eHealth Insomnia Intervention for Adult Survivors of Childhood Cancer

Insomnia Clinical Trial

Official title:

eHealth Insomnia Intervention for Adult Survivors of Childhood Cancer: A Randomized Clinical Trial

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT04317742
• Other study ID #: SLEEPWELL
• Secondary ID: 1R01CA239689
• Status: Recruiting
• Phase: N/A
• Start date: December 15, 2020
• Est. completion date: June 30, 2024

Study information

• Verified date: November 2023
• Source: St. Jude Children's Research Hospital
• Contact: Tara Brinkman, PhD
• Phone: 866-278-5833
• Email: referralinfo[@]stjude.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

There is evidence that survivors of childhood cancer have a high prevalence of poor sleep, including symptoms of insomnia. Insomnia is highly comorbid and has been associated with impaired cognitive performance, a range of psychiatric disorders, cardiovascular disease, and reduced quality of life. However, we still lack knowledge about the direct impact of available internet-based insomnia treatment programs for survivors of childhood cancer experiencing insomnia, in addition to how improving insomnia symptoms impacts neurocognitive function and late health morbidities in this population. Therefore, in this study, we will utilize the resources available in the Childhood Cancer Survivor Study (CCSS) to use an accepted, established, efficacious internet-delivered CBTi insomnia treatment program and evaluate the efficacy of this program in adult survivors of childhood cancer. Positive results from this study and our use of an internet-based intervention are likely generalizable and be scalable to the large and geographically diverse population of childhood cancer survivors with chronic health conditions.

Primary Objective

To examine the efficacy of an eHealth intervention for improving symptoms of insomnia among adult survivors of childhood cancer.

Secondary Objectives

To examine the impact of an eHealth intervention for insomnia on the clinical severity of insomnia symptoms in adult survivors of childhood cancer.

To determine whether treatment of insomnia symptoms will improve neurocognitive function in adult survivors of childhood cancer with both insomnia and neurocognitive impairment.

To explore the mediating effects of improved neurocognitive function, emotional distress, and cardiovascular health on the association between insomnia symptoms and quality of life.

Description:

Participants with clinically significant insomnia and neurocognitive impairment are eligible for the current study. Participants will complete a 9-week internet-based insomnia treatment program (SHUTi) or receive sleep education, depending on randomized group assignment. Participants will complete home-based assessments at 3 time points (baseline, post-intervention, 6 months). These assessments will include online questionnaires measuring insomnia symptoms, neurocognitive problems, fatigue, daytime sleepiness, and health related quality of life. In addition, at each time point participants will be asked to wear an activity monitor for one week to measure physical activity and sleep patterns. Each assessment time point will also include a home visit from Examination Management Services Inc (EMSI) to measure blood pressure, heart rate, cardiovascular biomarkers, and neurocognitive function.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 352
• Est. completion date: June 30, 2024
• Est. primary completion date: June 30, 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 65 Years

Eligibility

Inclusion Criteria:

• Enrollment in CCSS

• Between the ages of 18 and 65 years old

• Clinically significant insomnia (i.e. score >15 on the Insomnia Severity Index)

• Neurocognitive impairment (i.e. score >84th %ile of sibling normative data in at least one domain on the CCSS-NCQ)

• Regular access to the internet (at least 2-3 days per week)

• Ability to read and speak English

Exclusion Criteria:

• History of a brain tumor

• An irregular schedule that would prevent adoption of intervention strategies (i.e. work schedule resulting in usual bedtime earlier than 8 PM or later than 2 AM or arising time earlier than 4 AM or later than 10 AM)

• Currently pregnant or breast feeding

• Behavioral treatment for insomnia in the past 12 months

• Diagnosis of a schizophrenia or psychotic disorder

• Alcohol or drug abuse in past year

• Other concurrent sleep disorders, including narcolepsy, obstructive/central sleep apnea, or restless leg syndrome

• Current treatment or intervention for cognitive impairment (i.e. stimulant medication, transcranial direct current stimulation)

