Comparative Effects of Various Delivery Methods of Cognitive Behavioral Therapy for Insomnia Among Patients With Cancers: Systematic Review and Network Meta‐Analysis
Network meta-analysis reveals digital cognitive behavioral therapy produces the greatest improvements in cancer-related insomnia, indicating digital interventions offer scalable relief.
Key Points
To evaluate the comparative efficacy of different delivery modalities of cognitive behavioral therapy for insomnia (CBTi) among adult cancer survivors.
Conducted a systematic search of PubMed, Embase, CINAHL, and Cochrane Library through September 25, 2025, for randomized controlled trials evaluating CBTi delivery modes on subjective sleep outcomes in adult cancer patients (PROSPERO CRD42023429081).
Synthesized evidence from 22 randomized controlled trials involving 2,040 participants using a frequentist random-effects network meta-analysis.
Evaluated the primary outcome of Insomnia Severity Index (ISI) score alongside secondary outcomes including sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE).
Compared with treatment as usual, digital CBTi showed the greatest reduction in ISI scores (mean difference [MD] = -9.70, 95% CI = -10.80 to -8.61), followed by telephone CBTi (MD = -8.74).
Digital CBTi significantly improved SOL (-30.95 min), WASO (-25.62 min), TST (+31.67 min), and SE (+14.63%), while group CBTi significantly reduced SOL (-11.60 min) and WASO (-22.03 min).
Breast cancer diagnosis significantly moderated digital CBTi effects on SOL (coefficient = 25.20, p = 0.015) and SE (coefficient = -16.17, p = 0.007), though overall evidence certainty ranged from low to very low.