{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T17:54:30Z","timestamp":1791741270704,"version":"4.3.4"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T00:00:00Z","timestamp":1744156800000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sleep difficulties are common for people with advanced cancer and are associated with poorer mood, lower quality of life, and reduced survival. For these patients, insomnia severity ratings are tied to nighttime awakenings, but little is known about the reasons for awakenings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study reports actigraphy sleep outcomes, longitudinal self\u2010reported insomnia severity, and circadian rhythm disruptions from a randomized pilot study comparing a multi\u2010symptom intervention with a wait\u2010list control group for people with advanced cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty\u2010eight people with advanced cancer completed a brief intervention, Finding Our Center Under Stress (FOCUS), designed to enhance sleep and alleviate worry, depression, and fatigue. Participants completed questionnaires and wore an Actiwatch for 7 consecutive 24\u2010h periods pre\u2010 and post\u2010intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were no significant group\u00a0\u00d7\u00a0time actigraphy effects. However, sensitivity analyses with the full intervention sample including the wait\u2010list control arm demonstrated significant effects on actigraphy sleep efficiency, minutes awake after sleep onset (WASO), number of awakenings, naps, and activity at rest. Insomnia severity ratings on the Insomnia Severity Index were maintained longitudinally with 61% meeting the cut\u2010off for insomnia at baseline compared to 18% at 1\u00a0year. Participants demonstrated reductions in key reasons for awakenings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multi\u2010symptom interventions may be necessary for sustained insomnia improvements for people with advanced cancer. The FOCUS intervention is one of the first to demonstrate improvements on self\u2010reported and actigraphic measures of sleep in addition to other symptoms (i.e., worry, uncertainty, depression, fatigue interference, distress) for this population. Future effectiveness studies are warranted given results of this pilot trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Cognitive\u2010behavioral intervention for worry, uncertainty, and insomnia for cancer survivors (NCT01929720)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70141","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T22:52:31Z","timestamp":1744239151000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Combined Treatment With Cognitive Behavioral Therapy for Insomnia and Acceptance and Commitment Therapy Enhances Objective and Subjective Reports of Sleep in Patients With Advanced Cancer"],"prefix":"10.1002","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5193-7448","authenticated-orcid":false,"given":"Sharla","family":"Wells\u2010Di Gregorio","sequence":"first","affiliation":[{"name":"Division of Palliative Medicine Department of Internal Medicine The Ohio State University Wexner Medical Center  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy","family":"Flowers","sequence":"additional","affiliation":[{"name":"Department of Family Medicine Boonshoft School of Medicine Wright State University  Dayton Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Peng","sequence":"additional","affiliation":[{"name":"Center for Biostatistics The Ohio State University  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald R.","family":"Marks","sequence":"additional","affiliation":[{"name":"Division of Palliative Medicine Department of Internal Medicine The Ohio State University Wexner Medical Center  Columbus Ohio USA"},{"name":"Department of Advanced Studies in Psychology Kean University  Union New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Probst","sequence":"additional","affiliation":[{"name":"Division of Palliative Medicine Department of Internal Medicine The Ohio State University Wexner Medical Center  Columbus Ohio USA"},{"name":"Chronic Pain Rehabilitation Program Columbus Veteran's Administration Care Center  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Zaleta","sequence":"additional","affiliation":[{"name":"Division of Palliative Medicine Department of Internal Medicine The Ohio State University Wexner Medical Center  Columbus Ohio USA"},{"name":"Department of Research CancerCare  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don","family":"Benson","sequence":"additional","affiliation":[{"name":"Division of Hematology\u2010Oncology Department of Internal Medicine The Ohio State University Wexner Medical Center  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Cohn","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology Department of Obstetrics &amp; Gynecology The Ohio State University Wexner Medical Center  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Lustberg","sequence":"additional","affiliation":[{"name":"Breast Medical Oncology Yale Cancer Center  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Carson","sequence":"additional","affiliation":[{"name":"Division of Surgical Oncology Department of Surgery The Ohio State Wexner Medical Center  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uly","family":"Magalang","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine Department of Internal Medicine The Ohio State University Wexner Medical Center  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Baltimore","sequence":"additional","affiliation":[{"name":"Division of Palliative Medicine Department of Internal Medicine The Ohio State University Wexner Medical Center  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Ancoli\u2010Israel","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of California San Diego School of Medicine  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/10547738221092146"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/npp.2016.148"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1539"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/15402002.2012.660589"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.3642"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2022.101615"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1188\/09.ONF.E165\u2010E177"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010021\u201006317\u20103"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.1711"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4912"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010014\u20102204\u20105"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare\u20102018\u2010001505"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3603"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11764\u2010020\u201000930\u20107"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41416\u2010018\u20100154\u20102"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1188\/07.ONF.E51\u2010E59"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.47.7265"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.3918"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/15402002.2014.940108"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1188\/15.CJON.185\u2010191"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1438"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsz146"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.12.2135"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2014.161"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/082585979601200102"},{"issue":"11","key":"e_1_2_11_27_1","first-page":"35","article-title":"There\u2019s a S.M.A.R.T. 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