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Madsen MT, Huang C, Zangger G, Zwisler ADO, Gögenur I. Sleep Disturbances in Patients With Coronary Heart Disease: A Systematic Review. J Clin Sleep Med 2019; 15:489-504. [PMID: 30853047 DOI: 10.5664/jcsm.7684] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/08/2019] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVES Investigation into sleep and coronary heart disease (CHD) has predominantly been focused on sleep disturbances as a risk factor for developing CHD. Objectively measured and self-reported sleep at a patient level has only been sparsely and not systematically reported. Therefore, we set out to review the literature for studies using objectively measured and self-reported sleep in patients with CHD. The review focuses on patients with acute coronary syndrome (ACS) and stable CHD. METHODS A systematic review performed in four databases adhering to the PRISMA guidelines applying a qualitative synthesis of evidence. RESULTS Following ACS, we found sleep architecture to be significantly disturbed with changes normalizing over a period of up to 6 months. With increasing severity of CHD, sleep disturbances were more pronounced; however, the modulating effects of sleep-disordered breathing and ejection fraction on sleep in patients with CHD are conflicting. Overall, studies were predominantly cross-sectional in design and of low methodological quality. Polysomnography was the predominant outcome assessment tool and validated self-reported assessment tools were limited. CONCLUSIONS Future investigations in sleep and CHD applying both a longitudinal design and investigating objective and self-reported sleep assessments are warranted. SYSTEMATIC REVIEW REGISTRATION Registry: PROSPERO, Title: Sleep measures in relation to coronary heart disease: a systematic review, Identifier: CRD42017056377, URL: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=56377.
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Affiliation(s)
- Michael Tilling Madsen
- Center for Surgical Science, Zealand University Hospital, Denmark.,Department of Emergency, Zealand University Hospital, Denmark
| | - Chenxi Huang
- Center for Surgical Science, Zealand University Hospital, Denmark
| | - Graziella Zangger
- REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Denmark
| | - Ann Dorthe Olsen Zwisler
- REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital and University of Southern Denmark, Denmark
| | - Ismail Gögenur
- Center for Surgical Science, Zealand University Hospital, Denmark
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Palesh O, Scheiber C, Kesler S, Gevirtz R, Heckler C, Guido JJ, Janelsins M, Cases MG, Tong B, Miller JM, Chrysson NG, Mustian K. Secondary outcomes of a behavioral sleep intervention: A randomized clinical trial. Health Psychol 2019; 38:196-205. [PMID: 30762399 PMCID: PMC6892630 DOI: 10.1037/hea0000700] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Nearly 80% of cancer patients struggle with insomnia, which is associated with decreased heart rate variability (HRV) and quality of life (QOL). The aim of this secondary analysis was to evaluate the possible effects of Brief Behavioral Therapy for Cancer-Related Insomnia (BBT-CI), delivered during chemotherapy visits, on QOL and HRV in patients with breast cancer (BC). METHOD QOL and HRV data were obtained during a pilot clinical trial assessing the feasibility and effects of BBT-CI on insomnia. A total of 71 BC patients (mean age = 52.5 years) were randomly assigned to either BBT-CI or a healthy-eating control intervention (HEAL). BBT-CI and HEAL were delivered over 6 weeks (2 face-to-face sessions plus 4 phone calls) by trained staff at 4 National Cancer Institute-funded Community Oncology Research Program clinics. QOL was measured with the Functional Assessment of Cancer Therapy (FACT-G) and HRV with the Firstbeat device at baseline and after intervention. RESULTS There were significant improvements in QOL after intervention for BBT-CI (FACT-G, p = .009; FACT-B, p = .016; ANCOVA) and 5-min supine HRV measures (SDNN, p = .005; rMSSD, p = .004; HF, p = .009; ANCOVA) compared with HEAL. CONCLUSIONS Patients randomized to BBT-CI showed improvements in QOL and HRV, providing support for BBT-CI's possible benefit when delivered in the community oncology setting by trained staff. A more definitive efficacy trial of BBT-CI is currently being planned with sufficient statistical power to evaluate the intervention's clinical utility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford
University
| | - Caroline Scheiber
- Department of Psychiatry and Behavioral Sciences, Stanford
University
| | - Shelli Kesler
- Department of Neuro-Oncology, University of Texas MD
Anderson Cancer Center
| | - Richard Gevirtz
- Clinical Psychology PhD Program, Alliant International
University
| | - Charles Heckler
- James P. Wilmot Cancer Institute, University of Rochester
Medical Center
| | - Joseph J. Guido
- James P. Wilmot Cancer Institute, University of Rochester
Medical Center
| | - Michelle Janelsins
- James P. Wilmot Cancer Institute, University of Rochester
Medical Center
| | - Mallory G. Cases
- Department of Psychiatry and Behavioral Sciences, Stanford
University
| | - Bingjie Tong
- Department of Psychiatry and Behavioral Sciences, Stanford
University
| | - Jessica M. Miller
- Cancer Control Trials, Metro-Minnesota Community Oncology
Research Consortium
| | | | - Karen Mustian
- James P. Wilmot Cancer Institute, University of Rochester
Medical Center
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53
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Peoples AR, Garland SN, Pigeon WR, Perlis ML, Wolf JR, Heffner KL, Mustian KM, Heckler CE, Peppone LJ, Kamen CS, Morrow GR, Roscoe JA. Cognitive Behavioral Therapy for Insomnia Reduces Depression in Cancer Survivors. J Clin Sleep Med 2019; 15:129-137. [PMID: 30621831 DOI: 10.5664/jcsm.7586] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 10/01/2018] [Indexed: 01/06/2023]
Abstract
STUDY OBJECTIVES The current archival analyses examine the direct and indirect effects of cognitive behavioral therapy for insomnia (CBT-I) on depression in cancer survivors. METHODS We report on 67 cancer survivors from a 2 × 2 randomized controlled trial of CBT-I and armodafinil for insomnia, after collapsing across the noneffective study medication conditions (armodafinil/placebo) to create CBT-I (yes/no). Depression and insomnia were assessed before, during the 7-week CBT-I intervention, at postintervention, and 3 months later by the Patient Health Questionnaire and the Insomnia Severity Index, respectively. RESULTS Mean depression at baseline for all participants was 6.44 (standard error = 0.41, range 0-15). Paired t tests showed that depression improved from baseline to postintervention by 48% (P < .001) in the CBT-I group versus 15% (P = .016) in the non-CBT-I group. Analysis of covariance controlling for baseline found that participants receiving CBT-I had significantly less depression at postintervention (effect size = -0.62; P = .001), compared to those who did not receive CBT-I. These benefits were maintained at the 3-month follow-up. Spearman rank correlations showed that changes in insomnia severity from baseline to postintervention were significantly correlated with concurrent changes in depression (r = .73; P < .001). Path analysis revealed that improvement in depression was mediated by improvement in insomnia severity (P < .001). CONCLUSIONS Our findings provide preliminary support that in cancer survivors, CBT-I reduces depression via improvement in insomnia. Further, this reduction in depression remained stable 3 months after completing CBT-I. This suggests that a CBT-I intervention has a meaningful effect on depression. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Cognitive Behavioral Therapy +/- Armodafinil for Insomnia and Fatigue Following Chemotherapy; Identifier: NCT01091974; URL: https://clinicaltrials.gov/ct2/show/record/NCT01091974.
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Affiliation(s)
- Anita R Peoples
- Clinical and Translational Science Institute, University of Rochester Medical Center, Rochester, New York
| | - Sheila N Garland
- Departments of Psychology and Oncology, Memorial University, Newfoundland, Canada
| | - Wilfred R Pigeon
- Departments of Psychiatry and Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Michael L Perlis
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julie Rya Wolf
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Kathi L Heffner
- School of Nursing and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Karen M Mustian
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Charles E Heckler
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Luke J Peppone
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Charles S Kamen
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Gary R Morrow
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Joseph A Roscoe
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
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Gonzalez BD, Grandner MA, Caminiti CB, Hui SKA. Cancer survivors in the workplace: sleep disturbance mediates the impact of cancer on healthcare expenditures and work absenteeism. Support Care Cancer 2018; 26:4049-4055. [PMID: 29869719 PMCID: PMC6204101 DOI: 10.1007/s00520-018-4272-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/14/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE History of cancer is significantly associated with increases in healthcare costs, worse work performance, and higher absenteeism in the workplace. This is particularly important as most cancer survivors return to employment. Sleep disturbance is a largely overlooked potential contributor to these changes. METHODS Data from 9488 state employees participating in the Kansas State employee wellness program were used to assess cancer history, sleep disturbance, healthcare expenditures, work performance ratings, and absenteeism. Participants were categorized as having had no history of breast or prostate cancer, a past history only with no current cancer treatment, or current treatment for breast or prostate cancer. Indirect mediation analyses determined whether sleep disturbance mediated the influence of cancer status on outcomes. RESULTS Employees receiving treatment for breast or prostate cancer had significantly greater healthcare expenditures and absenteeism than those with a past history or no history of cancer (ps < .0001). Sleep disturbance significantly mediated the impact of cancer on healthcare expenditures and absenteeism (ps < .05), accounting for 2 and 8% of the impact of cancer on healthcare expenditure and missed full days of work, respectively. CONCLUSIONS The worse outcomes observed among employees receiving treatment for breast and prostate cancer, the most common forms of cancer among women and men, were partially explained by the impacts of cancer and treatment for cancer on sleep disturbance. These findings suggest that preventing or addressing sleep disturbance may result in economic benefits in addition to improvements in health and quality of life.
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Affiliation(s)
- Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, MRC-CAN CONT, Tampa, FL, 33612, USA.
| | - Michael A Grandner
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, AZ, USA
| | | | - Siu-Kuen Azor Hui
- Research and Evaluation Group, Public Health Management Corporation, Philadelphia, PA, USA
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55
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Palesh O, Scheiber C, Kesler S, Janelsins MC, Guido JJ, Heckler C, Cases MG, Miller J, Chrysson NG, Mustian KM. Feasibility and acceptability of brief behavioral therapy for cancer-related insomnia: effects on insomnia and circadian rhythm during chemotherapy: a phase II randomised multicentre controlled trial. Br J Cancer 2018; 119:274-281. [PMID: 30026614 PMCID: PMC6068121 DOI: 10.1038/s41416-018-0154-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 05/20/2018] [Accepted: 05/31/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This phase II RCT was conducted to determine the feasibility and acceptability of brief behavioral therapy for cancer-related insomnia (BBT-CI) in breast cancer patients undergoing chemotherapy. We also assessed the preliminary effects of BBT-CI on insomnia and circadian rhythm in comparison to a Healthy Eating Education Learning control condition (HEAL). METHODS Of the 71 participants recruited, 34 were randomised to receive BBT-CI and 37 to receive HEAL. Oncology staff was trained to deliver the intervention in four community clinics affiliated with the NCI. Insomnia was assessed with the Insomnia Severity Index (ISI), and circadian rhythm was assessed using a wrist-worn actiwatch. RESULTS Community staff interveners delivered 72% of the intervention components, with a recruitment rate of 77% and an adherence rate of 73%, meeting acceptability and feasibility benchmarks. Those randomised to BBT-CI improved their ISI scores by 6.3 points compared to a 2.5-point improvement in those randomised to HEAL (P = 0.041). Actigraphy data indicated that circadian functioning improved in the BBT-CI arm as compared to the HEAL arm at post-intervention (all P-values <0.05). CONCLUSIONS BBT-CI is an acceptable and feasible intervention that can be delivered directly in the community oncology setting by trained staff. The BBT-CI arm experienced significant improvements in insomnia and circadian rhythm as compared to the control condition.
