201
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Sato I, Onishi H, Yamada S, Kawakami K. Prevalence and initial prescription of psychotropics in patients with common cancers in Japan, based on a nationwide health insurance claims database. Psychooncology 2017; 27:450-457. [DOI: 10.1002/pon.4511] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/08/2017] [Accepted: 07/21/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Izumi Sato
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health; Kyoto University; Kyoto Japan
- Keihanshin Consortium for Fostering the Next Generation of Global Leaders in Research (K-CONNEX); Kyoto Japan
| | - Hideki Onishi
- Department of Psychooncology; Saitama Medical University International Medical Center; Saitama Japan
| | - Shuhei Yamada
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health; Kyoto University; Kyoto Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health; Kyoto University; Kyoto Japan
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202
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Carlson LE, Zelinski EL, Speca M, Balneaves LG, Jones JM, Santa Mina D, Wayne PM, Campbell TS, Giese-Davis J, Faris P, Zwicker J, Patel K, Beattie TL, Cole S, Toivonen K, Nation J, Peng P, Thong B, Wong R, Vohra S. Protocol for the MATCH study (Mindfulness and Tai Chi for cancer health): A preference-based multi-site randomized comparative effectiveness trial (CET) of Mindfulness-Based Cancer Recovery (MBCR) vs. Tai Chi/Qigong (TCQ) for cancer survivors. Contemp Clin Trials 2017; 59:64-76. [PMID: 28576734 PMCID: PMC5639905 DOI: 10.1016/j.cct.2017.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE A growing number of cancer survivors suffer high levels of distress, depression and stress, as well as sleep disturbance, pain and fatigue. Two different mind-body interventions helpful for treating these problems are Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ). However, while both interventions show efficacy compared to usual care, they have never been evaluated in the same study or directly compared. This study will be the first to incorporate innovative design features including patient choice while evaluating two interventions to treat distressed cancer survivors. It will also allow for secondary analyses of which program best targets specific symptoms in particular groups of survivors, based on preferences and baseline characteristics. METHODS AND SIGNIFICANCE The design is a preference-based multi-site randomized comparative effectiveness trial. Participants (N=600) with a preference for either MBCR or TCQ will receive their preferred intervention; while those without a preference will be randomized into either intervention. Further, within the preference and non-preference groups, participants will be randomized into immediate intervention or wait-list control. Total mood disturbance on the Profile of mood states (POMS) post-intervention is the primary outcome. Other measures taken pre- and post-intervention and at 6-month follow-up include quality of life, psychological functioning, cancer-related symptoms and physical functioning. Exploratory analyses investigate biomarkers (cortisol, cytokines, blood pressure/Heart Rate Variability, telomere length, gene expression), which may uncover potentially important effects on key biological regulatory and antineoplastic functions. Health economic measures will determine potential savings to the health system.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada.
| | - Erin L Zelinski
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Michael Speca
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Lynda G Balneaves
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer M Jones
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Peter M Wayne
- Osher Center for Integrative Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Janine Giese-Davis
- Department of Oncology, University of Calgary, Calgary, AB, Canada; Cancer Control Board, Alberta Health Services, AB, Canada
| | - Peter Faris
- Centre for Advancement of Health, Alberta Health Services, AB, Canada
| | - Jennifer Zwicker
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Kamala Patel
- Department of Immunology, University of Calgary, Calgary, AB, Canada
| | - Tara L Beattie
- Department of Biochemistry and Molecular Biology, University of Calgary, Calgary, AB, Canada
| | - Steve Cole
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kirsti Toivonen
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Jill Nation
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Philip Peng
- Department of Anesthesia, University of Toronto, ON, Canada
| | - Bruce Thong
- Department of Athletics and Recreation, McMaster University, Hamilton, ON, Canada
| | - Raimond Wong
- Department of Oncology, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sunita Vohra
- Department of Pediatrics, Faculty of Medicine and Dentistry, Integrative Health Institute, University of Alberta, Edmonton, AB, Canada
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203
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Kerner H, Samuels N, Ben Moshe S, Sharabi IS, Ben-Arye E. Impact of a patient-tailored complementary/integrative medicine programme on disturbed sleep quality among patients undergoing chemotherapy. BMJ Support Palliat Care 2017; 10:e21. [PMID: 28710110 DOI: 10.1136/bmjspcare-2017-001351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The present study examined the impact of a patient-tailored complementary/integrative medicine (CIM) programme on sleep quality in patients undergoing chemotherapy for breast and gynaecological cancer. METHODS Study participants received standard supportive care, with or without weekly CIM treatments. Disturbed sleep quality was defined as a score of ≥4 on the Edmonton Symptom Assessment Scale (ESAS) or a score of ≥3 on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Adherence to integrative care was defined as attending ≥4 CIM treatments, with ≤30 days between each session. RESULTS Of 388 eligible patients, 264 (68%) reported disturbed sleep quality. Baseline-to-follow up assessment (at 6 weeks) was optimal for 104 patients in the treatment group and for 76 controls, with 75 of treated patients found to be adherent to the CIM intervention. Sleep-related ESAS scores improved more significantly in treated patients (p=0.008), as did sleep-related concerns on EORTC (treatment group, p=0.026). CONCLUSIONS A patient-tailored CIM programme may improve sleep quality and related concerns among patients with breast and gynaecological cancer undergoing chemotherapy. Further research is needed to better understand the impact of CIM on sleep quality in this patient population. TRIAL REGISTRATION NUMBER NCT01860365.
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Affiliation(s)
- Hilit Kerner
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel.,Family Medicine Department, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noah Samuels
- Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Shlomi Ben Moshe
- Sleep Laboratory and Clinics, Clalit Health Services, Haifa and Western Galilee and Carmel Medical Center, Kiryat Bialik, Israel
| | - Ilanit Shalom Sharabi
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel.,Graduate Studies Authority, Haifa University, Haifa, Israel
| | - Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa, Israel.,Family Medicine Department, Technion-Israel Institute of Technology, Haifa, Israel
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204
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Mahtani RL. Insomnia in the Cancer Patient: A Complex Problem. Breast J 2017; 23:385-386. [DOI: 10.1111/tbj.12761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Reshma L. Mahtani
- Division of Hematology/Oncology; Sylvester Comprehensive Cancer Center; University of Miami Health System; Deerfield Beach Florida
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205
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Do Cancer-Related Beliefs Influence the Severity, Incidence, and Persistence of Psychological Symptoms? Cancer Nurs 2017; 40:E50-E58. [DOI: 10.1097/ncc.0000000000000412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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206
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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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207
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Choi TY, Kim JI, Lim HJ, Lee MS. Acupuncture for Managing Cancer-Related Insomnia: A Systematic Review of Randomized Clinical Trials. Integr Cancer Ther 2017; 16:135-146. [PMID: 27531549 PMCID: PMC5739128 DOI: 10.1177/1534735416664172] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/16/2016] [Accepted: 07/06/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Insomnia is a prominent complaint of cancer patients that can significantly affect their quality of life and symptoms related to sleep quality. Conventional drug approaches have a low rate of success in alleviating those suffering insomnia. The aim of this systematic review was to assess the efficacy of acupuncture in the management of cancer-related insomnia. METHODS A total of 12 databases were searched from their inception through January 2016 without language restriction. Randomized controlled trials (RCTs) and quasi-RCTs were included if acupuncture was used as the sole intervention or as an adjunct to another standard treatment for any cancer-related insomnia. The data extraction and the risk of bias assessments were performed by 2 independent reviewers. RESULTS Of the 90 studies screened, 6 RCTs were included. The risk of bias was generally unclear or low. Three RCTs showed equivalent effects on the Pittsburgh Sleep Quality Index and 2 RCTs showed the similar effects on response rate to those of conventional drugs at the end of treatment. The other RCT showed acupuncture was better than hormone therapy in the numbers of hours slept each night and number of times woken up each night. The 3 weeks of follow-up in 2 RCTs showed superior effects of acupuncture compared with conventional drugs, and a meta-analysis showed significant effects of acupuncture. Two RCTs tested the effects of acupuncture on cancer-related insomnia compared with sham acupuncture. One RCT showed favourable effects, while the other trial failed to do so. CONCLUSION There is a low level of evidence that acupuncture may be superior to sham acupuncture, drugs or hormones therapy. However, the number of studies and effect size are small for clinical significance. Further clinical trials are warranted.
