New Clues to Sleep Problems, Solutions in Cancer Patients

In In The News by Barbara Jacoby

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By: Mike Bassett

From: medpagetoday.com

Two late-breaking studies presented at the Oncology Nursing Society virtual annual meeting tackled an issue common to many cancer survivors — poor sleep.

In the first, researchers found that almost two-thirds of patients with gastrointestinal cancers who received chemotherapy had high levels of sleep disturbance, and that these patients were more likely to be younger, unmarried or unpartnered, have a higher comorbidity burden, and less likely to be physically active.

The study, led by Yufen Lin, MSN, RN, of Duke University School of Nursing in Durham, North Carolina, was part of a prospective longitudinal study of gastrointestinal cancer patients receiving chemotherapy. Participants included 405 patients from two comprehensive cancer centers, one VA hospital, and four community-based oncology programs.

The patients completed several questionnaires related to symptoms and outcomes, including performance status, sleep disturbance, depression and anxiety, and quality of life.

The researchers classified the patients into three groups:

  • Those with low sleep disturbance (35.8% of the total)
  • Those with high sleep disturbance (48.6% of the total)
  • Those with very high sleep disturbance (15.6% of the total)

The key differences in demographic and clinical characteristics in these groups included the following, Lin reported:

  • Patients in the high and very high sleep disturbance groups were younger (mean age of 57.1 and 55.0, respectively) than patients in the low sleep disturbance group (mean age of 60.4)
  • The number of comorbidities were higher in the very high (2.7) and high (2.5) sleep disturbance groups, compared with the low sleep disturbance group (2.0)
  • Similarly, the number of prior cancer treatments were higher in the very high (1.8) and high (1.5) groups, compared with the low disturbance group (1.1)

In addition, compared with patients in the low sleep disturbance group, patients in the high and very high groups were more likely to be female, less likely to be married or partnered, less likely to be employed, and less likely to engage in regular exercise. Patients in the very high sleep disturbance groups were more likely to suffer from depression (31.7%) and back pain (33.3%), than both the high sleep disturbance patients (16.2% and 22.8%, respectively) and low sleep disturbance patients (4.1% and 15.2%, respectively).

“Clinicians can use these common and distinct factors to identify high-risk patients with sleep disturbance and initiate appropriate sleep hygiene and referrals,” Lin said in her presentation.

“Also, future research is needed into personalized symptom management interventions,” she said adding that such interventions should incorporate patient preferences, their unique symptom experiences, and technologies that can further reduce the symptom burden and improve quality of life.

In the second study, researchers led by Gee Su Yang, PhD, RN, of the University of Connecticut School of Nursing in Storrs, determined that patients with breast cancer experience poor sleep quality while undergoing chemotherapy, but that it gradually improves over time.

“Only a few studies have examined long-term temporal changes of sleep disturbances and its relationships with multiple risk factors, such as health-promoting, lifestyle profiles, epigenetic factors, and perceived stress, as well as other psychoneurological symptoms,” Yang noted in her presentation.

She and her colleagues wanted to assess the characteristics of sleep disturbance and identify predictors that may contribute to the problem in breast cancer survivors, she explained.

The longitudinal study assessed 74 early-stage breast cancer patients at five points over a 2-year period (baseline prior to chemotherapy, midpoint in chemotherapy, and at 6-month, 1-year, and 2-year follow-up).

Patients reported “clinically meaningful” sleep disturbances in sleep onset latency, mid-sleep awakenings, early awakenings, and quality of sleep during chemotherapy, while mid-sleep awakenings, and fatigue at work showed significant temporal changes over 2 years, Yang said.

In addition, significant predictors of sleep disturbance included:

  • Anxiety at baseline, chemotherapy midpoint, and 1-year follow-up
  • Pain at baseline
  • Fatigue at the 6-month and 1-year follow-ups
  • Perceived stress at the 6-month and 2-year follow-ups

“The level of sleep disturbances has positive associations with levels of several concurrent symptoms, providing insight into important factors that could be considered for preventing or mitigating sleep disturbances in breast cancer survivors,” she said. “Our research suggests that symptom management can be strategized to ameliorate sleep disturbances considering there are associated predictors at different time points.”

Yang further suggested that self-awareness of anxiety, pain, fatigue, and perceived stress, as well as tailored interventions to address those symptoms, could help mitigate sleep disturbance throughout a patient’s cancer trajectory