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Assessment of sleep disturbances in patients with cancer: Cross-sectional study in a radiotherapy department

Published:March 15, 2015DOI:https://doi.org/10.1016/j.ejon.2014.12.008

      Abstract

      Purpose

      To explore sleep-related problems reported by patients with cancer prior to undergoing radiotherapy, and to analyse the effect of cancer severity, history of treatment and psychosomatic symptomatology on these problems.

      Method

      A descriptive cross-sectional study was conducted. One hundred and five patients with cancer were evaluated prior to radiotherapy. The primary endpoint was the sleep problem score measured by a self-rated version of the Oviedo Sleep Questionnaire. Secondary variables were impact of pain on sleep, anxiety and asthenia.

      Results

      Patients reported important levels of insomnia and hypersomnia. Insomnia-related problems were significantly higher in patients with more-severe disease (P < 0.05), and led to higher levels of hypnotic drug intake. Prior chemotherapy was significantly associated with hypersomnia-related problems (P < 0.05). Anxiety was significantly associated with both sleep-related problems.

      Conclusions

      Sleep problems are significant among patients with cancer prior to undergoing radiotherapy, and were found to be associated with progression of cancer, prior treatments and other psychosomatic symptoms (e.g. anxiety). Sleep problems within this context must be explored to provide adequate guidelines to palliate their effects on quality of life.