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Affiliation(s)
- Tae-Young Choi
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jong In Kim
- Division of Acupuncture & Moxibustion Medicine, Kyung Hee Korean Medicine Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Hyun-Ja Lim
- Department of Nursing, Chodang University, Muan, Republic of Korea
| | - Myeong Soo Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
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208
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Chen YC, Lin CY, Strong C, Li CY, Wang JS, Ko WC, Ko NY. Sleep disturbances at the time of a new diagnosis: a comparative study of human immunodeficiency virus patients, cancer patients, and general population controls. Sleep Med 2017; 36:38-43. [PMID: 28735919 DOI: 10.1016/j.sleep.2017.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/28/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Sleep disturbances are a prevalent and troubling symptom of patients with highly stressful illnesses, such as human immunodeficiency virus (HIV) and cancer. The aim of this study was to compare the prevalence and incidence of sleep disturbances among persons with HIV, those with cancer, and the general population of Taiwan. METHODS A matched cohort study design was used to compare the risk of sleep disturbances among three groups using reimbursement claims recorded in Taiwan's National Health Insurance Research Database (NHIRD). A total of 14,531 HIV-infected persons were compared with 1493 cancer patients and 1373 general population controls matched by gender and age. Cox proportional hazard regression models were used to test the hazard risk of sleep disturbances among the groups. RESULTS The mean durations between the date of the initial HIV/cancer diagnosis and onset of sleep disturbances of HIV-infected persons, cancer patients, and controls were 1.7, 2.3, and 1.8 years, respectively. The risk of developing sleep disturbances was significantly higher in HIV-infected persons (adjusted hazard ratio [AHR] = 3.74, p < 0.001) and cancer patients (AHR = 2.72, p < 0.001) than in controls. HIV-infected persons had a 20% higher risk of sleep disturbances than cancer patients (AHR = 1.20, p < 0.001). CONCLUSIONS HIV-infected persons exhibited a higher risk of developing sleep disturbances than cancer patients and general population controls. With efficacious treatments for sleep disturbances, we should focus on training and research programs for health care providers to intervene and treat earlier for the present and future health of cancer patients and HIV-infected persons.
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Affiliation(s)
- Yen-Chin Chen
- Department of Nursing, National Cheng Kung University and Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Yu Lin
- Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Sleep Medicine Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Carol Strong
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
| | - Chung-Yi Li
- Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Jeen-Shing Wang
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, National Cheng Kung University and Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan
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209
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Wright F, Cooper BA, Conley YP, Hammer MJ, Chen LM, Paul SM, Levine JD, Miaskowski C, Kober KM. Distinct Evening Fatigue Profiles in Oncology Outpatients Receiving Chemotherapy. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2017; 5:131-144. [PMID: 29725554 DOI: 10.1080/21641846.2017.1322233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Fatigue is the most common and debilitating symptom experienced by oncology patients during chemotherapy (CTX). Fatigue severity demonstrates a large amount of inter-individual and diurnal variability. Purpose Study purposes were to evaluate for subgroups of patients with distinct evening fatigue profiles and evaluate how these subgroups differed on demographic, clinical, and symptom characteristics. Methods Outpatients with breast, gastrointestinal, gynecological, or lung cancer (n=1332) completed questionnaires six times over two cycles of CTX. Lee Fatigue Scale (LFS) evaluated evening fatigue severity. Latent profile analysis was used to identify distinct evening fatigue profiles. Results Four distinct evening fatigue classes (i.e., Low (14.0%), Moderate (17.2%), High (36.0%), Very High (32.8%)) were identified. Compared to the Low class, patients in the Very High evening fatigue class were: younger, female, had childcare responsibilities, had more years of education, had a lower functional status, had a higher comorbidity burden, and were diagnosed with breast cancer. Patients in the Very High class reported higher levels of depressive symptoms, sleep disturbance, and evening fatigue at enrollment. Conclusions Findings provide new insights into modifiable risk factors for higher levels of evening fatigue. Clinicians can use this information to identify higher risk patients and plan appropriate interventions.
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Affiliation(s)
- Fay Wright
- School of Nursing, Yale University, New Haven, CT
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA
| | | | | | - Lee-May Chen
- School of Medicine, University of California, San Francisco, CA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA
| | | | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA
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210
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Balachandran DD, Bashoura L, Faiz SA. Sleep-Related Breathing Disorders and Cancer. CURRENT PULMONOLOGY REPORTS 2017. [DOI: 10.1007/s13665-017-0182-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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211
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Abstract
ABSTRACTObjective:Sleep can affect quality of life (QoL) during cancer survivorship, and symptoms related to poor sleep can be exacerbated. We examined the prevalence, severity, and nature of subjective sleep complaints in women surviving stage I-III breast cancer who were 1-10 years posttreatment. We also examined the demographic, medical, physical, and psychosocial correlates of poor sleep in these women in order to identify the subgroups that may be most in need of intervention. METHOD A total of 200 patients at a comprehensive cancer center who were 1-10 years posttreatment for primary stage I-III breast cancer with no evidence of disease at the time of enrollment completed a battery of questionnaires on demographics, sleep, physical symptoms, mood, cancer-specific fears, and QoL. RESULTS The women had a mean age of 57 years (SD = 10.0), with a mean of 63.3 months (SD = 28.8) of post-cancer treatment. Some 38% of these patients were identified as having poor-quality sleep. Women with poor sleep took longer to fall asleep, had more awakenings, and acquired 2 hours less sleep per night than those with good sleep. They also had a lower QoL, greater severity of pain, more concerns about health and recurrence, and increased vasomotor symptoms (p < 0.05). Daytime sleepiness and depression were found to be not significantly correlated with sleep quality. SIGNIFICANCE OF RESULTS Many breast cancer survivors had severe subjective insomnia, and several breast cancer survivor subgroups were identified as having members who might be most in need of sleep-improvement interventions. Addressing physical symptoms (e.g., vasomotor symptoms and pain) and providing education about the behavioral, social, environmental, and medical factors that affect sleep could result in substantial improvement in the life course of breast cancer survivors.
