Trajectories of sleep disturbance and daytime sleepiness in women before and after surgery for breast cancer

Prevalence and predictors of sleep problems in women following a cancer diagnosis: results from the women's wellness after cancer program

PURPOSE

Using a discrete dataset from the Women's Wellness after Cancer Program (WWACP), we examine the prevalence and predictors of self-reported sleep problems in women previously treated for cancer.

METHODS

Participants were 351 women (Mage = 53.2, SD = 8.8) from the WWACP who had completed surgery, chemotherapy and/or radiotherapy for breast, gynaecological or blood cancers within the previous 24 months. Sleep problems were measured using the Pittsburgh Sleep Quality Index (PSQI). Baseline data (i.e. prior to intervention randomisation) were analysed.

RESULTS

Most women (59%) reported clinically significant sleep disturbance (PSQI > 5), 40% reported insufficient sleep duration (< 7 h), 38% self-reported poor sleep quality and 28% reported poor habitual sleep efficiency (sleep efficiency < 75%). Fewer psychological and vasomotor climacteric symptoms, age < 45 years and having a partner were associated with reduced odds (AOR < 1) of sleep problems. Higher levels of pain-related disability, and an intermediate compared to 'high' level of education, were associated with increased odds (AOR > 1) of sleep problems.

CONCLUSIONS

These findings confirm previous studies that have found a high prevalence of sleep problems in women previously treated for cancer. A range of sociodemographic, climacteric and pain-related factors were associated with sleep problems in this study.

IMPLICATIONS FOR CANCER SURVIVORS

Targeted interventions to improve sleep quality after cancer treatment should be explored in this population. Predictors identified in this study could inform intervention targeting and development.

A qualitative study of sleep in young breast cancer survivors: "No longer able to sleep through the night"

Sleep disturbance is common among women with breast cancer and is associated with greater symptom distress and poorer outcomes. Yet, for the unique subgroup of young women with breast cancer (YWBC), there is limited information on sleep. To address the gap in our understanding of sleep health in YWBC, we explored their perspective on sleep quality, sleep changes over time, contributing factors, and any strategies used to promote sleep. As part of an explanatory sequential mixed method study, we recruited a sub-sample of 35 YWBC (≤ 50 years of age at the time of diagnosis) from the larger quantitative study phase. These participants were within the first 5 years since diagnosis and completed primary and systemic adjuvant therapy. We conducted virtual semi-structured interviews, transcribed them verbatim, and analyzed data with an interpretive description approach. YWBC experience difficulty falling asleep, waking up at night, and not feeling refreshed in the morning. They attributed interrupted sleep to vasomotor symptoms, anxiety/worry, ruminating thoughts, everyday life stressors, and discomfort. The sleep disturbance was most severe during and immediately after treatment but persisted across the 5 years of survivorship. The participants reported trying pharmacologic and non-pharmacologic strategies to improve the quantity and quality of their sleep. Future research would benefit from longitudinal designs to capture temporal changes in sleep and develop interventions to improve sleep health. Clinically, assessment of sleep health is indicated for YWBC related to the prevalence of disturbed sleep. IMPLICATIONS FOR CANCER SURVIVORS: Early access to sleep assessment and management, ideally before cancer treatment, would be beneficial for young breast cancer survivors. In addition, cancer treatment plans should include physical and psychological symptoms, especially those reported by women in this study: vasomotor symptoms, anxiety and worry, discomfort, and pain.

Exploration of the Relationships Between Stress and Distinct Pain and Sleep Disturbance Profiles in Patients Undergoing Chemotherapy

BACKGROUND

Unrelieved pain and sleep disturbance are common symptoms in oncology patients. Increased stress may be an underlying cause for both symptoms.

OBJECTIVES

The purposes of this study were to identify subgroups of outpatients with distinct pain and sleep disturbance profiles and to evaluate differences among these subgroups in demographic and clinical characteristics. Differences in global stress, cancer-specific stress, and cumulative life stress, as well as resilience and coping, were evaluated.

METHODS

Patients (N = 1343) completed self-report questionnaires for demographic and clinical characteristics and stress, resilience, and coping. Latent profile analysis was used to identify subgroups of patients with distinct pain and sleep disturbance profiles. Differences among the subgroups were determined using parametric and nonparametric tests.

