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Li R, Ma Y, Arditte Hall KA, Johnson C, Philpotts LL, Perez GK, Park ER, Hall DL. Representation of race and ethnicity among cancer survivors in trials of cognitive behavioral therapy for insomnia (CBT-I): A systematic review. Support Care Cancer 2023; 32:23. [PMID: 38095732 DOI: 10.1007/s00520-023-08207-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023]
Abstract
PURPOSE For cancer survivors, insomnia is highly prevalent and debilitating. Although cognitive behavioral therapy for insomnia (CBT-I) is recognized as a gold standard treatment, it is unclear whether benefits of treatment generalize to racial and ethnic minorities in the USA. This systematic review characterizes the representation of racial and ethnic diversity among cancer survivors in CBT-I clinical trials and provides recommendations for research in sleep/cancer survivorship. METHODS Literature searches were conducted in five electronic databases (PubMed, Cochrane Library via Ovid, PsycINFO via Ovid, Embase, Web of Science Core Collection) using concepts of CBT, insomnia, and cancer survivors. Information about CBT-I intervention details, sample racial demographics, and whether authors explicitly analyzed race and ethnicity were recorded. RESULTS A total of 1673 citations were retrieved, and 967 citations were uploaded to Covidence. Of these, 135 articles went through full-text review and 13 studies were included. Race and ethnicity were reported in 11/13 trials (84.6%). Of those reporting race and ethnicity, 8/11 (72.7%) trials were comprised of samples that were ≥ 85% non-Hispanic White. Among the trials that explicitly analyzed race and ethnicity, CBT-I was more effective among cancer survivors who were White and highly educated, and non-White cancer survivors were less likely to have private insurance and ability to participate in clinical trials. CONCLUSION Non-Hispanic White cancer survivors are overrepresented in CBT-I trials, the best available treatment for insomnia. Underrepresentation of racial and ethnic minorities likely contributes to barriers in access and uptake. Recommendations include implementing sustained efforts to expand diversity in CBT-I clinical trials for cancer survivors.
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Affiliation(s)
- Raissa Li
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA
- Tufts University School of Medicine, Medford, MA, USA
| | - Yan Ma
- Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Lisa L Philpotts
- Infection Control Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Giselle K Perez
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Elyse R Park
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Daniel L Hall
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, 100 Cambridge St., 16th Floor, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Diggens J, Bullen D, Maccora J, Wiley JF, Ellen S, Goldin J, Jefford M, Hickey M, Ftanou M. Feasibility and efficacy of 'Can-Sleep': effects of a stepped-care approach to cognitive-behavioral therapy for insomnia in cancer. J Cancer Surviv 2023:10.1007/s11764-023-01457-3. [PMID: 37751126 DOI: 10.1007/s11764-023-01457-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/23/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE This study aimed to evaluate the feasibility and clinical efficacy of the Can-Sleep stepped-care intervention for people with cancer-related sleep disturbance. METHODS A total of 147 individuals with cancer were screened. Participants who reported sleep disturbances and were at low-moderate risk for intrinsic sleep abnormalities were given self-managed cognitive behavioral therapy for insomnia (SMCBT-I). Those reporting sleep disturbance and scoring at high risk of intrinsic sleep abnormalities (i.e., restless leg syndrome and obstructive sleep apnoea) were referred to a specialist sleep clinic. In both groups, participants received a stepped-up group CBT-I intervention (GCBT-I) if they continued to report sleep disturbance following SMCBT-I or the specialist sleep clinic. RESULTS Overall, 87 participants reported sleep disturbance or screened at risk for intrinsic sleep abnormality. Thirty-four were referred to a specialist sleep clinic, and of the 17 who declined this referral, 14 were rereferred to SMCBT-I. In total, 62 participants were referred to SMCBT-I, and 56 commenced SMCBT-I. At post-intervention, the SMCBT-I group showed a significant decline in insomnia symptoms (p < .001, d = 1.01). Five participants who reported sleep disturbance after SMCBT-I and/or the specialist sleep clinic, accepted GCBT-I. Those who received the GCBT-I showed a significant reduction in insomnia symptoms (p < .01, d = 3.13). CONCLUSIONS This study demonstrates the feasibility and efficacy of a stepped-care intervention for sleep disturbances in people with cancer. IMPLICATIONS FOR CANCER SURVIVORS A stepped-care intervention for sleep disturbance is a feasible and potentially effective method of addressing a significant and unmet patient need.
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Affiliation(s)
- Justine Diggens
- Peter MacCallum Cancer Centre, 3000, Melbourne, VIC, Australia
| | - Dani Bullen
- Peter MacCallum Cancer Centre, 3000, Melbourne, VIC, Australia
| | - Jordan Maccora
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Joshua F Wiley
- Peter MacCallum Cancer Centre, 3000, Melbourne, VIC, Australia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Steve Ellen
- Peter MacCallum Cancer Centre, 3000, Melbourne, VIC, Australia
| | - Jeremy Goldin
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Michael Jefford
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, VIC, Australia
| | - Maria Ftanou
- Peter MacCallum Cancer Centre, 3000, Melbourne, VIC, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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Breast Cancer Survivorship: the Role of Rehabilitation According to the International Classification of Functioning Disability and Health-a Scoping Review. Curr Oncol Rep 2022; 24:1163-1175. [PMID: 35403973 PMCID: PMC9467947 DOI: 10.1007/s11912-022-01262-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 12/20/2022]
Abstract
Purpose of Review The population of breast cancer (BC) survivors is growing due to earlier diagnosis and effective combined treatments. A scoping review was performed to explore the role of rehabilitation in BC survivorship and the major issues in BC survivors with International Classification of Functioning Disability and Health (ICF) perspective. Recent Findings The authors searched PubMed from January 1, 2018, up until November 9, 2021. The 65 selected publications were analyzed with the Comprehensive ICF BC Core Set (CCS) perspective and assigned to the categories of the CCS components along with the 3 areas of health (physical, mental, and social health). The multidimensional aspects of BC survivor disability are evident, whereas the topics of the articles concern several categories of the ICF BC CCS and all 3 areas of health. However, the current ICF BC CCS does not include certain categories related to emerging issues of BC survivorship recurring in the papers. Summary Rehabilitation is crucial in BC survivorship management to give personalized answers to women beyond BC, and the ICF BC CCS remains an essential tool in rehabilitation assessment for BC survivors although it needs updating.
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Mellor A, Kavaliotis E, Mascaro L, Drummond SP. Approaches to the assessment of adherence to CBT-I, predictors of adherence, and the association of adherence to outcomes: A systematic review. Sleep Med Rev 2022; 63:101620. [DOI: 10.1016/j.smrv.2022.101620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 10/18/2022]
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Agnew S, Vallières A, Hamilton A, McCrory S, Nikolic M, Kyle SD, Fleming L, Crawford MR. Adherence to Cognitive Behavior Therapy for Insomnia. Sleep Med Clin 2021; 16:155-202. [DOI: 10.1016/j.jsmc.2020.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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