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212
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Associations of sleep disturbance with physical function and cognition in older adults with cancer. Support Care Cancer 2017; 25:3161-3169. [PMID: 28455547 DOI: 10.1007/s00520-017-3724-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Although sleep disturbances are common in older adults, studies evaluating the prevalence of sleep disturbance and its influence on functional outcomes in older adults with cancer are few. In this study, we examined the prevalence of sleep disturbance and its association with physical function and cognition in older adults with cancer. METHODS This is a cross-sectional study of patients who were referred and evaluated in the Specialized Oncology Care & Research in the Elderly (SOCARE) clinics at the Universities of Rochester and Chicago from May 2011 to October 2015. All patients underwent a geriatric assessment (GA) as part of their routine evaluation. Our final study cohort included patients who completed a sleep assessment and consented to the study. We collected demographics (age, sex, race, marital status, and education level) and clinical characteristics (depression, comorbidity, cancer type, and stage) from the GA and medical chart reviews. Presence of sleep disturbance was self-reported (yes/no). Physical function was assessed using Instrumental Activities of Daily Living (IADLs), physical activity (PA) survey, falls in the preceding 6 months, and Short Physical Performance Battery (SPPB). Cognition was screened using the Blessed Orientation-Memory-Concentration Test (impairment >4) or Montreal Cognitive Assessment (impairment <26). Bivariate and multivariable analyses were used to examine the associations between sleep disturbance with functional outcomes and cognition. RESULTS We included 389 older patients. The prevalence of sleep disturbance was 40%. Sixty-eight percent had ≥1 IADL impairment, 76% had PA limitation, 37% had ≥1 fall, 70% had impairment on SPPB, and 47% screened positive for cognitive impairment. On bivariate analyses, sleep disturbance was associated with IADL impairment (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.23-3.13, P = 0.005), and PA limitation (OR 2.43, 95% CI 1.38-4.28, P = 0.002). The associations remained significant on multivariable analyses. Sleep disturbance was not significantly associated with falls, impairment on SPPB, and performance on the cognitive screen. CONCLUSION Sleep disturbance was associated with IADL impairment and PA limitation. It is important for oncologists to inquire about sleep problems, and these patients should also be screened for functional impairment if sleep disturbance was present.
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213
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Cognitive-Behavioral Therapy for Insomnia in Cancer Patients: An Update of Efficacy Evidence and Areas for Future Research. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0067-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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214
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Medysky ME, Temesi J, Culos-Reed SN, Millet GY. Exercise, sleep and cancer-related fatigue: Are they related? Neurophysiol Clin 2017; 47:111-122. [PMID: 28392007 DOI: 10.1016/j.neucli.2017.03.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Cancer-related fatigue (CRF) is a commonly reported and debilitating side effect of cancer and/or cancer treatment. Sleep disorders are also highly reported in the cancer population; however it is unknown if sleep is associated with fatigue. In the general population, exercise has been shown to improve sleep, however in the cancer population this idea is under investigation. The primary purposes of this review were to: (i) review the prevalence and causes of sleep disorders in cancer patients and survivors, (ii) examine the relationship between sleep and CRF and (iii) review the impact of exercise interventions on sleep in cancer patients and survivors. A scoping review of the literature was conducted regarding exercise interventions in cancer patients and survivors with sleep as at least one outcome measure. A search of the literature revealed limited studies (n=21) assessing the effect of exercise on sleep disorders in the cancer population. Methodological issues are evident because assessing sleep is often not the main outcome of interest. The reviewed studies revealed that exercise positively impacts sleep quality and quantity. There seems to be possible relationship between sleep disorders, exercise and CRF. Further investigation of this relationship is necessary, specifically using objective measurement tools, in large, controlled studies, focusing on sleep as the primary outcome.
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Affiliation(s)
- Mary E Medysky
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - John Temesi
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Susan Nicole Culos-Reed
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada; Department of Oncology, Cumming School of Medicine, Calgary, Canada; Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, Canada
| | - Guillaume Y Millet
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada.
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215
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Luskin MR, Cronin AM, Owens RL, DeAngelo DJ, Stone RM, Wadleigh M, Steensma DP, Abel GA. Self-reported sleep disturbance and survival in myelodysplastic syndromes. Br J Haematol 2017; 177:562-566. [PMID: 28272741 DOI: 10.1111/bjh.14573] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/06/2016] [Indexed: 11/29/2022]
Abstract
Neither the prevalence of sleep disturbance nor its association with fatigue and overall survival (OS) are well understood for patients with myelodysplastic syndromes (MDS). New patients at our institution (n = 251; 2006-2014) completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, which includes questions about sleep and fatigue. Fifty-three per cent reported at least 'a little' trouble sleeping. In multivariable models, anaemia and sleep disturbance were associated with fatigue (both P < 0·001). Additionally, in separate models, sleep disturbance (P = 0·002) and fatigue (P = 0·04) both predicted OS. Our data suggest that improving sleep quality may impact MDS-related fatigue and OS.
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Affiliation(s)
- Marlise R Luskin
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | - Daniel J DeAngelo
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Richard M Stone
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Martha Wadleigh
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - David P Steensma
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Gregory A Abel
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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216
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Wang CH, Huang LC, Yang CC, Chen CL, Chou YJ, Chen YY, Yang WC, Chen L. Short- and long-term use of medication for psychological distress after the diagnosis of cancer. Support Care Cancer 2017; 25:757-768. [PMID: 27785583 PMCID: PMC5266776 DOI: 10.1007/s00520-016-3456-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/10/2016] [Indexed: 11/12/2022]
Abstract
PURPOSE This study investigated the short- and long-term use of medication for psychological distress after the diagnosis of cancer. METHODS Longitudinal data from the Taiwan National Health Insurance database were used to follow 35,137 cancer patients for 2.5 years after being diagnosed in 2006 and 2007. RESULTS Among those patients who survived for at least 180 days, 20.9 % had used psychotropic medications; sedatives were the most frequently prescribed (14.3 %), followed by antidepressants (5.5 %), anxiolytics (3.6 %), and antipsychotics (2.7 %). Lung cancer, prostate cancer, and oral cancer showed a significant association with the regular use of medication in the first 180 days. Among patients who survived for at least 2.5 years, 4.8 % still used psychotropic medication on a regular basis. Lung cancer and prostate cancer were associated with such prolonged use. CONCLUSIONS This longitudinal study found that the type of cancer was significantly associated with the use of psychotropic drugs after the diagnosis was made. It provided information about the trajectory of that use and found that a small number of patients were still using those medications after 2.5 years.
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Affiliation(s)
- Cheng-Hsu Wang
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- College of Medicine, Chang Gung University, Tao-Yuan, 333, Taiwan
| | - Lynn Chu Huang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, 350, Taiwan
| | - Chen-Chang Yang
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan
- Institute of Environmental & Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Toxicology & Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Liang Chen
- Department of Accounting, College of Business, Chung Yuan Christian University, Chung-Li, 320, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan
| | - Yen-Yuan Chen
- Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, 100, Taiwan
| | - Wei-Chih Yang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, 350, Taiwan
| | - Likwang Chen
- Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, 112, Taiwan.
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli, 350, Taiwan.
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217
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Armstrong TS, Shade MY, Breton G, Gilbert MR, Mahajan A, Scheurer ME, Vera E, Berger AM. Sleep-wake disturbance in patients with brain tumors. Neuro Oncol 2017; 19:323-335. [PMID: 27286798 PMCID: PMC5464298 DOI: 10.1093/neuonc/now119] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/04/2016] [Indexed: 02/07/2023] Open
Abstract
Sleep-wake disturbances are defined as perceived or actual alterations in sleep that result in impaired daytime functioning. Unlike other cancers, there is limited information about sleep-wake disturbances in adults with primary brain tumors throughout the illness trajectory. Sleep-wake disturbance is among the most severe and common symptoms reported by primary brain-tumor patients, particularly those undergoing radiation therapy. As with other cancers and neurologic illness, sleep-wake disturbance may also be clustered or related to other symptoms such as fatigue, depression, and cognitive impairment. There is increasing evidence for a genetic basis of normal sleep and sleep regulation in healthy adults. Specific mutations and single nucleotide variants have been reported to be associated with both fatigue and sleep-wake disorders, and both inflammation and alterations in circadian rhythms have been postulated to have a potential role. Guidelines for assessment and interventions have been developed, with cognitive behavioral therapy, exercise, and sleep hygiene demonstrating benefit in patients with other solid tumors. Further research is needed to identify risk and appropriate treatment in the brain-tumor patient population.
