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Cognitive Behavioral Therapy +/- Armodafinil for Insomnia and Fatigue Following Chemotherapy

This study has been completed.
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Joseph Roscoe, University of Rochester
ClinicalTrials.gov Identifier:
NCT01091974
First received: December 9, 2009
Last updated: August 4, 2015
Last verified: August 2015

December 9, 2009
August 4, 2015
February 2008
April 2013   (final data collection date for primary outcome measure)
Change in Insomnia Severity Index From Baseline to Post-intervention [ Time Frame: ANCOVA was employed with multiple imputation on the post-intervention score (average of the two post-intervention weeks), controlling for the score at the time of consent (pre). ] [ Designated as safety issue: No ]
The Insomnia Severity Index (ISI) is a commonly used, 7-item psychometrically validated measure used to rate insomnia with 0-7 = absence of insomnia, 8-14 = subthreshold insomnia symptoms, 15-21 = moderate insomnia, and 22-28 = severe insomnia.
To determine if one or more of the intervention strategies (i.e., CBT-I, armodafinil, or both), when compared to a placebo only group, reduce insomnia in breast cancer patients following the conclusion of chemotherapy. [ Time Frame: Severity of insomnia will be assessed by the total score of the Severity Index (ISI) which will be completed every Friday during weeks 3-11 of the study and again during weeks 23 and 24. ] [ Designated as safety issue: No ]
Complete list of historical versions of study NCT01091974 on ClinicalTrials.gov Archive Site
Fatigue Will be Assessed by the Total Score of the Revised Brief Fatigue Inventory (BFI) . [ Time Frame: ANCOVA was employed with multiple imputation on the post-intervention score (average of the two post-intervention weeks), controlling for the score at the time of ] [ Designated as safety issue: No ]
The revised Brief Fatigue Inventory (BFI) is a 9-item, patient-report instrument with established reliability and validity.
All three intervention strategies, as compared to the placebo only group, will reduce fatigue in patients, where the largest effects will occur with the two conditions that utilize armodafinil. [ Time Frame: Fatigue will be assessed by the total score of the revised Brief Fatigue Inventory (BFI) which will be completed every Friday during weeks 3-11 of the study and again during weeks 23 and 24. ] [ Designated as safety issue: No ]
Not Provided
Not Provided
 
Cognitive Behavioral Therapy +/- Armodafinil for Insomnia and Fatigue Following Chemotherapy
Cognitive Behavioral Therapy +/- Armodafinil for Insomnia and Fatigue Following Chemotherapy
This is a four-arm, randomized, controlled, clinical trial examining the efficacy of of cognitive behavioral therapy (CBT)-I and armodafinil in reducing insomnia in 226 female breast cancer patients who report sleep disturbances following completion of chemotherapy.

Treatment Protocol: CBT-I and armodafinil are being studied in a four-arm, randomized, controlled, clinical trial of 226 cancer survivors with chronic insomnia who are at least one month post treatment. The seven-week intervention is designed to determine the efficacy and acceptability of these treatment strategies in reducing insomnia in cancer survivors. Assessments will be made by questionnaires before, during, and two weeks following the study intervention. All ancillary treatments, as appropriate for control of symptoms caused by the cancer or its treatment may be administered as clinically indicated.

Withdrawal of Sleep Medications: All participants, prior to beginning the baseline data collection phase of the study, must have withdrawn from all sleep medications, including: prescription, over-the-counter, CAM and herbal remedies for at least one week prior to beginning the study.

CBT-I (Arms 3 & 4): CBT-I will be provided on an individual basis to all patients in study Arms 3 & 4 by a licensed clinical psychologist trained in CBT-I by Dr. Perlis. Subjects in these two study arms will receive 7 weeks of CBT-I, using a structured research grade protocol developed at the UR-SNRL. This manualized intervention, which exists as a published text: Perlis et al., 2005, includes four essential components: Sleep Restriction Therapy, Stimulus Control Instruction, Sleep Hygiene Guidelines, and a session of cognitive therapy.

