Androgen Deprivation and Sleep Disturbance: A Mixed Methods Pilot Study of Remote Assessment and Intervention

• Published in: Cancer nursing Vol. 46; no. 4; p. 259
• Main Authors: Myers, Jamie S, Siengsukon, Catherine, Sherman, Joseph, Shen, Xinglei, Ptomey, Lauren T, Montgomery, Robert, Bock, Karen, Rice, Anna, Parker, William P, Maliski, Sally
• Format: Journal Article
• Language: English
• Published: United States 01.07.2023
• Subjects: Androgen Antagonists - adverse effects; Androgens - therapeutic use; COVID-19 - complications; Hot Flashes; Humans; Male; Pandemics; Pilot Projects; Prostatic Neoplasms - complications; Prostatic Neoplasms - drug therapy; Sleep; Sleep Initiation and Maintenance Disorders - therapy; Sleep Wake Disorders - drug therapy; Treatment Outcome
• ISSN: 1538-9804
• DOI: 10.1097/NCC.0000000000001100

Men receiving androgen deprivation therapy (ADT) for prostate cancer (PC) are at risk for cardiovascular comorbidities and cognitive changes. Interventional research involves in-person assessment of physical fitness/activity and cognitive function, which has been negatively affected by the COVID-19 pandemic. Androgen deprivation therapy-related hot flashes and nocturia increase risk for insomnia. Insomnia is associated with fatigue and may exacerbate ADT-related cognitive changes. The purpose of this mixed-methods pilot was to (1) determine feasibility/acceptability of remotely assessing physical fitness/activity, cognitive function, and sleep; (2) deliver telehealth cognitive behavioral training for insomnia (teleCBT-I) to improve sleep; and (3) garner qualitative feedback to refine remote procedures and teleCBT-I content. Fifteen men with PC receiving ADT completed a 4-week teleCBT-I intervention. Videoconferencing was used to complete study assessments and deliver the weekly teleCBT-I intervention. Self-report of sleep quality improved ( P < .001) as did hot flash frequency ( P = .04) and bother ( P = .025). Minimal clinically important differences were detected for changes in insomnia severity and sleep quality. All sleep logs indicated improvement in sleep efficiency. Remote assessment of fitness/cognitive function was demonstrated for 100% of participants. Sufficient actigraph wear time allowed physical activity/sleep assessment for 80%. Sleep actigraphy did not demonstrate significant changes. Remote monitoring and teleCBT-I are feasible/acceptable to men with PC on ADT. Further research to confirm teleCBT-I efficacy is warranted in this population. Preliminary efficacy for teleCBT-I interventions was demonstrated. Remote assessments of physical fitness/activity, sleep, and cognitive function may enhance clinical trial access for rural or economically disadvantaged PC survivors.