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Affiliation(s)
- Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
| | - Caroline Scheiber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Shelli Kesler
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michelle C Janelsins
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Joseph J Guido
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Charles Heckler
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
| | - Mallory G Cases
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Jessica Miller
- Metro-Minnesota Community Oncology Research Consortium, Minneapolis, MN, USA
| | | | - Karen M Mustian
- University of Rochester Medical Center, James P. Wilmot Cancer Institute, Rochester, NY, USA
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56
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Kuo H, Tsao Y, Tu H, Dai Z, Creedy DK. Pilot randomized controlled trial of auricular point acupressure for sleep disturbances in women with ovarian cancer. Res Nurs Health 2018; 41:469-479. [DOI: 10.1002/nur.21885] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/27/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Hui‐Chen Kuo
- Kaohsiung Veterans General HospitalKaohsiungTaiwan
| | - Ying Tsao
- Department of NursingTzu‐Chi UniversityHualienTaiwan
| | - Hua‐You Tu
- Kaohsiung Veterans General HospitalKaohsiungTaiwan
| | - Zih‐Huei Dai
- Kaohsiung Veterans General HospitalKaohsiungTaiwan
| | - Debra K. Creedy
- School of Nursing & MidwiferyGriffith UniversityMeadowbrookQueenslandAustralia
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Vin-Raviv N, Akinyemiju TF, Galea S, Bovbjerg DH. Sleep disorder diagnoses and clinical outcomes among hospitalized breast cancer patients: a nationwide inpatient sample study. Support Care Cancer 2018; 26:1833-1840. [PMID: 29264658 DOI: 10.1007/s00520-017-4012-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/05/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE Sleep disturbances are recognized as a problem for many cancer patients, but little is known about the prevalence of sleep disorders among women hospitalized with breast cancer, or their relationship to in-hospital outcomes. The present study represents a first step toward determining the clinical significance of sleep disorders for hospitalized breast cancer patients with regard to complications, length of hospital stay, and mortality. METHODS The relationships between sleep disorders and in-hospital outcomes among 84,424 hospitalized breast cancer patients were examined. This study analyzed the Nationwide Inpatient Sample (NIS) database (2007 to 2011) for all women ages 40 years and older with a primary discharge diagnosis of breast cancer and a secondary discharge diagnosis of sleep disorder. Odds ratios, estimates, and 95% confidence intervals were computed using multivariable regression adjusting for age, comorbidities, race, cancer stage, income, insurance type, residential region, year of discharge, and surgical treatment type. RESULTS Among women hospitalized with a primary diagnosis of breast cancer, 2% (n = 1807) also received a diagnosis of a sleep disorder during hospitalization, the majority of which were sleep-related breathing disorders (n = 1274). Although there was no significant association between having a diagnosis of a sleep disorder and in-hospital mortality, patients with a sleep disorder were more likely to also experience complications (OR = 1.58, 95% CI 1.29-1.34) and have longer hospital stays (mean = 0.44 days longer, 95% CI 0.25-0.63). CONCLUSION Hospitalized breast cancer patients with a sleep disorder were more likely to experience clinical complications and stay longer in the hospital. It remains an open and important question for future research whether interventions to improve sleep during hospitalization would help to improve clinical outcomes.
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Affiliation(s)
- Neomi Vin-Raviv
- School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA.
- University of Northern Colorado Cancer Rehabilitation Institute, School of Sport and Exercise Science, University of Northern Colorado, Greeley, CO, USA.
| | - T F Akinyemiju
- Department of Epidemiology, University of Alabama School of Public Health, Birmingham, AL, USA
| | - S Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - D H Bovbjerg
- University of Pittsburgh, and the UPMC-Hillman Cancer Center, Division Departments of Psychiatry, Psychology, Behavioral & Community Health Sciences, and Health & Community Systems, Pittsburgh, PA, USA
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Kovacevic A, Mavros Y, Heisz JJ, Fiatarone Singh MA. The effect of resistance exercise on sleep: A systematic review of randomized controlled trials. Sleep Med Rev 2018; 39:52-68. [DOI: 10.1016/j.smrv.2017.07.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 06/04/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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59
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Henneghan AM, Carter P, Stuifbergan A, Parmelee B, Kesler S. Relationships between self-reported sleep quality components and cognitive functioning in breast cancer survivors up to 10 years following chemotherapy. Psychooncology 2018; 27:1937-1943. [PMID: 29683228 DOI: 10.1002/pon.4745] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/22/2018] [Accepted: 04/16/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Links have been made between aspects of sleep quality and cognitive function in breast cancer survivors (BCS), but findings are heterogeneous. The objective of this study is to examine relationships between specific sleep quality components (latency, duration, efficiency, daytime sleepiness, sleep disturbance, use of sleep aids) and cognitive impairment (performance and perceived), and determine which sleep quality components are the most significant contributors to cognitive impairments in BCS 6 months to 10 years post chemotherapy. METHODS Women 21 to 65 years old with a history of non-metastatic breast cancer following chemotherapy completion were recruited. Data collection included surveys to evaluate sleep quality and perceived cognitive impairments, and neuropsychological testing to evaluate verbal fluency and memory. Descriptive statistics, bivariate correlations, and hierarchical multiple regression were calculated. RESULTS Ninety women (mean age 49) completed data collection. Moderate significant correlations were found between daytime dysfunction, sleep efficiency, sleep latency, and sleep disturbance and perceived cognitive impairment (Rs = -0.37 to -0.49, Ps < .00049), but not objective cognitive performance of verbal fluency, memory, or attention. After accounting for individual and clinical characteristics, the strongest predictors of perceived cognitive impairments were daytime dysfunction, sleep efficiency, and sleep disturbance. CONCLUSIONS Findings support links between sleep quality and perceived cognitive impairments in BCS and suggest specific components of sleep quality (daytime dysfunction, sleep efficiency, and sleep disturbance) are associated with perceived cognitive functioning in this population. Findings can assist clinicians in guiding survivors to manage sleep and cognitive problems and aid in the design of interventional research.
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Affiliation(s)
- Ashley M Henneghan
- School of Nursing, University of Texas at Austin, Austin, TX, USA.,University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patricia Carter
- School of Nursing, University of Texas at Austin, Austin, TX, USA
| | | | - Brennan Parmelee
- School of Nursing, University of Texas Health Science Center Houston, Houston, TX, USA
| | - Shelli Kesler
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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60
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Henneghan AM, Palesh O, Harrison M, Kesler SR. Identifying cytokine predictors of cognitive functioning in breast cancer survivors up to 10 years post chemotherapy using machine learning. J Neuroimmunol 2018; 320:38-47. [PMID: 29759139 DOI: 10.1016/j.jneuroim.2018.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/28/2018] [Accepted: 04/17/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The purpose of this study is to explore 13 cytokine predictors of chemotherapy-related cognitive impairment (CRCI) in breast cancer survivors (BCS) 6 months to 10 years after chemotherapy completion using a multivariate, non-parametric approach. METHODS Cross sectional data collection included completion of a survey, cognitive testing, and non-fasting blood from 66 participants. Data were analyzed using random forest regression to identify the most significant predictors for each of the cognitive test scores. RESULTS A different cytokine profile predicted each cognitive test. Adjusted R2 for each model ranged from 0.71-0.77 (p's < 9.50-10). The relationships between all the cytokine predictors and cognitive test scores were non-linear. CONCLUSIONS Our findings are unique to the field of CRCI and suggest non-linear cytokine specificity to neural networks underlying cognitive functions assessed in this study.
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Affiliation(s)
- Ashley M Henneghan
- University of Texas MD Anderson Cancer Center, Neuro-Oncology, USA; University of Texas at Austin School of Nursing, USA.
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford University Cancer Institute, USA
| | | | - Shelli R Kesler
- University of Texas MD Anderson Cancer Center, Neuro-Oncology, USA
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Coles T, Bennett AV, Tan X, Battaglini CL, Sanoff HK, Basch E, Jensen RE, Reeve BB. Relationship between sleep and exercise as colorectal cancer survivors transition off treatment. Support Care Cancer 2018; 26:2663-2673. [PMID: 29470704 DOI: 10.1007/s00520-018-4110-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 02/11/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The primary objective of this study was to evaluate the relationship between exercise and sleep disturbance in a sample of individuals diagnosed with stage I, II, and III colorectal cancer (CRC) as patients transitioned off first-line treatment. We also sought to identify heterogeneity in the relationship between sleep disturbance and exercise. METHODS Data were obtained from the MY-Health study, a community-based observational study of adults diagnosed with cancer. Patient-Reported Outcomes Measurement Information System® (PROMIS) measures (e.g., PROMIS Sleep) were administered, and participants self-reported demographics, comorbidities, cancer treatment, and exercise. Regression mixture and multiple regression models were used to evaluate the relationship between sleep disturbance and exercise cross-sectionally at an average of 10 months after diagnosis, and the change in sleep disturbance over a 7-month period, from approximately 10 to 17 months post-diagnosis. RESULTS Patients whose exercise was categorized as likely at or above American College of Sports Medicine's guidelines did not report statistically better sleep quality compared to patients who were classified as not active. However, retirement (B = - 2.4), anxiety (B = 0.21), and fatigue (B = 0.24) had statistically significant relationships with sleep disturbance (p < 0.05). Increase in exercise was not significantly associated with a decrease in sleep disturbance. No statistical heterogeneity was revealed in the relationship between sleep and exercise. CONCLUSIONS Further prospective research using an objective measure of exercise is warranted to confirm or refute the nature of the relationship between exercise and sleep disturbance in individuals diagnosed with CRC transitioning off first-line treatment.
