Efficacy of a Stepped-Care Approach to Cognitive-Behavioural Therapy for Insomnia (Can-Sleep) in Adolescents and Young Adults With Cancer.

OBJECTIVE: Poor sleep is a common issue among adolescents and young adults (AYA) with cancer. The present study describes the feasibility and impact of the Can-Sleep stepped-care intervention for AYA with cancer. METHODS: A total of 51 AYA with cancer were screened. AYA who reported sleep disturbance (defined as insomnia severity index score [ISI] > 7) received self-managed cognitive behavioural therapy for insomnia (SMCBT-I) in the first instance (Step 1) followed by individual cognitive behavioural therapy for insomnia (ICBT-I) if symptoms continued (Step 2). AYA screened as high risk for intrinsic sleep abnormalities (e.g., obstructive sleep apnoea) were referred to a specialised service. RESULTS: Of the 51 AYA, 38 participants reported sleep disturbance. In total, 37 AYA commenced SMCBT-I, four attending the specialised sleep service prior. Thirty-one (84%) completed Step 1. Of these, 45% improved and required no further treatment, and 55% (17) were eligible for ICBT-I (ISI > 7). Following intervention, the SMCBT-I group showed a significant decline in insomnia symptoms (p < 0.001, d = 0.84). Among the 17 AYA continuing to report sleep disturbance, 11 (65%) were referred to ICBT-I, with 8 (73%) accepting and completing Step 2. Those who received the ICBT-I showed a significant reduction in insomnia symptoms (p = 0.007, d = 1.33). CONCLUSIONS: This study provides preliminary efficacy and acceptability of a stepped-care intervention for sleep disturbances in AYA with cancer. A stepped-care intervention may offer an effective and resource-efficient method for managing sleep disturbance in AYA with cancer.