Online program to address insomnia in young cancer survivors

Pediatric cancer survivors suffer the effects of insomnia even after treatment has ended. Untreated, lack of sleep can cause an array of physical problems as well as impact behavior, social relationships, school performance, mood and more.

Eric Zhou, Ph.D., instructor at Harvard Medical School and staff psychologist at Dana Farber Cancer Institute and Boston Children’s Hospital, is developing a Web-based cognitive behavioral therapy program for these adolescent cancer survivors, hoping to effectively intervene for this common disorder.

The pilot, launched on September 30, is called Sleep Healthy Using the Internet (SHUTi). Participating in the six-sessions of 20-30 minutes each are patients ages 14 to 25.

“Approximately one in four pediatric cancer survivors suffer from sleep that is so problematic that they describe it as ‘more overwhelming’ than the effects of cancer treatment itself,” Zhou noted.

He said that insomnia is sometimes overlooked by patients, their families and doctors because it is regarded as a temporary, non-emergency situation, no matter how long it lingers.

The challenge of heavy traffic and finding parking near a cancer center keeps patients and families from following up for the problem.

“Online (treatment) removes that major barrier to care,” Zhou said.

Zhou’s pilot program, which involves a trial with 40 patients, is funded by a $100,000 psychosocial grant over three years from Alex’s Lemonade Stand Foundation and Northwestern Mutual Foundation.

He said that intervention has to be tailored to the “developmentally unique sleep and circadian patterns,” of this young population as well as their more restrictive sleep environment (i.e., they live with parents, have limited independence and an inflexible school schedule).

“Alternatives to face-to-face sessions are needed,” Zhou said, “and meeting this critical need in pediatric oncology requires thinking outside of the box in terms of how to deliver the intervention program.”

Zhou explained that this territory is largely unexplored with a young population.

“Cognitive-behavioral treatment for insomnia has been proved to be the most effective therapy because it treats the underlying disorder instead of the symptoms as medication does,” Zhou said.

He noted, however, that the treatment protocols are designed and tested in adult populations.

The intervention has to be adapted because if it isn’t, “treatment is likely to be ineffective at best and potentially harmful at worst,” he said.

Zhou said the program will be the first of its kind and will advance the understanding of how to help patients with sleep disorders as well as serve as a “platform” to launch his career in improving treatment for long-term consequences of cancer therapy.

He added that the project aims to treat insomnia and also address the patient’s emotional and physical health effects to improve his or her quality of life.

In a statement, Jay Scott, co-executive director of Alex’s Lemonade Stand Foundation said, “We are conscious of the effects the fight against childhood cancer can have emotionally and behaviorally on children and their families. With these grants, we aim to address the psychosocial aspects of childhood cancer treatment and hope to make a difference in the quality of life and care for these children and their families.”