Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue

Ann M. Berger, Brett R. Kuhn, Lynne A. Farr, James C. Lynch, Sangeeta Agrawal, Julie Chamberlain, Susanna G. Von Essen

Research output: Contribution to journalArticlepeer-review

119 Scopus citations


Background: To determine whether sleep quality and fatigue associated with breast cancer adjuvant chemotherapy treatments can be improved with behavioral therapy (BT) [Individualized Sleep Promotion Plan (ISPP©)] including modified stimulus control, modified sleep restriction, relaxation therapy, and sleep hygiene. Methods: Randomized-controlled trial based on Piper Integrated Fatigue Model, 219 stages I-IIIA breast cancer patients. Prior to the initial chemotherapy treatment, BT participants developed an ISPP plan that was regularly reinforced and revised. Controls received healthy eating information and attention. Pittsburgh Sleep Quality Index (PSQI), daily diary, actigraph, and Piper Fatigue Scale (PFS) data were collected 2 days prior, during the 7 days after each treatment, and 30 days after the last treatment. Repeated measures analysis of variance was used. Results: Prior to chemotherapy, participants reported mild fatigue and fairly poor sleep quality. All variables changed over time. A group by time interaction was found for sleep quality (PSQI) improving in the BT group. Diary revealed group differences on number of awakenings, minutes awake after sleep onset, and sleep efficiency. Fatigue (PFS) was similar between groups. Conclusions: The BT group showed improved sleep quality over time and better sleep (diary). Perceptions of improved sleep quality over time are not consistently associated with diary or actigraph or result in lower fatigue.

Original languageEnglish (US)
Pages (from-to)634-646
Number of pages13
Issue number6
StatePublished - 2009


  • Actigraph
  • Breast cancer adjuvant chemotherapy
  • Fatigue
  • Medical oncology
  • Sleep

ASJC Scopus subject areas

  • Experimental and Cognitive Psychology
  • Oncology
  • Psychiatry and Mental health


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