Home-Based Programs for Improving Sleep in Cancer Survivors

DISEASE CHARACTERISTICS:

* Prior diagnosis of cancer
* At least 2 months and ≤ 24 months since completed curative-intent treatment (chemotherapy, surgery, and/or radiotherapy)

  * Ongoing hormonal therapy (i.e., tamoxifen, aromatase inhibitors, casodex)
  * Concurrent trastuzumab and maintenance rituximab allowed
* Sleep difficulty defined as self report of sleep latency of ≥ 30 minutes on 3 out of 7 nights in a week and wishing therapeutic intervention, and/or self report of waking up after first falling asleep and not being able to fall back asleep for ≥ 30 minutes on 3 out of 7 nights in a week
* No history of diagnosis of primary insomnia (patient medical record, defined by having had behavioral, cognitive, or pharmacologic treatment) for \> 30 consecutive days in the year before cancer diagnosis
* No active cancer (i.e., not considered no evidence of disease)
* No concurrent CNS malignancy
* No history of diagnosed sleep disorder (i.e., obstructive sleep apnea, restless legs, or periodic leg movement disorder)

PATIENT CHARACTERISTICS:

* ECOG performance status 0-1
* Availability of a CD player and head or earphones
* Ability to complete questionnaires
* No uncontrolled chronic pain (i.e., pain score of ≥ 4 on Numeric Analogue Sleep and Pain Scale)
* No diagnosis of major depression disorder, acute anxiety disorder, or schizophrenia per medical record
* No hot flashes that interrupt sleep
* Not working overnight hours and unable to change schedule
* No emotional, psychological, or physical state that, according to physician and/or study personnel evaluation, would preclude adherence to daily home intervention implementation

PRIOR CONCURRENT THERAPY:

* See Disease Characteristics
* More than 4 days since prior corticosteroid, including inhaled steroids, of any dose for \> 2 days
* No prior experience with guided imagery or cognitive behavioral therapy for insomnia
* No concurrent new herbal therapies

  * Stable dose of daily herbal supplements started ≥ 8 weeks before study intervention allowed
  * Herbal teas or herbs in various drink products allowed
* No concurrent treatment with variable doses of any of the following:

  * Antidepressants
  * Anxiolytics
  * Pain medication (not including over the counter ad anti-inflammatory pain relievers)
* Pharmacologic treatment for sleep/wake disturbances is allowed, but must be used for 4 weeks before study entry, and can be used daily or intermittently