Efficacy of a Stepped‐Care Approach to Cognitive‐Behavioural Therapy for Insomnia (Can‐Sleep) in Adolescents and Young Adults With Cancer

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Abstract
Objective: Poor sleep is a common issue among adolescents and young adults (AYA) with cancer. The present study describes the feasibility and impact of the Can‐Sleep stepped‐care intervention for AYA with cancer. Methods: A total of 51 AYA with cancer were screened. AYA who reported sleep disturbance (defined as insomnia severity index score [ISI] > 7) received self‐managed cognitive behavioural therapy for insomnia (SMCBT‐I) in the first instance (Step 1) followed by individual cognitive behavioural therapy for insomnia (ICBT‐I) if symptoms continued (Step 2). AYA screened as high risk for intrinsic sleep abnormalities (e.g., obstructive sleep apnoea) were referred to a specialised service. Results: Of the 51 AYA, 38 participants reported sleep disturbance. In total, 37 AYA commenced SMCBT‐I, four attending the specialised sleep service prior. Thirty‐one (84%) completed Step 1. Of these, 45% improved and required no further treatment, and 55% (17) were eligible for ICBT‐I (ISI > 7). Following intervention, the SMCBT‐I group showed a significant decline in insomnia symptoms ( p < 0.001, d = 0.84). Among the 17 AYA continuing to report sleep disturbance, 11 (65%) were referred to ICBT‐I, with 8 (73%) accepting and completing Step 2. Those who received the ICBT‐I showed a significant reduction in insomnia symptoms ( p = 0.007, d = 1.33). Conclusions: This study provides preliminary efficacy and acceptability of a stepped‐care intervention for sleep disturbances in AYA with cancer. A stepped‐care intervention may offer an effective and resource‐efficient method for managing sleep disturbance in AYA with cancer.
Funding Information
  • Department of Health, State Government of Victoria

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