Non-pharmacological interventions for sleep disturbance ("insomnia") in patients with advanced cancer: a scoping review

Abstract

Purpose: Sleep disturbances are a common yet overlooked symptom in patients with advanced cancer. Pharmacological interventions have been widely used to manage sleep disturbances; however, concerns related to their adverse effects have resulted in a need for alternative interventions. The purpose of this scoping review is to appraise the published literature on the non-pharmacological management of sleep disturbances in patients with advanced cancer.

Methods: This scoping review was completed using the recommended methodological framework. An extensive literature search was completed using five electronic databases (Medline, CINAHL, Embase, APA PsycINFO, CENTRAL) and the Cochrane library. There were no restrictions applied to the search in relation to the years published. Only studies published in the English language were included.

Results: We identified 9 studies published between 2010 and 2023 which focused on non-pharmacological management of sleep disturbances in patients with advanced cancer. Specific interventions included cognitive behavioural therapy, mindfulness-based therapies, bright light therapy, sleep hygiene, and other non-standard interventions. Improvements in sleep disturbance were noted in all studies, but only some studies showed statistical significance.

Conclusion: This scoping review identified a relatively small number of relevant studies, involving a relatively small number of participants. Moreover, the studies involved very different interventions, with very different methodologies (including type/time of assessments). Thus, it is difficult to recommend any particular non-pharmacological intervention at this time. Nevertheless, non-pharmacological interventions undoubtedly have a role to play in the management of sleep disturbance in patients with advanced cancer.

Keywords: Cancer; Non-pharmacological; Oncology; Palliative care; Sleep disturbance.

Fig. 1

Flow chart of article inclusion