The influence of yoga and cognitive behavioral therapy on mediational relationships between insomnia and cancer-related fatigue: A URCC NCORP RCT in 550 cancer survivors.

Authors

Po-Ju Lin

Po-Ju Lin

James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY

Po-Ju Lin , Brian James Altman , Richard Francis Dunne , Lindsey Jean Mattick , Alisha Chakrabarti , Stephen Rajan Samuel , Umang Gada , Eva Culakova , Anthony John Jaslowski , Charles S. Kuzma , Karen Michelle Mustian

Organizations

James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, University of Rochester Medical Center, Rochester, NY, Cancer Research of Wisconsin and Northern Michigan Consortium (CROWN), Green Bay, WI, Southeast Clinical Oncology Research Consortium (SCOR), Winston-Salem, NC

Research Funding

National Cancer Institute

Background: Cancer-related fatigue (CRF) often co-occurs with insomnia and both are incapacitating adverse toxicities of cancer and its treatment which may persist months and years after the completion of treatment. Yoga and Cognitive Behavioral Therapy for Insomnia (CBT-I) are promising behavioral approaches for improving CRF and insomnia among cancer survivors. However, the influence of changes in insomnia resulting from participating in yoga or CBT-I on the subsequent changes in CRF is not fully understood. Methods: We conducted mediation analyses on data collected from a multicenter phase III RCT among cancer survivors who were randomized to receive 1) Yoga for Cancer Survivors (YOCAS, 75-min./session, 2x/wk. for 4 wks.), 2) CBT-I (90-min./session, 1x/wk. for 8 wks.), or 3) a behavioral placebo (ASCO recommended Survivorship Education, 75-min/session, 2x/wk. for 4 wks.). Brief Fatigue Inventory and Insomnia Severity Index were used to assess CRF and insomnia, respectively, at pre-, mid-, and post-intervention. Causal mediation analyses were conducted to estimate the influence of changes in insomnia at mid-intervention resulting from participating in YOCAS, CBT-I, or behavioral placebo on subsequent changes in CRF at post-intervention. Results: 550 survivors (93% female; mean age 57 years; 75% were breast cancer survivors) completed baseline and post-intervention assessments. YOCAS, compared to placebo, significantly improved CRF and insomnia at mid-intervention (CRF: -0.38±0.16, p = 0.01; Insomnia: -1.15±0.35, p < 0.01) and post-intervention (CRF: -0.35±0.17, p = 0.03; Insomnia: -1.43±0.41, p < 0.01). Among YOCAS participants, improvement in insomnia at mid-intervention significantly influenced the subsequent reduction in CRF (-0.14±0.06, p = 0.01) and accounted for 37% (95% CI: 0% - 78%) of the total reduction in CRF at post-intervention. CBT-I, compared to placebo, also significantly improved CRF and insomnia at mid- (CRF: -0.32±0.18, p = 0.06; Insomnia: -2.64±0.40, p < 0.01) and post-intervention (CRF: -0.59±0.18, p < 0.01; Insomnia: -4.95±0.46, p < 0.01). Among CBT-I participants, the improvement in insomnia at mid-intervention significantly influenced the subsequent reduction in CRF (-0.40±0.09, p < 0.01) and accounted for 60% (95% CI: 21% - 99%) of the total reduction in CRF at post-intervention. Conclusions: Both YOCAS and CBT-I effectively improve CRF and insomnia among survivors. 37%-60% of the reduction in CRF resulting from participating in YOCAS or CBT-I is due to improvement in insomnia. Clinicians should consider prescribing YOCAS yoga or CBT-I for survivors who experience CRF and insomnia. Clinical trial information: NCT02613364.

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Abstract Details

Meeting

2024 ASCO Annual Meeting

Session Type

Rapid Oral Abstract Session

Session Title

Symptom Science and Palliative Care

Track

Symptom Science and Palliative Care

Sub Track

Toxicities–Prevention and Management Strategies

Clinical Trial Registration Number

NCT02613364

Citation

J Clin Oncol 42, 2024 (suppl 16; abstr 12015)

DOI

10.1200/JCO.2024.42.16_suppl.12015

Abstract #

12015

Abstract Disclosures

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