Mindfulness and Cognitive Behavioral Therapy for Sleep in Cancer

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Hematologic cancer patients are at high risk for developing insomnia and daytime fatigue, pain, and distress in the months after inpatient treatment. Extended hospitalization for chemotherapy can activate predisposing factors (e.g., hyperarousal) and precipitate poor sleep patterns. Lack of sleep and subsequent worry about poor sleep quality may negatively impact daytime fatigue, pain, and distress, and lead to problematic behaviors that further exacerbate insomnia (e.g., napping/extended time in bed, medication use). Sleep difficulties can become chronic as patients struggle to disengage from thoughts about insomnia and its interference to valued activities. Chronic insomnia places cancer patients at elevated risk for disease progression. Mindfulness-Based Therapy for Insomnia (MBTI) is new group-based treatment that combines sleep restriction and stimulus control with mindfulness principles and meditations to treat insomnia, reduce rumination, and promote positive responses to poor sleep (e.g., less time in bed, less medication). To date, MBTI has not been applied to hematologic cancer patients who are particularly prone to both nighttime sleep disturbance and daytime fatigue, pain, and distress in the months following discharge from inpatient chemotherapy. Adaptations to MBTI are warranted to better address the unique challenges facing immunosuppressed hematologic cancer patients with insomnia, fatigue, pain, and distress after demanding inpatient treatments. The proposed study seeks to adapt and assess an MBTI protocol that includes mindfulness-based sleep techniques and training in coping skills for daytime fatigue, pain, and distress. Participants will be hematologic cancer patients endorsing insomnia, fatigue, pain, and distress 1-4 weeks after discharge from inpatient chemotherapy. Phase I aims to use information gathered from patient (N=3) and provider (N=1) focus groups to adapt MBTI for individual treatment and improved symptom management. Intervention content and procedures will be further refined through iterative user testing (N=5). We hypothesize these activities will result in a manualized, adapted MBTI protocol including patient materials and a structured therapist manual to standardize the intervention. Phase II aims to conduct a single-arm pilot study (N=30) to assess the feasibility, acceptability, and examine pre- to post-intervention outcomes. We hypothesize that participants will report improvement in the primary outcome of insomnia symptoms (i.e., severity and interference) and secondary outcomes (i.e., fatigue, pain, anxiety and depressive symptoms, hyperarousal, mindfulness, and self-efficacy for symptom management). Consistent with the National Cancer Institute’s mission to reduce suffering from cancer, this project initiates a program of research focused on critical symptom management needs for the understudied hematologic cancer population. Positive results from this study would provide support for a larger, methodologically rigorous randomized efficacy trial. Future work might examine the effects of adapted MBTI on neuroendocrine and immune markers that are linked to sleep and have implications for cancer progression.