1
|
Wong AK, Wang D, Marco D, Le B, Philip J. Prevalence, Severity, and Predictors of Insomnia in Advanced Colorectal Cancer. J Pain Symptom Manage 2023; 66:e335-e342. [PMID: 37295563 DOI: 10.1016/j.jpainsymman.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
CONTEXT Insomnia is an under-recognized and undertreated symptom in palliative care and advanced cancer cohorts. Insomnia in an advanced colorectal cancer cohort is yet to be investigated despite colorectal cancer being the third commonest cancer worldwide and one with a high symptom burden. OBJECTIVES To examine the prevalence of insomnia and its associations in a large advanced colorectal cancer cohort. METHODS A consecutive cohort study of 18,302 patients with colorectal cancer seen by palliative care services across various settings (inpatient, outpatient, and ambulatory) was conducted from an Australia-wide database (2013-2019). The Symptom Assessment Score (SAS) was used to assess the severity of insomnia. Clinically significant insomnia was defined as SAS score ≥3/10, and used to compare associations with other symptoms and functional scores from validated questionnaires. RESULTS The prevalence of any insomnia was 50.5%, and clinically significant insomnia 35.6%, particularly affecting people who were younger (<45-years-old), more mobile (AKPS score ≥70), or physically capable (RUG-ADL score ≤5). Outpatients and patients living at home had higher prevalence of insomnia. Nausea, anorexia and psychological distress were the commonest concurrent symptoms in patients with clinically significant insomnia. CONCLUSIONS To our knowledge, this study was the first to investigate the prevalence and associations of insomnia in an advanced colorectal cancer cohort. Our findings demonstrate several groups at greater risk of suffering from insomnia (younger, greater physical capacity, living at home, and those with greater psychological distress). This may guide earlier recognition and management of insomnia to improve overall quality of life in this population.
Collapse
Affiliation(s)
- Aaron K Wong
- Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Eastern Hill Campus, (A.K.W., D.M., J.P.), University of Melbourne, Fitzroy, Victoria, Australia.
| | - Dorothy Wang
- Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - David Marco
- Department of Medicine, Eastern Hill Campus, (A.K.W., D.M., J.P.), University of Melbourne, Fitzroy, Victoria, Australia; Centre for Palliative Care, St Vincent's Hospital Melbourne (D.M.), Fitzroy, Victoria, Australia
| | - Brian Le
- Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jennifer Philip
- Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Eastern Hill Campus, (A.K.W., D.M., J.P.), University of Melbourne, Fitzroy, Victoria, Australia; Palliative Care Service (J.P.), St Vincent's Hospital, Fitzroy, Victoria, Australia
| |
Collapse
|
2
|
Schieber K, Niecke A, Geiser F, Erim Y, Bergelt C, Büttner-Teleaga A, Maatouk I, Stein B, Teufel M, Wickert M, Wuensch A, Weis J. The course of cancer-related insomnia: don't expect it to disappear after cancer treatment. Sleep Med 2019; 58:107-113. [PMID: 31146122 DOI: 10.1016/j.sleep.2019.02.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The study aimed to examine the 12-month course of cancer-related insomnia (CRI) and to identify possible predictors for the prevalence and persistence of CRI. METHODS This longitudinal multicenter study included N = 405 patients with cancer (56% females, mean age: 58.6 years). CRI was measured by the Insomnia Severity Index (ISI). Socio-demographic and clinical data, as well as psychological parameters (Distress Thermometer, PHQ-9, GAD-7, and EORTC-Fatigue), were assessed at baseline (T1) and 12 months later (T2). RESULTS In our sample, a high prevalence of relevant insomnia symptoms (49.4%, ISI > 7) was found, while a clinical insomnia diagnosis was verified in 12.8% (ISI > 14). When insomnia was present at T1, this problem was persistent after one year in 64%. At T2, however, significantly more women suffered from insomnia symptoms (53.3% women vs. 39.3% men; p = 0.003). Insomnia was associated with many clinical and psychological parameters, especially with fatigue (r = 0.5). Multiple regression analysis revealed that, in women, only insomnia at T1 was a significant predictor for insomnia at T2 (R2 = 0.40; F(5) = 12.5; p < 0.001), whereas in men insomnia, depressive symptoms and the use of psychotropic drugs at T1 predicted the extent of insomnia at T2 (R2 = 0.28; F(7) = 9.5; p < 0.001). In all participants, levels of distress, depression, and anxiety decreased from T1 to T2 (p's < 0.016). CONCLUSION Insomnia is a common disorder in cancer patients. Although medical and psychological parameters improved during the 12-month course of cancer treatment, our results show that insomnia is highly persistent, especially in women. This indicates that adequate support for those affected is needed. CLINICAL TRIAL REGISTRATION NUMBER DRKS00004860.
