Insomnia is found in up to 60% of cancer survivors; at least double the general population1. Insomnia is associated with anxiety, depression, cognitive difficulties, pain, fatigue, sedative use and poorer quality of life2. Cognitive behavioural therapy (CBT) is recommended as first-line treatment for insomnia3. Studies strongly demonstrate CBT’s efficacy in cancer populations4, and this project aims to implement and evaluate an innovative, multi-site, stepped-care service for insomnia and sleep disturbances in cancer survivors.
250 adult cancer survivors (from haematology, breast, gynaecology, urology, lung and late effects clinics) will be screened for sleep disturbances across partnering sites (Peter MacCallum Cancer Centre, The Royal Women’s Hospital and The Royal Melbourne Hospital (RMH). Patients identified with intrinsic sleep abnormality (such as sleep apnoea) will receive referral to the Department of Respiratory and Sleep Medicine at the RMH for assessment and treatment. Patients with insomnia symptoms (Pittsburgh Sleep Quality Index, PSQI >5) will be given a CBT self-help booklet, designed specifically for cancer survivors. Brief therapist contact with patients using this booklet will aim to enhance their engagement and application of CBT strategies. Patients will be re-screened, and offered “stepped-up” care to a four-session group CBT program or specialist individual CBT if screening at each step identifies ongoing insomnia symptoms.
Preliminary results from this intervention will be presented. It is anticipated that PSQI data will demonstrate reductions in insomnia symptoms, and that this stepped-care approach will be an acceptable and feasible model of care, as measured by uptake and completion rates, and patient and staff surveys.
It is anticipated that this innovative model of care will successfully lead to the systematic early detection and treatment of insomnia symptoms in cancer survivors. It has the potential for uptake by all tumour steams, and other cancer services.