title: Cognitive behavioral therapy for insomnia outcomes in women after primary breast cancer treatment: a randomized, controlled trial.
abstract: OBJECTIVE
  To examine the effect of cognitive-behavioral therapy for insomnia (CBTI) on sleep improvement, daytime symptoms, and quality of life (QOL) in breast cancer survivors (BCSs) after cancer treatment.
  
  
  METHODS
  A prospective, longitudinal, randomized, controlled trial.
  
  
  METHODS
  Oncology clinics, breast cancer support groups, and communities in Colorado.
  
  
  METHODS
  56 middle-aged BCSs with chronic insomnia.
  
  
  METHODS
  Women were randomly assigned to CBTI or behavioral placebo treatment (BPT) and completed measures of sleep, QOL, functioning, fatigue, and mood at baseline, postintervention, and at three- and six-month follow-ups.
  
  
  METHODS
  Sleep outcomes (e.g., sleep efficiency, sleep latency, total sleep time, wake after sleep onset, number of nightly awakenings); secondary variables included sleep medication use, insomnia severity, QOL, physical function, cognitive function, fatigue, depression, anxiety, and sleep attitudes or knowledge.
  
  
  RESULTS
  Sleep efficiency and latency improved more in the CBTI group than the BPT group; this difference was maintained during follow-up. Women in the CBTI group had less subjective insomnia, greater improvements in physical and cognitive functioning, positive sleep attitudes, and increased sleep hygiene knowledge. No group differences in improvement were noted relative to QOL, fatigue, or mood.
  
  
  CONCLUSIONS
  Nurse-delivered CBTI appears to be beneficial for BCSs' sleep latency/efficiency, insomnia severity, functioning, sleep knowledge, and attitudes more than active placebo, with sustained benefit over time.
  
  
  CONCLUSIONS
  Oncology nurses are in a unique position to identify insomnia in cancer survivors. When sleep disturbances become chronic, nurses need to make recommendations and referrals.
authors.affiliation: College of Nursing, University of Colorado in Aurora.
authors.forename: Ellyn E
authors.initials: EE
authors.lastname: Matthews
authors.affiliation: College of Nursing, Omaha Division, University of Nebraska Medical Center.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Berger
authors.affiliation: Department of Biostatistics and Informatics, School of Public Health.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Schmiege
authors.affiliation: College of Nursing, University of Colorado in Denver.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Cook
authors.affiliation: College of Nursing, University of Colorado in Denver.
authors.forename: Michaela S
authors.initials: MS
authors.lastname: McCarthy
authors.affiliation: Department of Biostatistics and Informatics in the School of Public Health, University of Colorado in Denver.
authors.forename: Camille M
authors.initials: CM
authors.lastname: Moore
authors.affiliation: National Jewish Health, Denver, CO.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Aloia
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications*; D015928:Cognitive Behavioral Therapy; D003120:Colorado; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D059035:Perioperative Period; D011446:Prospective Studies; D011788:Quality of Life; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000628:therapy*; D017741:Survivors; D016896:Treatment Outcome
keywords: breast cancer; fatigue; late effects of cancer treatment; outcomes research; survivorship