Collapse
Affiliation(s)
- Katharina Schieber
- University Hospital of Erlangen, Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, D-91054, Erlangen, Germany.
| | - Alexander Niecke
- University Hospital Cologne, Department of Psychosomatics and Psychotherapy & Centre Psychooncology (CePO), Kerpener Str. 62, D-50937, Cologne, Germany
| | - Franziska Geiser
- University of Bonn, Clinic for Psychosomatic Medicine and Psychotherapy, Sigmund-Freud-Str.25, D-53127, Bonn, Germany
| | - Yesim Erim
- University Hospital of Erlangen, Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Schwabachanlage 6, D-91054, Erlangen, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Center for Psychosocial Medicine, Martinistrasse 52, D-20246, Hamburg, Germany
| | - Antje Büttner-Teleaga
- Institute of Cognitive Science, Woosuk University, 565-701, Samrye-up, Wanju-gun, Jeonbuk, Republic of Korea
| | - Imad Maatouk
- Medical University Hospital Heidelberg, Department of General Internal Medicine and Psychosomatics, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Prof.-Ernst-Nathan-Straße 1, D-90419, Nuremberg, Germany
| | - Martin Teufel
- University of Duisburg-Essen, Department of Psychosomatic Medicine and Psychotherapy, Comprehensive Cancer Center Essen (WTZ) and LVR Hospital, Virchowstr. 174, D-45147, Essen, Germany
| | - Martin Wickert
- Medical University Hospital Tuebingen, Universitätsklinikum Tübingen, Comprehensive Cancer Center Tübingen-Stuttgart, Herrenberger Str. 23, D-72070, Tübingen, Germany
| | - Alexander Wuensch
- Clinic for Psychosomatic Medicine and Psychotherapy, Medical Center Freiburg, Faculty of Medicine, University Freiburg in Cooperation with Outpatient Support for Cancer Patients, Comprehensive Cancer Center Freiburg, Hauptstr. 5a, D-79104, Freiburg, Germany
| | - Joachim Weis
- Comprehensive Cancer Center, Department Self-help Research, Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, D-79106, Freiburg, Germany
| |
Collapse
|
3
|
Capezuti E, Sagha Zadeh R, Woody N, Basara A, Krieger AC. An Integrative Review of Nonpharmacological Interventions to Improve Sleep among Adults with Advanced Serious Illness. J Palliat Med 2018; 21:700-717. [PMID: 29337603 PMCID: PMC6909694 DOI: 10.1089/jpm.2017.0152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sleep fragmentation is common among those with advanced serious illness. Nonpharmacological interventions to improve sleep have few, if any, adverse effects and are often underutilized in these settings. OBJECTIVE We aimed to summarize the literature related to nonpharmacological interventions to improve sleep among adults with advanced serious illness. METHODS We systematically searched six electronic databases for literature reporting sleep outcomes associated with nonpharmacological interventions that included participants with advanced serious illness during the period of 1996-2016. RESULTS From a total of 2731 results, 42 studies met the inclusion criteria. A total of 31 individual interventions were identified, each evaluated individually and some in combination with other interventions. Twelve of these studies employed either multiple interventions within an intervention category (n = 8) or a multicomponent intervention consisting of interventions from two or more categories (n = 5). The following intervention categories emerged: sleep hygiene (1), environmental (6), physical activity (4), complementary health practices (11), and mind-body practices (13). Of the 42 studies, 22 demonstrated a statistically significant, positive impact on sleep and represented each of the categories. The quality of the studies varied considerably, with 17 studies classified as strong, 17 as moderate, and 8 as weak. CONCLUSIONS Several interventions have been demonstrated to improve sleep in these patients. However, the small number of studies and wide variation of individual interventions within each category limit the generalizability of findings. Further studies are needed to assess interventions and determine effectiveness and acceptability.
