ONC-SLEEP Collaborative: COMISA Collaborative Care Integration in Oncology - Sleep problems affect most people with cancer yet often go unnoticed, driving fatigue, declines in daily functioning, and lower quality of life. A particularly harmful pattern is having both insomnia and obstructive sleep apnea (COMISA), which spans all ages and is linked to high blood pressure, heart disease, and higher mortality. While exact COMISA rates in oncology are not well measured, sleep apnea alone is common after treatment, often higher than in the general population, highlighting missed detection. More than 60% of patients report insomnia symptoms ranging from trouble falling or staying asleep to unrefreshing sleep and daytime sleepiness. These problems can worsen inflammation and metabolism and strain recovery, yet clinics rarely screen, underuse simple home testing, and lack clear referral paths. The ONC-SLEEP Collaborative (R21) tackles this gap by building and testing a clinic-friendly, team-based pathway grounded in the Collaborative Care Model (CoCM) that weaves sleep care into everyday oncology visits. The pathway includes brief screening for all patients, same-day warm handoffs to a care manager, home sleep testing when apnea is suspected, proven help for insomnia via cognitive behavioral therapy for insomnia (CBT-I), and practical support to use breathing devices for apnea using positive airway pressure (PAP). A simple registry will track who was screened, who started treatment, and who needs extra help so the team can adjust quickly. Aim 1 co-designs the pathway with patients and staff using short build, test, and refine cycles, finalizing screening steps, clarifying roles and handoffs, creating easy dashboards and checklists, and producing clear, multilingual materials in English, Arabic, and Spanish along with a brief clinic training kit. Aim 2 pilots the pathway in one National Cancer Institute (NCI) designated clinic with 15 to 20 patients to test workability and usefulness and to capture early benefits. We will track reach through screening and enrollment, timeliness by how quickly CBT-I starts, fidelity through PAP use and follow-up completion, and acceptability for patients and providers. We will also measure changes in insomnia, fatigue, and PAP adherence over about three months to inform a larger trial. This first tailored use of a collaborative, population-based CoCM approach for COMISA in oncology combines behavioral and device-based treatments, guided by simple tracking and designed for real clinic flow. Our team in oncology primary care, sleep medicine, and population science, together with Karmanos Cancer Institute infrastructure, is ready to deliver. If successful, we will produce a co-created pathway, a practical training toolkit, evidence of feasibility and acceptability, and early signs of improved sleep and energy, laying the groundwork for a scalable, patient-centered model that can spread across cancer centers.