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Affiliation(s)
- Theresa Coles
- RTI-Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC, 27709, USA.
| | - Antonia V Bennett
- University of North Carolina at Chapel Hill Department of Health Policy and Management, Chapel Hill, NC, USA.,University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Xianming Tan
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.,Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claudio L Battaglini
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hanna K Sanoff
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ethan Basch
- University of North Carolina at Chapel Hill Department of Health Policy and Management, Chapel Hill, NC, USA.,University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Roxanne E Jensen
- Department of Oncology, Georgetown University, Washington, DC, USA
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Coles T, Tan X, Bennett AV, Sanoff HK, Basch E, Jensen RE, Reeve BB. Sleep quality in individuals diagnosed with colorectal cancer: Factors associated with sleep disturbance as patients transition off treatment. Psychooncology 2017; 27:1050-1056. [PMID: 29265709 DOI: 10.1002/pon.4595] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/21/2017] [Accepted: 11/14/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify patient characteristics associated with sleep disturbance and worsening of sleep in individuals diagnosed with localized colorectal cancer and assess heterogeneity in these relationships. METHODS Data were from the MY-Health study, a community-based observational study of adults diagnosed with cancer. Patient-Reported Outcomes Measurement Information System® Sleep Disturbance, Anxiety, Depression, Fatigue, and Pain Interference measures were administered. Participants self-reported demographics, comorbidities, and treatment information. Regression mixture and multiple regression models were used to evaluate the relationship between sleep disturbance and patient characteristics cross-sectionally at an average of 10 months after diagnosis (n = 613) as well as change in sleep disturbance over a 6-month period (n = 361). RESULTS Pain, anxiety, fatigue, and the existence of multiple comorbid conditions had statistically significant relationships with sleep disturbance (B = 0.09, 0.22, 0.29, and 1.53, respectively; P < 0.05). Retirement (B = -2.49) was associated with sleep quality in the cross-sectional model. Worsening anxiety (B = 0.14) and fatigue (B = 0.20) were associated with worsening sleep disturbance, and more severe sleep disturbance 10 months after diagnosis (B = -0.21) was associated with improvement in sleep quality after diagnosis (P < 0.05). No evidence of latent subgroups of patients (heterogeneity) was present. CONCLUSIONS Pain, anxiety, fatigue, employment, and comorbid conditions were associated with sleep disturbance, but regression coefficients were small (< |2.5|). Results suggest that screening for anxiety, depression, fatigue, or pain is not sufficient for identifying sleep disturbance. Given the negative consequences of sleep disturbance, sleep disturbance screening may be warranted.
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Affiliation(s)
- Theresa Coles
- RTI Health Solutions, Research Triangle Park, Durham, NC, USA
| | - Xianming Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Antonia V Bennett
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hanna K Sanoff
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ethan Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Roxanne E Jensen
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA.,Department of Oncology, Georgetown University, Washington, DC, USA
| | - Bryce B Reeve
- Department of Population Health Sciences, Duke School of Medicine, Durham, NC, USA
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Henneghan A, Stuifbergen A, Becker H, Kesler S, King E. Modifiable correlates of perceived cognitive function in breast cancer survivors up to 10 years after chemotherapy completion. J Cancer Surviv 2017; 12:224-233. [PMID: 29116555 DOI: 10.1007/s11764-017-0661-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/22/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cognitive changes following breast cancer treatment are likely multifactorial and have been linked to emotional factors, biophysiological factors, and fatigue, among others. Little is known about the contributions of modifiable factors such as stress, loneliness, and sleep quality. The purpose of this study was to explore the direct and indirect effects of perceived stress, loneliness, and sleep quality on perceived cognitive function (PCF) in breast cancer survivors (BCS) after chemotherapy completion. METHODS In this observational study, BCS 6 months to 10 years post chemotherapy were recruited from the community. We measured perceived stress, loneliness, sleep quality, anxiety, depression, fatigue, and PCF. Data analyses included descriptive statistics, correlations, and mediation analyses utilizing ordinary least square regression. RESULTS Ninety women who were on average 3 years post chemotherapy completion participated in the study. Moderate to largely negative correlations were found between PCF and the psychosocial and sleep variables (r values ranged from - 0.31 to - 0.70, p values < .0009). Mediation analyses revealed that stress and daytime sleepiness both directly and indirectly impact PCF and that loneliness and sleep quality only have indirect effects (through anxiety and fatigue). CONCLUSION Our findings suggest that perceived cognitive changes following breast cancer treatment are multifactorial and that higher stress levels, loneliness, daytime sleepiness, and poorer sleep quality are linked to worse perceived cognitive functioning. Also, stress, loneliness, and sleep quality may affect cognitive functioning through a shared psychobiological pathway. IMPLICATIONS FOR CANCER SURVIVORS Interventions targeting stress, loneliness, and sleep quality may improve perceived cognitive functioning in breast cancer survivors.
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Affiliation(s)
- Ashley Henneghan
- School of Nursing, University of Texas at Austin, 1710 Red River, Austin, TX, 78701, USA.
| | - Alexa Stuifbergen
- School of Nursing, University of Texas at Austin, 1710 Red River, Austin, TX, 78701, USA
| | - Heather Becker
- School of Nursing, University of Texas at Austin, 1710 Red River, Austin, TX, 78701, USA
| | - Shelli Kesler
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Roswall N, Bidstrup PE, Raaschou-Nielsen O, Solvang Jensen S, Overvad K, Halkjær J, Sørensen M. Residential road traffic noise exposure and colorectal cancer survival - A Danish cohort study. PLoS One 2017; 12:e0187161. [PMID: 29084272 PMCID: PMC5662233 DOI: 10.1371/journal.pone.0187161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/15/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Residential traffic noise exposure may entail sleep disruption and compromised circadian functioning; two factors which have been associated with a poor colorectal cancer (CRC) prognosis. Hence, the aim of the present study was to investigate the association between residential road traffic noise and CRC survival. METHODS AND MATERIALS Road traffic noise was calculated for all residential addresses from 1987 to February 2012 for incident CRC cases (n = 1,234) in a cohort of 57,053 Danes. We used Cox Proportional Hazard Models to investigate the association between residential road traffic noise at different time-windows, and overall and CRC-specific mortality. Furthermore, we investigated interaction with sex, age, prognostic factors, and comorbidity. Mortality Rate Ratios (MRR) were calculated in unadjusted models, and adjusted for railway noise, lifestyle factors, and socioeconomic variables. RESULTS During a median follow-up of 4 years, 594 patients died; 447 from CRC. We found no association between road traffic noise exposure and overall (MRR 1.00 (0.88-1.13) per 10 dB) or CRC-specific mortality (MRR 0.98 (0.85-1.13) per 10 dB) over the entire follow-up period, or 1 year preceding death. Results did not differ when examining colon and rectal cancer separately. Interaction analyses suggested that patients with less clinically advanced disease could be more susceptible to harmful effects of traffic noise. CONCLUSION The present study suggests no overall association between residential road traffic noise and concurrent mortality in CRC patients. As it is the first study of its kind, with relatively limited power, further studies are warranted.
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Affiliation(s)
- Nina Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark
- * E-mail:
| | | | | | | | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Jytte Halkjær
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Mette Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark
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Kamen C, Scheiber C, Janelsins M, Jo B, Shen H, Palesh O. Effects of childhood trauma exposure and cortisol levels on cognitive functioning among breast cancer survivors. CHILD ABUSE & NEGLECT 2017; 72:163-171. [PMID: 28818733 PMCID: PMC5659913 DOI: 10.1016/j.chiabu.2017.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/02/2017] [Accepted: 07/12/2017] [Indexed: 06/07/2023]
Abstract
Cognitive functioning difficultiesin breast cancer patients receiving chemotherapy are common, but not all women experience these impairments. Exposure to childhood trauma may impair cognitive functioning following chemotherapy, and these impairments may be mediated by dysregulation of hypothalamic-pituitary-adrenal (HPA) axis function and cortisol slope. This study evaluated the association between childhood trauma exposure, cortisol, and cognition in a sample of breast cancer survivors. 56 women completed measures of trauma exposure (the Traumatic Events Survey), salivary cortisol, and self-reported cognitive functioning (the Functional Assessment of Cancer Therapy - Cognitive). We examined correlations between childhood trauma exposure and cognitive functioning, then used linear regression to control for factors associated with cognition (age, education, time since chemotherapy, depression, anxiety, and insomnia), and the MacArthur approach to test whether cortisol levels mediated the relationship between trauma and cognitive functioning. 57.1% of the sample had experienced at least one traumatic event in childhood, with 19.6% of the sample witnessing a serious injury, 17.9% experiencing physical abuse, and 14.3% experiencing sexual abuse. Childhood trauma exposure and cognitive functioning were moderately associated (r=-0.29). This association remained even when controlling for other factors associated with cognition; the final model explained 47% of the variance in cognitive functioning. The association between childhood trauma and cognitive functioning was mediated by steeper cortisol slope (partial r=0.35, p=0.02). Childhood trauma exposure is associated with self-reported cognitive functioning among breast cancer survivors and is mediated by cortisol dysregulation. Trauma should be considered, among other factors, in programs aiming to address cognition in this population.
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Affiliation(s)
- Charles Kamen
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420658, Rochester, NY 14642, USA.
| | - Caroline Scheiber
- Department of Psychiatry and Behavioral Sciences, Stanford University,401 Quarry Road, Stanford, CA 94305, USA
| | - Michelle Janelsins
- Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420658, Rochester, NY 14642, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University,401 Quarry Road, Stanford, CA 94305, USA
| | - Hanyang Shen
- Department of Psychiatry and Behavioral Sciences, Stanford University,401 Quarry Road, Stanford, CA 94305, USA
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University,401 Quarry Road, Stanford, CA 94305, USA
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Linder LA, Erickson JM, Stegenga K, Macpherson CF, Wawrzynski S, Wilson C, Ameringer S. Symptom self-management strategies reported by adolescents and young adults with cancer receiving chemotherapy. Support Care Cancer 2017; 25:3793-3806. [PMID: 28718079 DOI: 10.1007/s00520-017-3811-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/27/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Adolescents and young adults (AYAs) with cancer experience multiple symptoms related to their cancer and its treatment which can negatively impact their development and quality of life. An understanding of the strategies AYAs use to self-manage their symptoms is limited. This study described symptom self-management strategies reported by AYAs with cancer using an iPad-based symptom heuristics tool, the Computerized Symptom Capture Tool. METHODS The study used a cross-sectional, descriptive design. AYAs' free text responses relating their symptom self-management strategies were explored using qualitative content analysis procedures. Strategies were examined overall and by individual symptoms. RESULTS Seventy-two AYAs 13-29 years of age (mean 18.4 years) reported a total of 772 symptom self-management codes for 585 individual symptoms. These codes were organized into 119 distinct categories. These categories were further organized into 16 subthemes and 3 overarching themes: "Things I Take … or Not" (n = 209 codes), "Physical Care Things I Do" (n = 367 codes), and "Psychosocial Care Things I Do" (n = 132 codes). AYAs frequently reported strategies from all three of the symptom self-management themes to manage individual symptoms; however, "medications" was the most frequently reported strategy. CONCLUSION AYAs receiving chemotherapy use multiple common, yet uniquely individual symptom self-management strategies. AYAs' reported strategies range from those that involve shared management with a healthcare provider to those that AYAs implement independently. The study provides a foundation for future research to empower AYAs to engage in symptom self-management and to guide healthcare providers as they discuss developmentally relevant and evidence-based symptom self-management strategies.