Related Conditions & MeSH terms

• Childhood Cancer
• Insomnia
• Late Effect
• Neurocognitive Impairment
• Sleep
• Sleep Initiation and Maintenance Disorders
• Survivorship

Intervention

Device:
• Sleep Healthy Using the Internet (SHUTi) Intervention Group
SHUTi is a fully automated, interactive and tailored web-based program that incorporates the primary tenets of face-to-face CBT-I, including sleep restriction, stimulus control, cognitive restructuring, sleep hygiene, and relapse prevention. Intervention content is presented in six "Cores," metered out over time.
• Online Patient Education (PE) Control Group
The online PE program provides static information about: insomnia symptoms; the impact, prevalence, and causes of insomnia; when to see a doctor; and basic lifestyle, environmental, and behavioral strategies to improve sleep.

Locations

Country	Name	City	State
United States	St. Jude Children's Research Hospital	Memphis	Tennessee

Sponsors (2)

Lead Sponsor	Collaborator
St. Jude Children's Research Hospital	National Cancer Institute (NCI)

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in Insomnia Severity Index (ISI) scores from Baseline to Post-Intervention (approximately 10 weeks after Baseline)	This is a 7-item, Likert scale, self-report questionnaire assessing perception of sleep and consequences of insomnia. The scores range from 0 to 28 with higher values indicating increasing symptom burden.	Baseline and Post-Intervention Follow up (approximately 10 weeks after Baseline)]
Secondary	Change in Childhood Cancer Survivor Study-Neurocognitive questionnaire (CCSS-NCQ) scores from Baseline to Post-Intervention (approximately 10 weeks after Baseline)	The CCSS-NCQ was developed specifically to address neurocognitive concerns of adult survivors of childhood cancer and includes assessment of problems with memory, task efficiency, organization, and emotional regulation. T-scores are calculated using sibling normative data (Mean= 50, SD=10) with higher scores indicating worse problems.	Baseline and Post-Intervention Follow up (approximately 10 weeks after Baseline)]
Secondary	Change in The NIH Toolbox Cognitive Battery (NIHTB-CB) scores from Baseline to Post-Intervention (approximately 10 weeks after Baseline)	This is a computerized assessment that measures 3 domains of cognitive function; Executive Function, Processing Speed and Working Memory. Age, sex, and race specific T-Scores (M=50, SD=10) are calculated. Higher scores indicate better functioning.	Baseline and Post-Intervention Follow up (approximately 10 weeks after Baseline)]
Secondary	Change in daily sleep behaviors evaluated by a Sleep Diary from Baseline to Post-Intervention (approximately 10 weeks after Baseline)	An online diary and will be included in the SHUTi program (including the patient education arm). The sleep dairy will assess daily sleep behaviors (e.g. time in bed, sleep onset latency, nighttime awakenings, sleep quality).	Baseline and Post-Intervention Follow up (approximately 10 weeks after Baseline)]
Secondary	Change in Patient Health Questionnaire (PHQ-9) scores from Baseline to Post-Intervention (approximately 6 months after Baseline)	This questionnaire measures symptoms of depression. Scores range from 0 to 27 with higher scores indicating more severe symptoms.	Baseline and Post-Intervention Follow up (approximately 6 months after Baseline)]
Secondary	Change in Generalized Anxiety Disorder-7 (GAD-7) scores from Baseline to Post-Intervention (approximately 6 months after Baseline)	This questionnaire measures symptoms of anxiety with scores ranging from 0 to 21. Higher scores indicate greater symptoms of anxiety.	Baseline and Post-Intervention Follow up (approximately 6 months after Baseline)]
Secondary	Change in Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health questionnaire (HRQoL) scores from Baseline to Post-Intervention (approximately 6 months after Baseline)	This questionnaire measures general health-related quality of life. T-scores are calculated (M=50, SD=10) with higher scores indicated better quality of life.	Baseline and Post-Intervention Follow up (approximately 6 months after Baseline)]

External Links

•   Clinical Trials Open at St. Jude
•   St. Jude Children's Research Hospital