Can-Sleep: For Health Professionals

The Can-Sleep service helps patients with night-time sleep problems, and provides information and resources for health professionals

Sleep Problems in People with Cancer

About 6 in every 10 people with cancer struggle with night-time sleep difficulties(1), and poor sleep has been associated with anxiety, depression, concentration and memory difficulties, fatigue, lower quality of life, higher rates of pain, and increased use of sedatives(1,2). Cognitive behavioural therapy (CBT) is the recommended first-line treatment for insomnia, and is known to be as effective as medication in the short-term, and more beneficial than medication in the longer term.

The Can-Sleep Program

The Can-Sleep service is a first of its kind. It provides cancer patients with gold standard, evidence-based cognitive behavioural approaches to identifying and addressing night-time sleep problems. Can-Sleep was initiated in 2017, and is available to patients attending the Peter MacCallum Cancer Centre (Peter Mac). It was established with the support of the Victorian State Government, via funding from a Victoria Cancer Survivorship Program grant in 2017. The Can-Sleep pilot program involved the Peter MacCallum Cancer Centre, the Royal Melbourne Hospital, Royal Women’s Hospital, Monash University, Monash Institute of Cognitive and Clinical Neurosciences, The University of Melbourne, and the Australian Cancer Survivorship Centre. Following completion of the Can-Sleep pilot, the program has successfully transitioned into an ongoing service provided by the Department of Clinical Psychology at Peter Mac. Can-Sleep is a stepped-care service, involving screening, self-help then more intensive interventions.

What does the Can-Sleep service involve?

Screening

The Can-Sleep service involves initial screening of cancer patients for insomnia, sleep apnoea and restless legs syndrome. Screening tools used in Can-Sleep include:

The Insomnia Severity Index(3)
The Epworth Sleepiness Scale(4)
The STOP-Bang(5)
A five-item screener for Restless Legs Syndrome

Further assessment and intervention

Patients who are screened at high risk of sleep apnoea or restless legs syndrome are offered referral to a specialist sleep clinic for further assessment. The Can-Sleep service is partnered with the Department of Respiratory and Sleep Medicine at the Royal Melbourne Hospital.

For all other patients screened as having symptoms of night-time insomnia, evidence-based CBT interventions are available. These include:

a self-help intervention (a Can-Sleep CBT booklet for patients)
a four-session CBT group program for insomnia

The Can-Sleep self-help booklet

To support the delivery of Can-Sleep, a

CBT self-help booklet

has been developed that is tailored specifically for people with cancer. Patients are advised of relevant sections to read, and encouraged to apply self-help strategies appropriate to their situations. Patients attend follow-up appointments (around 3 and 6 weeks later) to assist in uptake of these new skills, and review progress.

This booklet is available for all cancer patients and cancer survivors. This booklet also has a section for health care professionals, with advice on best ways to support and assist patients with sleep problems.

The Can-Sleep Group CBT program

A group CBT program is available for patients with sleep problems that persist beyond the use of the self-help booklet. The group program provides more intensive and personalised treatment for eligible patients with persistent insomnia. A pre-group assessment is conducted to ensure suitability before commencing the group program. The group is conducted over 4 sessions and involves small groups of 4 to 6 patients.

Outcomes of the Can-Sleep Pilot

Our pilot Can-Sleep program involved the recruitment of 191 cancer patients attending the lung, breast, genitourinary, gynae-oncology and haematology outpatient clinics. Following initial screening we found that 63% of participants had mild, moderate or severe symptoms of insomnia. About one third of these participants (20% of all participants) also screened at high risk of sleep apnoea or restless legs syndrome. These patients were offered a referral to the Department of Respiratory and Sleep Medicine at the Royal Melbourne Hospital, for specialist assessment. The majority of patients who went on to attend this service were found to have previously undiagnosed sleep apnoea or restless legs syndrome.

For patients engaging in the CBT self-help booklet (42% of all patients screened), over half (53%) reported improvement in their sleep at the completion of this intervention, such that they required no further treatment for sleep problems. Statistical analyses indicated that the Can-Sleep booklet leads to large and significant improvements in sleep (pre Insomnia Severity Index M = 15.2, SD = 4.1; post Insomnia Severity Index M =10.4, SD = 6.7) with estimate of the difference (95% confidence interval) = 4.8 (3.4, 6.3), Cohen’s d=1.2). This demonstrates the enormous usefulness of this self-help booklet, with only brief therapist input and follow-up.

The Can-Sleep group CBT program has now been delivered to a number of patients with persistent sleep difficulties (i.e. following completion of the initial self-help intervention). By completing the group CBT program, additional improvements in sleep were reported by the majority of participants.

Summary

In summary, the Can-Sleep service has been shown to be a highly successful service for people with cancer seeking to address night-time sleep problems. Can-Sleep leads to improved identification of sleep difficulties, and access for cancer survivors to evidence-based CBT for insomnia and medical treatments for sleep apnoea and restless legs syndrome. Of importance, the CBT self-help booklet is an effective method of improving sleep, with over half of cancer patients with sleep problems achieving sufficient improvements in their sleep by using this booklet. The stepped-up group CBT program for insomnia also offers a resource-efficient intervention for people who require more intensive or personalised treatments.

Who can attend the Can-Sleep service?

The Can-Sleep service is available for patients of Peter Mac.

Cost

Can-Sleep is a no-cost service.

Referral to can-sleep

Patients can seek referral from their Peter Mac treating team, or can contact Can-Sleep directly. Patients can visit the main Can-Sleep webpage.

Contacting Can-Sleep

Can-Sleep is run by the Psychology Department. Please ask to speak to one of the Can-Sleep clinicians.

Phone: (03) 8559 5265
Email: [email protected]
Web: www.petermac.org/services/cancer-information-resources/can-sleep

Can-Sleep Podcast

Listen to our Podcast on the Can-Sleep program.

Webinar training on CBT for insomnia

View a 2-hour webinar on the Can-Sleep service, with detailed information about applying CBT interventions for cancer patients. This training webinar is suitable for health professionals who have an understanding of CBT.

Other sleep websites

Additional Psychosocial Oncology services at Peter Mac

The Psychosocial Oncology Program at Peter Mac provides a range of services for patients and their families. For more information:

Website: www.petermac.org/services/treatment/psychosocial-oncology
Phone: (03) 8559 5265
Email [email protected]

References

Garland SN, Johnson JA, Savard J, Gehrman P, Perlis M, Carlson L, et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatric disease and treatment. 2014;10:1113-24.
Mansel JK & Carey EC. Nonpharmacologic approach to sleep disorders. Cancer Journal. 2014;20: 345–351
Morin CM, Belleville G, Bélanger L, Ivers H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011 May 1;34(5):601-8
Johns MW. A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep, 1991; 14: 50-55.
Chung F. Hairil AR & Liao Pu. STOP-Bang Questionnaire: A Practical Approach to Screen for Obstructive Sleep Apnea. 2016;149(3):631-638.