Meta-analysis of the efficacy of cognitive behavioural therapy for insomnia (CBT-I) on sleep, mood disturbance, fatigue and quality of life in cancer patients

Abstract

Our study conducted a systematic review and meta-analysis to examine the efficacy of cognitive-behavioural therapy for insomnia (CBT-I) in cancer patients. The improvement in sleep measures as well as the secondary outcome of depression, anxiety, fatigue and quality of life were assessed. The protocol was pre-registered on PROSPERO (CRD42021245306). Twelve primary studies were included in our analysis. The result showed that the CBT-I could improve the subjective sleep measure (g = -0.80), objective sleep measure (g = -0.51), anxiety (g = -0.26), depression (g = -0.37), fatigue (g = -0.39) and quality of life (g = -0.27). The maintenance effect at short-term follow-up was shown in subjective sleep (g = -0.65) and fatigue (g = -0.24). In long-term follow-up, all outcome variables showed significant improvement except depression. Subgroup and moderator analyses were performed, showing that the treatment effect was larger in younger age, female patients and patients with chronic insomnia than those with acute insomnia. The results of meta-regression also showed that the improvement of fatigue and depression was predicted by the improvement in subjective sleep disturbance. Overall, the results showed that CBT-I was also efficacious to provide improvement in secondary outcomes of anxiety, depression, fatigue and quality of life, which improvement in subjective sleep outcome would predict the alleviation of secondary symptoms. The importance of integrating CBT-I in care was discussed and recommended to improve the wellbeing of the cancer patients.