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Affiliation(s)
- Lauri A Linder
- College of Nursing, University of Utah and Cancer Transplant Center, Primary Children's Hospital, Salt Lake City, UT, USA.
| | - Jeanne M Erickson
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | | | | - Sarah Wawrzynski
- College of Nursing, University of Utah and Pediatric Critical Care Services, Primary Children's Hospital, Salt Lake City, UT, USA
| | | | - Suzanne Ameringer
- College of Nursing, Virginia Commonwealth University, Richmond, VA, USA
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Palesh O, Haitz K, Lévi F, Bjarnason GA, Deguzman C, Alizeh I, Ulusakarya A, Packer MM, Innominato PF. Relationship between subjective and actigraphy-measured sleep in 237 patients with metastatic colorectal cancer. Qual Life Res 2017; 26:2783-2791. [PMID: 28656534 DOI: 10.1007/s11136-017-1617-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Patients with cancers frequently experience sleep and circadian dysfunction. To date, only a few studies have used both a questionnaire and actigraphy for concomitant evaluation of sleep and circadian function in patients with cancer. We sought to evaluate objective sleep and circadian parameters in metastatic colon cancer (MCC) patients and their associations with symptoms and quality of life (QOL). METHODS Patients reported subjective sleep problems on the EORTC QLQ-C30. Sleep and circadian parameters were calculated using a wrist-actigraph that patients wore for 72 h. RESULTS 237 Patients with MCC (mean age: 60.4 years; range: 20.7-77.6; Male/Female ratio: 1.66) participated in this cross-sectional study. Subjective sleep problems were reported by 63.4% of patients (S+). No differences in any sleep parameters (sleep efficiency, sleep latency, total sleep time, total time in bed, wake after sleep onset, activity bathyphase) were observed between S+ and S- patients. However, S+ patients displayed a significantly worse circadian function than S- patients (96.4 vs 98.1%; p = 0.005). The presence of poor subjective sleep and objective circadian dysfunction negatively affected symptoms and QOL domains (p = 0.038). CONCLUSIONS Subjective report of sleep problems was not associated with worse objectively measured sleep parameters in patients with MCC although it was associated with disrupted circadian rest-activity rhythm and poorer QOL. These findings coincide with prior research in cancer patients in that an inconsistent relationship exists between subjective and objective sleep measurements on some sleep domains. This study supports the value of coupled evaluation of self-reported and objective measures of sleep and circadian function in cancer patients.
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Affiliation(s)
- Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA. .,Stanford Cancer Institute, Stanford School of Medicine, Stanford, CA, USA.
| | - Karyn Haitz
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA
| | - Francis Lévi
- INSERM U935 and AP-HP, Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.,Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Coventry, Warwickshire, UK.,Department of Oncology, Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Georg A Bjarnason
- Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Carl Deguzman
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA
| | - Igbal Alizeh
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA
| | - Ayhan Ulusakarya
- INSERM U935 and AP-HP, Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France
| | - Mary Melissa Packer
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA.,Stanford Cancer Institute, Stanford School of Medicine, Stanford, CA, USA
| | - Pasquale F Innominato
- Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Coventry, Warwickshire, UK.,Department of Oncology, Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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Abstract
Chronotherapeutics aim at treating illnesses according to the endogenous biologic rhythms, which moderate xenobiotic metabolism and cellular drug response. The molecular clocks present in individual cells involve approximately fifteen clock genes interconnected in regulatory feedback loops. They are coordinated by the suprachiasmatic nuclei, a hypothalamic pacemaker, which also adjusts the circadian rhythms to environmental cycles. As a result, many mechanisms of diseases and drug effects are controlled by the circadian timing system. Thus, the tolerability of nearly 500 medications varies by up to fivefold according to circadian scheduling, both in experimental models and/or patients. Moreover, treatment itself disrupted, maintained, or improved the circadian timing system as a function of drug timing. Improved patient outcomes on circadian-based treatments (chronotherapy) have been demonstrated in randomized clinical trials, especially for cancer and inflammatory diseases. However, recent technological advances have highlighted large interpatient differences in circadian functions resulting in significant variability in chronotherapy response. Such findings advocate for the advancement of personalized chronotherapeutics through interdisciplinary systems approaches. Thus, the combination of mathematical, statistical, technological, experimental, and clinical expertise is now shaping the development of dedicated devices and diagnostic and delivery algorithms enabling treatment individualization. In particular, multiscale systems chronopharmacology approaches currently combine mathematical modeling based on cellular and whole-body physiology to preclinical and clinical investigations toward the design of patient-tailored chronotherapies. We review recent systems research works aiming to the individualization of disease treatment, with emphasis on both cancer management and circadian timing system–resetting strategies for improving chronic disease control and patient outcomes.
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Affiliation(s)
- Annabelle Ballesta
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
| | - Pasquale F Innominato
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
| | - Robert Dallmann
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
| | - David A Rand
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
| | - Francis A Lévi
- Warwick Medical School (A.B., P.F.I., R.D., F.A.L.) and Warwick Mathematics Institute (A.B., D.A.R.), University of Warwick, Coventry, United Kingdom; Warwick Systems Biology and Infectious Disease Epidemiological Research Centre, Senate House, Coventry, United Kingdom (A.B., P.F.I., R.D., D.A.R., F.A.L.); INSERM-Warwick European Associated Laboratory "Personalising Cancer Chronotherapy through Systems Medicine" (C2SysMed), Unité mixte de Recherche Scientifique 935, Centre National de Recherche Scientifique Campus, Villejuif, France (A.B., P.F.I., R.D., D.A.R., F.A.L.); and Queen Elisabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Cancer Unit, Edgbaston Birmingham, United Kingdom (P.F.I., F.A.L.)
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Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapy. Support Care Cancer 2017; 25:2485-2494. [PMID: 28281049 DOI: 10.1007/s00520-017-3655-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/20/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE In a sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer who received at least two cycles of chemotherapy (CTX), the purposes were to evaluate for inter-individual differences in the severity of sleep disturbance and determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of sleep disturbance. METHODS A total of 1331 patients completed study questionnaires in their homes, at six time points over two cycles of CTX (prior to CTX administration, approximately 1 week after CTX administration, and approximately 2 weeks after CTX administration). Questionnaires included demographic, clinical, and symptom assessments (i.e., General Sleep Disturbance Scale, Lee Fatigue Scale, Center for Epidemiological Studies-Depression Scale, Spielberger State-Trait Anxiety Inventories, Attentional Function Index). Hierarchical linear modeling based on full maximum likelihood estimation was performed. RESULTS Characteristics associated with higher initial levels of sleep disturbance included higher body mass index, poorer functional status, higher trait anxiety, higher depressive symptoms, and higher evening fatigue. Characteristics associated with the worse trajectories of sleep disturbance were higher levels of education and higher sleep disturbance at enrollment. Characteristics associated with both higher initial levels and worse trajectories of sleep disturbance were higher morning fatigue and worse attentional function. CONCLUSIONS A large amount of inter-individual variability exists in sleep disturbance during CTX. The modifiable and non-modifiable characteristics found in this study can be used to identify higher risk patients and provide earlier interventions to reduce sleep disturbance.
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Steindorf K, Wiskemann J, Ulrich CM, Schmidt ME. Effects of exercise on sleep problems in breast cancer patients receiving radiotherapy: a randomized clinical trial. Breast Cancer Res Treat 2017; 162:489-499. [DOI: 10.1007/s10549-017-4141-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/02/2017] [Indexed: 01/12/2023]
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Zhou ES, Partridge AH, Syrjala KL, Michaud AL, Recklitis CJ. Evaluation and treatment of insomnia in adult cancer survivorship programs. J Cancer Surviv 2017; 11:74-79. [PMID: 27495283 PMCID: PMC5865603 DOI: 10.1007/s11764-016-0564-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/26/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Insomnia is commonly experienced by cancer survivors. Chronic insomnia is associated with significant physical and psychosocial consequences if not properly treated. Both the National Cancer Institute (NCI) and the National Comprehensive Cancer Network (NCCN) recommend the evaluation of sleep disturbances and evidence-based treatment of insomnia during routine survivorship care. To better understand current clinical practices, we conducted a survey of major cancer centers across the United States (US). METHODS Adult survivorship programs at the 25 US cancer centers that are both NCI-designated comprehensive cancer centers and NCCN member institutions were surveyed about the evaluation and treatment of insomnia in their hospital. RESULTS All institutions responded to the survey. Thirteen centers (56 %) reported screening <25 % of survivors for sleep disorders, and few clinicians providing survivorship care were well-prepared to conduct a proper sleep evaluation. Insomnia was most commonly treated with sleep hygiene, or pharmacotherapy, rather than cognitive-behavioral therapy. No program reported that >50 % of their survivors were receiving optimal insomnia-related care. A variety of methods to improve insomnia care were endorsed by respondents. CONCLUSIONS There is a clear need to improve the evaluation and treatment of insomnia for cancer survivors at institutions across the country. Cancer centers deemed a number of modalities relevant for improving provider confidence in addressing sleep challenges. IMPLICATIONS FOR CANCER SURVIVORS To improve the quality of insomnia care for survivors, systematic interventions to increase standardized screening for sleep disorders, providing additional sleep medicine training for survivorship clinicians, and optimizing the role of sleep medicine specialists in the oncology setting should be considered.