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Affiliation(s)
| | - Marcia Y Shade
- University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ghislain Breton
- Department of Integrative Biology, UTHealth McGovern Medical School, Houston, Texas, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Anita Mahajan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Elizabeth Vera
- University of Texas Health Science Center, Houston, Texas, USA
| | - Ann M Berger
- University of Nebraska Medical Center, Omaha, Nebraska, USA
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218
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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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219
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Baker TA, O'Connor ML, Krok-Schoen JL. Influence of Social and Health Indicators on Pain Interference With Everyday Activities Among Older Black and White Cancer Patients. Gerontol Geriatr Med 2017; 2:2333721415624989. [PMID: 28138484 PMCID: PMC5119878 DOI: 10.1177/2333721415624989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 11/25/2022] Open
Abstract
Objective: This prospective study aimed to determine the influence social and health factors have on pain interference with everyday activities among older patients receiving outpatient treatment services from a comprehensive cancer center. Method: Participants were surveyed on questions assessing pain interference, and social (communication), health (pain severity, comorbidities), behavioral (self-efficacy, affect), and demographic characteristics. Multivariate analyses were specified to examine determinants of pain interference, with items loading on separate cluster composites: physical interference and psychosocial interference. Results: Pain severity was a significant indicator for physical interference. Similarly, pain severity, education, self-efficacy, negative affect, and communication were predictors of psychosocial interference. Discussion: Factors defining the daily lived experiences of older adults are important in providing baseline information on functional status. This emphasizes the need to rigorously examine the association between pain, and clinical and psychosocial indicators, but more importantly indicators that contribute to the patient’s ability to perform normal everyday activities.
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220
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Carli F, Silver JK, Feldman LS, McKee A, Gilman S, Gillis C, Scheede-Bergdahl C, Gamsa A, Stout N, Hirsch B. Surgical Prehabilitation in Patients with Cancer. Phys Med Rehabil Clin N Am 2017; 28:49-64. [DOI: 10.1016/j.pmr.2016.09.002] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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221
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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: 72] [Impact Index Per Article: 10.3] [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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222
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Park B, Youn S, Hann CWC, Yi K, Lee S, Lee JS, Chung S. Prevalence of Insomnia among Patients with the Ten Most Common Cancers in South Korea: Health Insurance Review and Assessment Service-National Patient Sample. SLEEP MEDICINE RESEARCH 2016. [DOI: 10.17241/smr.2016.00073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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223
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Mercadante S, Adile C, Ferrera P, Masedu F, Valenti M, Aielli F. Sleep disturbances in advanced cancer patients admitted to a supportive/palliative care unit. Support Care Cancer 2016; 25:1301-1306. [DOI: 10.1007/s00520-016-3524-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
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224
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Kienle GS, Mussler M, Fuchs D, Kiene H. Individualized Integrative Cancer Care in Anthroposophic Medicine: A Qualitative Study of the Concepts and Procedures of Expert Doctors. Integr Cancer Ther 2016; 15:478-494. [PMID: 27151589 PMCID: PMC5739166 DOI: 10.1177/1534735416640091] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/20/2016] [Accepted: 02/12/2016] [Indexed: 11/16/2022] Open
Abstract
Background Cancer patients widely seek integrative oncology which embraces a wide variety of treatments and system approaches. Objective To investigate the concepts, therapeutic goals, procedures, and working conditions of integrative oncology doctors in the field of anthroposophic medicine. Methods This qualitative study was based on in-depth interviews with 35 highly experienced doctors working in hospitals and office-based practices in Germany and other countries. Structured qualitative content analysis was applied to examine the data. Results The doctors integrated conventional and holistic cancer concepts. Their treatments aimed at both tumor and symptom control and at strengthening the patient on different levels: living with the disease, overcoming the disease, enabling emotional and cognitive development, and addressing spiritual or transcendental issues according to the patient's wishes and initiatives. Therapeutic procedures were conventional anticancer and symptom-relieving treatments, herbal and mineral remedies, mistletoe therapy, art therapies, massages and other external applications, nutrition and lifestyle advice, psychological support, and multiple forms of empowerment. The approach emphasised good patient-doctor relationships and sufficient time for patient encounters and decision-making. Individualization appeared in several dimensions and was interwoven with standards and mindlines. The doctors often worked in teams and cooperated with other cancer care-related specialists. Conclusion Integrative cancer care pursues an individualized and patient-centered approach, encompassing conventional and multimodal complementary interventions, and addressing, along with physical and functional needs, the emotional and spiritual needs of patients. This seems to be important for tumor and symptom control, and addresses major challenges and important goals of modern cancer care.
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Affiliation(s)
- Gunver S Kienle
- University of Witten Herdecke, Freiburg, Germany
- University Medical Center Freiburg, Freiburg, Germany
| | | | | | - Helmut Kiene
- University of Witten Herdecke, Freiburg, Germany
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225
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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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226
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Mustian KM, Cole CL, Lin PJ, Asare M, Fung C, Janelsins MC, Kamen CS, Peppone LJ, Magnuson A. Exercise Recommendations for the Management of Symptoms Clusters Resulting From Cancer and Cancer Treatments. Semin Oncol Nurs 2016; 32:383-393. [PMID: 27776835 DOI: 10.1016/j.soncn.2016.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To review existing exercise guidelines for cancer patients and survivors for the management of symptom clusters. DATA SOURCES Review of PubMed literature and published exercise guidelines. CONCLUSION Cancer and its treatments are responsible for a copious number of incapacitating symptoms that markedly impair quality of life. The exercise oncology literature provides consistent support for the safety and efficacy of exercise interventions in managing cancer- and treatment-related symptoms, as well as improving quality of life in cancer patients and survivors. IMPLICATIONS FOR NURSING PRACTICE Effective management of symptoms enhances recovery, resumption of normal life activities and quality of life for patients and survivors. Exercise is a safe, appropriate, and effective therapeutic option before, during, and after the completion of treatment for alleviating symptoms and symptom clusters.
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227
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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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228
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George GC, Iwuanyanwu EC, Anderson KO, Yusuf A, Zinner RG, Piha-Paul SA, Tsimberidou AM, Naing A, Fu S, Janku F, Subbiah V, Cleeland CS, Mendoza TR, Hong DS. Sleep quality and its association with fatigue, symptom burden, and mood in patients with advanced cancer in a clinic for early-phase oncology clinical trials. Cancer 2016; 122:3401-3409. [PMID: 27412379 DOI: 10.1002/cncr.30182] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/21/2016] [Accepted: 05/16/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Limited data exist about sleep quality for patients with advanced cancer in phase 1 clinical trials. Poor sleep quality is often not captured as an adverse event, and its association with fatigue, one of the most frequently reported adverse events, is not documented routinely. This article describes sleep quality and its relation with fatigue, symptom burden, and mood in patients recruited from an early-phase clinic for targeted therapy. METHODS Sleep, fatigue, symptom burden, and mood were assessed with the Pittsburgh Sleep Quality Index (PSQI), the Brief Fatigue Inventory, the MD Anderson Symptom Inventory (MDASI), and the Brief Profile of Mood States, respectively; the Eastern Cooperative Oncology Group (ECOG) performance status (PS) was determined from medical records. RESULTS The sample (n = 256) was 51.2% female, 90% had an ECOG PS of 0 or 1, and the mean age was 58 ± 0.8 years. Poor sleepers (global PSQI score > 5) constituted 64% of the sample. In separate multiple regression models, poor sleepers had higher levels of fatigue (P < .001), symptom burden (P < .001), and overall mood disturbance (P < .001) than good sleepers. Also, compared with good sleepers, poor sleepers had greater fatigue-related and symptom-related interference with daily activities (all P values < .001). The MDASI disturbed-sleep item correlated well with the global PSQI score (Pearson's r = 0.679, P < .001), and this suggests its usefulness as a patient-reported outcome screener of sleep quality in early-phase clinical trials clinics. CONCLUSIONS Poor sleep quality was a significant problem in the current study and was associated with greater fatigue, symptom burden, and mood disturbance. Sleep quality should be routinely assessed in patients with advanced cancer who are participating in early-phase clinical trials. Cancer 2016;122:3401-3409. © 2016 American Cancer Society.
