The deterioration of sleep quality in individuals undergoing chemotherapy for breast cancer (BC) is a well-documented concern. This study explores the feasibility and acceptability of delivering Cognitive Behaviour Therapy for Insomnia (CBT-I) via telehealth to people with early-stage BC during chemotherapy. The findings offer promising insights into the potential benefits of telehealth interventions in managing sleep disturbances in this patient population.
A multi-centre, single-arm, phase 2 feasibility trial was conducted, involving participants with stage I-III BC. They received four sessions of telehealth-delivered CBT-I over eight weeks while undergoing chemotherapy. The primary endpoint was the proportion of participants who completed all four sessions, with secondary measures including sleep quality assessments using the Pittsburgh Sleep Quality Index (PSQI) and other Patient Reported Outcome Measures (PROMs) at various stages.
High Completion and Acceptability Rates
The study recruited 41 participants, with a mean age of 51 years. Notably, 85% of participants successfully completed all four CBT-I sessions. The acceptability of the program was high, with 71% of participants finding the program useful. These results indicate strong feasibility and positive reception for telehealth CBT-I among breast cancer patients undergoing chemotherapy.
Despite initial concerns, there was no significant difference in the number of poor sleepers from baseline to the end of the study. At baseline, 73% of participants were classified as poor sleepers, compared to 68% at week 24. Additionally, the mean PSQI scores showed minimal change from baseline to week 24, indicating stable sleep quality over time.
Impact on Sleep Quality and Patient Outcomes
From baseline to week 24, 28% of participants experienced a significant improvement in sleep quality, marked by a ≥ 3 point improvement in their PSQI scores. Conversely, 20% of participants had a ≥ 3 point deterioration in sleep quality. These mixed results suggest that while telehealth CBT-I can benefit some patients, its efficacy may vary based on individual factors.
There were no significant changes in mean PROM scores throughout the study, indicating that the overall patient-reported outcomes remained stable. This stability suggests that telehealth CBT-I did not adversely affect other aspects of patients’ well-being during chemotherapy.
Key Takeaways for Practitioners
• Telehealth CBT-I is feasible and well-received among breast cancer patients undergoing chemotherapy.
• A significant proportion of participants completed all sessions, indicating strong adherence.
• Sleep quality remained stable for most participants, with some showing notable improvements.
• The program did not significantly alter other patient-reported outcomes, suggesting it is a safe intervention.
In conclusion, delivering CBT-I through telehealth is a viable option for managing sleep disturbances in breast cancer patients undergoing chemotherapy. Contrary to previous literature, sleep quality did not significantly deteriorate during the study period. Telehealth CBT-I holds potential for both preventing and managing sleep disturbances in this patient population.
Original Article: Support Care Cancer. 2024 May 23;32(6):375. doi: 10.1007/s00520-024-08554-8.
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