PURPOSE/OBJECTIVES: To examine the effect of cognitive-behavioral therapy for 
insomnia (CBTI) on sleep improvement, daytime symptoms, and quality of life 
(QOL) in breast cancer survivors (BCSs) after cancer treatment.
DESIGN: A prospective, longitudinal, randomized, controlled trial.
SETTING: Oncology clinics, breast cancer support groups, and communities in 
Colorado.
SAMPLE: 56 middle-aged BCSs with chronic insomnia.
METHODS: Women were randomly assigned to CBTI or behavioral placebo treatment 
(BPT) and completed measures of sleep, QOL, functioning, fatigue, and mood at 
baseline, postintervention, and at three- and six-month follow-ups.
MAIN RESEARCH VARIABLES: Sleep outcomes (e.g., sleep efficiency, sleep latency, 
total sleep time, wake after sleep onset, number of nightly awakenings); 
secondary variables included sleep medication use, insomnia severity, QOL, 
physical function, cognitive function, fatigue, depression, anxiety, and sleep 
attitudes or knowledge.
FINDINGS: Sleep efficiency and latency improved more in the CBTI group than the 
BPT group; this difference was maintained during follow-up. Women in the CBTI 
group had less subjective insomnia, greater improvements in physical and 
cognitive functioning, positive sleep attitudes, and increased sleep hygiene 
knowledge. No group differences in improvement were noted relative to QOL, 
fatigue, or mood.
CONCLUSIONS: Nurse-delivered CBTI appears to be beneficial for BCSs' sleep 
latency/efficiency, insomnia severity, functioning, sleep knowledge, and 
attitudes more than active placebo, with sustained benefit over time.
IMPLICATIONS FOR NURSING: Oncology nurses are in a unique position to identify 
insomnia in cancer survivors. When sleep disturbances become chronic, nurses 
need to make recommendations and referrals.