The effectiveness of non-pharmacological interventions on sleep quality in lung cancer patients: a systematic review and meta-analysis (2015-2025)
Clinical Snapshot
PICO Framework
| P — Population | Adult patients with lung cancer (any stage, any treatment phase) experiencing sleep disturbance or sleep disorders |
| I — Intervention | Non-pharmacological interventions (e.g., cognitive behavioural therapy for insomnia [CBT-I], exercise, mindfulness-based stress reduction, acupuncture, music therapy, relaxation techniques, digital/telehealth modalities) |
| C — Comparator | Usual care, placebo, or standard oncology care |
| O — Outcomes | Primary: sleep quality (predominantly measured by Pittsburgh Sleep Quality Index [PSQI]); Secondary: health-related quality of life and anxiety levels |
Bottom Line
This systematic review and meta-analysis synthesises evidence from 24 studies (2,604 patients) on non-pharmacological interventions for sleep disturbance in lung cancer patients. The directional findings suggest benefit across sleep quality, quality of life, and anxiety outcomes, and the authors appropriately rate evidence certainty as low to moderate using GRADE. However, the absence of reported pooled effect sizes, confidence intervals, and heterogeneity statistics in the abstract significantly limits independent appraisal of clinical magnitude and consistency. The extreme diversity of interventions studied — spanning CBT-I, exercise, acupuncture, mindfulness, and music therapy — makes pooled estimates difficult to interpret clinically. Publication bias cannot be excluded given the predominantly positive findings and heavy reliance on Chinese-language literature. For Australian clinicians, CBT-I remains the most evidence-supported non-pharmacological option for cancer-related insomnia and is accessible via Medicare-subsidised psychology services. This review supports the clinical rationale for offering structured non-pharmacological sleep interventions to lung cancer patients but does not provide sufficient precision or certainty to mandate specific protocols. High-quality, adequately powered RCTs with pre-registered protocols and objective sleep measurement are needed before definitive practice recommendations can be made.
Key Findings
P Value: Not reported in the abstract
Effect Size: Not reported in the abstract; pooled standardised mean difference not disclosed
Primary Outcome: Sleep quality in lung cancer patients, measured predominantly by the Pittsburgh Sleep Quality Index (PSQI); non-pharmacological interventions demonstrated a positive directional effect compared with usual care or standard oncology care across 20 included studies
Nnt Or Sensitivity: Not calculable from available abstract data; no NNT, SMD, or response rate data provided. GRADE certainty rated as low to moderate, indicating that the true effect may differ substantially from the estimated effect
Confidence Interval: Not reported in the abstract
Clinical Application
Non-pharmacological interventions are generally low-risk and feasible in oncology settings. CBT-I is deliverable by trained nurses, psychologists, or via digital platforms. Exercise-based interventions require physiotherapy input and safety screening. Mindfulness and relaxation techniques have low resource requirements. Acupuncture requires credentialled practitioners. Implementation feasibility varies significantly by intervention type, patient performance status, and healthcare setting (inpatient vs. community). Scalability is a practical concern in resource-constrained oncology services. In Australia, lung cancer is the leading cause of cancer mortality, with approximately 13,800 new cases diagnosed annually (Cancer Australia data). Sleep disturbance is a recognised but undertreated comorbidity in this population. RACGP and Cancer Australia guidelines acknowledge the importance of supportive care in cancer management. CBT-I is recommended as first-line therapy for chronic insomnia by the RACGP and is increasingly available via Medicare-subsidised psychology services (Better Access initiative, Mental Health Treatment Plans). Acupuncture is not currently PBS-listed for cancer-related insomnia but may be accessed privately. Exercise oncology programs are supported by Cancer Australia and delivered through services such as Exercise & Sports Science Australia (ESSA)-credentialled practitioners. Digital health interventions (e.g., Sleepio, SleepHub) are not yet TGA-regulated as therapeutic devices for cancer-related insomnia but represent a growing area. The predominantly Chinese study population in this review limits direct generalisability to the ethnically diverse Australian lung cancer population, and cultural adaptation of interventions would be required. Adult patients with confirmed lung cancer (any histological type or stage) experiencing clinically significant sleep disturbance, particularly those in active treatment or survivorship phases where pharmacological sleep aids carry heightened risk (e.g., opioid-sparing contexts, patients with respiratory compromise, polypharmacy burden)
Abstract
PURPOSE: Sleep disorders are highly prevalent among lung cancer patients and seriously affect their quality of life and mental health. This systematic review and meta-analysis aimed to assess the effects of non-pharmacological interventions on sleep quality, quality of life, and anxiety in lung cancer patients. METHODS: PubMed, Web of Science, Cochrane Library, CINAHL, Embase, CNKI, Wanfang Data, and VIP databases for studies published between 2015 and February 2025. The primary outcome was sleep quality, with quality of life and anxiety levels as secondary outcomes. We assessed the risk of bias using the Cochrane tool and synthesized data using meta-analysis. RESULTS: Twenty-four studies involving 2604 patients were included. Non-pharmacological interventions were compared with usual care, placebo, or standard oncology care. After excluding studies with inappropriate content and methods, 20 studies evaluated sleep quality, and 12 studies evaluated quality of life and anxiety levels, respectively. The quality of the evidence was low to moderate; the promotion results should be interpreted with caution, but they may have a positive effect on the sleep quality, quality of life, and anxiety levels of lung cancer patients. CONCLUSIONS: Diverse non-pharmacological interventions can improve sleep quality, quality of life, and anxiety in lung cancer patients. However, high-quality, rigorously designed randomized controlled trials are still needed to confirm these findings. Future research should focus on personalized interventions tailored to lung cancer patients' characteristics and integrate digital health interventions to better support clinical decision-making.
References
- 1.Zhao, J., Yu, Y., Shu, S., Shi, J., Zhang, T., Wang, P., & Chen, Y. (2026). The effectiveness of non-pharmacological interventions on sleep quality in lung cancer patients: a systematic review and meta-analysis (2015-2025). Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer. https://doi.org/10.1002/pon.5167
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