Brief CBT-I improves insomnia symptoms in women receiving chemotherapy for breast cancer
In a randomized clinical trial of 219 women undergoing chemotherapy for breast cancer, 6 weeks of CBT-I significantly reduced insomnia symptoms (ISI score MD, -2.19 [95% CI, -3.33 to -1.05]; P=.002) compared to non-CBT-I groups. However, CBT-I did not significantly improve fatigue symptoms (PROMIS-Fatigue MD, -0.90 [95% CI, -3.08 to 1.28]; P=.52). Bright light therapy (BLT) did not significantly improve either insomnia or fatigue symptoms compared to non-BLT groups.
Evidence Score
Study Evidence
Study 1. Cognitive Behavior vs Bright Light Therapy for Insomnia in Women Undergoing Chemotherapy for Breast Cancer: A Randomized Clinical Trial.
rctDo TT, Maccora J, Wallace R, Aedo-Lopez V, Alexander M, Ancoli-Israel S, Bei B, Blum R, Boyle F, Day D, Diggens J, Francis PA, Ftanou M, Garland SN, Kepert A, Mortimer D, Phillips AJK, Sharma S, Stafford L, White M, Wiley JF · JAMA network open (2026)
Result: In a randomized clinical trial of 219 women undergoing chemotherapy for breast cancer, 6 weeks of CBT-I significantly reduced insomnia symptoms (ISI score MD, -2.19 [95% CI, -3.33 to -1.05]; P=.002) compared to non-CBT-I groups. However, CBT-I did not significantly improve fatigue symptoms (PROMIS-Fatigue MD, -0.90 [95% CI, -3.08 to 1.28]; P=.52). Bright light therapy (BLT) did not significantly improve either insomnia or fatigue symptoms compared to non-BLT groups.
Mechanism Graph
Limitations
- ⚠Fatigue was not improved by CBT-I, suggesting limited generalizability to fatigue outcomes
- ⚠Subgroup analysis for metastatic cancer was exploratory and not pre-specified
- ⚠High adherence subgroup results were comparable but not detailed in abstract
- ⚠Study was conducted in Australia, limiting generalizability to other healthcare settings
Frequently Asked Questions
Does CBT-I improve insomnia in breast cancer patients on chemotherapy?▼
Yes, the study found that 6 weeks of CBT-I significantly reduced insomnia symptoms (ISI score MD, -2.19 points) compared to non-CBT-I groups.
Does bright light therapy improve fatigue in breast cancer patients?▼
No, bright light therapy did not significantly improve fatigue symptoms compared to non-BLT groups in the overall sample. However, exploratory analysis in metastatic breast cancer patients showed a significant improvement in fatigue (MD, -5.16 points).
What was the study design?▼
It was a 6-week, 2x2 factorial, superiority, parallel randomized clinical trial conducted at 5 hospitals in Australia, with 219 women randomized to CBT-I alone, BLT alone, CBT-I plus BLT, or sleep hygiene education.
How long did the intervention last?▼
The intervention lasted 6 weeks, with assessments at baseline, midpoint (3 weeks), postintervention (6 weeks), and follow-up at 3 and 6 months.
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References
- 1.Do TT, Maccora J, Wallace R, Aedo-Lopez V, Alexander M, Ancoli-Israel S, Bei B, Blum R, Boyle F, Day D, Diggens J, Francis PA, Ftanou M, Garland SN, Kepert A, Mortimer D, Phillips AJK, Sharma S, Stafford L, White M, Wiley JF. "Cognitive Behavior vs Bright Light Therapy for Insomnia in Women Undergoing Chemotherapy for Breast Cancer: A Randomized Clinical Trial.." JAMA network open, 2026. PMID: 42658497 DOI: 10.1001/jamanetworkopen.2026.30320