Collapse
Affiliation(s)
- Elizabeth Capezuti
- School of Nursing, Hunter College and The Graduate Center, City University of New York, New York, New York
| | - Rana Sagha Zadeh
- Department of Design and Environmental Analysis, Cornell University, Ithaca, New York
| | - Nicole Woody
- Healthcare Strategy and Operations Consultant, New York, New York
| | - Aleksa Basara
- Department of Economics, Health Design Innovations Laboratory, Department of Design and Environmental Analysis, Cornell University, Ithaca, New York
| | - Ana C. Krieger
- Departments of Medicine, Neurology, and Genetic Medicine, Center for Sleep Medicine, Weill Cornell Medical Center, New York, New York
| |
Collapse
|
4
|
Sleep-wake difficulties in community-dwelling cancer patients receiving palliative care: subjective and objective assessment. Palliat Support Care 2017; 16:756-766. [PMID: 28933313 DOI: 10.1017/s1478951517000815] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Prevalence rates of sleep difficulties in advanced cancer patients have varied widely across studies (12 to 96%), and none of these employed a diagnostic interview to distinguish different types of sleep-wake disorders. Moreover, very limited information is available on subjective and objective sleep parameters in this population. Our study was conducted in palliative cancer patients and aimed to assess rates of sleep-wake disorders and subsyndromal symptoms and to document subjective and objective sleep-wake parameters across various types of sleep-wake difficulties. METHOD The sample was composed of 51 community-dwelling cancer patients receiving palliative care and having an Eastern Cooperative Oncology Group score of 2 or 3. Relevant sections of the Duke Interview for Sleep Disorders were administered over the phone. An actigraphic recording and a daily sleep diary were completed for 7 consecutive days. RESULTS Overall, 68.6% of the sample had at least one type of sleep-wake difficulty (disorder or symptoms): 31.4% had insomnia and 29.4% had hypersomnolence as their main sleep-wake problem. Participants with insomnia as their main sleep difficulty had greater disruptions of subjective sleep parameters, while objectively-assessed sleep was more disrupted in patients with hypersomnolence comorbid with another sleep-wake difficulty.Significance of the Results:The high rates of sleep-wake difficulties found in this study indicate a need to screen more systematically for sleep-wake disorders, including insomnia and hypersomnolence, in both palliative care research and clinical practice, and to develop effective nonpharmacological interventions specifically adapted to this population.
