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Feasibility of a Cognitive-Behavioral and Environmental Intervention for Sleep-Wake Difficulties in Community-Dwelling Cancer Patients Receiving Palliative Care

Bernatchez, Marie Solange PhD; Savard, Josée PhD; Savard, Marie-Hélène PhD; Aubin, Michèle MD, PhD, FCFP, CCFP

doi: 10.1097/NCC.0000000000000603

Background High rates of sleep-wake difficulties have been found in patients with cancer receiving palliative care. Pharmacotherapy is the most frequently used treatment option to manage these difficulties despite numerous adverse effects and the absence of empirical evidence of its efficacy and innocuity in palliative care.

Objective This pilot study aimed to assess the feasibility and acceptability of a cognitive-behavioral and environmental intervention (CBT-E) to improve insomnia and hypersomnolence in patients with a poor functioning level and to collect preliminary data on its effects.

Methods Six patients with cancer receiving palliative care (Eastern Cooperative Oncology Group score 2–3), who had insomnia and/or hypersomnolence, received 1 CBT-E individual session at home. They applied the strategies for 3 weeks. Patients completed the Insomnia Severity Index, the Epworth Sleepiness Scale, a daily sleep diary, and a 24-hour actigraphic recording (7 days) at pretreatment and posttreatment, in addition to a semistructured interview (posttreatment).

Results Participants found strategies easy to apply most of the time, and none was rated as impossible to use because of their health condition. However, their adherence and satisfaction toward CBT-E were highly variable. Results on the effects of CBT-E were heterogeneous, but improvements were observed in patients with a persistent insomnia disorder.

Conclusions The CBT-E protocol tested among this highly selected sample was fairly well received and suggested positive outcomes in some patients, particularly those with an insomnia complaint alone.

Implications Efforts should be pursued to adapt CBT-E and develop other nonpharmacological interventions, in order to provide an alternative to pharmacotherapy for sleep-wake difficulties in this population.

Author Affiliations: School of Psychology, Université Laval (Drs Bernatchez, J. Savard and M.-H. Savard); CHU de Québec–Université Laval Research Center (Drs Bernatchez, J. Savard and M.-H. Savard); Laval University Cancer Research Center (Drs Bernatchez, J. Savard and M.-H. Savard); and Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada (Dr Aubin).

This study was supported by training awards held by the first author from the Canadian Institutes of Health Research, the Fonds de Recherche Santé Québec and the Psychosocial Oncology Research Training Program, and a research grant held by the second and the fourth authors from the Équipe de Recherche Michel-Sarrazin en Oncologie Psychosociale et Soins Palliatifs.

The authors have no conflicts of interest to disclose.

Correspondence: Josée Savard, PhD, Centre de Recherche du CHU de Québec–Université Laval, 11 Côte du Palais, Québec, Québec, Canada G1R 2J6 (

Accepted for publication February 13, 2018.

Online date: May 15, 2018

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