AYA ‘Can-Sleep’ Program : protocol for a stepped-care, cognitive behavioral therapy based approach to the management of sleep difficulties in adolescents and young adults with cancer

Abstract Background Sleep problems are reported in up to 50% of adolescents and young adults (AYA) with cancer. Cognitive Behaviour Therapy for insomnia (CBTi) is considered the gold-standard treatment. In the AYA population, CBTi is associated with improvements in insomnia, daytime sleepiness, fatigue and quality of life. In adults, stepped care interventions can improve accessibility to CBTi. This study aims to evaluate the acceptability and feasibility of a stepped care CBTi program in AYA with cancer. Methods and analysis : AYA (target N=80) will be screened using the Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS). When sleep difficulties are identified by the ISI and/or ESS, they will be screened for obstructive sleep apnoea and restless leg syndrome and referred as indicated. The remainder will be offered a stepped care sleep program including CBT self-management and coaching (first step). Participants will then be re-screened at 5 weeks, and those with ongoing sleep difficulties will be offered individualised CBT (second step). Recruitment and retention rates, adherence to intervention, and time taken to deliver screening and intervention will be collected to assess the feasibility of the program. AYA and clinicians will complete evaluation surveys to assess the acceptability of the AYA Can-Sleep Program. Discussion We seek to contribute to the evidence-base regarding screening and treatment of sleep difficulties in the AYA population by implementing the AYA Can-Sleep program and determining its feasibility and acceptability as an approach to care in an Adolescent & Young Adult Cancer Service.