How to Better Manage Insomnia in French Cancer Patients With a Guided Internet‐Based Cognitive Behavioral Therapy? The Sleep‐4‐All 2.0 Real World Multicenter Single‐Arm Interventional Study

INTRODUCTION: Internet-Based Cognitive Behavioral Therapy for Insomnia (ICBT-I) can be leveraged to facilitate access to CBT in oncology. Nevertheless, adherence to self-guided ICBT remains low (50%-60%). The Sleep-4-All-2.0 study combined an ICBT-I (Insomnet) with phone-based guidance provided by a CBT psychologist. This study assessed: (1) the performance of this combined approach in terms of adherence and insomnia remission rates, and (2) patients' characteristics associated with better or poorer outcomes. METHODS: This real-world multicenter single-arm interventional study included patients with any tumor type and with an Insomnia Severity Index (ISI) score ≥ 8. Online questionnaires were used to compare adherence, insomnia remission, and sleep perception at weeks (W) 6, 12, and 24 post-intervention. Descriptive and multivariate analyses were performed. RESULTS: Among 348 consenting patients, 310 (89%) initiated Insomnet and completed baseline assessment (W0). Questionnaire completion rates among initiators were 85% (263/310) at W6, 71% (219/310) at W12, and 53% (164/310) at W24. Program adherence (≥ 5/6 modules completed by W12) was 74% (230/310). Insomnia remission rates were 34%, 46%, and 50%, and insomnia was no longer a problem for 48%, 63%, and 66% in W6, 12, and 24, respectively. Unemployed patients at baseline were more likely to show a decrease in ISI scores. Patients taking a sleep medication, with high sleepiness and fatigue scores at baseline and with fewer digital skills, seem to benefit less from the intervention. CONCLUSION: ICBT-I with phone-based guidance showed satisfactory rates of adherence and insomnia remission. Implementing the program effectively requires considering patients' profiles.