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Affiliation(s)
- Eric S Zhou
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Ann H Partridge
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Karen L Syrjala
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, Seattle, WA, 98109, USA
| | - Alexis L Michaud
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Christopher J Recklitis
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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Galiano-Castillo N, Arroyo-Morales M, Ariza-Garcia A, Fernández-Lao C, Fernández-Fernández AJ, Cantarero-Villanueva I. Factors that Explain the Cancer-Related Insomnia. Breast J 2017; 23:387-394. [DOI: 10.1111/tbj.12759] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Noelia Galiano-Castillo
- Instituto de Investigación Biosanitaria de Granada; Granada Spain
- Department of Physical Therapy; Health Sciences Faculty; University of Granada; Granada Spain
| | - Manuel Arroyo-Morales
- Instituto de Investigación Biosanitaria de Granada; Granada Spain
- Department of Physical Therapy; Health Sciences Faculty; University of Granada; Granada Spain
| | - Angélica Ariza-Garcia
- Department of Physical Therapy; Health Sciences Faculty; University of Granada; Granada Spain
- Physical Medicine and Rehabilitation Department; Clinico Universitario San Cecilio; Granada Spain
| | - Carolina Fernández-Lao
- Instituto de Investigación Biosanitaria de Granada; Granada Spain
- Department of Physical Therapy; Health Sciences Faculty; University of Granada; Granada Spain
| | | | - Irene Cantarero-Villanueva
- Instituto de Investigación Biosanitaria de Granada; Granada Spain
- Department of Physical Therapy; Health Sciences Faculty; University of Granada; Granada Spain
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Sleep duration is associated with survival in advanced cancer patients. Sleep Med 2017; 32:208-212. [PMID: 28366336 DOI: 10.1016/j.sleep.2016.06.041] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Sleep problems have been linked to increased risk of mortality in the general population. Limited evidence suggests similar relationships among people diagnosed with cancer. The aims of the present study were to investigate the type and rates of sleep problems in advanced cancer patients and examine whether sleep problems are associated with survival. METHODS A prospective study of 292 patients with advanced cancers affecting the hepatobiliary and pancreatic systems were administered a battery of questionnaires measuring sociodemographic information, sleep, and depression. Descriptive statistics, ANOVA, Chi-square, Kaplan-Meier survival, and Cox regression analyses were performed to test the aims. RESULTS The majority of patients were male (64%) and the mean age was 62 years (SD = 11). Fifty-nine percent of patients reported poor sleep quality; 43% reported sleeping ≤6 h and 2% ≥10 h; 40% reported sleep latency of 30 min or greater; average sleep efficiency was 80%. Of the 292 patients, 58% reported clinically levels of depression and depressive symptoms were related to shorter sleep duration (p = 0.02). After adjusting for factors known to contribute to survival, a curvilinear relationship was observed between sleep duration and mortality: short and long sleep duration were associated with increased mortality [linear term: hazard ratio (HR) = 0.485, 95% confidence interval (CI) = 0.275-0.857; quadratic term: HR = 1.064, 95% CI = 1.015-1.115]. CONCLUSIONS Consistent with findings in the general population, a curvilinear relationship between sleep duration and mortality was observed in advanced cancer patients. The high prevalence of sleep problems and link with mortality warrants routine screening and development of evidence-based treatments for sleep problems in the oncology setting.
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Madsen MT, Hansen MV, Andersen LT, Hageman I, Rasmussen LS, Bokmand S, Rosenberg J, Gögenur I. Effect of Melatonin on Sleep in the Perioperative Period after Breast Cancer Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Sleep Med 2017; 12:225-33. [PMID: 26414973 DOI: 10.5664/jcsm.5490] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 08/21/2015] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVES To investigate whether administration of an oral dose of 6 mg melatonin before bedtime perioperatively in breast cancer surgery could change sleep outcomes measured by actigraphy. METHODS This paper reports secondary outcomes from a double-blind, placebo-controlled, randomized clinical trial where patients received 6 mg melatonin (n = 27) or placebo (n = 21) approximately 60 minutes before bedtime 3 nights preoperatively until at least one week postoperatively. Participants were monitored in the entire period with actigraphy, and were instructed to complete visual analogue scale (VAS) for sleep, and the Karolinska Sleepiness Scale (KSS) each morning. RESULTS Administration of 6 mg oral melatonin approximately 1 hour before bedtime resulted in significantly increased sleep efficiency and reduced wake after sleep onset for the entire 2-week postoperative period. No other significant differences for actigraphy determined sleep outcomes or subjective outcome parameters in the perioperative period were found between the groups. Overall, the patients sleep outcomes were within normal ranges and no participants had pathological sleep disturbances. CONCLUSIONS Melatonin significantly changed sleep efficiency and wake after sleep onset after surgery, but had no effects on other objective sleep outcomes or on subjective sleep quality (VAS and KSS).
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Affiliation(s)
- Michael Tvilling Madsen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.,Department of Breast Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Melissa Voigt Hansen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.,Department of Breast Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Lærke Toftegård Andersen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.,Department of Breast Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Ida Hageman
- Psychiatric Centre Copenhagen, Rigshospitalet, University of Copenhagen, København N, Denmark
| | - Lars Simon Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, København N, Denmark
| | - Susanne Bokmand
- Department of Breast Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jacob Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Ismail Gögenur
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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75
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Budhrani PH, Lengacher CA, Kip K, Tofthagen C, Jim H. An integrative review of subjective and objective measures of sleep disturbances in breast cancer survivors. Clin J Oncol Nurs 2016; 19:185-91. [PMID: 25840384 DOI: 10.1188/15.cjon.185-191] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sleep disturbances are recognized as a side effect of cancer treatment, affecting physiological and psychological functioning. Sleep disturbances can persist through treatment and survivorship, and are increasingly prevalent among breast cancer survivors (BCSs). OBJECTIVES The purpose of this review is to summarize current research on subjective and objective measures of sleep disturbances, the association between subjective and objective measures, and interventions used to manage sleep disturbances among BCSs after the completion of treatment. METHODS Articles published from 2003-2013 were retrieved using PubMed, Web of Science, and ScienceDirect. Key search terms included breast cancer, sleep actigraphy, and sleep disturbances. Articles assessing sleep subjectively and objectively in the post-treatment period were included. FINDINGS Twelve studies met the inclusion criteria.
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Affiliation(s)
- Pinky H Budhrani
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Boston, MA
| | | | - Kevin Kip
- College of Nursing at the University of South Florida in Tampa
| | - Cindy Tofthagen
- College of Nursing at the University of South Florida in Tampa
| | - Heather Jim
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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76
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Roswall N, Bidstrup PE, Raaschou-Nielsen O, Jensen SS, Olsen A, Sørensen M. Residential road traffic noise exposure and survival after breast cancer - A cohort study. ENVIRONMENTAL RESEARCH 2016; 151:814-820. [PMID: 27687723 DOI: 10.1016/j.envres.2016.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND It is generally acknowledged that patients with already existing clinical conditions are especially vulnerable to the effects of traffic noise exposure. The aim of the present study was to investigate the association between residential road traffic noise and breast cancer survival. METHODS Road traffic noise was calculated for all residential addresses from 1987 to February 2012 for incident breast cancer cases (n=1,759) in a cohort of 57,053 Danes. We used Cox Proportional Hazard Models to investigate the association between residential road traffic noise at different time-windows, and overall and breast cancer-specific mortality. Furthermore, we investigated interaction with prognostic and socioeconomic factors. Mortality Rate Ratios (MRR) were calculated in both unadjusted models, and adjusted for residential railway noise, lifestyle factors and socioeconomic variables. RESULTS During a median of 7.3 years of follow-up, 402 patients died; 274 from breast cancer. We found no association between time-weighted averages of residential road traffic noise 1-, 3- or 5-years before death, or over the entire follow-up period, and overall or breast cancer-specific mortality. A 10dB higher road traffic noise from diagnosis until censoring was associated with an adjusted MRR of 0.94 (0.81-1.08) for all-cause mortality. The association was modified by lymph node involvement, with a MRR of 1.20 (0.97-1.48) for those with tumor-positive lymph nodes and 0.76 (0.59-0.98) for those without. CONCLUSION The present study suggests no association between residential road traffic noise and concurrent mortality. As it is the first study of its kind, with relatively limited power, further studies are warranted.
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Affiliation(s)
- Nina Roswall
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark.
| | | | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark; Department of Environmental Science, Aarhus University, Frederiksborgvej 399, Postboks 358, DK-4000 Roskilde, Denmark
| | - Steen Solvang Jensen
- Department of Environmental Science, Aarhus University, Frederiksborgvej 399, Postboks 358, DK-4000 Roskilde, Denmark
| | - Anja Olsen
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark
| | - Mette Sørensen
- Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark
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77
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Aricò D, Raggi A, Ferri R. Cognitive Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Review of the Literature. Front Psychol 2016; 7:1162. [PMID: 27536265 PMCID: PMC4971442 DOI: 10.3389/fpsyg.2016.01162] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/20/2016] [Indexed: 12/16/2022] Open
Abstract
Background: Insomnia is a common sleep disorder in patients with breast cancer and studies show a higher frequency than in the general population but it appears to be understudied and the treatment seems to be a neglected problem. There is a growing body of evidence about the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in breast cancer survivors (BCS). The aim of this review is to examine the best available scientific evidence related to CBT-I and insomnia in patients with breast cancer and to assess the effect of CBT-I on their psychosocial functioning, sleep, quality of life, and mood. Methods: Empirical articles published in peer-reviewed journals from the earliest reports available until August 2015 were considered. The research on PubMed generated 18 papers, three of which did not meet the inclusion criteria. Another paper was retrieved by screening the reference list of the previously selected papers. Results: A total of 16 studies were found that evaluated the effects of CBT-I in breast cancer patients. CBT-I appears to be an effective therapy for insomnia in BCS, improving mood, general and physical fatigue, and global and cognitive dimensions of quality of life. CBT-I may also reduce menopausal symptoms, such as hot flushes and night sweat problems, frequency of medicated nights, level of depression, and anxiety. Conclusions: CBT-I seems to be an eligible intervention for improving sleep in BCS. Improvements concerning insomnia and sleep quality are durable (usually up to 12 months) and statistically significant.
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Affiliation(s)
- Debora Aricò
- Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging Troina, Italy
| | - Alberto Raggi
- Unit of Neurology, G. B. Morgagni- L. Pierantoni Hospital Forlì, Italy
| | - Raffaele Ferri
- Department of Neurology, Oasi Institute for Research on Mental Retardation and Brain Aging Troina, Italy
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78
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Jalali R, Rezaei M, Khaledi Paveh B, Aznab M, AmiriFard N, Mohammadi E. Sleep Disorder and its Correlates in Patients Undergoing Chemotherapy. ACTA ACUST UNITED AC 2016. [DOI: 10.29252/ijn.29.99.100.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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79
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Matthews EE, Tanner JM, Dumont NA. Sleep Disturbances in Acutely Ill Patients with Cancer. Crit Care Nurs Clin North Am 2016; 28:253-68. [PMID: 27215362 DOI: 10.1016/j.cnc.2016.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Intensive care units may place acutely ill patients with cancer at additional risk for sleep loss and associated negative effects. Research suggests that communication about sleep in patients with cancer is suboptimal and sleep problems are not regularly assessed or adequately treated throughout the cancer trajectory. However, many sleep problems and fatigue can be managed effectively. This article synthesizes the current literature regarding the prevalence, cause, and risk factors that contribute to sleep disturbance in the context of acute cancer care. It describes the consequences of poor sleep and discusses appropriate assessment and treatment options.
