Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: a pilot randomized controlled trial

Yoshio Nakamura, David L Lipschitz, Renee Kuhn, Anita Y Kinney, Gary W Donaldson, Yoshio Nakamura, David L Lipschitz, Renee Kuhn, Anita Y Kinney, Gary W Donaldson

Abstract

Purpose: After completing treatment, cancer survivors may suffer from a multitude of physical and mental health impairments, resulting in compromised quality of life. This exploratory study investigated whether two mind-body interventions, i.e., Mind-Body Bridging (MBB) and Mindfulness Meditation (MM), could improve posttreatment cancer survivors' self-reported sleep disturbance and comorbid symptoms, as compared to sleep hygiene education (SHE) as an active control.

Methods: This randomized controlled trial examined 57 cancer survivors with clinically significant self-reported sleep disturbance, randomly assigned to receive MBB, MM, or SHE. All interventions were conducted in three sessions, once per week. Patient-reported outcomes were assessed via the Medical Outcomes Study Sleep Scale and other indicators of psychosocial functioning relevant to quality of life, stress, depression, mindfulness, self-compassion, and well-being.

Results: Mixed effects model analysis revealed that mean sleep disturbance symptoms in the MBB (p = .0029) and MM (p = .0499) groups were lower than in the SHE group, indicating that both mind-body interventions improved sleep. In addition, compared with the SHE group, the MBB group showed reductions in self-reported depression symptoms (p = .040) and improvements in overall levels of mindfulness (p = .018), self-compassion (p = .028), and well-being (p = .019) at postintervention.

Conclusions: This study provides preliminary evidence that brief sleep-focused MBB and MM are promising interventions for sleep disturbance in cancer survivors. Integrating MBB or MM into posttreatment supportive plans should enhance care of cancer survivors with sleep disturbance. Because MBB produced additional secondary benefits, MBB may serve as a promising multipurpose intervention for posttreatment cancer survivors suffering from sleep disturbance and other comorbid symptoms.

Implications for cancer survivors: Two brief sleep-focused mind-body interventions investigated in the study were effective in reducing sleep disturbance and one of them further improved other psychosocial aspects of the cancer survivors' life. Management of sleep problems in survivors is a high priority issue that demands more attention in cancer survivorship.

Trial registration: ClinicalTrials.gov NCT00935376.

Figures

Fig. 1
Fig. 1
Study flow, described in accordance with the CONSORT Guidelines
Fig. 2
Fig. 2
Primary outcome indicator, the adjusted means of MOS-SS Sleep Problems Index II (SPI-II), averaged over all time points in the three groups, with 95 % confidence interval (CI). Here, “adjusted” means “adjusted for baseline scores,” allowing the outcome indicators to be directly compared with one another. Both MM and MBB were found to be lower than SHE (p = .0499 and p = .0029 respectively). Note that the CIs depicted here are not those CIs actually used in the linear mixed model analysis. A dashed horizontal line in represents the mean baseline covariate value, representing a common baseline reference across the three groups
Fig. 3
Fig. 3
Estimated mean scores of SPI-II adjusted for baseline scores from pre, for SHE (dotted line), MBB (solid line), and MM (dashed line), as a function of assessment times (week 2, week 3, post, and follow-up). Here, “adjusted” means “adjusted for baseline scores,” allowing them to be directly compared with one another. Therapeutic benefits in MM and MBB continued to improve over time, while that in SHE leveled off after the completion of the study sessions. A dashed horizontal line in represents the mean baseline covariate value, representing a common baseline reference across the three groups
Fig. 4
Fig. 4
Effects of the three sleep interventions on: a) depression symptoms (CES-D), b) mindfulness (FF-MQ), c) self-compassion (SCS), and d) well-being (WBI). Estimated means, adjusted for baseline scores from Pre, for each scale are presented for SHE, MBB, and MM, with 95 % Confidence Interval (CI). Here, “adjusted” means “adjusted for baseline scores,” allowing them to be directly compared with one another. Note that the CIs depicted in Figure 4a, 4b, 4c, and 4d are not those CIs actually used in linear mixed model analysis. In all scales, MBB was different from SHE at post-intervention, indicating that MBB led to a reduced level of self-reported depression symptoms (4a) and enhanced levels of mindfulness, self-compassion, and well-being (4b, 4c, 4d). A dashed horizontal line in each Figure represents the mean baseline covariate value of each scale, representing a common baseline reference across the three groups

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