---
title: "Comparative Effectiveness of CBT-I Delivery Methods for Insomnia in Cancer Survivors"
id: "pubmed-42670890"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42670890"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42670890/"
doi: "10.1002/pon.70593"
published_at: "2026-09-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Comparative Effectiveness of CBT-I Delivery Methods for Insomnia in Cancer Survivors
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42670890
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42670890/)
- **DOI:** [10.1002/pon.70593](https://doi.org/10.1002%2Fpon.70593)
- **Published At:** 2026-09-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Insomnia affects an estimated **30%–60%** of cancer survivors, with about **20%** meeting criteria for insomnia disorder; **CBTi** is the guideline-recommended first-line treatment but access barriers exist. - The study is a systematic review and frequentist random-effects **network meta-analysis (NMA)** of randomized controlled trials comparing different CBTi delivery modes in adults with cancer; databases searched included PubMed, Embase, CINAHL and Cochrane Library to September 25, 2025. - Inclusion: randomized trials of adult cancer patients reporting subjective sleep outcomes. Primary outcome: **Insomnia Severity Index (ISI)**. Secondary outcomes: sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE). - Twenty-two trials with a total of **2040 participants** were included in the analysis. - Compared with treatment as usual (TAU), **digital CBTi (dCBTi)** produced the largest reduction in ISI (mean difference **-9.70**, 95% CI **-10.80 to -8.61**). Telephone CBTi also reduced ISI (MD **-8.74**). - dCBTi significantly improved secondary sleep outcomes versus TAU: SOL decreased by **-30.95 minutes**, WASO by **-25.62 minutes**, TST increased by **+31.67 minutes**, and SE improved by **+14.63%**. - Group CBTi showed significant improvements in SOL (**-11.60 minutes**) and WASO (**-22.03 minutes**) versus TAU. - Meta-regression identified **breast cancer diagnosis** as a significant moderator of dCBTi effects on SOL (coefficient **25.20**, p = **0.015**) and SE (coefficient **-16.17**, p = **0.007**). - The overall certainty of evidence was rated from **low to very low**, mainly due to imprecision and network incoherence; network inconsistency was present for selected outcomes. - Authors conclude that **dCBTi** demonstrated the greatest potential among evaluated delivery modes, but findings should be interpreted cautiously pending high-quality head-to-head trials. - Trial protocol was prospectively registered on PROSPERO (CRD42023429081).
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan. * 2 Department of Clinical Psychology, Fu Jen Catholic University, Taipei, Taiwan. * 3 Department of Psychology, Chung Yuan Christian University, Taoyuan, Taiwan. * 4 Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. * 5 Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. * 6 Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. * 7 Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan. * 8 Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan. * PMID: **42670890** * DOI: [ 10.1002/pon.70593 ](https://doi.org/10.1002/pon.70593) Item in Clipboard Review # Comparative Effects of Various Delivery Methods of Cognitive Behavioral Therapy for Insomnia Among Patients With Cancers: Systematic Review and Network Meta-Analysis Chen-I Lee et al. Psychooncology. 2026 Sep. Show details Display options Display options Format Abstract PubMed PMID Psychooncology Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Psychooncology%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Psychooncology%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670890/) . 