Video intervention benefits childhood cancer survivors with insomnia
Key takeaways:
- A videoconference program improved sleep and quality of life for childhood cancer survivors.
- The program can be implemented without extensive training in sleep medicine.
A videoconference-based behavioral intervention program significantly improved sleep and quality-of-life among elementary school-aged pediatric cancer survivors, according to study results.
Researchers at Dana-Farber Cancer Institute evaluated the intervention by enrolling 15 caregivers of cancer survivors aged 5 to 12 years suffering from insomnia. Hospital staff without previous sleep education or training administered the intervention sessions, which provided evidence-based strategies tailored to family needs.
Investigators collected self-report measures from caregivers prior to the intervention and approximately 2 weeks after. Caregivers reported significant improvements in survivors’ sleep and quality of life.
“Finding a pediatric behavioral sleep expert in the community is not easy,” Eric S. Zhou, PhD, a member of the faculty in the division of sleep medicine and an assistant professor of psychiatry at Harvard Medical School, told Healio. “Our interventionists weren’t physicians who spent years specializing in sleep medicine.”
Healio spoke with Zhou about how the intervention came about, the benefits it provided and the next steps for developing this approach.
Healio: How problematic are insomnia and sleep disorders for childhood cancer survivors?
Zhou: About one in four childhood cancer survivors are likely to be struggling with their sleep. It is time to acknowledge this important issue and to do our best to help these children.
Healio: What motivated you to develop this insomnia intervention?
Zhou: The school-aged population is very much overlooked in intervention trials for insomnia among cancer survivors. A lot more work has been done with adults. We recommend cognitive behavioral therapy for insomnia (CBT-I) in that population because it is so effective. A few trials have shown that adapting adult CBT-I can work for adolescent survivors, as well.
But that leaves us with this segment that may be too young to benefit from standard CBT-I, and are too old for the types of strategies that a pediatrician might recommend to a parent of a toddler. There was no cancer survivorship toolkit for this group.
Healio: How did your intervention come about? What does it entail?
Zhou: Michelle Garrison, PhD, developed a sleep health program for school-aged children in the community. We partnered with her to modify elements of her program so that it would be suitable to cancer survivors.
We suspected that these families would be overwhelmed by their child’s history. They had survived cancer and spent months — if not years, by this point — coming to the hospital for doctor’s appointments and treatment. We knew they wouldn’t want to keep doing much more of that. That’s what drove us to do this via telemedicine, and what drove us to make this a three-session program rather than a longer program.
In the first session, families met with the interventionist, who shared a menu of options for the common sleep challenges we see in this age group. The interventionist helped to point out some of the issues that are especially common after cancer and asked the families to consider the areas they wanted to change, then provided them with straightforward strategies to fix the issue.
In the second and third sessions, the families worked with the interventionist to try to continually set small, manageable goals to get them closer to what they ultimately wanted their child’s sleep to be like.
Importantly, the interventionist helped the families understand that you can’t change 3 years of bad sleep in a heartbeat, and gave them a timeline for when things might start to get better.
Healio: How well did the intervention perform?
Zhou: We were very pleased. We use the term “effect size” to show how big or small of a change had been achieved. In this case, our effect sizes for improving sleep were large. We were able to see that we changed the children’s sleep habits, as well as how their sleep was impairing their function. We changed their perceptions of how impaired their sleep was.
Additionally, we improved some quality-of-life outcomes, even though nothing in this intervention specifically targeted quality of life . We saw changes in physical, emotional and school quality of life. Those are all areas that get disturbed if a child sleeps poorly.
Healio: Do you think this program could be widely adopted?
Zhou: We designed it to be. We had two interventionists. One was a social worker who had experience with pediatric patients with cancer but had never received sleep training before. The second was a program manager for our families, without a clinical or sleep background. They did all of this teaching for families during the intervention. In our study, it took about 25 hours of training to bring them up to a level where they could make meaningful changes for families.
Healio: What questions remain unanswered?
Zhou: Two things need to be done. First, we need to conduct a randomized trial. Second, we may need to make this easier still for our families. They are just so overwhelmed. We had 15 families who enrolled. Two dropped out before they even got a single session of the intervention. Two told us midway through that there were too many things going on with their families to continue participating. I don’t believe that these families failed to understand how important sleep was for their children. They wanted to do the right thing, but life got in the way. I’m glad we helped 10 families, but I’d like to be able to figure out how to serve all of the families who want to change their child’s sleep.
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For more information:
Eric S. Zhou, PhD, can be reached at eric_zhou@dfci.harvard.edu.
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