Effectiveness of an urban forest healing program for improving sleep in cancer survivors

Sleep disturbance is common among cancer survivors, impairing their psychological and physical well-being. While the effectiveness of cognitive behavioral therapy and exercise has been established, structured nature-based interventions remain underexplored. Forest therapy may improve sleep and health; however, data on its benefits in cancer survivors who experience sleep disturbances remain limited. This study aimed to evaluate the effectiveness of an eight-session structured forest therapy program in improving sleep among cancer survivors.

A mixed-methods design was employed to integrate both quantitative and qualitative analyses. The study used a one-group pre-post-test design involving 29 cancer survivors who had completed curative treatments. The participants attended 8 structured 2-h sessions, held weekly in 2 urban forests. Sleep quality and experience, insomnia severity, sleep hygiene, psychological distress, fatigue, quality of life, muscle strength, and balance before and after the intervention were assessed. Qualitative data were collected through in-depth interviews and analyzed using qualitative content analysis.

All 29 participants reported significant improvements in sleep onset time, sleep quality, post-wake behavior, sleep hygiene, and insomnia severity (P ​< ​0.001). Psychological distress, cancer-related fatigue, and quality of life were also improved (P ​< ​0.001). Physical function indicators, including grip strength, balance, and cardiorespiratory endurance, were significantly improved as well (P ​< ​0.05). The qualitative findings revealed four themes: perceived forest benefits, empathy through shared experiences, active health self-management, and expanded self-awareness.

Our structured forest therapy program is associated with improved sleep and well-being among cancer survivors, offering a promising non-pharmacological approach to survivorship care.