title: A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer.
abstract: OBJECTIVE
  This study aims to provide recommendations on the optimal strategies and interventions for the prevention, screening, assessment, and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) in adult cancer populations.
  
  
  METHODS
  A systematic search of the published health literature was conducted to identify randomized controlled trials, clinical practice guidelines, systematic reviews, and other guidance documents. The Sleep Disturbance Expert Panel [comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers, and guideline methodologists] reviewed, discussed, and approved the final version of the guideline. Health care professionals across Canada were asked to provide feedback through an external review process.
  
  
  RESULTS
  Three clinical practice guidelines and 12 randomized controlled trials were identified as the evidence base. Overall, despite the paucity of evidence, the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using standardized screening tools on a routine basis. While prevention of sleep disturbance is the desired objective, cognitive behavioral therapies are effective in improving sleep outcomes. As part of the external review with 16 health care providers, 81 % indicated that they agreed with the recommendations as written.
  
  
  CONCLUSIONS
  Sleep difficulty is a prevalent problem in cancer populations that needs greater recognition by health professionals. Prevention, screening, assessment, and treatment strategies supported by the best available evidence are critical. Recommendations and care path algorithms for practice are offered.
authors.affiliation: University Health Network (Princess Margaret Hospital), 610 University Avenue PMH, Room 15-617, Toronto, ON, Canada, doris.howell@uhn.on.ca.
authors.forename: Doris
authors.initials: D
authors.lastname: Howell
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Oliver
authors.forename: Sue
authors.initials: S
authors.lastname: Keller-Olaman
authors.forename: Judith
authors.initials: J
authors.lastname: Davidson
authors.forename: Sheila
authors.initials: S
authors.lastname: Garland
authors.forename: Charles
authors.initials: C
authors.lastname: Samuels
authors.forename: Josée
authors.initials: J
authors.lastname: Savard
authors.forename: Cheryl
authors.initials: C
authors.lastname: Harris
authors.forename: Michèle
authors.initials: M
authors.lastname: Aubin
authors.forename: Karin
authors.initials: K
authors.lastname: Olson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sussman
authors.forename: James
authors.initials: J
authors.lastname: Macfarlane
authors.forename: Claudette
authors.initials: C
authors.lastname: Taylor
mesh_terms: D000328:Adult; D002170:Canada; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D016032:Randomized Controlled Trials as Topic; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*