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Affiliation(s)
- Goldy C George
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas. .,Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Eucharia C Iwuanyanwu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen O Anderson
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alizeh Yusuf
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ralph G Zinner
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarina A Piha-Paul
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Apostolia M Tsimberidou
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aung Naing
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Siqing Fu
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Filip Janku
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tito R Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David S Hong
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Feasibility and diagnostic accuracy of the Patient-Reported Outcomes Measurement Information System (PROMIS) item banks for routine surveillance of sleep and fatigue problems in ambulatory cancer care. Cancer 2016; 122:2906-17. [DOI: 10.1002/cncr.30134] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 04/05/2016] [Accepted: 04/25/2016] [Indexed: 11/07/2022]
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230
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Savard J, Ivers H, Savard MH. Capacity of the Edmonton Symptom Assessment System and the Canadian Problem Checklist to screen clinical insomnia in cancer patients. Support Care Cancer 2016; 24:4339-44. [PMID: 27193119 DOI: 10.1007/s00520-016-3273-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/05/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Insomnia is highly prevalent in cancer patients. Efficacious treatments exist for this condition but, for these interventions to be offered, an effective screening needs to be carried out beforehand. The pan-Canadian practice guidelines on sleep disturbances provide recommendations on how to use the Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist (CPC) to screen for sleep difficulties in cancer. However, empirical evidence to support these recommendations is lacking. The goal of this study was to assess the capacity of the ESAS (drowsiness and "other" items) and the CPC (sleep item) to screen for clinical insomnia in cancer patients. METHODS As part of routine care, 615 patients with various cancer types completed the ESAS, the CPC, and the Insomnia Severity Index, used as the standard for establishing the presence of clinical insomnia. RESULTS None of the criteria provided an effective screening when used alone. No patient used the ESAS-other item to report sleep difficulties. The sensitivity and specificity rates of the CPC-sleep item alone were 60.4 and 89.6 %, respectively. A score ≥2 on the ESAS-drowsiness item had a sensitivity of 61.5 % and a specificity of 75.4 %. When used in combination, the best option was scoring positively on the CPC-sleep item OR a score ≥2 on the ESAS-drowsiness item (sensitivity 84.2 %; specificity 69.7 %). CONCLUSIONS When used alone, the CPC-sleep and the ESAS-drowsiness items yielded insufficient sensitivity rates for a first screening, but when used in combination, they provided a good balance between sensitivity and specificity.
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Affiliation(s)
- Josée Savard
- School of Psychology, Université Laval, Québec, Canada. .,CHU de Québec-Université Laval Research Center, Québec, Canada. .,Université Laval Cancer Research Centre, Québec, Canada.
| | - Hans Ivers
- School of Psychology, Université Laval, Québec, Canada.,CHU de Québec-Université Laval Research Center, Québec, Canada.,Université Laval Cancer Research Centre, Québec, Canada
| | - Marie-Hélène Savard
- CHU de Québec-Université Laval Research Center, Québec, Canada.,Université Laval Cancer Research Centre, Québec, Canada
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231
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Kienle GS, Mussler M, Fuchs D, Kiene H. Intravenous Mistletoe Treatment in Integrative Cancer Care: A Qualitative Study Exploring the Procedures, Concepts, and Observations of Expert Doctors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:4628287. [PMID: 27239209 PMCID: PMC4860234 DOI: 10.1155/2016/4628287] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/07/2016] [Indexed: 11/20/2022]
Abstract
Background. Mistletoe therapy (MT) is widely used in patient-centered integrative cancer care. The objective of this study was to explore the concepts, procedures, and observations of expert doctors, with a focus on intravenous MT. Method. A qualitative interview study was conducted with 35 highly experienced doctors specialized in integrative and anthroposophic medicine. Structured qualitative content analysis was applied. For triangulation, the results were compared with external evidence that was systematically collected, reviewed, and presented. Results. Doctors perform individualized patient assessments that lead to multimodal treatment approaches. The underlying goal is to help patients to live with and overcome disease. Mistletoe infusions are a means of accomplishing this goal. They are applied to stabilize disease, achieve responsiveness, induce fever, improve quality of life, and improve the tolerability of conventional cancer treatments. The doctors reported long-term disease stability and improvements in patients' general condition, vitality, strength, thermal comfort, appetite, sleep, pain from bone metastases, dyspnea in pulmonary lymphangitis carcinomatosa, fatigue, and cachexia; chemotherapy was better tolerated. Also patients' emotional and mental condition was reported to have improved. Conclusion. Individualized integrative cancer treatment including MT aims to help cancer patients to live well with their disease. Further research should investigate the reported observations.
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Affiliation(s)
- Gunver S. Kienle
- Institute for Applied Epistemology and Medical Methodology, University of Witten/Herdecke, Zechenweg 6, 79111 Freiburg, Germany
- Center for Complementary Medicine, Institute for Environmental Health Sciences and Hospital Infection Control, University Medical Center Freiburg, Breisacher Strasse 115B, 79106 Freiburg, Germany
| | - Milena Mussler
- Institute for Applied Epistemology and Medical Methodology, University of Witten/Herdecke, Zechenweg 6, 79111 Freiburg, Germany
| | - Dieter Fuchs
- Department of Theology, Caritas Sciences, University of Freiburg, Werthmannplatz 3, 79098 Freiburg, Germany
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology, University of Witten/Herdecke, Zechenweg 6, 79111 Freiburg, Germany
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Savard J, Ivers H, Savard MH, Morin CM. Long-Term Effects of Two Formats of Cognitive Behavioral Therapy for Insomnia Comorbid with Breast Cancer. Sleep 2016; 39:813-23. [PMID: 26715229 DOI: 10.5665/sleep.5634] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/26/2015] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES The goal of this randomized controlled trial, conducted in breast cancer patients, was to assess the long-term efficacy of a video-based cognitive behavioral therapy for insomnia (VCBT-I), as compared to a professionally administered intervention (PCBT-I) and to a no-treatment group (CTL). An earlier report revealed that, at posttreatment, VCBT-I patients showed significantly greater sleep improvements than CTL, but that PCBT-I produced superior effects than VCBT-I on some sleep and secondary outcomes. In this report, long-term effects are compared. METHODS Two hundred forty-two women with breast cancer and with insomnia symptoms or using hypnotic medications participated to this three-arm randomized controlled trial: (1) PCBT-I (n = 81); (2) VCBT-I (n = 80); or (3) no treatment (CTL; n = 81) group. PCBT-I was composed of six weekly, individual sessions of approximately 50 min, whereas VCBT-I comprised a 60-min animated video and six booklets. RESULTS Study measures (sleep and secondary variables) were administered at pretreatment and posttreatment, and at a 3-, 6-, and 12-mo follow-up. Treatment gains were well sustained at follow-up in both PCBT-I and VCBT-I. As at posttreatment, the remission rate of insomnia at follow-up was greater in PCBT-I than in VCBT-I, which was greater than in CTL. CONCLUSIONS Although face-to-face therapy remains the optimal format to efficaciously administer CBT for insomnia in cancer patients, a minimal intervention, such as the video-based intervention tested in this study, produces significant and sustainable treatment effects. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier NCT00674830.