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Affiliation(s)
- Ellyn E Matthews
- Department of Nursing Science, College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham Street, #529, Little Rock, AR 72205, USA.
| | - J Mark Tanner
- Department of Nursing Science, College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham Street, #529, Little Rock, AR 72205, USA
| | - Natalie A Dumont
- Department of Nursing Science, College of Nursing, University of Arkansas for Medical Sciences, 4301 West Markham Street, #529, Little Rock, AR 72205, USA
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80
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Lemétayer F, Lanfranchi JB, Chastagner P. [Assessment of daily quality of life in children surviving cancer]. Arch Pediatr 2016; 23:447-54. [PMID: 27021879 DOI: 10.1016/j.arcped.2016.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/09/2015] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The purpose of this study was to identify the daily problems experienced by school-age children in remission from cancer. It also sought to assess the predictive value of these problems on the mental health of these children 1 year after the first assessment. PATIENTS AND METHOD Against this background, 50 children in remission from cancer and in mainstream education, aged 8-12 years, completed two questionnaires: the Quality of Life Systemic Inventory for Children (QLSI-C) (Missotten et al., 2007) and the Child Depression Inventory (CDI). THE QLSI-C consists of 20 life areas: Sleep, Diet, Physical pain, Health, Clothing, Physical appearance, Bedroom, Grandparents, Mother, Father, Siblings, Friends, How my friends talk about me, School, School results, Sport, Non-sporting activities, Autonomy, Obedience to authority, and Tolerance of frustration. Each of these 20 life areas was evaluated by the child by reference on each occasion to an ideal situation, first in relation to their current situation and then in relation to their personal goals, in order to measure the gap between these two evaluations. This difference was then weighted by the importance given to each life area and the dynamic situation of approximation to or distance from the goals. All the children in this study were seen in person for two interviews 1 year apart (T1 and T2). RESULTS The analyses conducted following the PLS-PM approach enabled eight of the 20 life areas evaluated to be identified as difficult to access by the children in this study. These analyses also showed that the difficulties perceived by children in remission from cancer have mainly proximal effects (i.e., short-term) on the discomfort experienced (direct effect of difficulties expressed in T1 on discomfort felt at T1; idem for T2). However, the areas perceived as difficult at T1 did not enable distal effects (i.e., effect over a year) on the discomfort expressed in T2 to be updated. Nonetheless, the conflicts at T1 fed the conflicts at T2 and, as a consequence, indirectly affected the experience of depression at T2. DISCUSSION The discussion examines the nature of the daily difficulties perceived by school-age children in remission from cancer and the short-term psychological distress experienced by these children. It concludes that the difficulties encountered by children in remission from cancer are not necessarily cumulative over time and that they do not inevitably result in permanent psychological suffering.
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Affiliation(s)
- F Lemétayer
- Unité de recherche-APEMaC équipe de psychologie de la santé-Metz [EPSaM] EA 4360, université de Lorraine, île du Saulcy, CS 60228, 57045 Metz cedex 01, France.
| | - J-B Lanfranchi
- Unité de recherche-APEMaC équipe de psychologie de la santé-Metz [EPSaM] EA 4360, université de Lorraine, île du Saulcy, CS 60228, 57045 Metz cedex 01, France
| | - P Chastagner
- Service d'oncologie pédiatrique, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
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81
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Evans BJ, Phillips KM, Gonzalez BD, Apte S, Small BJ, Jacobsen PB, Jim HSL. Psychosocial resources and sleep disturbance before chemotherapy for gynecologic cancer. J Psychosoc Oncol 2016; 34:60-76. [PMID: 26771556 DOI: 10.1080/07347332.2015.1128507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Personal psychosocial resources (e.g., positive affect, social support, perceived mastery, meaning in life) are associated with better sleep in noncancer populations, but there have been few studies in cancer patients. The present study examined psychosocial resources and sleep in gynecological cancer patients. Before chemotherapy, 72 participants completed self-report measures of sleep and psychosocial resources; 63 also completed actigraphic monitoring. Subjective sleep was associated with positive affect, social support, perceived mastery, and meaning in life; objective sleep was associated with social support. Future studies should examine whether interventions to enhance psychosocial resources result in improved sleep in this population.
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82
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De Lorenzo BHP, de Oliveira Marchioro L, Greco CR, Suchecki D. Sleep-deprivation reduces NK cell number and function mediated by β-adrenergic signalling. Psychoneuroendocrinology 2015; 57:134-43. [PMID: 25929826 DOI: 10.1016/j.psyneuen.2015.04.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 11/28/2022]
Abstract
Reduction of sleep time triggers a stress response, leading to augmented levels of glucocorticoids and adrenaline. These hormones regulate components of the innate immune system such as natural killer (NK) and NKT cells. In the present study, we sought to investigate whether and how stress hormones could alter the population and function of NK and NKT cells of mice submitted to different lengths of paradoxical sleep deprivation (PSD, from 24 to 72 h). Results showed that 72h of PSD decreased not only NK and NKT cell counts, but also their cytotoxic activity against B16F10 melanoma cells in vitro. Propranolol treatment during PSD reversed these effects, indicating a major inhibitory role of beta-adrenergic receptors (β-AR) on NK cells function. Moreover, both corticosterone plasma levels and expression of beta 2-adrenergic receptors (β2-AR) in NK cells increased by 48 h of PSD. In vitro incubation of NK cells with dexamethasone augmented the level of β2-AR in the cell surface, suggesting that glucocorticoids could induce β2-AR expression. In summary, we propose that reduction of NK and NKT cell number and cytotoxic activity appears to be mediated by glucocorticoids-induced increased expression of β2-AR in these cells.
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Affiliation(s)
- Beatriz H P De Lorenzo
- Department of Psychobiology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - 1° andar, Vila Clementino, 04024-002 São Paulo, SP, Brazil; Centro Universitário São Camilo, Avenida Nazaré, 1501, Ipiranga, 04263-200 São Paulo, SP, Brazil.
| | - Laís de Oliveira Marchioro
- Department of Psychobiology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - 1° andar, Vila Clementino, 04024-002 São Paulo, SP, Brazil
| | - Carollina Ribeiro Greco
- Department of Psychobiology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - 1° andar, Vila Clementino, 04024-002 São Paulo, SP, Brazil
| | - Deborah Suchecki
- Department of Psychobiology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 925 - 1° andar, Vila Clementino, 04024-002 São Paulo, SP, Brazil
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83
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Madsen MT, Huang C, Gögenur I. Actigraphy for measurements of sleep in relation to oncological treatment of patients with cancer: A systematic review. Sleep Med Rev 2015; 20:73-83. [DOI: 10.1016/j.smrv.2014.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/06/2014] [Accepted: 07/07/2014] [Indexed: 11/26/2022]
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84
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Danhauer SC, Griffin LP, Avis NE, Sohl SJ, Jesse MT, Addington EL, Lawrence JA, Messino MJ, Giguere JK, Lucas SL, Wiliford SK, Shaw E. Feasibility of implementing a community-based randomized trial of yoga for women undergoing chemotherapy for breast cancer. JOURNAL OF COMMUNITY AND SUPPORTIVE ONCOLOGY 2015; 13:139-147. [PMID: 28713846 DOI: 10.12788/jcso.0125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Treatment-related symptoms and decreased health-related quality of life (HRQoL) frequently occur during chemotherapy for breast cancer. Although research findings suggest that yoga can reduce symptoms and Improve HRQoL after treatment, potential benefits of yoga during chemotherapy have received minimal attention. OBJECTIVE To estimate accrual, adherence, study retention, and preliminary efficacy of a yoga intervention compared with an active control group for breast cancer patients during chemotherapy. METHODS Women with stage I-III breast cancer were recruited from 3 community cancer clinics and randomized to 10 weeks of gentle yoga or wellness education. Depressive symptoms, fatigue, sleep, and HRQoL were assessed at baseline, mid-intervention (Week 5), and after intervention (Week 10). RESULTS 40 women aged 29-83 years (median, 48 years; 88% white) were randomized to yoga (n = 22) or wellness education (n = 18). The groups did not differ significantly on baseline characteristics, adherence, or study retention. Participant feedback was positive and comparable between groups. Meaningful within-group differences were identified For sleep adequacy and quantity in yoga participants and for somnolence in wellness-education participants. LIMITATIONS Small sample size and lack of a usual-care control group. CONCLUSIONS This study established Feasibility of a community-based randomized trial of yoga and an active comparison group for women undergoing chemotherapy for breast cancer. Preliminary efficacy estimates suggest that yoga improves sleep adequacy Symptom severity and interference remained stable during chemotherapy for the yoga group and snowed a trend toward increasing in the control group. The study highlighted obstacles to multisite yoga research during cancer treatment. FUNDING/SPONSORSHIP National Cancer Institute (3U10 CA081851, PI; Shaw; R25 CA122061, PI: Avis); Translational Science Institute, Wake Forest School of Medicine.
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Affiliation(s)
| | - Leah P Griffin
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Nancy E Avis
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Michelle T Jesse
- Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Psychology, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Elizabeth L Addington
- Wake Forest School of Medicine, Winston-Salem, North Carolina.,Department of Psychology, University of North Carolina at Charlotte, Charlotte, North Carolina
| | | | | | | | | | | | - Edward Shaw
- Wake Forest School of Medicine, Winston-Salem, North Carolina
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85
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Savard J, Ivers H, Savard MH, Morin CM. Cancer treatments and their side effects are associated with aggravation of insomnia: Results of a longitudinal study. Cancer 2015; 121:1703-11. [PMID: 25677509 DOI: 10.1002/cncr.29244] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/16/2014] [Accepted: 12/17/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Insomnia affects between 30% to 60% of patients with cancer but to the authors' knowledge little is known regarding factors associated with its development. It has been postulated that adjuvant cancer treatments and their side effects could trigger sleep disturbances in this population but empirical evidence is lacking. The goal of the current study was to assess, separately in patients with breast and prostate cancer, the effect of adjuvant treatments on the evolution of insomnia symptoms and the mediating role of somatic symptoms. METHODS As part of a population-based epidemiological study, patients with breast cancer (465 patients) and prostate cancer (263 patients) completed at baseline (perioperative period) and 2 months, 6 months, 10 months, 14 months, and 18 months later the Insomnia Severity Index (ISI) and a questionnaire assessing various somatic symptoms. RESULTS In patients with breast cancer, radiotherapy (overall effect) and chemotherapy (at 2 months), but not hormone therapy, were associated with increased insomnia severity, whereas androgen deprivation therapy was related to increased insomnia in patients with prostate cancer. In patients with breast cancer, the effect of chemotherapy and radiotherapy on insomnia was found to be significantly mediated by a variety of somatic symptoms, whereas night sweats had a particularly marked mediating role for hormone therapy, both in patients with breast and prostate cancer. CONCLUSIONS The findings of the current study indicate that cancer treatments and their side effects contribute to the aggravation of insomnia symptoms. Side effects of cancer treatments should be monitored more closely and managed as effectively as possible to prevent the occurrence or aggravation of insomnia.
