Feasibility of a video-based cognitive behavioral therapy for insomnia in French adult cancer outpatients: results from the Sleep-4-All-1 study

Support Care Cancer. 2021 Oct;29(10):5883-5894. doi: 10.1007/s00520-021-06151-7. Epub 2021 Mar 24.


Background: Insomnia affects up to 63% of patients with cancer. Cognitive behavioral therapy for insomnia (CBT-I) is considered to be the non-pharmacological gold standard treatment, but it remains underutilized in France. Self-administered interventions offer new ways to overcome some of the barriers that restrict access to efficacious supportive care.

Objective: To assess the feasibility, among French adult cancer outpatients, of a validated Quebec video-based, self-administered, cognitive behavioral therapy for insomnia (VCBT-I).

Methods: A pre-post design with quantitative measures (Insomnia Severity Index, Edmonton Symptom Assessment System, Treatment Perception Questionnaire) and qualitative measures (semi-structured interviews) was used.

Results: One hundred and seventy-three cancer outpatients were self-screened for insomnia, and 57% (n=99) reported significant symptoms. Among them, 80% (n=79) agreed to participate in the VCBT-I. The download rate of the VCBT-I was 78% (n=62/79). Several technical and contextual barriers to the delivery and the applicability of the VCBT-I emerged. However, participants reported a high level of satisfaction, and some valuable benefits at post-immediate intervention (increased knowledge about sleep, better quality of sleep, and higher acceptance of the burden of insomnia), regardless of whether or not they still had insomnia.

Discussion: This study confirms that there is a demand for a VCBT-I, which was perceived as appropriate by a sample of French cancer outpatients with insomnia, but it also highlights some limitations in terms of implementation and practicality. Remote professional support appears to be a core need in order to address these issues and personalize the guidance process.

Keywords: Cancer; Cognitive behavioral therapy for insomnia; Insomnia; Self-administered intervention; Video.

MeSH terms

  • Adult
  • Cognitive Behavioral Therapy*
  • Feasibility Studies
  • Humans
  • Neoplasms* / complications
  • Neoplasms* / therapy
  • Outpatients
  • Sleep
  • Sleep Initiation and Maintenance Disorders* / etiology
  • Sleep Initiation and Maintenance Disorders* / therapy
  • Treatment Outcome