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Affiliation(s)
- Josée Savard
- School of Psychology, Université Laval, Québec, Québec, Canada.,CHU de Québec-Université Laval Research Center, Québec, Québec, Canada.,Université Laval Cancer Research Center, Québec, Québec, Canada
| | - Hans Ivers
- School of Psychology, Université Laval, Québec, Québec, Canada.,CHU de Québec-Université Laval Research Center, Québec, Québec, Canada.,Université Laval Cancer Research Center, Québec, Québec, Canada
| | - Marie-Hélène Savard
- CHU de Québec-Université Laval Research Center, Québec, Québec, Canada.,Université Laval Cancer Research Center, Québec, Québec, Canada
| | - Charles M Morin
- School of Psychology, Université Laval, Québec, Québec, Canada
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233
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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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234
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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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235
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Roth ME, O'Mara AM, Seibel NL, Dickens DS, Langevin AM, Pollock BH, Freyer DR. Low Enrollment of Adolescents and Young Adults Onto Cancer Trials: Insights From the Community Clinical Oncology Program. J Oncol Pract 2016; 12:e388-95. [PMID: 27026648 PMCID: PMC4960459 DOI: 10.1200/jop.2015.009084] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Stagnant outcomes for adolescents and young adults (AYAs; 15 to 39 years old) with cancer are partly attributed to poor enrollment onto clinical trials. The National Cancer Institute (NCI) Community Clinical Oncology Program (CCOP) was developed to improve clinical trial participation in the community setting, where AYAs are most often treated. Further, many CCOP sites had pediatric and medical oncologists with collaborative potential for AYA recruitment and care. For these reasons, we hypothesized that CCOP sites enrolled proportionately more AYAs than non-CCOP sites onto Children's Oncology Group (COG) trials. METHODS For the 10-year period 2004 through 2013, the NCI Division of Cancer Prevention database was queried to evaluate enrollments into relevant COG studies. The proportional enrollment of AYAs at CCOP and non-CCOP sites was compared and the change in AYA enrollment patterns assessed. All sites were COG member institutions. RESULTS Although CCOP sites enrolled a higher proportion of patients in cancer control studies than non-CCOP sites (3.5% v 1.8%; P < .001), they enrolled a lower proportion of AYAs (24.1% v 28.2%, respectively; P < .001). Proportional AYA enrollment at CCOP sites decreased during the intervals 2004 through 2008 and 2009 through 2013 (26.7% v 21.7%; P < .001). CONCLUSION Despite oncology practice settings that might be expected to achieve otherwise, CCOP sites did not enroll a larger proportion of AYAs in clinical trials than traditional COG institutions. Our findings suggest that the CCOP (now the NCI Community Oncology Research Program) can be leveraged for developing targeted interventions for overcoming AYA enrollment barriers.
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Affiliation(s)
- Michael E Roth
- Albert Einstein College of Medicine, Bronx, NY; National Cancer Institute, Bethesda, MD; Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of California, Davis; and University of Southern California, Los Angeles, CA
| | - Ann M O'Mara
- Albert Einstein College of Medicine, Bronx, NY; National Cancer Institute, Bethesda, MD; Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of California, Davis; and University of Southern California, Los Angeles, CA
| | - Nita L Seibel
- Albert Einstein College of Medicine, Bronx, NY; National Cancer Institute, Bethesda, MD; Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of California, Davis; and University of Southern California, Los Angeles, CA
| | - David S Dickens
- Albert Einstein College of Medicine, Bronx, NY; National Cancer Institute, Bethesda, MD; Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of California, Davis; and University of Southern California, Los Angeles, CA
| | - Anne-Marie Langevin
- Albert Einstein College of Medicine, Bronx, NY; National Cancer Institute, Bethesda, MD; Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of California, Davis; and University of Southern California, Los Angeles, CA
| | - Brad H Pollock
- Albert Einstein College of Medicine, Bronx, NY; National Cancer Institute, Bethesda, MD; Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of California, Davis; and University of Southern California, Los Angeles, CA
| | - David R Freyer
- Albert Einstein College of Medicine, Bronx, NY; National Cancer Institute, Bethesda, MD; Helen DeVos Children's Hospital at Spectrum Health, Grand Rapids, MI; University of Texas Health Science Center at San Antonio, San Antonio, TX; University of California, Davis; and University of Southern California, Los Angeles, CA
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236
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Garland SN, Gehrman P, Barg FK, Xie SX, Mao JJ. CHoosing Options for Insomnia in Cancer Effectively (CHOICE): Design of a patient centered comparative effectiveness trial of acupuncture and cognitive behavior therapy for insomnia. Contemp Clin Trials 2016; 47:349-55. [DOI: 10.1016/j.cct.2016.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/21/2016] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
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237
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Ratcliff CG, Milbury K, Chandwani KD, Chaoul A, Perkins G, Nagarathna R, Haddad R, Nagendra HR, Raghuram NV, Spelman A, Arun B, Wei Q, Cohen L. Examining Mediators and Moderators of Yoga for Women With Breast Cancer Undergoing Radiotherapy. Integr Cancer Ther 2016; 15:250-62. [PMID: 26867802 PMCID: PMC4972683 DOI: 10.1177/1534735415624141] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Hypothesis. This study examines moderators and mediators of a yoga intervention targeting quality-of-life (QOL) outcomes in women with breast cancer receiving radiotherapy.Methods. Women undergoing 6 weeks of radiotherapy were randomized to a yoga (YG; n = 53) or stretching (ST; n = 56) intervention or a waitlist control group (WL; n = 54). Depressive symptoms and sleep disturbances were measured at baseline. Mediator (posttraumatic stress symptoms, benefit finding, and cortisol slope) and outcome (36-item Short Form [SF]-36 mental and physical component scales [MCS and PCS]) variables were assessed at baseline, end-of-treatment, and 1-, 3-, and 6-months posttreatment. Results. Baseline depressive symptoms (P = .03) and sleep disturbances (P < .01) moderated the Group × Time effect on MCS, but not PCS. Women with high baseline depressive symptoms in YG reported marginally higher 3-month MCS than their counterparts in WL (P = .11). Women with high baseline sleep disturbances in YG reported higher 3-months MCS than their counterparts in WL (P < .01) and higher 6-month MCS than their counterparts in ST (P = .01). YG led to greater benefit finding than ST and WL across the follow-up (P = .01). Three-month benefit finding partially mediated the effect of YG on 6-month PCS. Posttraumatic stress symptoms and cortisol slope did not mediate treatment effect on QOL. Conclusion. Yoga may provide the greatest mental-health–related QOL benefits for those experiencing pre-radiotherapy sleep disturbance and depressive symptoms. Yoga may improve physical-health–related QOL by increasing ability to find benefit in the cancer experience.
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Affiliation(s)
- Chelsea G Ratcliff
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA Baylor College of Medicine, Houston, TX, USA VA South Central Mental Illness Research, Education, and Clinical Center, Houston, TX, USA
| | - Kathrin Milbury
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alejandro Chaoul
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - George Perkins
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Robin Haddad
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - N V Raghuram
- Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, India
| | - Amy Spelman
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Banu Arun
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Qi Wei
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lorenzo Cohen
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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López E, de la Torre-Luque A, Lazo A, Álvarez J, Buela-Casal G. Assessment of sleep disturbances in patients with cancer: Cross-sectional study in a radiotherapy department. Eur J Oncol Nurs 2016; 20:71-6. [DOI: 10.1016/j.ejon.2014.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 12/27/2014] [Accepted: 12/31/2014] [Indexed: 11/17/2022]
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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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240
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Abstract
Lung cancer is the most common cancer worldwide and is the leading cause of cancer death for both men and women in the USA. Symptom burden in patients with advanced lung cancer is very high and has a negative impact on their quality of life (QOL). Palliative care with its focus on the management of symptoms and addressing physical, psychosocial, spiritual, and existential suffering, as well as medically appropriate goal setting and open communication with patients and families, significantly adds to the quality of care received by advanced lung cancer patients. The Provisional Clinical Opinion (PCO) of American Society of Clinical Oncology (ASCO) as well as the National Cancer Care Network's (NCCN) clinical practice guidelines recommends early integration of palliative care into routine cancer care. In this chapter, we will provide an overview of palliative care in lung cancer and will examine the evidence and recommendations with regard to a comprehensive and interdisciplinary approach to symptom management, as well as discussions of goals of care, advance care planning, and care preferences.