Collapse
|
5
|
Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapy. Support Care Cancer 2017; 25:2485-2494. [PMID: 28281049 DOI: 10.1007/s00520-017-3655-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/20/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE In a sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer who received at least two cycles of chemotherapy (CTX), the purposes were to evaluate for inter-individual differences in the severity of sleep disturbance and determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of sleep disturbance. METHODS A total of 1331 patients completed study questionnaires in their homes, at six time points over two cycles of CTX (prior to CTX administration, approximately 1 week after CTX administration, and approximately 2 weeks after CTX administration). Questionnaires included demographic, clinical, and symptom assessments (i.e., General Sleep Disturbance Scale, Lee Fatigue Scale, Center for Epidemiological Studies-Depression Scale, Spielberger State-Trait Anxiety Inventories, Attentional Function Index). Hierarchical linear modeling based on full maximum likelihood estimation was performed. RESULTS Characteristics associated with higher initial levels of sleep disturbance included higher body mass index, poorer functional status, higher trait anxiety, higher depressive symptoms, and higher evening fatigue. Characteristics associated with the worse trajectories of sleep disturbance were higher levels of education and higher sleep disturbance at enrollment. Characteristics associated with both higher initial levels and worse trajectories of sleep disturbance were higher morning fatigue and worse attentional function. CONCLUSIONS A large amount of inter-individual variability exists in sleep disturbance during CTX. The modifiable and non-modifiable characteristics found in this study can be used to identify higher risk patients and provide earlier interventions to reduce sleep disturbance.
Collapse
|
6
|
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
| |
Collapse
|
7
|
Bardy J, Finnegan-John J, Molassiotis A, Mackereth P. Providing acupuncture in a breast cancer and fatigue trial: The therapists' experience. Complement Ther Clin Pract 2015; 21:217-22. [PMID: 26573446 DOI: 10.1016/j.ctcp.2015.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the experiences of therapists providing acupuncture in a trial context, to women with fatigue, following breast cancer treatment. METHODS The focus groups were nested within a multi-site randomised control trial. Therapists (n = 15) involved in the trial were invited to participate in one of the focus groups, which took place in the north and south of England. The treatment protocol imposed constraints on dialogue to essential procedural conversation and stipulated needling times of 20 min. RESULTS All 15 therapists (100%) participated. Whilst they reported learning more about fatigue and cancer, adhering to the trial protocol limited the holistic nature of their practice. Seeing improvements, despite the protocol, made some therapists question their practice, in terms of needling times and limiting dialogue. CONCLUSIONS The study provided information about the therapists' perspective of working within a trial. This could have implications for providing acupuncture treatments more cost effectively and timely within clinical practice.
Collapse
Affiliation(s)
- J Bardy
- The Christie NHS Foundation Trust, Complementary Therapies Department, Wilmslow Road, Manchester, United Kingdom; School of Nursing, Social Work and Midwifery, University of Manchester, Oxford, Manchester, United Kingdom
| | - J Finnegan-John
- Breast Cancer Care, 5-13 Great Suffolk Street, London, United Kingdom
| | - A Molassiotis
- School of Nursing, Social Work and Midwifery, University of Manchester, Oxford, Manchester, United Kingdom; School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong Special Administrative Region
| | - P Mackereth
- School of Nursing, Social Work and Midwifery, University of Manchester, Oxford, Manchester, United Kingdom.
| |
Collapse
|
8
|
Mackereth P, Farrell C, Bardy J, Molassiotis A, Finnegan-John J. Legitimising fatigue after breast-cancer treatment. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:S4, S6, S8-12. [PMID: 25723371 DOI: 10.12968/bjon.2015.24.sup4.s4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study aimed to explore the experience of women living with fatigue following chemotherapy for breast cancer. Six focus groups were conducted (n=40); all participants had taken part in a multi-site acupuncture trial. There were three to seven people per focus group. Additionally, two people attended one-to-one interviews and four people provided written responses to the trigger questions. The audiotapes from these sessions were transcribed and analysed using a thematic approach. Participants raised concerns about fatigue possibly being a symptom of the cancer coming back or a sign of senility. Respondents described the effects of fatigue on relationships, sexuality, social life, home life and returning to work. The Coping with Fatigue booklet ( Macmillan Cancer Support, 2011 ) was discussed in terms of legitimising the experience of cancer-related fatigue and explaining symptoms to family and work colleagues. More research work is required to evaluate non-pharmaceutical interventions and advice to support women living with fatigue after chemotherapy for breast cancer.
Collapse
|
9
|
|