Efficacy of mind-body therapies for sleep disturbance in patients with early-stage cancer: A systematic review and network meta-analysis.
Study Goal
The researchers aimed to evaluate and compare the efficacy of mindfulness and other mind-body therapies for reducing sleep disturbance in patients with early-stage cancer.
Results Summary
Mindfulness demonstrated the largest effect size in reducing subjective sleep disturbance for cancer patients receiving active treatment, with moderate GRADE evidence. For patients who had completed active treatment, mindfulness also showed a moderate effect, though smaller than qigong and hypnosis.
Population
Patients aged ≥18 years with early-stage cancer, either receiving active treatment or having completed it.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
mindfulness | decrease | subjective sleep disturbance | cancer patients receiving active treatment | standardised mean difference [SMD]: 0.85; 95% confidence intervals [CI]: 0.20-1.50 | demonstrated the largest effect size in reducing | #1 |
mindfulness | decrease | subjective sleep disturbance | cancer patients receiving active treatment | - | had the highest cumulative probability compared to usual care or waitlist | #2 |
qigong | decrease | subjective sleep disturbance | cancer patients who had completed active treatment | SMD: 0.99; 95% CI: 0.35-1.63 | demonstrated the largest effect size in reducing | #3 |
hypnosis | decrease | subjective sleep disturbance | cancer patients who had completed active treatment | SMD: 0.87; 95% CI: 0.32-1.42 | demonstrated effect size in reducing | #4 |
mindfulness | decrease | subjective sleep disturbance | cancer patients who had completed active treatment | SMD: 0.42; 95% CI: 0.24-0.59 | demonstrated effect size in reducing | #5 |
qigong | increase | objective sleep efficiency | cancer patients who had completed active treatment | weighted mean differences: 10.76; 95% CI: 2.01-19.50 | demonstrated the largest effect size in improving | #6 |
cognitive behavioral therapy (CBT) | decrease | subjective sleep disturbance | patients with early-stage cancer | surface under the cumulative ranking curve: 96.3% | showed the highest cumulative probability | #7 |
cognitive behavioral therapy (CBT) | increase | objective sleep efficiency | patients with early-stage cancer | SUCRA: 83.3% | showed the second highest cumulative probability | #8 |
mindfulness | decrease | sleep disturbance | patients with early-stage cancer | - | can be recommended as an optional treatment for reducing | #9 |
qigong | decrease | sleep disturbances | patients with early-stage cancer who had completed active treatment | - | some support was observed for | #10 |
hypnosis | decrease | sleep disturbances | patients with early-stage cancer who had completed active treatment | - | some support was observed for | #11 |
OBJECTIVE: To evaluate and compare the efficacy of different mind-body therapies (MBTs) for sleep disturbance in patients with early-stage cancer. METHODS: Randomised controlled trials that included patients (aged ≥18 years) with early stage cancer who underwent MBTs (mindfulness, hypnosis, relaxation, yoga, and qigong) were searched in the CINAHL via the EBSCO Host, Cochrane Library, Embase, MEDLINE, PsycINFO, PubMed, and Scopus databases, from the date of database inception to October 2022. The outcomes were subjective sleep disturbance and objective sleep efficiency. Network meta-analysis (NMA) and comparative effects ranking were performed using STATA (v14.0; STATACorp, College Station, TX, USA). RESULTS: Forty-seven studies investigating five MBTs were included in the NMA. For cancer patients receiving active treatment, mindfulness demonstrated the largest effect size in reducing subjective sleep disturbance (standardised mean difference [SMD]: 0.85; 95% confidence intervals [CI]: 0.20-1.50; Grading of Recommendations Assessment, Development, and Evaluation assessment: moderate), and had the highest cumulative probability compared to usual care or waitlist. For cancer patients who had completed active treatment, qigong demonstrated the largest effect size in reducing subjective sleep disturbance (SMD: 0.99; 95% CI: 0.35-1.63; GRADE: low), followed by hypnosis (SMD: 0.87; 95% CI: 0.32-1.42; GRADE: moderate), and mindfulness (SMD: 0.42; 95% CI: 0.24-0.59; GRADE: moderate). Qigong also demonstrated the largest effect size in improving objective sleep efficiency (weighted mean differences: 10.76; 95% CI: 2.01-19.50; GRADE: low); however, the effect of qigong was tested in only one study in this NMA. Among the eight different treatment conditions, cognitive behavioral therapy (CBT) showed the highest cumulative probability (surface under the cumulative ranking curve: 96.3%) in reducing subjective sleep disturbance and the second highest cumulative probability (SUCRA: 83.3%) in improving objective sleep efficiency. CONCLUSION: There is no evidence supporting the use of MBTs to replace or be comparable to CBT. Mindfulness can be recommended as an optional treatment for reducing sleep disturbance in patients with early-stage cancer. Some support was observed for qigong and hypnosis in reducing sleep disturbances in patients with early-stage cancer who had completed active treatment. More rigorous trials are warranted to confirm whether different forms of MBTs have different effects on sleep in patients with cancer.