Data Collection: Patients will complete the Insomnia Severity (ISI) at the time of consent and every Friday during weeks 3-11 of the study. A follow-up call by study personnel will be made to each participant not currently receiving CBT-I on each of these Fridays to promote compliance, prompt completion, assess potential side effects of study medication, and answer patient questions.

Interventional
Phase 2
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Supportive Care
  • Insomnia
  • Fatigue
  • Breast Cancer
  • Drug: armodafinil
    Armodafinil P.O. daily/47 days (3-days at 50mg, then 40 days at 100mg, then 4 days at 50mg)
  • Drug: Placebo Comparator
    Placebo for 47 days
  • Behavioral: CBT-I
    Seven weekly sessions of cognitive behavioral therapy for insomnia (CBT-I)
  • Experimental: 1 - CBT-I + placebo
    CBT-I and placebo
    Interventions:
    • Drug: Placebo Comparator
    • Behavioral: CBT-I
  • Experimental: 2 - CBT-I + Armodafinil
    CBT-I + Armodafinil
    Interventions:
    • Drug: armodafinil
    • Behavioral: CBT-I
  • Placebo Comparator: 3 - Placebo only
    Placebo only
    Intervention: Drug: Placebo Comparator
  • Experimental: 4 - Armodafinil only
    Armodafinil only
    Intervention: Drug: armodafinil
Roscoe JA, Garland SN, Heckler CE, Perlis ML, Peoples AR, Shayne M, Savard J, Daniels NP, Morrow GR. Randomized placebo-controlled trial of cognitive behavioral therapy and armodafinil for insomnia after cancer treatment. J Clin Oncol. 2015 Jan 10;33(2):165-71. doi: 10.1200/JCO.2014.57.6769.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Completed
138
April 2013
April 2013   (final data collection date for primary outcome measure)

Inclusion Criteria:

  1. Have a diagnosis of cancer.
  2. Be able to understand written and spoken English
  3. Be able to swallow medication
  4. Have preferred sleep phase between 7:30 pm and 11:00 am
  5. Be willing to discontinue any medications/OTCs/Herbals for sleep for the 11-week study period
  6. Be presumed to be in a state of cancer remission; use of tamoxifen, an aromatase inhibitor, and/or Herceptin is permitted
  7. Self-report problems with insomnia for at least three months and that the insomnia began or got worse with the onset of cancer or treatment
  8. Have completed chemotherapy and or radiation not less than one month ago. Note: Both types of treatment must be completed at least one month ago if patient receives chemotherapy and radiation therapy and there is no outer limit to how long ago treatments were completed.)
  9. Report insomnia on the SDS-CL at a frequency of at least 3 days a week

Exclusion Criteria:

  1. Have ever taken modafinil or had CBT-I therapy. CBT-I therapy for the sake of this protocol will be defined as any cognitive behavioral-based treatment for insomnia that includes a sleep restriction component.
  2. Have an unstable medical or psychiatric illness (Axis I-current or within the last 5 years)
  3. Have a history of seizures or severe headaches, or uncontrolled cardiac disease or hypertension
  4. Be presently taking an anticoagulant or a corticosteroid
  5. Have taken amphetamines (e.g., methylphenidate, pemoline [Cylert®] or similar psycho stimulants) within the past 30 days
  6. Be currently pregnant or nursing
  7. Have a history of substance abuse, or meet criteria for current alcohol abuse or dependence as assessed by a CAGE test score >=2 or an Alcohol Use Disorders Identification Test (AUDIT) score >=13
  8. Have surgery planned within the study period
  9. Have have ever been diagnosed with sleep apnea or have sleep apnea as indicated by endorsing either question 11 (I wake up choking or gasping for air) or question 12 (My bed partner has noticed that I seem to stop breathing) on the Sleep Disorders Symptom Check at the "Often" or "Frequently" level.
Both
21 Years to 75 Years   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
United States
 
NCT01091974
UCCS07090, 1R01CA126968-01A1
Yes
Not Provided
Not Provided
Joseph Roscoe, University of Rochester
University of Rochester
National Cancer Institute (NCI)
Principal Investigator: Joseph A Roscoe, PhD University of Rochester
University of Rochester
August 2015

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP