, provides a quantitative evaluation of insomnia perception by targeting the symptoms and consequences of insomnia as well as the degree of concern and distress experienced by the respondent. ISI scores range from 0-28 with higher scores representing more severe insomnia. The QLQ-C30  is a cancer-specific measure of QOL and is composed of five multi-item functional scales that evaluate physical, role, emotional, cognitive, and social function and one global health status/QOL scale. The HADS measures anxiety and depression via 7- items subscales. The AFI assesses perceived effectiveness of cognitive functioning in daily life. Respondents rate themselves on 14 items anchored with polar opposite phrases ranging from 0 (not at all) to 100 (extremely well) in response to how well they were functioning in key cognitive activities. Results: Women ranged in age from 35-65 (M = 52.4 years, SD = 6.9). The overall average score of the ISI was > 17 which implies clinical insomnia of moderate severity. Recruitment, withdrawal rate, sleep intervention attendance suggest MET+CBTI is a feasible sleep intervention in breast cancer survivors. Eight participants interviewed at the conclusion of 6 weeks of MET+CBTI suggested that this intervention is well tolerated, acceptable, and helpful. Comments included: “Since sleep was not a problem before breast cancer, I didn’t know how to deal with it, and this treatment really helped me feel confident…a lot of it [treatment] was a joint effort…seeing [sleep] improvements boosted my confidence.” Our preliminary data suggests a trend toward greater subjective adherence. Thus, MET+CBTI may be effective in maximizing adherence, but a larger, longitudinal trial is needed. Implications: Insomnia has a significant impact on the daily lives of women with breast cancer. MET+CBTI has the potential to improve adherence and outcomes. Additional findings and implications will be discussed in greater detail during the presentation.en_GB
dc.subjectBreast canceren_GB
dc.subjectInsomniaen_GB
dc.subjectBehavioral treatmenten_GB
dc.date.available2012-02-20T12:05:07Z-
dc.date.issued2012-02-20T12:05:07Z-
dc.date.accessioned2012-02-20T12:05:07Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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