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Affiliation(s)
- Arvind M Shinde
- Department of Hematology and Oncology, Samuel Oschin Cancer Center, 8700 Beverly Blvd, AC1045, Los Angeles, CA, 90048, USA.
- Department of Medicine, Supportive Care Medicine Program, Cedars Sinai Medical Center, Becker Bldg., B224, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA.
| | - Azadeh Dashti
- Department of Medicine, Supportive Care Medicine Program, Cedars Sinai Medical Center, Becker Bldg., B224, 8700 Beverly Blvd, Los Angeles, CA, 90048, USA
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241
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Garland SN, Roscoe JA, Heckler CE, Barilla H, Gehrman P, Findley JC, Peoples AR, Morrow GR, Kamen C, Perlis ML. Effects of armodafinil and cognitive behavior therapy for insomnia on sleep continuity and daytime sleepiness in cancer survivors. Sleep Med 2015; 20:18-24. [PMID: 27318221 DOI: 10.1016/j.sleep.2015.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/29/2015] [Accepted: 12/22/2015] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVES This study involves the analysis of a secondary outcome of a trial examining whether cognitive behavior therapy for insomnia (CBT-I), a wake-promoting medication (armodafinil), or both results in greater improvement in prospectively assessed sleep continuity and daytime sleepiness than a placebo-alone group among a heterogeneous group of cancer survivors. Whether or not armodafinil alone, and/or when combined with CBT-I, affected adherence with CBT-I was evaluated. DESIGN This study is a randomized, placebo-controlled, clinical trial. SETTING This study was conducted at two northeastern academic medical centers. PARTICIPANTS Eighty-eight cancer survivors with chronic insomnia were recruited between October 2008 and November 2012. Participants were assigned to one of four conditions: 1) CBT-I and placebo (CBT-I+P); 2) CBT-I and armodafinil (CBT-I + A); 2) armodafinil alone (ARM); or 4) placebo alone (PLA). INTERVENTIONS CBT-I was delivered in seven weekly individual therapy sessions (three in person, four via telephone). The armodafinil dosage was 50 mg BID. MEASUREMENTS AND RESULTS Sleep continuity was measured with daily sleep diaries assessing sleep latency (SL), wake after sleep onset (WASO), and total sleep time (TST). The Epworth Sleepiness Scale (ESS) measured daytime sleepiness. Compared to the PLA group, the CBT-I+P and CBT-I+A groups reported a significant reduction in SL with effect sizes of 0.67 and 0.58, respectively. A significant reduction was observed in WASO in the CBT-I+A group with an effect size of 0.64. An increasing trend of TST was observed in the CBT-I+P, CBT-I+A, and PLA groups, but not in the ARM group. No statistically significant reductions in daytime sleepiness (ESS) were observed for any of the groups. CONCLUSION CBT-I alone and in combination with armodafinil caused significant improvement in sleep continuity. The addition of armodafinil did not appear to improve daytime sleepiness or enhance adherence to CBT-I.
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Affiliation(s)
- Sheila N Garland
- Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Abramson Cancer Center, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA; Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA 19104, USA; Department of Psychology, Memorial University of Newfoundland, 232 Elizabeth Avenue, St. John's, NL A1B 3X9, Canada.
| | - Joseph A Roscoe
- James P. Wilmot Cancer Center, University of Rochester, 265 Crittenden Blvd. CU 420658, Rochester, NY 14642, USA
| | - Charles E Heckler
- James P. Wilmot Cancer Center, University of Rochester, 265 Crittenden Blvd. CU 420658, Rochester, NY 14642, USA
| | - Holly Barilla
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA 19104, USA
| | - Philip Gehrman
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA 19104, USA
| | - James C Findley
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA 19104, USA
| | - Anita R Peoples
- James P. Wilmot Cancer Center, University of Rochester, 265 Crittenden Blvd. CU 420658, Rochester, NY 14642, USA
| | - Gary R Morrow
- James P. Wilmot Cancer Center, University of Rochester, 265 Crittenden Blvd. CU 420658, Rochester, NY 14642, USA
| | - Charles Kamen
- James P. Wilmot Cancer Center, University of Rochester, 265 Crittenden Blvd. CU 420658, Rochester, NY 14642, USA
| | - Michael L Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, PA 19104, USA.
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Reinsel RA, Starr TD, O'Sullivan B, Passik SD, Kavey NB. Polysomnographic Study of Sleep in Survivors of Breast Cancer. J Clin Sleep Med 2015; 11:1361-70. [PMID: 26194735 DOI: 10.5664/jcsm.5264] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 05/28/2015] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE Insomnia is a frequent complaint in breast cancer patients during and after treatment. Breast cancer survivors, 1-10 years posttreatment, underwent in-lab polysomnography (PSG) to objectively define the insomnia in those patients with such a complaint. METHODS Twenty-six breast cancer survivors (aged 39-80, mean 54.0 months posttreatment) spent 2 nights in the sleep laboratory. Sleep on Night 2 was scored for sleep stages, sleep onset latency, REM sleep onset latency, wake time, apneas and hypopneas, periodic limb movements and arousals. Subjects were allocated into 2 groups by their scores on the Pittsburgh Sleep Quality Index (PSQI): no/ mild sleep disturbance (PSQI score ≤ 9, n = 15) or moderate/ severe sleep disturbance (PSQI ≥ 10, n = 11). RESULTS Standard PSG/EEG parameters failed to differentiate insomniacs from non-insomniacs. The single variable that distinguished the insomnia group was periodic limb movements in sleep (PLMS). PLMS were significantly correlated (r ≅ 0.7, p < 0.02) with subjective report of insomnia on PSQI and insomnia severity index. Log[Number of PLMS] was higher in the moderate/severe insomnia group (p = 0.008). Five of 11 patients in the moderate/severe insomnia group had a PLMS index ≥ 15, compared to only one of 15 patients in the none/mild insomnia group (p = 0.02). Menopausal symptoms and use of caffeine, hypnotics, and antidepressants were unrelated to insomnia severity or PLMS. CONCLUSIONS PLMS was the sole PSG variable that separated breast cancer survivors with moderate/severe insomnia from those with no/mild sleep disturbance. Further study of the incidence and significance of PLMS in breast cancer survivors with the complaint of insomnia is merited.
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Affiliation(s)
- Ruth A Reinsel
- National Sleep Research Institute, New York, NY.,Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY
| | - Tatiana D Starr
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Neil B Kavey
- National Sleep Research Institute, New York, NY.,The Rockefeller University Hospital, New York, NY.,Department of Psychiatry, Columbia University Medical Center, New York, NY
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Abstract
Sleep-wake cycle disturbances are prevalent in patients with medical conditions and frequently present as part of a symptom cluster. Sleep disturbances impair functioning and quality of life, decrease adherence to treatments of the primary medical condition, and increase morbidity and mortality. The pathophysiology of sleep disturbances in these patients involves alterations in immune and neuroendocrine function and shares common pathophysiologic pathways with comorbidities such as fatigue and depression. Emphasis is placed on the evaluation and management of medical and psychiatric comorbidities and other factors contributing to sleep problems. Primary treatments include cognitive-behavioral therapy and pharmacotherapy.
