Adaptation and Pilot Testing of a Mindfulness-Based Insomnia and Symptom Management Intervention for Women with Breast Cancer in Rural Areas

Insomnia is prevalent during breast cancer and exacerbates other common symptoms such as fatigue, distress, and pain, which in turn worsen sleep. This symptom burden is disproportionate for women receiving treatment in rural areas. Nite2Day is a mindfulness-based, behavioral insomnia and symptom management intervention previously applied in hematologic cancer. We adapted and pilot-tested Nite2Day in patients with breast cancer in rural areas. Patient (N = 8) and clinician (N = 6) interviews informed adaptation. A single-arm pilot (N = 15) evaluated feasibility (accrual, attrition, adherence), acceptability, and changes to patient-reported outcomes (insomnia symptoms, fatigue, distress, pain, pre-sleep arousal, mindfulness, symptom management self-efficacy) from baseline to post-intervention. Participants were enthusiastic about mindfulness and behavioral skills to address symptoms. Qualitative feedback guided protocol changes (e.g., mindfulness definitions, telephone and evening sessions). Nite2Day was feasible. The accrual target was met in 6 months, and all participants completed the intervention and post-treatment assessments. Acceptability of Nite2Day was strong (M = 30.53/32). Pre-post change for all patient-reported outcomes was in the expected direction. These feasibility and acceptability data provide support for next-step pilot testing using a randomized design. This research could extend access to an evidence-based behavioral intervention targeting concurrent insomnia, fatigue, distress, and pain symptoms reported by patients in rural cancer care settings.