2026 Sep;35(9):e70593. doi: 10.1002/pon.70593. ### Authors [Chen-I Lee](https://pubmed.ncbi.nlm.nih.gov/?term=Lee+CI&cauthor_id=42670890)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670890/#short-view-affiliation-1 "School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan."), [Muhammad Amirul Mukminin](https://pubmed.ncbi.nlm.nih.gov/?term=Mukminin+MA&cauthor_id=42670890)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670890/#short-view-affiliation-1 "School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan."), [Ya-Wen Jan](https://pubmed.ncbi.nlm.nih.gov/?term=Jan+YW&cauthor_id=42670890)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42670890/#short-view-affiliation-2 "Department of Clinical Psychology, Fu Jen Catholic University, Taipei, Taiwan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42670890/#short-view-affiliation-3 "Department of Psychology, Chung Yuan Christian University, Taoyuan, Taiwan."), [Tzu-Hao Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+TH&cauthor_id=42670890)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670890/#short-view-affiliation-1 "School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan."), [Tsai-Wei Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+TW&cauthor_id=42670890)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670890/#short-view-affiliation-1 "School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42670890/#short-view-affiliation-4 "Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42670890/#short-view-affiliation-5 "Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan."), [Hsiao-Yean Chiu](https://pubmed.ncbi.nlm.nih.gov/?term=Chiu+HY&cauthor_id=42670890)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42670890/#short-view-affiliation-1 "School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42670890/#short-view-affiliation-6 "Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42670890/#short-view-affiliation-7 "Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan.")[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42670890/#short-view-affiliation-8 "Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan.") ### Affiliations * 1 School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan. * 2 Department of Clinical Psychology, Fu Jen Catholic University, Taipei, Taiwan. * 3 Department of Psychology, Chung Yuan Christian University, Taoyuan, Taiwan. * 4 Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. * 5 Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. * 6 Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. * 7 Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan. * 8 Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan. * PMID: **42670890** * DOI: [ 10.1002/pon.70593 ](https://doi.org/10.1002/pon.70593) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Insomnia affects 30%-60% of cancer survivors, with around 20% meeting criteria for insomnia disorder. Cognitive behavioral therapy for insomnia (CBTi) is the first-line treatment, but access is limited by cost and therapist availability, prompting exploration of alternative delivery modes, including digital interventions. **Purpose:** To systematically review and conduct a network meta-analysis (NMA) of the efficacy of different CBTi delivery methods for managing insomnia in cancer survivors. **Methods:** The PubMed, Embase, CINAHL and Cochrane Library were searched for relevant articles published before September 25, 2025. Only randomized controlled trials of adult cancer patients evaluating the effects of any CBTi delivery mode on subjective sleep outcomes were included. Primary outcome was insomnia severity index (ISI) score; secondary outcomes included sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE). A frequentist random-effects NMA was conducted. **Results:** Twenty-two trials involving 2040 participants were included. Compared with treatment as usual (TAU), digital CBTi (dCBTi) demonstrated the largest reduction in ISI scores (MD = -9.70, 95% CI = -10.80 to -8.61), followed by telephone CBTi (MD = -8.74). dCBTi also significantly improved SOL (-30.95 min), WASO (-25.62 min), TST (+31.67 min), and SE (+14.63%). Group CBTi significantly improved SOL (-11.60 min) and WASO (-22.03 min). Meta-regression analyses identified breast cancer diagnosis as a significant moderator of dCBTi effects on SOL (coefficient = 25.20, p = 0.015) and SE (coefficient = -16.17, p = 0.007). The certainty of evidence ranged from low to very low, primarily because of imprecision and network incoherence. **Conclusions:** dCBTi