Cognitive behaviour therapy may be superior to bright light therapy for insomnia in women with breast cancer undergoing chemotherapy

1. Cognitive behaviour therapy for insomnia (CBT-I) is more effective in reducing insomnia for women undergoing chemotherapy for breast cancer compared to bright light therapy (BLT).

Evidence Rating Level: 1 (Excellent)

Insomnia symptoms are extremely common among women with breast cancer undergoing chemotherapy and are associated with worse clinical outcomes. Some existing options for the management of insomnia include CBT-I, which remains first-line therapy, and BLT, which targets the circadian rhythm to alleviate insomnia symptoms. However, evidence for these therapies among chemotherapy patients is lacking. This randomized controlled trial therefore sought to investigate the efficacy of CBT-I and BLT in the management of insomnia in women undergoing chemotherapy for breast cancer. 219 women (mean[SD] age, 50.7[10.8] years] from 5 Australian centres with breast cancer undergoing chemotherapy were included in the trial. Patients were randomized to either CBT-I alone, BLT alone, CBT-I plus BLT, and sleep hygiene education (SHE). Patients in CBT-I groups had significantly greater reduction in insomnia symptoms compared with non-CBT-I groups (insomnia severity index [ISI] score mean difference [MD], −2.19 [95% CI, −3.33 to −1.05] points; P = .002; standardized mean difference, -0.40). There were no significant differences in ISI scores between BLT and non-BLT groups with an ISI score MD of -0.88 points (95% CI, −2.02 to 0.26 points; P = .26). Overall, this study found that among women undergoing chemotherapy for breast cancer, CBT-I is significantly more effective compared with BLT in improving insomnia symptoms. 

Click here to read this study in JAMA Network Open

Image: PD

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