Interventions for managing clinically relevant sleep disturbances or insomnia in cancer patients and survivors: an up-to-date systematic review and meta-analysis of self-reported sleep disturbance

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Background Sleep disturbances are common after-effects of cancer. While the effectiveness of interventions in managing sleep disturbances in cancer have been evaluated, the effectiveness of interventions on reducing clinically relevant sleep disturbances remains unknown. This systematic review and meta-analysis aimed to appraise the effectiveness of up-to-date interventions managing clinical sleep disturbances in cancer patients or survivors. Methods Data from randomized controlled trials were analysed following PRISMA guidelines. Five English databases were searched from January 2012 to June 2025. Outcomes were measured using Hedge’s g with random-effects models. The methodological quality of the trials was assessed by Cochrane Risk of Bias Tool 2.0 and the certainty of evidence was determined using GRADE. Results 42 trials with 3,844 participants were identified, with sample sizes ranging from 22 to 255. A moderate and large effect was found for cognitive behavioural therapy for insomnia (CBT-I) on improving sleep quality ( g = 0.57; 95% CI = 0.20 - 0.93, p < 0.01) and insomnia severity ( g = 0.91; 95% CI = 0.49 - 1.34, p < 0.01) respectively. Complementary and alternative medicine (CAM) showed a large effect size for improving sleep quality ( g = 1.11; 95% CI = 0.43 - 1.78, p < 0.01) but indicated presence of publication bias. Other interventions, including mindfulness, exercise-based interventions, herbal medicine, relaxation and brief behavioural therapy for insomnia (BBT-I), showed less convincing evidence compared to CBT-I. Only one study scored low in overall risk of bias. Conclusion The existing evidence base needs to be expanded to adequately evaluate the effectiveness of other interventions for clinical sleep disturbances. CBT-I is currently the most empirically supported treatment for cancer patients and survivors with clinically relevant sleep disturbances.

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