A Feasibility Study of Group-Delivered Behavioral Interventions for Insomnia Among Breast Cancer Survivors: Comparing Cognitive Behavioral Therapy for Insomnia and a Mind-Body Intervention.

Objectives: An estimated 30%-50% of breast cancer survivors (BCSs) report persistent insomnia, which may affect daytime functioning and quality of life, and lead to longer term health complications. Although the gold standard insomnia intervention, cognitive behavioral therapy for insomnia (CBT-I), has demonstrated efficacy, accessibility is limited due to a scarcity of trained providers, and adherence to therapy is variable. Group-delivered alternative therapies may offer an opportunity to reach and treat BCSs with insomnia. This pilot study was designed to assess feasibility of a group-delivered mind-body intervention compared with group-delivered CBT-I among BCSs. Design: The authors recruited n = 25 stages I - IV BCSs to a 9-week trial of group therapy for insomnia. Eligible women were assigned to the next upcoming group until it was full. Primary outcomes were to assess intervention feasibility measured by (1) qualitative focus group feedback and (2) attendance. The feasibility of using the Insomnia Severity Index (ISI) was also assessed in this population and ISI change scores were gathered to allow for power calculations in a future trial. Means and frequencies were used to describe participant demographics and attendance. Results: The authors found higher attendance (86% vs. 67% of sessions) and greater satisfaction with the intervention (84.6% vs. 57.1%) reported among mind-body participants than among CBT-I participants. Qualitative feedback suggested more group cohesion among the mind-body group and lower incentive to attend in-person among the CBT-I group. Conclusions: The results suggest that delivering a mind-body intervention for BCSs is feasible and acceptable, based on attendance and qualitative feedback.

Pilot Study of Massage to Improve Sleep and Fatigue in Hospitalized Adolescents With Cancer.

BACKGROUND: Adolescents with cancer experience many troubling symptoms, including sleep disruptions that can affect mood and quality of life. Massage is a safe and popular intervention that has demonstrated efficacy in pediatric and adult patients with cancer. This study aimed to assess the feasibility of conducting a massage intervention to help with sleep in hospitalized adolescent oncology patients. PROCEDURE: Adolescents ages 12-21 with cancer who were expected to be hospitalized for at least four consecutive nights were recruited from the inpatient unit at Children's National Health System and randomized to either massage intervention or a waitlist control. Patients in the intervention group received one massage per night, for two or three nights. Sleep was measured with actigraphy and patient and proxy reported instruments were used to measure fatigue, mood, and anxiety. RESULTS: The majority (78%) of patients approached for the study consented, and almost all patients in the intervention group (94%) received at least one massage, 69% received two, and rates of completion of instruments among adolescents were high demonstrating feasibility. There were trends toward increased night time and overall sleep in the intervention group compared with standard of care, but no differences between groups in the patient reported outcome measures. Participant and parent feedback on the intervention was positive and was the impetus for starting a clinical massage service at the hospital. CONCLUSIONS: Massage for hospitalized adolescents with cancer is feasible, well received, and can potentially improve patients' sleep. A randomized multicenter efficacy study is warranted.