title: Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue.
abstract: BACKGROUND
  To determine whether sleep quality and fatigue associated with breast cancer adjuvant chemotherapy treatments can be improved with behavioral therapy (BT) [Individualized Sleep Promotion Plan (ISPP)] including modified stimulus control, modified sleep restriction, relaxation therapy, and sleep hygiene.
  
  
  METHODS
  Randomized-controlled trial based on Piper Integrated Fatigue Model, 219 stages I-IIIA breast cancer patients. Prior to the initial chemotherapy treatment, BT participants developed an ISPP plan that was regularly reinforced and revised. Controls received healthy eating information and attention. Pittsburgh Sleep Quality Index (PSQI), daily diary, actigraph, and Piper Fatigue Scale (PFS) data were collected 2 days prior, during the 7 days after each treatment, and 30 days after the last treatment. Repeated measures analysis of variance was used.
  
  
  RESULTS
  Prior to chemotherapy, participants reported mild fatigue and fairly poor sleep quality. All variables changed over time. A group by time interaction was found for sleep quality (PSQI) improving in the BT group. Diary revealed group differences on number of awakenings, minutes awake after sleep onset, and sleep efficiency. Fatigue (PFS) was similar between groups.
  
  
  CONCLUSIONS
  The BT group showed improved sleep quality over time and better sleep (diary). Perceptions of improved sleep quality over time are not consistently associated with diary or actigraph, or result in lower fatigue.
authors.affiliation: University of Nebraska Medical Center, Omaha, NE 68198-5330, USA. aberger@unmc.edu
authors.forename: Ann M
authors.initials: AM
authors.lastname: Berger
authors.forename: Brett R
authors.initials: BR
authors.lastname: Kuhn
authors.forename: Lynne A
authors.initials: LA
authors.lastname: Farr
authors.forename: James C
authors.initials: JC
authors.lastname: Lynch
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Agrawal
authors.forename: Julie
authors.initials: J
authors.lastname: Chamberlain
authors.forename: Susanna G
authors.initials: SG
authors.lastname: Von Essen
mesh_terms: D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000523:psychology*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D003131:Combined Modality Therapy; D005221:Fatigue / Q000139:chemically induced / Q000523:psychology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education; D006801:Humans; D015409:Mastectomy, Radical; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life / Q000523:psychology; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology* / Q000628:therapy*