Non-pharmacological sleep management in breast cancer survivors: Evidence from a systematic review and meta-analysis of RCTs

Objective: Breast cancer is the most commonly diagnosed cancer among women worldwide. Although survival rates have improved through advances in screening and treatment, many survivors continue to experience chronic sleep disturbances that impair quality of life. This review synthesizes evidence from randomized clinical trials evaluating non-pharmacological interventions for sleep management in breast cancer survivors. Methods: Following PRISMA guidelines, systematic searches were conducted in PubMed, EMBASE, Scopus, and Web of Science from inception to December 2024. Eighty-nine eligible studies were identified, and 73 met the predefined criteria for inclusion in the meta-analysis. Results: Psychosocial interventions lead to substantial improvements in sleep quality (SMD = −1.12; 95% CI: −1.57, −0.68), while physical therapies, such as acupuncture, demonstrate moderate benefits (SMD = −0.86; 95% CI: −1.32, −0.41). Physical activity interventions showed minimal effects (SMD = −0.20; 95% CI: −0.39, 0.00). Additionally, psychosocial interventions significantly reduced insomnia symptoms (SMD = −0.82; 95% CI: −1.09, −0.55). Conclusion: Nonpharmacological interventions, particularly psychosocial strategies, may effectively improve sleep quality and reduce insomnia among breast cancer survivors, supporting the integration of individualized supportive care plans within comprehensive survivorship and long-term follow-up programs.