demonstrated the greatest potential for improving insomnia outcomes among the evaluated CBTi delivery modalities. However, given the low certainty of evidence and the presence of network inconsistency for selected outcomes, these findings should be interpreted cautiously. High-quality head-to-head trials are needed to confirm the comparative effectiveness of different CBTi delivery modalities in oncology populations. **Trial registration:** The study protocol was prospectively registered on PROSPERO (registration no. CRD42023429081). **Keywords:** cancer; cognitive behavior therapy; insomnia; network meta‐analysis; sleep. © 2026 The Author(s). Psycho‐Oncology published by John Wiley & Sons Ltd. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Comparative Effects of Various Modalities of Cognitive Behavioral Therapy for Insomnia in Adolescents: A Systematic Review and Network Meta-Analysis. ](https://pubmed.ncbi.nlm.nih.gov/42439579/) Rohmah I, Hsieh TN, Jan YW, Hasan F, Chen YC, Widodo AF, Lee HC, Lin CJ, Chiu HY.Rohmah I, et al.Worldviews Evid Based Nurs. 2026 Aug;23(4):e70158. doi: 10.1111/wvn.70158.Worldviews Evid Based Nurs. 2026.PMID: 42439579Free PMC article. * [ Cognitive behavioural therapy for insomnia in people with cancer. ](https://pubmed.ncbi.nlm.nih.gov/41170811/) Cai Z, Tang Y, Liu C, Li H, Zhao G, Zhao Z, Zhang B.Cai Z, et al.Cochrane Database Syst Rev. 2025 Oct 31;10(10):CD015176. doi: 10.1002/14651858.CD015176.pub2.Cochrane Database Syst Rev. 2025.PMID: 41170811 * [ Acupuncture for insomnia in people with cancer. ](https://pubmed.ncbi.nlm.nih.gov/41347621/) Ma Q, Liu C, Zhao G, Guo S, Li H, Zhang B, Li B, Cai Z.Ma Q, et al.Cochrane Database Syst Rev. 2025 Dec 5;12(12):CD015177. doi: 10.1002/14651858.CD015177.pub2.Cochrane Database Syst Rev. 2025.PMID: 41347621 * [ Comparative efficacy of digital cognitive behavioral therapy for insomnia: A systematic review and network meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/34902820/) Hasan F, Tu YK, Yang CM, James Gordon C, Wu D, Lee HC, Yuliana LT, Herawati L, Chen TJ, Chiu HY.Hasan F, et al.Sleep Med Rev. 2022 Feb;61:101567. doi: 10.1016/j.smrv.2021.101567. Epub 2021 Nov 10.Sleep Med Rev. 2022.PMID: 34902820 * [ Effects of cognitive-behavioral therapy for insomnia compared with controls among cancer survivors: a systematic review and meta-analysis of randomized trials. ](https://pubmed.ncbi.nlm.nih.gov/40369457/) Cooper JT, Svoboda E, Prochazka AV, Ha DM.Cooper JT, et al.BMC Cancer. 2025 May 14;25(1):871. doi: 10.1186/s12885-025-14192-y.BMC Cancer. 2025.PMID: 40369457Free PMC article. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42670890) ## References 1. 1. S. Mercadante, F. Aielli, C. Adile, et al., “Sleep Disturbances in Patients With Advanced Cancer in Different Palliative Care Settings,” Journal of Pain and Symptom Management 50, no. 6 (2015): 786–792, . 2. 1. J. Savard, H. Ivers, J. Villa, A. Caplette‐Gingras, and C. M. Morin, “Natural Course of Insomnia Comorbid With Cancer: An 18‐Month Longitudinal Study,” Journal of Clinical Oncology 29, no. 26 (2011): 3580–3586, . 3. 1. L. Grassi, R. Zachariae, R. Caruso, et al., “Insomnia in Adult Patients With Cancer: ESMO Clinical Practice Guideline,” ESMO Open 8, no. 6 (2023): 102047, . 4. 1. N. L. Rauwerda, T. A. Kuut, A. M. Braamse, et al., “Co‐occurrence of Severe Fatigue and Insomnia: Implications for the Outcome of Cognitive Behavioural Therapies,” Behavioural and Cognitive Psychotherapy 53, no. 4 (2025): 1–15, . 5. 1. L. Palagini, M. Miniati, D. Riemann, and L. Zerbinati, “Insomnia, Fatigue, and Depression: Theoretical and Clinical Implications of a Self‐Reinforcing Feedback Loop in Cancer,” Clinical Practice and Epidemiology in Mental Health 17, no. 1 (2021): 257–263, . Show all 71 references ## Publication types * Systematic Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Systematic+Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Systematic+Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42670890/) * Network Meta-Analysis Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Network+Meta-Analysis%22%5Bpt%5D&sort=date&sort_order=desc) *
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