      Keywords

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      References

        • Alfaro E.
        • Dhruva A.
        • Langford D.J.
        • Koetters T.
        • Merriman J.D.
        • West C.
        • et al.
        Associations between cytokine gene variations and self-reported sleep disturbance in women following breast cancer surgery.
        European Journal of Oncology Nursing. 2014; 18: 85-93
        • American Academy of Sleep Medicine
        The International Classification of Sleep Disorders, Revised. Diagnostic and Coding Manual.
        (Authors, Westchester)2001
        • Andersen B.L.
        • Golden-Kreutz D.M.
        • Emery C.F.
        • Thiel D.L.
        Biobehavioral intervention for cancer stress: conceptualization, components, and intervention strategies.
        Cognitive and Behavioral Practice. 2009; 16: 253-265
        • Berger A.M.
        Update on the state of the science: sleep–wake disturbances in adult patients with cancer.
        Oncology Nursing Forum. 2009; 36: E165-E177
        • Berger A.M.
        • Wielgus K.
        • Hertzog M.
        • Fischer P.
        • Farr L.
        Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy.
        Supportive Care in Cancer. 2010; 18: 105-114
        • Bobes J.
        • Gonzalez M.P.
        • Saiz P.
        • Bascarán M.T.
        • Iglesias C.
        • Fernandez J.M.
        Propiedades psicométricas del Cuestionario Oviedo de Sueño.
        Psicothema. 2000; 12: 107-112
        • Cheng K.K.F.
        • Yeung R.M.W.
        Impact of mood disturbance, sleep disturbance, fatigue and pain among patients receiving cancer therapy.
        European Journal of Cancer Care. 2013; 22: 70-78
        • Clevenger L.
        • Schrepf A.
        • Christensen D.
        • DeGeest K.
        • Bender D.
        • Ahmed A.
        • et al.
        Sleep disturbance, cytokines, and fatigue in women with ovarian cancer.
        Brain, Behavior, and Immunity. 2012; 26: 1037-1044
        • Colagiuri B.
        • Christensen S.
        • Jensen A.B.
        • Price M.A.
        • Butow P.N.
        • Zachariae R.
        Prevalence and predictors of sleep difficulty in a national cohort of women with primary breast cancer three to four months postsurgery.
        Journal of Pain and Symptom Management. 2011; 42: 710-720
        • Costa-Requena G.
        • Rodríguez A.
        • Fernández-Ortega P.
        Longitudinal assessment of distress and quality of life in the early stages of breast cancer treatment.
        Scandinavian Journal of Caring Science. 2013; 27: 77-83
        • Davidson J.R.
        • MacLean A.W.
        • Brundage M.D.
        • Schulze K.
        Sleep disturbance in cancer patients.
        Social Science and Medicine. 2002; 54: 1309-1321
        • Dhruva A.
        • Paul S.M.
        • Cooper B.A.
        • Lee K.
        • West C.
        • Aouizerat B.E.
        • et al.
        A longitudinal study of measures of objective and subjective sleep disturbance in patients with breast cancer before, during, and after radiation therapy.
        Journal of Pain and Symptom Management. 2012; 44: 215-228
        • Die Trill M.
        Anxiety and sleep disorders in cancer patients.
        European Journal of Cancer. 2013; 11: 216-224
        • Dirksen S.R.
        • Epstein D.R.
        • Hoyt M.A.
        Insomnia, depression, and distress among outpatients with prostate cancer.
        Applied Nursing Research. 2009; 22: 154-158
        • Fiorentino L.
        • Rissling M.
        • Liu L.
        • Ancoli-Israel S.
        The symptom cluster of sleep, fatigue and depressive symptoms in breast cancer patients: severity of the problem and treatment options.
        Drug Discovery Today: Disease Models. 2011; 8: 167-173
        • Forsythe L.P.
        • Helzlsouer K.J.
        • MacDonald R.
        • Gallichio L.
        Daytime sleepiness and sleep duration in long-term cancer survivors and non-cancer controls: results from a registry-based survey study.
        Supportive Care in Cancer. 2012; 20: 2425-2432
        • Fortner B.V.
        • Stepanski E.J.
        • Wang S.C.
        • Kasprowicz S.
        • Durrence H.H.
        Sleep and quality of life in breast cancer patients.
        Journal of Pain and Symptom Management. 2002; 24: 471-480
        • García-Portilla M.P.
        • Sáiz P.A.
        • Díaz-Mesa E.M.
        • Fonseca E.
        • Arrojo M.
        • Sierra P.
        • et al.
        Rendimiento psicométrico del Cuestionario Oviedo de Sueño en pacientes con trastorno mental grave.
        Revista de Psiquiatría y Salud Mental. 2009; 2: 169-177
        • Gibbins J.
        • McCoubrie R.
        • Kendrick A.H.
        • Senior-Smith G.
        • Davies A.N.
        • Hanks G.W.
        Sleep–wake disturbances in patients with advanced cancer and their family carers.
        Journal of Pain and Symptom Management. 2009; 38: 860-870
        • Hamilton M.
        The assessment of anxiety states by rating.
        British Journal of Medical Psychology. 1959; 32: 50-55
        • Hanisch L.J.
        • Gooneratne N.S.
        • Soin K.
        • Gehrman P.R.
        • Vaughn D.J.
        • Coyne J.C.
        Sleep and daily functioning during androgen deprivation therapy for prostate cancer.
        European Journal of Cancer Care. 2011; 20: 549-554
        • Howell D.
        • Oliver T.K.
        • Keller-Olaman S.
        • Davidson J.
        • Garland S.
        • Samuels C.
        • et al.
        A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer.
        Supportive Care in Cancer. 2013; 21: 2695-2706
        • Jensen M.P.
        The validity and reliability of pain measures in adults with cancer.
        Journal of Pain. 2003; 4: 2-21
        • Kirkova J.
        • Aktas A.
        • Walsh D.
        • Davis M.P.
        Cancer symptom clusters: clinical and research methodology.
        Journal of Palliative Medicine. 2011; 14: 1149-1166
        • Lazarus R.S.
        • Folkman S.
        Stress, Appraisal, and Coping.
        Springer, 1984
        • Le Guen Y.
        • Gagnadoux F.
        • Hureaux J.
        • Jeanfaivre T.
        • Meslier N.
        • Racineux J.L.
        • et al.