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Affiliation(s)
- Jayesh Kamath
- Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-6415, USA.
| | - Galina Prpich
- Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-6415, USA
| | - Sarah Jillani
- Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-6415, USA
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Mercadante S, Aielli F, Adile C, Ferrera P, Valle A, Cartoni C, Pizzuto M, Caruselli A, Parsi R, Cortegiani A, Masedu F, Valenti M, Ficorella C, Porzio G. Sleep Disturbances in Patients With Advanced Cancer in Different Palliative Care Settings. J Pain Symptom Manage 2015; 50:786-92. [PMID: 26311122 DOI: 10.1016/j.jpainsymman.2015.06.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/08/2015] [Accepted: 07/06/2015] [Indexed: 11/15/2022]
Abstract
CONTEXT Information regarding sleep disturbances in the population with advanced cancer is meager. OBJECTIVES To assess the prevalence of sleep disturbances and possible correlations with associated factors in a large number of patients with advanced cancer admitted to different palliative care settings. METHODS This was an observational study performed in different settings of palliative care. A consecutive sample of patients with advanced cancer was prospectively assessed for a period of six months. Epidemiological and clinical data, treatments received in the last month, Karnofsky status, Edmonton Symptom Assessment System scores, and concomitant medical treatment were recorded. Patients were administered the Athens Insomnia Scale and the Hospital Anxiety and Depression Scale (HADS). RESULTS A total of 820 patients were surveyed. Mean age was 69.7 years (SD 12.7), and 429 patients were males. Consistent sleep disturbances (moderate to maximum) were found in 60.8% of patients. Aged patients were less likely to have sleep disturbances, whereas a poor Karnofsky level was significantly associated with sleep problems. Breast, gastrointestinal, head and neck, lung, and prostate cancers were associated with sleep problems. Patients who had a secondary school or undergraduate education had less sleep disturbances. Hormone therapy and use of opioids and corticosteroids were positively associated with sleep disturbances, and there was a positive correlation of HADS-Anxiety and HADS-Depression scores with sleep disturbances. CONCLUSION More than 60% of palliative care patients have relevant sleep disturbances. Several factors associated with sleep disorders have been identified and should prompt physicians to make a careful examination and subsequent treatment of these disturbances.
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Affiliation(s)
| | - Federica Aielli
- Supportive Care Task Force, University of L'Aquila, L'Aquila, Italy
| | - Claudio Adile
- Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | - Patrizia Ferrera
- Pain Relief and Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | | | - Claudio Cartoni
- Division of Hematology, Department of Cellular Biotechnologies and Hematology, Policlinico Umberto I, Home Care Service of the Rome Section of the Italian Association Against Leukemias, Rome, Italy
| | - Massimo Pizzuto
- Palliative Care Unit, Istituti Clinici di Perfezionamento Hospital, Milan, Italy
| | - Amanda Caruselli
- Home Care Program, SAMO, Palermo, Italy; Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | | | - Andrea Cortegiani
- Department of Biopathology, Medical and Forensic Biotechnologies, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | - Francesco Masedu
- Section of Clinical Epidemiology and Environmental Medicine, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Marco Valenti
- Section of Clinical Epidemiology and Environmental Medicine, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Giampiero Porzio
- Supportive Care Task Force, University of L'Aquila, L'Aquila, Italy
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246
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Kim HS, Oh EG, Lee H, Kim SH, Kim HK. Predictors of symptom experience in Korean patients with cancer undergoing chemotherapy. Eur J Oncol Nurs 2015; 19:644-53. [DOI: 10.1016/j.ejon.2015.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 04/01/2015] [Accepted: 04/10/2015] [Indexed: 12/20/2022]
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247
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Hughes JG, Towler P, Storey L, Wheeler SL, Molassiotis A. A feasibility study of auricular therapy and self-administered acupressure for insomnia following cancer treatment. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yennurajalingam S, Balachandran D, Pedraza Cardozo SL, Berg EA, Chisholm GB, Reddy A, DeLa Cruz V, Williams JL, Bruera E. Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item. BMJ Support Palliat Care 2015; 7:274-280. [PMID: 26475092 DOI: 10.1136/bmjspcare-2015-000847] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 07/23/2015] [Accepted: 09/16/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA
| | - Dave Balachandran
- Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sandra L Pedraza Cardozo
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA
| | - Elyssa A Berg
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA
| | - Gary B Chisholm
- The University of Texas MD Anderson Cancer Center, Biostatistics, Houston, Texas, USA
| | - Akhila Reddy
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA
| | - Vera DeLa Cruz
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA
| | - Janet L Williams
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston Texas, USA
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249
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Garland SN, Rouleau CR, Campbell T, Samuels C, Carlson LE. The Comparative Impact of Mindfulness-Based Cancer Recovery (MBCR) and Cognitive Behavior Therapy for Insomnia (CBT-I) on Sleep and Mindfulness in Cancer Patients. Explore (NY) 2015; 11:445-54. [PMID: 26386748 DOI: 10.1016/j.explore.2015.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Insomnia is an important but often overlooked side effect of cancer. Dysfunctional sleep beliefs have been identified as an important perpetuating factor for insomnia. Mindfulness practice has been demonstrated to improve sleep quality but it is unknown whether these effects relate to changes in dysfunctional sleep beliefs. PURPOSE This study is a secondary analysis of a randomized controlled trial comparing mindfulness-based cancer recovery (MBCR) to cognitive behavior therapy for insomnia (CBT-I) in cancer patients with insomnia. This present analysis compares program impact on mindfulness, dysfunctional sleep beliefs, and insomnia severity clinical cutoffs. METHODS Patients (MBCR, n = 32; CBT-I, n = 40) were assessed at baseline, post-program, and 3-month follow-up. RESULTS Across both groups, patients showed improvements over time in acting with awareness (P = .021) and not judging experiences (P = .023). Changes in dysfunctional sleep beliefs produced by the CBT-I group exceeded those produced by MBCR at post-program and follow-up (P < .001). Acting with awareness, non-judging, and non-reacting were the facets of mindfulness associated with an overall reduction in dysfunctional sleep beliefs. There were no significant differences between the MBCR and CBT-I groups in the percentage of patients exceeding insomnia severity clinical cutoffs at post-program or follow-up. CONCLUSIONS This study supports the use of both CBT-I and MBCR to reduce insomnia severity and suggests the development of mindfulness facets as a method of reducing dysfunctional sleep beliefs.
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Affiliation(s)
- Sheila N Garland
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, 415 Curie Blvd, Philadelphia, PA 19104.
| | - Codie R Rouleau
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Tavis Campbell
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Charles Samuels
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Linda E Carlson
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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250
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The effect of melatonin on sleep and quality of life in patients with advanced breast cancer. Support Care Cancer 2015; 24:1097-105. [PMID: 26260726 DOI: 10.1007/s00520-015-2883-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/29/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Fatigue and sleep problems are prevalent in cancer patients and can be associated with disruption of circadian rhythmicity. In this prospective phase II trial, we sought to assess the effect of melatonin on circadian biomarkers, sleep, and quality of life in breast cancer patients. METHODS Thirty-two patients with metastatic breast cancer, receiving hormonal or trastuzumab therapy, took 5 mg of melatonin at bedtime for 2 months. Before starting and after 2 months on melatonin therapy, sleep and circadian rhythmicity were assessed by actigraphy, diurnal patterns of serum cortisol, and the expression of the core clock genes PER2 and BMAL1 in peripheral blood mononuclear cells. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire was completed for subjective parameters. RESULTS Bedtime melatonin was associated with a significant improvement in a marker of objective sleep quality, sleep fragmentation and quantity, subjective sleep, fatigue severity, global quality of life, and social and cognitive functioning scales. Morning clock gene expression was increased following bedtime melatonin intake. Melatonin did not affect actigraphy measure of circadian rhythmicity, or the diurnal cortisol pattern. CONCLUSION These results invite further investigation of melatonin as a potentially useful therapeutic agent for improving sleep and quality of life in cancer patients.
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