A randomized controlled trial of mindfulness-based stress reduction for insomnia secondary to cervical cancer: Sleep effects
Introduction
Cervical cancer is the second most common type of cancer among women in Southeast Asia and the leading cause of cancer deaths among women in low- and middle-income countries (Shrestha, Neupane, Vedsted, & Kallestrup, 2018). Therapies for stages I and II cervical cancer patients involve surgical operation that is integrated with chemotherapy/radiotherapy. Considering radiotherapy- and hysterectomy-induced urodynamic modifications (decreased storage, bladder emptying ability, and urinary incontinence) (Lin, Wu, Yang, Sheu, & Lin, 2004), cervical cancer patients are more likely to have bad sleep quality (Lin et al., 2004; Lutgendorf et al., 2002). During the time of diagnosis and treatment, patients with cervical cancer frequently have high distress (Costanzo, Lutgendorf, Rothrock, & Anderson, 2006). Since they are susceptible to a broad scope of troubles (loss of fertility, early menopause, sexual disharmony, and poor living circumstances) (Burns, Costello, Ryan-Woolley, & Davidson, 2007). Throughout therapy, the patients can be made in sensory discomfort and pain by chemotherapy-induced peripheral neurotoxicity (CIPN) (Markman, 1996). Activities restriction throughout the day and decrease exposure to natural illumination can lead to alterations in the regularity of rhythms (Lee, Cho, Miaskowski, & Dodd, 2004). These phenomena consequently make cervical cancer patients possibly at elevated danger for sleep disturbance. Non-pharmacological therapies, nevertheless, are preferred by cancer patients for sleep troubles (Davidson, Feldman-Stewart, Brennenstuhl, & Ram, 2007), stimulating the need for studies concerned with non-pharmacological interventions for insomnia secondary to cancer.
Psychological interventions ought to be the favored option, in relation to hypnotic medications, while insomnia is chronic (Hall, 1998). Though cognitive-behavioral treatment has been recognized as a reliable non-pharmacological therapy for insomnia, it does not focus on anxieties and raised psychological distress of recurrence among cancer survivors (Espie et al., 2008). Positive effects on depression and anxiety were shown by a study concerned with mindfulness-based treatment for cancer patients (Piet, Wurtzen, & Zachariae, 2012). Furthermore, several studies have revealed that Mindfulness-based stress reduction (MBSR) significantly enhanced outcomes of subjective sleep parameters (SSP) among cancer survivors (Carlson, Speca, Patel, & Goodey, 2003; Shapiro, Bootzin, Figueredo, Lopez, & Schwartz, 2003). However, studies carried out on insomnia linked to cervical cancer are rare.
Previous researches provided mixed outcomes of relaxation training's effect on insomnia symptoms of tumor patients (Stam & Bultz, 1986). More lately, nonrandomized studies illustrated certain results for insomnia (i.e., improved subjective sleep) (Davidson, Waisberg, Brundage, & MacLean, 2001; Simeit, Deck, & Conta-Marx, 2004). A randomized trial, however, is still needed to better explore the effect of MBSR on patients with insomnia secondary to cancer.
Therefore, the study's object was to evaluate MBSR's influences on sleep parameters and hypnotic medication use of patients with insomnia secondary to cervical cancer. This study was a randomized controlled trial. It was registered on Chinese Clinical Trial Registry (registered number: ChiCTR1800018571). The ethic approval was obtained from the ethic committee of Wuchang University of Technology. All written informed consent was obtained from the participators.
Section snippets
Methods
In this study, participants were recruited between June 2017 and July 2017 from a tertiary hospital in China, subsequently, those who were eligible for the trial were selected (more detail information was shown in the section of participants). Doctors were asked to assist in identification of eligible patients. If patients met the inclusion criteria, then doctors would invite them to join an introduction meeting. During the meeting, informed consent was collected. After participants were
Participants
Between June 2017 and July 2017, 2022 patients were evaluated and 70 were at random assigned. Each group have 35 parents. Research process was showed in Fig. 1. The demographic, treatment and insomnia characteristics of the two groups were not statistically different at baseline (Table 2). During the intervention, some patients drop out (4 for the MBSR group and 2 for the control group). At 6-month follow-up and 12-month follow-up, more 2 patients dropped out (Fig. 1).
Sleep diaries
Estimated marginal group
Discussion
This research aimed at evaluating MBSR's efficacy as a therapy for chronic insomnia that was secondary to cervical cancer. In summary, MBSR was discovered to have small impacts on insomnia secondary to cervical cancer. But the long-term effect was not satisfied. First, the findings illustrated therapy efficacy's evidence for MBSR to decrease TWT, raise SE and TST in SSP from baseline to post-intervention. Secondly, PSG data between the two groups showed no significantly differences.
Conclusion
In conclusion, the study suggests that patients with chronic insomnia secondary to cervical cancer may benefit from MBSR in short-term efficacy, but the long-term maintenance effect is not satisfactory. By serving as a more desirable choice to supplementation with hypnotics, MBSR may offer cervical cancer patients a sustainable recovery from sleep.
Acknowledgement
This work was supported by Guangzhou Municipal Bureau of Health (grant number: 20130418).
Declaration of Competing Interest
We confirm that this manuscript has not been published elsewhere and is not under consideration by another journal. All authors have approved the manuscript and agree with submission. The authors have no conflicts of interest to declare.
References (39)
- et al.
Methodological challenges when using actigraphy in research
Journal of Pain and Symptom Management
(2008) - et al.
The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: Implementation and evaluation of a sleep clinic in general medical practice
Behaviour Research and Therapy
(2001) - et al.
The clinical effectiveness of cognitive behaviour therapy for chronic insomnia: Implementation and evaluation of a sleep clinic in general medical practice
Behaviour Research and Therapy
(2001) - et al.
Impaired sleep and rhythms in persons with cancer
Sleep Medicine Reviews
(2004) - et al.
Cognitive behavioral therapy for insomnia in stable heart failure: Protocol for a randomized controlled trial
Contemporary Clinical Trials
(2017) - et al.
The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: An exploratory study
Journal of Psychosomatic Research
(2003) - et al.
The treatment of severe insomnia in a cancer-patient
Journal of Behavior Therapy and Experimental Psychiatry
(1986) - et al.
Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer
Support Care Cancer
(2006) - et al.
Long-term effectiveness of a short-term cognitive-behavioral group treatment for primary insomnia
European Archives of Psychiatry and Clinical Neuroscience
(2001) - et al.
The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue
Oncology Nursing Forum
(1999)