Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

A stepped-care cognitive behavioural intervention for insomnia in cancer survivors (#389)

Justine Diggens 1 , Dr Maria Ftanou 1 , A/Prof Steve Ellen 1 , Dr Michael Jefford 2 , Amanda Piper 2 , Dr Jo Phipps-Nelson 3 , A/Prof Jeremy Goldin 4 , Dr Kirk Kee 4 , Dr Lesley Stafford 5 , Dr Elizabeth Barson 6 , Kate Willcox 6 , Dr Bei Bei 7 , Dr Joshua Wiley 7 , Helena Bean 7 , A/Prof Justin Tse 8 , Wallace Crellin 9
  1. Dept of Psychosocial Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  2. Australian Cancer Survivorship Centre, A Richard Pratt Legacy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  3. Dept of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  4. Dept of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
  5. Centre for Women's Mental Health, Royal Women's Hospital, Parkville, Victoria, Australia
  6. Dept of Psychology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
  7. Sleep Program, Monash Institute of Cognitive and Clinical Neuroscience, Monash University, Notting Hill, Victoria, Australia
  8. Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
  9. Consumer Representative, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia


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.

  1. Garland S, Johnson J, Savard J, Gehrman P, Perlis M, Carlson L and Campbell T. Sleeping well with cancer: a systematic review of cognitive behavioural therapy for insomnia in cancer patients. Neuropsychiatric Disease and Treatment. 2014; 10: 1113-1124.
  2. Mansel K, Carey E. Nonpharmacologic Approach to Sleep Disorders. The Cancer Journal. 2014; 20:345-351
  3. Howell, D, Oliver, TK, Keller-Olaman, S, Davidson, J, Garland, S, Samuels, C, Savard, J, Harris, C, Aubin, M, Olson, K, Sussman, J, MacFarlane, J, and Taylor, C Sleep Disturbance Expert Panel on behalf of the Cancer Journey Advisory Group of the Canadian Partnership Against Cancer 2012. A Pan-Canadian Practice Guideline: Prevention, Screening, Assessment and Treatment of Sleep Disturbances in Adults with Cancer. Supportive Care Cancer. 2013; 21: 2695-706.
  4. Johnson J, Rash J, Campbell T, Savard J, Gehrman P, Perlis M, Carlson L, Garland S. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT-I) in cancer survivors. Sleep Medicine Review. 2016; 27: 20-28.