Nonpharmacological Interventions for Sleep in People With Upper Gastrointestinal Cancer: A Systematic Review and Meta-Analysis.

Abstract

Sleep problems are common after an upper gastrointestinal (GI) cancer diagnosis. Identifying evidence-based interventions is critical to address sleep problems. This review aimed to summarise evidence on the efficacy of nonpharmacological interventions (NPIs) for sleep in individuals with upper GI cancer and to meta-analyse randomised controlled trials (RCTs). Six databases were searched from inception until July 2025. RCTs and quasi-experimental trials were included. The standardized mean difference (SMD) with random-effects model was used to report the pooled treatment effect. Cochrane risk-of-bias tool for RCTs (RoB 2) and GRADE scoring were used to assess the risk of bias and quality of the evidence overall and for each intervention type. Twenty-eight studies were included involving 2693 participants with upper GI cancer. The overall effect size of NPIs was large (SMD = -1.18, 95% CI [-1.62, -0.74], I² = 94%, P < 0.001). NPIs were divided into four types. The effect size of (1) physical activity and rehabilitation interventions (SMD = -0.35, 95 % CI [-0.64, 0.00], I² = 56%, P = 0.05), and (2) nutritional support interventions (SMD = -0.35, 95 % CI [-0.71, 0.02], I² = 57%, P = 0.06) were not statistically significant. However, statistically significant results were observed for other two intervention types: (3) Psychological, information and symptom management interventions (SMD = -1.85, 95 % CI [-2.70, -0.99], I² = 94%, P < 0.001), and (4) sensory-based interventions (SMD = -1.66, 95% CI [-2.60, -0.71], I² = 94%, P < 0.001). Most studies had some concerns or high risk of bias in at least one domain, particularly due to deviations from intended interventions and in measurement of the outcome. Due to heterogeneity and a limited number of trials, it is not possible to make definitive recommendations for the optimal intervention for improving sleep in people with upper GI cancer. Future research should include larger sample sizes, be randomised and include standardised procedures.