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Affiliation(s)
- Josée Savard
- School of Psychology, Laval University, Quebec City, Quebec, Canada; Centre de recherche du CHU de Québec, Quebec City, Quebec, Canada; Cancer Research Center, Laval University, Quebec City, Quebec, Canada
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86
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Roscoe JA, Garland SN, Heckler CE, Perlis ML, Peoples AR, Shayne M, Savard J, Daniels NP, Morrow GR. Randomized placebo-controlled trial of cognitive behavioral therapy and armodafinil for insomnia after cancer treatment. J Clin Oncol 2014; 33:165-71. [PMID: 25452447 DOI: 10.1200/jco.2014.57.6769] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Insomnia is a distressing and often persisting consequence of cancer. Although cognitive behavioral therapy for insomnia (CBT-I) is the treatment of choice in the general population, the use of CBT-I in patients with cancer is complicated, because it can result in transient but substantial increases in daytime sleepiness. In this study, we evaluated whether CBT-I, in combination with the wakefulness-promoting agent armodafinil (A), results in better insomnia treatment outcomes in cancer survivors than CBT-I alone. PATIENTS AND METHODS We report on a randomized trial of 96 cancer survivors (mean age, 56 years; female, 87.5%; breast cancer, 68%). The primary analyses examined whether ≥ one of the 7-week intervention conditions (ie, CBT-I, A, or both), when compared with a placebo capsule (P) group, produced significantly greater clinical gains. Insomnia was assessed by the Insomnia Severity Index and sleep quality by the Pittsburgh Sleep Quality Inventory. All patients received sleep hygiene instructions. RESULTS Analyses controlling for baseline differences showed that both the CBT-I plus A (P = .001) and CBT-I plus P (P = .010) groups had significantly greater reductions in insomnia severity postintervention than the P group, with effect sizes of 1.31 and 1.02, respectively. Similar improvements were seen for sleep quality. Gains on both measures persisted 3 months later. CBT-I plus A was not significantly different from CBT-I plus P (P = .421), and A alone was not significantly different from P alone (P = .584). CONCLUSION CBT-I results in significant and durable improvements in insomnia and sleep quality. A did not significantly improve the efficacy of CBT-I or independently affect insomnia or sleep quality.
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Affiliation(s)
- Joseph A Roscoe
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada.
| | - Sheila N Garland
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Charles E Heckler
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Michael L Perlis
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Anita R Peoples
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Michelle Shayne
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Josée Savard
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Nina P Daniels
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
| | - Gary R Morrow
- Joseph A. Roscoe, Charles E. Heckler, Anita R. Peoples, Michelle Shayne, Nina P. Daniels, and Gary R. Morrow, University of Rochester, Rochester, NY; Sheila N. Garland and Michael L. Perlis, University of Pennsylvania, Philadelphia, PA; and Josée Savard, Université Laval, Quebec City, Quebec, Canada
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87
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Ortiz-Tudela E. Crosstalk between sleep disturbances and cancer survival. Sleep Med 2014; 16:315-6. [PMID: 25533543 DOI: 10.1016/j.sleep.2014.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
Affiliation(s)
- E Ortiz-Tudela
- Laboratory of Chronobiology, Department of Physiology, University of Murcia, 30100. Murcia, Spain. Tel.: +34 868 88 4937; fax: +34 868 88 3963..
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88
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Abstract
Here, we review the prevalence and treatment of anxiety and depression among patients with breast cancer. Cancer-related symptoms include similarities to responses to traumatic stress. Well-developed screening devices for identifying and tracking psychiatric comorbidity are discussed. Basic principles of psychopharmacology, and individual and group psychotherapy are presented. Finally, effects of effective treatment of anxiety and depression on quality of life and overall survival are reviewed.
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Affiliation(s)
- David Spiegel
- Department of Psychiatry, Stanford School of Medicine, Stanford, California
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89
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Jim HSL, Evans B, Jeong JM, Gonzalez BD, Johnston L, Nelson AM, Kesler S, Phillips KM, Barata A, Pidala J, Palesh O. Sleep disruption in hematopoietic cell transplantation recipients: prevalence, severity, and clinical management. Biol Blood Marrow Transplant 2014; 20:1465-84. [PMID: 24747335 PMCID: PMC4163090 DOI: 10.1016/j.bbmt.2014.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 04/09/2014] [Indexed: 10/25/2022]
Abstract
Sleep disruption is common among hematopoietic cell transplant (HCT) recipients, with over 50% of recipients experiencing sleep disruption pre-transplant, with up to 82% of patients experiencing moderate to severe sleep disruption during hospitalization for transplant and up to 43% after transplant. These rates of sleep disruption are substantially higher than what we see in the general population. Although sleep disruption can be distressing to patients and contribute to diminished quality of life, it is rarely discussed during clinical visits. The goal of the current review is to draw attention to sleep disruption and disorders (ie, insomnia, obstructive sleep apnea, restless legs syndrome) as a clinical problem in HCT in order to facilitate patient education, intervention, and research. We identified 35 observational studies published in the past decade that examined sleep disruption or disorders in HCT. Most studies utilized a single item measure of sleep, had small sample size, and included heterogeneous samples of patients. Six studies of the effects of psychosocial and exercise interventions on sleep in HCT have reported no significant improvements. These results highlight the need for rigorous observational and interventional studies of sleep disruption and disorders in HCT recipients..
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Affiliation(s)
| | - Bryan Evans
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Jiyeon M Jeong
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Laura Johnston
- Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, California
| | - Ashley M Nelson
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Shelli Kesler
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | | | - Anna Barata
- Moffitt Cancer Center, Tampa, Florida; Psychiatry and Legal Medicine PhD Program, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, Florida
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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90
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Innominato PF, Roche VP, Palesh OG, Ulusakarya A, Spiegel D, Lévi FA. The circadian timing system in clinical oncology. Ann Med 2014; 46:191-207. [PMID: 24915535 DOI: 10.3109/07853890.2014.916990] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The circadian timing system (CTS) controls several critical molecular pathways for cancer processes and treatment effects over the 24 hours, including drug metabolism, cell cycle, apoptosis, and DNA damage repair mechanisms. This results in the circadian time dependency of whole-body and cellular pharmacokinetics and pharmacodynamics of anticancer agents. However, CTS robustness and phase varies among cancer patients, based on circadian monitoring of rest- activity, body temperature, sleep, and/or hormonal secretion rhythms. Circadian disruption has been further found in up to 50% of patients with metastatic cancer. Such disruption was associated with poor outcomes, including fatigue, anorexia, sleep disorders, and short progression-free and overall survival. Novel, minimally invasive devices have enabled continuous CTS assessment in non-hospitalized cancer patients. They revealed up to 12-hour differences in individual circadian phase. Taken together, the data support the personalization of chronotherapy. This treatment method aims at the adjustment of cancer treatment delivery according to circadian rhythms, using programmable-in-time pumps or novel release formulations, in order to increase both efficacy and tolerability. A fixed oxaliplatin, 5-fluorouracil and leucovorin chronotherapy protocol prolonged median overall survival in men with metastatic colorectal cancer by 3.3 months as compared to conventional delivery, according to a meta-analysis (P=0.009). Further analyses revealed the need for the prevention of circadian disruption or the restoration of robust circadian function in patients on chronotherapy, in order to further optimize treatment effects. The strengthening of external synchronizers could meet such a goal, through programmed exercise, meal timing, light exposure, improved social support, sleep scheduling, and the properly timed administration of drugs that target circadian clocks. Chrono-rehabilitation warrants clinical testing for improving quality of life and survival in cancer patients.
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Affiliation(s)
- Pasquale F Innominato
- INSERM, UMRS 776 'Biological Rhythms and Cancers', Campus CNRS , 7 rue Guy Môquet, 94801 Villejuif Cedex , France
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91
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Palesh O, Aldridge-Gerry A, Zeitzer JM, Koopman C, Neri E, Giese-Davis J, Jo B, Kraemer H, Nouriani B, Spiegel D. Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep 2014; 37:837-42. [PMID: 24790261 DOI: 10.5665/sleep.3642] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Poor sleep, prevalent among cancer survivors, is associated with disrupted hormonal circadian rhythms and poor quality of life. Using a prospective research design, this study aimed to clarify the relationship between objective measures of sleep efficiency and sleep disruption with survival among women with advanced breast cancer. METHOD We examined sleep quality and duration via wrist-worn actigraphy and sleep diaries for 3 days among 97 women in whom advanced breast cancer was diagnosed (age = 54.6 ± 9.8 years). Sleep efficiency was operationalized using actigraphy as the ratio of total sleep time to total sleep time plus wake after sleep onset. RESULTS As hypothesized, better sleep efficiency was found to predict a significant reduction in overall mortality (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.94-0.98; P < 0.001) at median 6 y follow-up. This relationship remained significant (HR, 0.94; 95% CI, 0.91-0.97; P < 0.001) even after adjusting for other known prognostic factors (age, estrogen receptor status, cancer treatment, metastatic spread, cortisol levels, and depression). Secondary hypotheses were also supported (after adjusting for baseline prognostic factors) showing that less wake after sleep onset (HR, 0.41; 95% CI, 0.25-0.67; P < 0.001), fewer wake episodes, (HR, 0.93; 95% CI, 0.88-0.98; P = 0.007); and shorter wake episode duration (HR, 0.29; 95% CI, 0.14-0.58; P < 0.001) also contributed to reductions in overall mortality. CONCLUSIONS These findings show that better sleep efficiency and less sleep disruption are significant independent prognostic factors in women with advanced breast cancer. Further research is needed to determine whether treating sleep disruption with cognitive behavioral and/or pharmacologic therapy could improve survival in women with advanced breast cancer.
