Effects of cognitive behavioral therapy for depression on improving insomnia and quality of life in Chinese women with breast cancer: results of a randomized, controlled, multicenter trial

Abstract

Purpose

Cognitive behavioral therapy (CBT) for depression had been found to be effective in reducing depressive and anxiety symptoms in breast cancer survivors. It is not known whether CBT for depression would also improve insomnia and quality of life (QOL). The aim of this study was to investigate whether CBT for depression would improve insomnia and QOL in a randomized controlled multicenter trial.

Patients and methods

In this study, breast cancer survivors (n=392) were randomly allocated to the following three groups: CBT (n=98), self-care management (SCM, n=98), and usual care (UC, n=196) in a ratio of 1:1:2. CBT and SCM received a series of nine sessions for 12 weeks, whereas UC received UC only. Insomnia and QOL were evaluated using Athens Insomnia Scale (AIS) and Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaire at baseline, 4, 12, and 24 weeks.

Results

There was a significant intergroup difference in AIS and FACT-B scores (both P<0.01). CBT showed less insomnia problems and better overall QOL compared with those in SCM and UC (both P<0.01). No significant differences were found between SCM and UC in insomnia problems and overall QOL. Moreover, the effects of CBT on insomnia and QOL were maintained during the follow-up period.

Conclusion

CBT for depression can be effective in improving insomnia problems and QOL in the Chinese breast cancer survivors.

Keywords:

• cancer
• psychotherapy
• sleep
• prognosis

Acknowledgments

This research was supported by the National Key Technologies R&D program in the 11th 5-year plan from the Ministry of Science and Technology of the People’s Republic of China (grant number: 2009BAI77B06). Many thanks to Chunyan Zhu, Liuxiu Xu, Yiqun Yu, Xiaodan Xie, and Li Chen for their assistance in project management.

Author contributions

Jincai He, Changjin Li, and Suo Jiang designed the study and wrote the protocol. Xiongzhao Zhu, Yanjie Yang, Yan Lin, Shanshan Shen, Jingjing He, Ye Fu, Xiaoqu Hu, and Kai Wang conducted the trial. Huihua Qiu conducted literature searches and provided summaries of previous research studies. Guangyun Mao, Shanping Mao, Hongying Shi, Xiuchan Guo, Ke Zhao, and Yingying Gu conducted the statistical analyses. Huihua Qiu and Wenwei Ren wrote the first draft of the manuscript. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.