        Sleep disturbances and impaired daytime functioning in outpatients with newly diagnosed lung cancer.
        Lung Cancer. 2007; 58: 139-143
        • Liu L.
        • Mills P.J.
        • Rissling M.
        • Fiorentino L.
        • Natarajan L.
        • Dimsdale J.E.
        • et al.
        Fatigue and sleep quality are associated with changes in inflammatory markers in breast cancer patients undergoing chemotherapy.
        Brain, Behavior, and Immunity. 2012; 26: 706-713
        • López E.
        • Lazo A.
        • de la Torre-Luque A.
        • Álvarez J.
        Assessment of sleep disturbances and anxiety in breast cancer patients.
        in: XVII National Congress of the Spanish Society for Radiation Oncology, Vigo, Spain, Oral presentation. 2013
        • McGregor B.A.
        • Antoni M.H.
        Psychological intervention and health outcomes among women treated for breast cancer: a review of stress pathways and biological mediators.
        Brain, Behavior, and Immunity. 2009; 23: 159-166
        • Miaskowski C.
        • Lee K.
        • Dunn L.
        • Dodd M.
        • Aouizerat B.E.
        • West C.
        • et al.
        Sleep–wake circadian activity rhythm parameters and fatigue in oncology patients before the initiation of radiation therapy.
        Cancer Nursing. 2011; 34: 255-268
        • Miller G.A.
        • Chapman J.P.
        Misunderstanding analysis of covariance.
        Journal of Abnormal Psychology. 2001; 110: 40-48
        • Monroe S.M.
        Modern approaches to conceptualizing and measuring human life stress.
        Annual Review of Clinical Psychology. 2008; 4: 33-52
        • Mosher C.E.
        • DuHamel K.N.
        An examination of distress, sleep, and fatigue in metastatic breast cancer patients.
        Psycho-Oncology. 2012; 21: 100-107
        • Mystakidou M.
        • Parpa E.
        • Tsilika E.
        The relationship of subjective sleep quality, pain, and quality of life in advanced cancer patients.
        Sleep. 2007; 30: 737-742
        • Mystakidou M.
        • Parpa E.
        • Tsilika E.
        How is sleep quality affected by the psychological and symptom distress of advanced cancer patients?.
        Palliative Medicine. 2009; 23: 46-53
        • Otte J.L.
        • Carpenter J.S.
        • Russell K.M.
        • Bigatti S.
        • Champion V.L.
        Prevalence, severity, and correlates of sleep–wake disturbances in long-term breast cancer survivors.
        Journal of Pain and Symptom Management. 2010; 39: 535-547
        • Palesh O.G.
        • Collie K.
        • Batiuchok D.
        • Tilston J.
        • Koopman C.
        • Perlis M.L.
        • et al.
        A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer.
        Biological Psychology. 2007; 75: 37-44
        • Palesh O.G.
        • Roscoe J.A.
        • Mustian K.M.
        • Roth T.
        • Savard J.
        • Ancoli-Israel S.
        • et al.
        Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center–Community Clinical Oncology Program.
        Journal of Clinical Oncology. 2010; 28: 292-298
        • Price M.A.
        • Zachariae R.
        • Butow P.N.
        • deFazio A.
        • Chauhan D.
        • Espie C.A.
        • et al.
        Prevalence and predictors of insomnia in women with invasive ovarian cancer: anxiety a major factor.
        European Journal of Cancer. 2009; 45: 3262-3270
        • Reimer M.A.
        • Flemons W.W.
        Quality of life in sleep disorders.
        Sleep Medicine Reviews. 2003; 7: 335-349
        • Roscoe J.A.
        • Kaufman M.E.
        • Matteson-Rusby S.E.
        • Palesh O.G.
        • Ryan J.L.
        • Kohli S.
        • et al.
        Cancer-related fatigue and sleep disorders.
        Oncologist. 2007; 12: 35-42
        • Savard J.
        • Liu L.
        • Natarajan L.
        • Rissling M.B.
        • Neikrug A.B.
        • He F.
        • et al.
        Breast cancer patients have progressively impaired sleep–wake activity rhythms during chemotherapy.
        Sleep. 2009; 32: 1155-1160
        • Schag C.C.
        • Heinrich R.L.
        • Ganz P.A.
        Karnofsky performance status revisited: reliability, validity, and guidelines.
        Journal of Clinical Oncology. 1984; 2: 187-193
        • Sharma N.
        • Hansen C.H.
        • O'Connor M.
        • Thekkumpurath P.
        • Walker J.
        • Kleiboer A.
        • et al.
        Sleep problems in cancer patients: prevalence and association with distress and pain.
        Psycho-Oncology. 2011; 21: 1003-1009
      1. Sobin L.H. Gospodarowicz M.K. Wittekind C. TNM Classification of Malignant Tumors. seventh ed. Wiley-Blackwell, Oxford2009
        • Stiegelis H.E.
        • Ranchor A.V.
        • Sanderman R.
        Psychological functioning in cancer patients treated with radiotherapy.
        Patient Education and Counseling. 2004; 52: 131-141
        • Thomas K.S.
        • Bower J.
        • Hoyt M.A.
        • Sepah S.
        Disrupted sleep in breast and prostate cancer patients undergoing radiation therapy: the role of coping processes.
        Psycho-Oncology. 2010; 19: 767-776
        • Tsai J.S.
        • Wu C.H.
        • Chiu T.Y.
        • Chen C.Y.
        Significance of symptom clustering in palliative care of advanced cancer patients.
        Journal of Pain and Symptom Management. 2010; 39: 655-662
        • Van Onselen C.
        • Dunn L.B.
        • Lee K.
        • Dodd M.
        • Koetters T.
        • West C.
        • et al.
        Relationship between mood disturbance and sleep quality in oncology outpatients at the initiation of radiation therapy.
        European Journal of Oncology Nursing. 2010; 14: 373-379
        • Wu H.-S.
        • Davis J.E.
        • Natavio T.
        Fatigue and disrupted sleep–wake patterns in patients with cancer: a shared mechanism.
        Clinical Journal of Oncology Nursing. 2012; 16: E56-E68
        • Zimmermann C.
        • Burman D.
        • Follwell M.
        • Wakimoto K.
        • Seccareccia D.
        • Bryson J.
        • et al.
        Predictors of symptom severity and response in patients with metastatic cancer.
        American Journal of Hospice and Palliative Care. 2010; 27: 175-181