Merck Lecture: “I Can’t Sleep!”: Gathering the evidence for an innovative intervention for insomnia in cancer patients

Nancy (Surya) A. Absolon, Tracy L. Truant, Lynda G. Balneaves, Frankie L. Goodwin, Rosemary L. Cashman, Margurite E. Wong, Manisha B. Witmans


Sleep-wake disturbances, in particular insomnia, are experienced by 30%–75% of oncology patients, yet no effective interventions have been designed to address this distressing symptom in the ambulatory setting. In response to an identified gap in care, I share the development and evaluation of an innovative sleep intervention designed specifically for the ambulatory setting. Preliminary findings, as well as an informative blueprint for conducting point-of-care research, are described. As a “bedside” nurse it is possible and within our moral imperative and social justice mandate to take action to find evidence-informed solutions to improve care for populations of patients experiencing gaps in care. The “I” used throughout the article refers to the lead author Surya.

Full Text:



Berger, A.M. (2009). Update on the state of the science: Sleepwake

disturbances in adult patients with cancer. Oncology

Nursing Forum, 36(4), E165–77. doi:10.1188/09.ONF.


Bhasin, M.K., Dusek, J.A., Chang, B.H., Joseph, M.G., Denninger,

J.W., Fricchione, G.L., et al. (2013). Relaxation response

induces temporal transcriptome changes in energy

metabolism, insulin secretion and inflammatory pathways.

PloS One, 8(5), e62817. doi:10.1371/journal.pone.0062817

Brzezinski, A., Vangel, M.G., Wurtman, R.J., Norrie, G., Zhdanova,

I., Ben-Shushan, A., et al. (2005). Effects of exogenous

melatonin on sleep: A meta-analysis. Sleep Medicine Reviews,

(1), 41–50. doi:S1087079204000607 [pii]

Buysse, D., Reynolds, C., & Monk, T. (1989). The Pittsburgh sleep

quality index: A new instrument for psychiatric practice and

research. Psychiatry Research, 28, 193.

Canadian Association of Nurses in Oncology. (2006). Canadian

association of nurses in oncology (CANO/ACIO) (2006)

standards and competencies for the specialized oncology nurse.

Vancouver, BC. Retrieved from


Canadian Nurses Association. (2009). Ethics in practice for registered

nurses: Social justice in practice. Retrieved from http://www.cnaaiic.



Canadian Nurses Association. (2010). Social justice...a means to an

end, an end in itself. 2nd ed. Ottawa, ON. Retrieved from http://


Carlson, L.E., & Garland, S.N. (2005). Impact of mindfulnessbased

stress reduction (MBSR) on sleep, mood, stress and

fatigue symptoms in cancer outpatients. International Journal of Behavioral Medicine, 12(4), 278–285. doi:10.1207/


Davidson, J.R., Feldman-Stewart, D., Brennenstuhl, S., & Ram, S.

(2007). How to provide insomnia interventions to people with

cancer: Insights from patients. Psycho-Oncology, 16(11), 1028–


Garland, S.N., Carlson, L.E., Stephens, A.J., Antle, M.C., Samuels,

C., & Campbell, T.S. (2014). Mindfulness-based stress reduction

compared with cognitive behavioral therapy for the treatment of

insomnia comorbid with cancer: A randomized, partially blinded,

noninferiority trial. Journal of Clinical Oncology: Official Journal

of the American Society of Clinical Oncology, 32(5), 449–457.


Howell, D., Oliver, T.K., Keller-Olaman, S., Davidson, J., Garland,

S., Samuels, C., Savard, J., … Taylor, C. (2012). A Pan-Canadian

Practice Guideline: Prevention, Screening, Assessment and

Treatment of Sleep Disturbances in Adults with Cancer.

Toronto, ON. Retrieved from


Howell, D., Oliver, T.K., Keller-Olaman, S., Davidson, J.R., Garland,

S., Samuels, C., et al. (2014). Sleep disturbance in adults with

cancer: A systematic review of evidence for best practices in

assessment and management for clinical practice. Annals of

Oncology: Official Journal of the European Society for Medical

Oncology / ESMO, 25(4), 791-800. doi:10.1093/annonc/


Hubbling, A., Reilly-Spong, M., Kreitzer, M.J., & Gross, C.R.

(2014). How mindfulness changed my sleep: Focus groups

with chronic insomnia patients. BMC Complementary and

Alternative Medicine, 14(50). doi:10.1186/1472-6882-14-50;


Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine

for chronic pain patients based on the practice of mindfulness

meditation: Theoretical considerations and preliminary results.

General Hospital Psychiatry, 4(1), 33–47.

Kabat-Zinn, J. (1990). Full catastrophic living: Using the wisdom of

your body and mind to face stress, pain and illness. New York:


Kim, H.J., McGuire, D.B., Tulman, L., & Barsevick, A.M. (2005).