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Affiliation(s)
- Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Arianna Aldridge-Gerry
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Cheryl Koopman
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Janine Giese-Davis
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA ; Tom Baker Cancer Centre, Psychosocial Resources, Calgary, Canada
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Helena Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Bita Nouriani
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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92
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Courneya KS, Segal RJ, Mackey JR, Gelmon K, Friedenreich CM, Yasui Y, Reid RD, Jespersen D, Cook D, Proulx C, Trinh L, Dolan LB, Wooding E, Forbes CC, McKenzie DC. Effects of exercise dose and type on sleep quality in breast cancer patients receiving chemotherapy: a multicenter randomized trial. Breast Cancer Res Treat 2014; 144:361-9. [PMID: 24554388 DOI: 10.1007/s10549-014-2883-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/12/2014] [Indexed: 01/24/2023]
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93
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Haddad NE, Palesh O. Acupuncture in the treatment of cancer-related psychological symptoms. Integr Cancer Ther 2014; 13:371-85. [PMID: 24501113 DOI: 10.1177/1534735413520181] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Acupuncture is being adopted by cancer patients for a wide range of cancer-related symptoms including highly prevalent psychological symptoms like depression, anxiety, insomnia, and impairment in quality of life. Pharmacological treatment of prevalent symptoms like anxiety, depression, and sleep disturbance can contribute to the high chemical burden already carried by cancer patients, creating additional side effects. As a result, patients and providers alike are interested in evidence-based nonpharmacologic alternatives like acupuncture for these symptoms. This article reviews the current literature (January 2000 through April 2013) for acupuncture in cancer-related psychological symptoms with attention to both efficacy and acupuncture-specific methodology. All published studies that met our review criteria demonstrate a positive signal for acupuncture for the treatment of depression, anxiety, sleep disturbance, and for improving quality of life with most results showing statistical significance. However, there are only a handful of acupuncture studies that were specifically designed to evaluate depression, sleep disturbance, and quality of life as primary outcomes, and no studies were found that looked at anxiety as a primary outcome in this population. Published studies in cancer patients and survivors show that acupuncture treatment is not only safe but also more acceptable with fewer side effects than standard of care pharmacological treatments like antidepressants. Finally, there is wide variability in both the implementation and reporting of acupuncture methods in the literature, with only 2 of 12 studies reporting full details of acupuncture methods as outlined in the revised Standards for Reporting Interventions in Clinical Trials of Acupuncture guidelines, published in 2010 and providing an essential framework for the reporting of acupuncture methodology. This lack of methodological detail affects outcomes, generalizability, and validity of research involving acupuncture. Reasons for ongoing challenges in the development of high-quality acupuncture trials are discussed. In conclusion, results are encouraging for the development of randomized trials to directly evaluate the therapeutic impact of acupuncture in cancer-related psychological symptoms, including depression, anxiety, sleep disturbance, and quality of life, but attention to acupuncture methodological specific challenges in the development of high-quality research is necessary.
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Affiliation(s)
- Nadia Elisabeth Haddad
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Oxana Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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94
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Janelsins MC, Kesler SR, Ahles TA, Morrow GR. Prevalence, mechanisms, and management of cancer-related cognitive impairment. Int Rev Psychiatry 2014; 26:102-13. [PMID: 24716504 PMCID: PMC4084673 DOI: 10.3109/09540261.2013.864260] [Citation(s) in RCA: 454] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This review summarizes the current literature on cancer-related cognitive impairment (CRCI) with a focus on prevalence, mechanisms, and possible interventions for CRCI in those who receive adjuvant chemotherapy for non-central nervous system tumours and is primarily focused on breast cancer. CRCI is characterized as deficits in areas of cognition including memory, attention, concentration, and executive function. Development of CRCI can impair quality of life and impact treatment decisions. CRCI is highly prevalent; these problems can be detected in up to 30% of patients prior to chemotherapy, up to 75% of patients report some form of CRCI during treatment, and CRCI is still present in up to 35% of patients many years following completion of treatment. While the trajectory of CRCI is becoming better understood, the mechanisms underlying the development of CRCI are still obscure; however, host characteristics, immune dysfunction, neural toxicity, and genetics may play key roles in the development and trajectory of CRCI. Intervention research is limited, though strategies to maintain function are being studied with promising preliminary findings. This review highlights key research being conducted in these areas, both in patient populations and in animals, which will ultimately result in better understanding and effective treatments for CRCI.
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Affiliation(s)
- Michelle C. Janelsins
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, NY
- James P. Wilmot Cancer Center, Rochester, NY
| | | | - Tim A. Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Gary R. Morrow
- Department of Surgery, Cancer Control, University of Rochester Medical Center, Rochester, NY
- James P. Wilmot Cancer Center, Rochester, NY
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
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Mustian KM, Janelsins M, Peppone LJ, Kamen C. Yoga for the Treatment of Insomnia among Cancer Patients: Evidence, Mechanisms of Action, and Clinical Recommendations. ACTA ACUST UNITED AC 2014; 10:164-168. [PMID: 25861453 DOI: 10.17925/ohr.2014.10.2.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Up to 90% of cancer patients report symptoms of insomnia during and after treatment. Symptoms of insomnia include excessive daytime sleepiness, difficulty falling asleep, difficulty staying asleep, and waking up too early. Insomnia symptoms are among the most prevalent, distressing and persistent cancer- and cancer treatment-related toxicities reported by patients, and can be severe enough to increase cancer morbidity and mortality. Despite the ubiquity of insomnia symptoms, they are under-screened, under-diagnosed, and under-treated in cancer patients. When insomnia symptoms are identified, providers are hesitant to prescribe, and patients are hesitant to take pharmaceuticals due to polypharmacy concerns. In addition, sleep medications do not cure insomnia. Yoga is a well-tolerated mode of exercise with promising evidence for its efficacy in improving insomnia symptoms among cancer patients. This article reviews existing clinical research on the effectiveness of yoga for treating insomnia among cancer patients. The article also provides clinical recommendations for prescribing yoga for the treatment of insomnia in this population.
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Affiliation(s)
- Karen M Mustian
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Wilmot Cancer Institute, Rochester, NY 14642
| | - Michelle Janelsins
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Wilmot Cancer Institute, Rochester, NY 14642
| | - Luke J Peppone
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Wilmot Cancer Institute, Rochester, NY 14642
| | - Charles Kamen
- Department of Surgery, University of Rochester School of Medicine and Dentistry, Wilmot Cancer Institute, Rochester, NY 14642
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Hurtado-Alvarado G, Pavón L, Castillo-García SA, Hernández ME, Domínguez-Salazar E, Velázquez-Moctezuma J, Gómez-González B. Sleep loss as a factor to induce cellular and molecular inflammatory variations. Clin Dev Immunol 2013; 2013:801341. [PMID: 24367384 PMCID: PMC3866883 DOI: 10.1155/2013/801341] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/19/2013] [Accepted: 10/21/2013] [Indexed: 12/17/2022]
Abstract
A reduction in the amount of time spent sleeping occurs chronically in modern society. Clinical and experimental studies in humans and animal models have shown that immune function is impaired when sleep loss is experienced. Sleep loss exerts a strong regulatory influence on peripheral levels of inflammatory mediators of the immune response. An increasing number of research projects support the existence of reciprocal regulation between sleep and low-intensity inflammatory response. Recent studies show that sleep deficient humans and rodents exhibit a proinflammatory component; therefore, sleep loss is considered as a risk factor for developing cardiovascular, metabolic, and neurodegenerative diseases (e.g., diabetes, Alzheimer's disease, and multiple sclerosis). Circulating levels of proinflammatory mediators depend on the intensity and duration of the method employed to induce sleep loss. Recognizing the fact that the concentration of proinflammatory mediators is different between acute and chronic sleep-loss may expand the understanding of the relationship between sleep and the immune response. The aim of this review is to integrate data from recent published reports (2002-2013) on the effects of sleep loss on the immune response. This review may allow readers to have an integrated view of the mechanisms involved in central and peripheral deficits induced by sleep loss.
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Affiliation(s)
- Gabriela Hurtado-Alvarado
- Area of Neurosciences, Department of Biology of Reproduction, CBS, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Avenida San Rafael Atlixco No. 186, Colonia Vicentina, Iztapalapa, 09340 Mexico City, Mexico
| | - Lenin Pavón
- Department of Psychoimmunology, National Institute of Psychiatry, “Ramón de la Fuente”, Calzada México-Xochimilco 101, Colonia San Lorenzo Huipulco, Tlalpan, 14370 Mexico City, DF, Mexico
| | - Stephanie Ariadne Castillo-García
- Area of Neurosciences, Department of Biology of Reproduction, CBS, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Avenida San Rafael Atlixco No. 186, Colonia Vicentina, Iztapalapa, 09340 Mexico City, Mexico
| | - María Eugenia Hernández
- Department of Psychoimmunology, National Institute of Psychiatry, “Ramón de la Fuente”, Calzada México-Xochimilco 101, Colonia San Lorenzo Huipulco, Tlalpan, 14370 Mexico City, DF, Mexico
| | - Emilio Domínguez-Salazar
- Area of Neurosciences, Department of Biology of Reproduction, CBS, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Avenida San Rafael Atlixco No. 186, Colonia Vicentina, Iztapalapa, 09340 Mexico City, Mexico
| | - Javier Velázquez-Moctezuma
- Area of Neurosciences, Department of Biology of Reproduction, CBS, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Avenida San Rafael Atlixco No. 186, Colonia Vicentina, Iztapalapa, 09340 Mexico City, Mexico
| | - Beatriz Gómez-González
- Area of Neurosciences, Department of Biology of Reproduction, CBS, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Avenida San Rafael Atlixco No. 186, Colonia Vicentina, Iztapalapa, 09340 Mexico City, Mexico
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Mustian KM. Yoga as Treatment for Insomnia Among Cancer Patients and Survivors: A Systematic Review. EUROPEAN MEDICAL JOURNAL. ONCOLOGY 2013; 1:106-115. [PMID: 25343044 PMCID: PMC4204627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Many cancer patients and survivors, between 15 to 90%, report some form of insomnia or sleep quality impairment during and post-treatment, such as excessive daytime napping, difficulty falling asleep, difficulty staying asleep, and waking up too early. Insomnia and sleep quality impairment are among the most prevalent and distressing problems reported by cancer patients and survivors, and can be severe enough to increase cancer mortality. Despite the ubiquity of insomnia and sleep quality impairment, they are under-diagnosed and under-treated in cancer patients and survivors. When sleep problems are present, providers and patients are often hesitant to prescribe or take pharmaceuticals for sleep problems due to poly pharmacy concerns, and cognitive behavioral therapy for insomnia can be very difficult and impractical for patients to adhere to throughout the cancer experience. Research suggests yoga is a well-tolerated exercise intervention with promising evidence for its efficacy in improving insomnia and sleep quality impairment among survivors. This article provides a systematic review of existing clinical research on the effectiveness of yoga for treating insomnia and sleep quality impairment among cancer patients and survivors.
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