RESULTS

Three distinct profiles were identified (ie, No Pain + Moderate Sleep Disturbance (SD) (27.6%), Moderate Pain + Moderate SD (38.6%), Severe Pain + High SD (33.8%)). Compared with the other 2 classes, Severe Pain + High SD class was younger, had fewer years of education, was more likely to be female, more likely to live alone, less likely to be employed, and had a higher level of comorbidity. This class had the highest stress scores and was more likely to report higher rates of adverse childhood experiences.

CONCLUSION

Over 70% of our sample reported clinically meaningful levels of both symptoms, and 33.8% reported relatively high rates of adverse childhood experiences.

IMPLICATION FOR PRACTICE

Clinicians need to perform routine assessments, particularly of adverse childhood experiences, and initiate appropriate referrals.

Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life

BACKGROUND

Anxiety and sleep disturbance are frequent symptoms during chemotherapy.

OBJECTIVES

Purposes were to identify subgroups of oncology outpatients with distinct joint anxiety and sleep disturbance profiles, as well as evaluate for differences in demographic and clinical characteristics, sleep disturbance characteristics, severity of common symptoms, and quality-of-life outcomes among these subgroups.

METHODS

Oncology outpatients (n = 1331) completed self-report measures of anxiety and sleep disturbance 6 times over 2 chemotherapy cycles. Latent profile analysis was done to identify subgroups of patients with distinct joint anxiety and sleep disturbance profiles.

RESULTS

Three profiles were identified (ie, no anxiety and low sleep disturbance (59.7%), moderate anxiety and high sleep disturbance (32.5%), high anxiety and very high sleep disturbance (7.8%)). Compared with the no anxiety and low sleep disturbance class, the other 2 classes were younger; less likely to be married; had a lower annual household income; and had childcare responsibilities. Patients in the 2 worse profiles had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and evening fatigue, as well as lower levels of morning and evening energy, cognitive function, and poorer quality of life.

CONCLUSIONS

More than 40% of patients had moderate or high levels of anxiety and high or very high levels of sleep disturbance. Modifiable risk factors associated with these profiles may be used to develop targeted interventions for 1 or both symptoms.

IMPLICATIONS FOR PRACTICE

Clinicians need to assess for the co-occurrence of anxiety and sleep disturbance.

Trajectories of sleep disturbance in cancer survivors during the first 2 years post-treatment

STUDY OBJECTIVES

To examine the trajectories of sleep disturbance in cancer survivors during the first 2 years post-treatment and to investigate whether psychological, cognitive, and physical factors differentiate trajectories.

METHODS

A total of 623 Chinese cancer survivors of diverse cancer types participated in a 2-year-long prospective study after the completion of cancer treatment. Sleep disturbance was measured using Pittsburgh Sleep Quality Index at 3 (T2), 6 (T3), 12 (T4), 18 (T5), and 24 (T6) months after baseline (within 6-months post-treatment; T1). Latent growth mixture modeling identified distinctive sleep disturbance trajectories and tested if these longitudinal patterns were predicted by baseline psychological distress, attentional control, attentional bias and physical symptom distress and T2 cancer-related distress. Fully adjusted multinomial logistic regression then identified whether these factors differentiated trajectories.

RESULTS

Two distinct sleep disturbance trajectories were identified, namely stable good sleepers (69.7%) and persistent high sleep disturbance (30.3%). Compared to those in the stable good sleep group, patients in the persistent high sleep disturbance group were less likely to report avoidant (OR=0.49, 95% CI = 0.26-0.90), while more likely to report intrusive thoughts (OR = 1.76, 95% CI = 1.06-2.92) and cancer-related hyperarousal (OR = 3.37, 95% CI = 1.78-6.38). Higher depression scores also predicted persistent high sleep disturbance group membership (OR = 1.13, 95% CI = 1.03-1.25). Attentional bias, attentional control, anxiety, and physical symptom distress did not predict sleep trajectory membership.

CONCLUSIONS

One in three cancer survivors experienced persistent high sleep disturbance. Screening and managing depressive symptoms and cancer-related distress in early cancer rehabilitation may reduce risk of persistent sleep disturbance among cancer survivors.

Moderate-to-high risk of obstructive sleep apnea with excessive daytime sleepiness is associated with postoperative neurocognitive disorders: a prospective one-year follow-up cohort study

Background

Few studies found that obstructive sleep apnea (OSA) may be related to postoperative neurocognitive disorders (PND) including postoperative delirium (POD) and cognitive decline (POCD) in the early postoperative period. However, the results are controversial and need further verification, and no research has explored the effect of OSA on the incidence of PND during the 1-year follow-up periods. Furthermore, OSA patients with excessive daytime sleepiness (EDS) as a severe phenotype have more significant neurocognitive impairments, but the relationship between OSA with EDS and PND within 1 year after surgery has not been studied.

