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Nonpharmacological Interventions for Sleep in People With Upper Gastrointestinal Cancer: A Systematic Review and
Lijun Li1, Shuman Wang1, Qian Sun2
1School of Psychological Sciences (L.L., S.W., T.S., J.W.), Monash University, Melbourne, Australia.
Journal of Pain and Symptom Management
|September 4, 2025
Summary
Nonpharmacological interventions (NPIs) show promise for improving sleep in upper gastrointestinal cancer patients. Psychological, information, symptom management, and sensory-based interventions were most effective, though more research is needed.
Area of Science:
- Oncology
- Sleep Medicine
- Evidence-Based Practice
Background:
- Sleep disturbances are prevalent in patients diagnosed with upper gastrointestinal (GI) cancer.
- Identifying effective, evidence-based interventions is crucial for managing sleep problems in this population.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of nonpharmacological interventions (NPIs) for sleep disturbances in individuals with upper GI cancer.
- To identify which types of NPIs demonstrate the most significant improvements in sleep quality.
Main Methods:
- A comprehensive search of six databases was conducted up to July 2025, including randomized controlled trials (RCTs) and quasi-experimental trials.
- A random-effects model was employed for meta-analysis, calculating standardized mean differences (SMD) to pool treatment effects.
- The Cochrane risk-of-bias tool (RoB 2) and GRADE scoring were used to assess study quality and risk of bias.
Main Results:
- Twenty-eight studies involving 2693 participants were analyzed, revealing a large overall effect size for NPIs (SMD=-1.18).
- Psychological, information, and symptom management interventions (SMD=-1.85) and sensory-based interventions (SMD=-1.66) showed statistically significant improvements in sleep.
- Physical activity/rehabilitation and nutritional support interventions did not yield statistically significant sleep improvements in this meta-analysis.
Conclusions:
- While NPIs demonstrate potential for improving sleep in upper GI cancer patients, heterogeneity and risk of bias limit definitive recommendations.
- Psychological and sensory-based interventions appear most promising, but further high-quality, large-scale randomized trials with standardized protocols are warranted.
- Future research should focus on robust methodologies to establish optimal interventions for sleep disturbances in this patient group.
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