A small pilot trial of virtual group cognitive behavioral therapy for insomnia in gynecologic oncology patients

To evaluate the feasibility and acceptability of virtual, small-group cognitive behavioral therapy for insomnia (CBT-I) in patients with gynecologic cancers.

Patients with gynecologic cancers were recruited to participate in a weekly, online, small-group CBT-I program. Eligible participants were ≥ 18 years old, English-speaking, had access to the internet, had moderate-severe insomnia (Insomnia Severity Index (ISI) score of ≥15), and were not taking prescription sleep medications. Feasibility was assessed by attendance, internet connectivity, and participation. An acceptability survey was administered at the end of each session. Exploratory endpoints included quality of life and insomnia symptoms. Participants tracked sleep outcomes using the Insomnia Coach Explorer. Follow-up assessments were completed 4, 12, and 24 weeks following program completion.

Five participants were recruited and four completed the intervention. 60% of participants attended four or more sessions. Internet connectivity, participation, and acceptability met the predefined benchmarks for feasibility. Compared to a baseline score of 18, mean ISI scores decreased by more than 6 points by week 6 (10.81, 95% CI: 7.12-14.5, p = 0.0002). The improvement in ISI scores was sustained throughout the follow-up period of 24 weeks. There was a decrease in the number of times awoken from the baseline 2.10 (-0.21/week, p = 0.021). No significant changes were observed in PSQI or FACT-G7 scores or other sleep outcomes from the sleep diary.

Virtual, small-group CBT-I is a feasible and acceptable strategy for patients with gynecologic cancers to manage insomnia. Implementation of this intervention may also help expand access to evidence-based treatment for insomnia.