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The investigators will answer the question of whether treating insomnia using the mobile-app-based intervention of Cognitive Behavioural Therapy for Insomnia (CBT-I) for cancer survivors ("iCANSleep") can improve symptoms of insomnia in Canadian cancer survivors compared to a waitlist control group. The investigators will recruit 146 people with insomnia who have completed cancer treatment at least 3 months prior to the study.
The investigators will conduct a randomized controlled trial of immediate treatment with the CBT-I app "iCANSleep" compared to a delayed treatment group with 146 cancer survivors who have completed primary treatment at least 3 months prior and meet DSM diagnostic criteria for insomnia. Participants who are randomized to the immediate treatment group will complete the 7-modules of the CBT-I treatment right away. Those randomized to the delayed treatment group will begin the intervention following an 8-week waiting period. The treatment group will complete assessments at baseline, mid-treatment, post-treatment, and 3-month follow-up. The delayed treatment group will complete an assessment at baseline, halfway through their wait at 4 weeks, and prior to beginning treatment at 8 weeks. They will also complete assessments at mid-treatment, post-treatment and 3-month follow-up. Insomnia severity will be analyzed using the Insomnia Severity Index (ISI) as the primary outcome. Other measures will include fatigue, anxiety, depression, pain, work productivity, sleep beliefs, daytime impact of insomnia, and pre-sleep arousal.
The investigators hypothesize that the immediate treatment group will report significantly greater improvements in insomnia compared to the waitlist control group at post-treatment (primary endpoint). The investigators also hypothesize that these improvements will be maintained at 3-months follow-up (secondary endpoint).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Immediate Treatment | Experimental | The immediate treatment group will begin the app-based insomnia intervention immediately after enrolling. |
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| Waitlist Control | Experimental | The waitlist control group will begin the app-based intervention after a waiting period of 8 weeks after enrolling. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| App-Based Cognitive Behavioural Therapy for Insomnia | Behavioral | The iCANSleep app is based on an established CBT-I protocol. The core features of the iCANSleep app include 1) a modified CBT-I protocol for cancer survivors and 2) daily sleep diaries. Core components of CBT-I treatment to be implemented include sleep restriction, stimulus control, cognitive restructuring, and psychoeducation. These components will be modified into 7-weekly modules. |
| Measure | Description | Time Frame |
|---|---|---|
| Insomnia Severity | Insomnia Severity Index (Min: 0, Max: 28; Higher scores = worse outcomes) | From enrollment until 3-month follow-up |
| Sleep Efficiency | Sleep efficiency measured by the Consensus Sleep Diary | From enrollment to end of treatment at 7 weeks |
| Sleep-Onset Latency | Sleep-onset latency measured by the Consensus Sleep Diary | From enrollment to end of treatment at 7 weeks |
| Wake After Sleep Onset | Wake after sleep onset measured by the Consensus Sleep Diary | From enrollment to end of treatment at 7 weeks |
| Total Sleep Time | Total sleep time measured by the Consensys Sleep Diary | From enrollment to end of treatment at 7 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Fatigue | Patient-Reported Outcome Measurement Information System: Fatigue 8a Short Form (Min: 8, Max: 40; Higher scores = worse outcomes) | From enrollment to 3-month follow-up |
| Anxiety | Patient-Reported Outcome Measurement Information System Anxiety 8a Short Form (Min: 8, Max: 40; Higher scores = worse outcomes) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sheila N Garland | Contact | 1 (709) 864-8035 | icansleepapp@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Sheila N Garland | Memorial University of Newfoundland | Principal Investigator |
| Rachel M Lee | Memorial University of Newfoundland | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Memorial University of Newfoundland | Recruiting | St. John's | Newfoundland and Labrador | A1B 3X9 | Canada |
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| Label | URL |
|---|---|
| The official iCANSleep study website | View source |
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| ID | Term |
|---|---|
| D007319 | Sleep Initiation and Maintenance Disorders |
| D009369 | Neoplasms |
| ID | Term |
|---|---|
| D020919 | Sleep Disorders, Intrinsic |
| D020920 | Dyssomnias |
| D012893 | Sleep Wake Disorders |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D015928 | Cognitive Behavioral Therapy |
| ID | Term |
|---|---|
| D001521 | Behavior Therapy |
| D011613 | Psychotherapy |
| D004191 | Behavioral Disciplines and Activities |
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| From enrollment to 3-month follow-up |
| Depression | Patient-Reported Outcome Measurement Information System Depression 8a Short Form (Min: 8, Max: 40; Higher scores = worse outcomes) | From enrollment to 3-month follow-up |
| Pain Level | Patient-Reported Outcome Measurement Information System Pain 8a Short Form (Min: 8, Max: 40; Higher scores = worse outcomes) | From enrollment to 3-month follow-up |
| Cognitive Function | Patient-Reported Outcome Measurement Information System Cognitive Function 8a Short Form (Min: 8, Max: 40; Higher scores = worse outcomes) | From enrollment to 3-month follow-up |
| Work Productivity and Activity Impairment | Work Productivity and Activity Impairment (WPAI; Min: 0%, Max: 100%; Higher scores = greater impairment) | From enrollment to 3-month follow-up |
| App Engagement | App engagement will be measured based on the number of logins, complete session use (duration of time on the app), number of visits and amount of time on each module, use of the daily sleep journal and engagement with extra resources and support material. | From time of starting the app to completing treatment (7 weeks) |
| Adverse Events | There is no validated method of reporting AEs in trials of CBT-I in cancer populations. As such, we will use the method developed for the Addressing Cancer Treatment-Related Insomnia Online in Atlantic Canada (ACTION) study, based on the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0 and the National Cancer Institute, Cancer Therapy Evaluation Program attribution standards. AEs will be assessed using open- and closed-ended questions. This method follows the CONSORT 2022 guidelines for reporting harms to ensure that the: (1) AEs are clearly defined with descriptions of anticipated AEs; (2) Measurement of AEs and methodology are clearly stated, including validation of measures and timing of use; (3) AEs are reported with an attribution to the relationship of the intervention (i.e. is the AE actually related to the intervention?); and (4) Severity of each AE is reported. This measure will be administered at mid-treatment (4 weeks) and post-treatment (8 weeks). | From enrollment to 3-month follow-up |
| Sleep-Related Beliefs | Cancer-related dysfunctional beliefs and attitudes about sleep (C-DBAS-14; Min: 0, Max: 140; Higher scores = more dysfunctional beliefs) | From enrollment to 3-month follow-up |
| Pre-Sleep Arousal | Pre-sleep arousal scae (PSAS; Min: 16, Max: 80; Higher scores = worse outcomes) | From enrollment to 3-month follow-up |
| Sleep Metrics | Whole week Self Assessment of sleep survey (SASS) | During 8-week waiting period for waitlist control group and from treatment end (7 weeks) to 3-month follow up |
| Daytime Impact of Insomnia | Insomnia daytime symptom and impact questionnaire (IDSIQ; Min: 0, Max: 140; Higher scores = worse outcomes) | From enrollment to 3-month follow-up |
| Smartphone Self-Efficacy | The Smartphone Self-Efficacy Scale (SSES; Min: 19, Max: 95; Higher scores = worse outcomes) | Baseline |
| D001523 |
| Mental Disorders |