Symptom clusters: Concept analysis and clinical implications

for cancer nursing. Cancer Nursing, 28(4), 270–82; quiz 283–4.


Kwekkeboom, K.L., Abbott-Anderson, K., & Wanta, B. (2010).

Feasibility of a patient-controlled cognitive-behavioral

intervention for pain, fatigue, and sleep disturbance in cancer.

Oncology Nursing Forum, 37(3), E151–9. doi:10.1188/10.ONF.


Kwekkeboom, K.L., Cherwin, C.H., Lee, J.W., & Wanta, B. (2010).

Mind-body treatments for the pain-fatigue-sleep disturbance

symptom cluster in persons with cancer. Journal of Pain

and Symptom Management, 39(1), 126–138. doi:10.1016/j.


Langford, D.J., Lee, K., & Miaskowski, C. (2012). Sleep disturbance

interventions in oncology patients and family caregivers:

A comprehensive review and meta-analysis. Sleep Medicine

Reviews, 16(5), 397–414. doi:


Lee, K., Cho, M., Miaskowski, C., & Dodd, M. (2004). Impaired sleep

and rhythms in persons with cancer. Sleep Medicine Reviews,

(3), 199–212. doi:10.1016/j.smrv.2003.10.001

Lengacher, C., Jim, H., Reich, R., Ramesar, S., Carranza, I., Paterson,

C., et al. (2012). Examination of objective sleep quality within

an R01 mindfulness based stress reduction symptom cluster

trial for breast cancer survivors. Psycho-Oncology, 21, 55–56.


Lengacher, C.A., Reich, R.R., Post-White, J., Moscoso, M., Shelton,

M.M., Barta, M., et al. (2012). Mindfulness based stress reduction

in post-treatment breast cancer patients: An examination

of symptoms and symptom clusters. Journal of Behavioral

Medicine, 35(1), 86–94.

Matthews, E.E., Berger, A.M., Schmiege, S.J., Cook, P.F., McCarthy,

M.S., Moore, C.M., et al. (2014). Cognitive behavioral therapy

for insomnia outcomes in women after primary breast cancer

treatment: A randomized, controlled trial. Oncology Nursing

Forum, A1–A13. doi:D166095621V7X42X [pii]

McMillan, S.C., Tofthagen, C., & Morgan, M.A. (2008). Relationships

among pain, sleep disturbances, and depressive symptoms

in outpatients from a comprehensive cancer center. Oncology

Nursing Forum, 35(4), 603–611. doi:10.1188/08.ONF.603-611

Morin, C.M. (2004). Cognitive-behavioral approaches to the

treatment of insomnia. Journal of Clinical Psychiatry, 65(Suppl.

, 33–40.

Musial, F., Bussing, A., Heusser, P., Choi, K.E., & Ostermann, T.

(2011). Mindfulness-based stress reduction for integrative cancer

care: A summary of evidence. Forschende Komplementarmedizin

(2006), 18(4), 192–202. doi:10.1159/000330714

Oncology Nursing Society. (2013). ONS Putting Evidence into Practice

(PEP) Research Evidence Table Sleep-Wake Disturbance. Retrieved



Paul, M.A., Gray, G., Kenny, G., & Pigeau, R.A. (2003). Impact of

melatonin, zaleplon, zopiclone, and temazepam on psychomotor

performance. Aviation, Space, and Environmental Medicine,

(12), 1263–1270.

Sateia, M.J., & Lang, B.J. (2008). Sleep and cancer: Recent

developments. Current Oncology Reports, 10(4), 309–318.

Savard, J., & Morin, C.M. (2001). Insomnia in the context of cancer:

A review of a neglected problem. Journal of Clinical Oncology,

(3), 895–908.

Savard, J., Simard, S., Giguere, I., Ivers, H., Morin, C.M., Maunsell,

E., et al. (2006). Randomized clinical trial on cognitive therapy

for depression in women with metastatic breast cancer:

Psychological and immunological effects. Palliative & Supportive

Care, 4(3), 219–237.

Savard, J., Villa, J., Simard, S., Ivers, H., & Morin, C.M. (2011).

Feasibility of a self-help treatment for insomnia comorbid

with cancer. Psycho-Oncology, 20(9), 1013–1019. doi:10.1002/

pon.1818; 10.1002/pon.1818

Singh, R.N. (1998). Self-healing: Powerful techniques. London, ON:

Health Psychology Associates Inc.

The Bright Path. (2008). What is the Ishaya’s Ascension? Retrieved


Woodward, S.C. (2011). Cognitive-behavioral therapy for insomnia

in patients with cancer. Clinical Journal of Oncology Nursing,

(4), E42–52. doi:10.1188/11.CJON.E42-E52; 10.1188/11.CJON.



  • There are currently no refbacks.