Cognitive Behavioral Effects on Sleep, Pain, and Cytokines in Gynecologic Cancer

Gynecologic cancers cause substantial morbidity and mortality among women. Developing, implementing, and disseminating interventions that reduce morbidity and mortality secondary to gynecologic cancers are a public health priority. In spite of this, there is a paucity of research examining the effects of psychosocial interventions on patient-centered and physiological outcomes in this population. To the extent that psychological factors may influence quality of life and tumor biology among women with gynecologic cancers, psychological interventions may represent an important adjunct to standard clinical care in this population. As such, this study will examine the effects of a psychosocial intervention on sleep, pain, mood, cortisol, and cytokines in women with gynecologic cancers.

Sex

Female

Minimum age

18 Years

Maximum age

90 Years

Inclusion Criteria

* Women 18 and older scheduled and/ or have recently had a surgical resection, debulking, or cytoreduction for gynecologic malignancies for which adjuvant treatment or chemotherapy is the standard of care. Most of these cases are expected to be: (i) epithelial ovarian cancer, any stage, any grade, (ii) epithelial endometrial cancer, clear cell, papillary serous, or carcinosarcoma morphologies; any stage; any grade, (iii) epithelial endometrial cancer, endometrioid morphology; any stage any grade, (iv) fallopian tube cancer, any stage, any grade, (v) peritoneal cancer, any stage, any grade, or (vi) squamous cell carcinomas of the female genital tract (uterus, cervix, vulva, and vagina), any stage, any grade, in situ, or (vii) borderline ovarian tumors.
* Endorsement of any of the following sleep related complaints in the month prior to enrollment (at pre- or post-surgery): difficulty initiating sleep, difficulty maintaining sleep, waking up too early, or sleep that is chronically nonrestorative or poor in quality.
* During the two weeks of sleep evaluation at the post-surgical timepoint: sleep diary/clinical interview confirmed insomnia (e.g., sleep onset or awake time during the night \> 30 minutes) at least 3 nights per week; or, sleep diary/clinical interview confirmed insomnia on 1 to 5 nights across the two weeks of evaluation plus Sleep Efficiency on Pittsburgh Sleep Quality Index at post-surgery \< 85%.
* Presence of daytime dysfunction due to insomnia (mood, cognitive, social, or occupational impairment) at post-surgery.
* Able to read and understand English.
* Willing to undergo randomization.

Exclusion Criteria:

* Unable to provide informed consent.
* Current, severe, uncontrolled psychopathology that would make randomization to conditions unethical.
* Past or current diagnosis of Bipolar Disorder or seizure disorder that would prevent the safe implementation of sleep restriction techniques.
* Participation in Cognitive Behavioral Therapy or any nonpharmacological treatment for sleep outside of the current study.
* Sleep apnea or periodic limb movement disorder (PLMD).
* Physician estimated survival less than 6 months.

• RESULTPadron A, McCrae CS, Robinson ME, Waxenberg LB, Antoni MH, Berry RB, Castagno J, Schultz G, Kacel EL, Ulfig C, Garey S, Patidar S, Sannes T, Trinastic L, Wong S, Pereira DB. Impacts of Cognitive Behavioral Therapy for Insomnia and Pain on Sleep in Women with Gynecologic Malignancies: A Randomized Controlled Trial. Behav Sleep Med. 2022 Jul-Aug;20(4):460-476. doi: 10.1080/15402002.2021.1932500. Epub 2021 Jun 14. PMID 34124972
• RESULTHanvey GA, Padron A, Kacel EL, Cartagena G, Bacharz KC, McCrae CS, Robinson ME, Waxenberg LB, Antoni MH, Berry RB, Schultz GS, Castagno J, Pereira DB. Accrual and retention of diverse patients in psychosocial cancer clinical trials. J Clin Transl Sci. 2022 Apr 1;6(1):e45. doi: 10.1017/cts.2022.380. eCollection 2022. PMID 35651964
• DERIVEDCai Z, Tang Y, Liu C, Li H, Zhao G, Zhao Z, Zhang B. Cognitive behavioural therapy for insomnia in people with cancer. Cochrane Database Syst Rev. 2025 Oct 31;10(10):CD015176. doi: 10.1002/14651858.CD015176.pub2. PMID 41170811
• DERIVEDKacel EL, Kirsch JL, Sannes TS, Patidar S, Postupack R, Jensen S, Wong S, Garey S, Dodd S, Ulfig CM, McCrae CS, Robinson ME, Castagno J, Schultz GS, Pereira DB. Interleukin-6 and body mass index, tobacco use, and sleep in gynecologic cancers. Health Psychol. 2019 Oct;38(10):866-877. doi: 10.1037/hea0000775. Epub 2019 Aug 1. PMID 31368718
• DERIVEDKirsch JL, Robinson ME, McCrae CS, Kacel EL, Wong SS, Patidar S, Sannes TS, Garey S, Castagno JC, Pereira DB. Associations Among Sleep Latency, Subjective Pain, and Thermal Pain Sensitivity in Gynecologic Cancer. Pain Med. 2020 Jan 1;21(1):5-12. doi: 10.1093/pm/pny236. PMID 30481329