Objectives

To explore the effect of moderate-to-high risk of OSA and the moderate-to-high risk of OSA with EDS on PND within 1 year after surgery.

Methods

In this prospective cohort study, including 227 older patients, moderate-to-high risk of OSA (using STOP-BANG), subjective EDS (using Epworth Sleepiness Scale), and objective EDS (using Actigraphy) were selected as exposures. Key outcomes included POD during hospitalization (using Confusion Assessment Method-Severity), POCD at discharge, 1-month and 1-year after surgery (using Mini-Mental State Examination and Telephone Interview for Cognitive Status-40). We applied multiple logistic regression models to estimate the effect of moderate-to-high risk of OSA and moderate-to-high risk of OSA with EDS on PND.

Results

In the multivariate analysis, moderate-to-high risk of OSA was not associated with POD during hospitalization and POCD at discharge, 1-month, and 1-year after surgery (p > 0.05). However, the moderate-to-high risk of OSA with subjective EDS was related to POCD at discharge compared to the moderate-to-high risk of OSA or normal group (no moderate-to-high risk of OSA and no EDS) (p < 0.05). In addition, moderate-to-high risk of OSA with objective EDS was associated with POCD at discharge, 1-month, and 1-year postoperatively compared to the moderate-to-high risk of OSA or normal group (p < 0.05).

Conclusion

Moderate-to-high risk of OSA with EDS, not moderate-to-high risk of OSA alone, was a clinically helpful predictor for POCD within 1-year after surgery and should be routinely assessed before surgery.

Tackling Insomnia Symptoms through Vestibular Stimulation in Patients with Breast Cancer: A Perspective Paper

Insomnia symptoms are common among patients with breast cancer (BC; 20-70%) and are predictors of cancer progression and quality of life. Studies have highlighted sleep structure modifications, including increased awakenings and reduced sleep efficiency and total sleep time. Such modifications may result from circadian rhythm alterations consistently reported in this pathology and known as carcinogenic factors, including lower melatonin levels, a flattened diurnal cortisol pattern, and lower rest-activity rhythm amplitude and robustness. Cognitive behavioral therapy and physical activity are the most commonly used non-pharmacological interventions to counter insomnia difficulties in patients with BC. However, their effects on sleep structure remain unclear. Moreover, such approaches may be difficult to implement shortly after chemotherapy. Innovatively, vestibular stimulation would be particularly suited to tackling insomnia symptoms. Indeed, recent reports have shown that vestibular stimulation could resynchronize circadian rhythms and improve deep sleep in healthy volunteers. Moreover, vestibular dysfunction has been reported following chemotherapy. This perspective paper aims to support the evidence of using galvanic vestibular stimulation to resynchronize circadian rhythms and reduce insomnia symptoms in patients with BC, with beneficial effects on quality of life and, potentially, survival.

Demoralization and Its Association with Quality of Life, Sleep Quality, Spiritual Interests, and Suicide Risk in Breast Cancer Inpatients: A Cross-Sectional Study

With decreasing mortality, the quality of life, spiritual needs, and mental health of breast cancer patients have become increasingly important. Demoralization is a poor prognostic factor for cancer patients. The extent of demoralization in breast cancer patients and its association with these factors remains unclear. This cross-sectional study was conducted at a Taiwanese medical center. We enrolled 121 participants (34 with high demoralization and 87 with low demoralization, as per the Mandarin Version of Demoralization Scale). High demoralization was associated with reduced quality of life, sleep quality, and spiritual interests. Multivariate analyses revealed that the scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire ≥ 62.5 (OR = 0.21, p = 0.002) and Spiritual Interests Related to Illness Tool Chinese Version ≥ 3.66 (OR = 0.11, p < 0.001) were associated with low demoralization. Demoralized patients with depression had a poorer quality of life and sleep quality. Although not statistically significant, depressed and demoralized participants were at a higher risk of suicide. Cancer patients with both depression and demoralization had the worst prognosis. Breast cancer patients exhibited demoralization when they had unmet bio-psycho-social-spiritual needs. An early assessment of demoralization may improve holistic healthcare for breast cancer patients.

The sleep, cancer and rest (SleepCaRe) trial: Rationale and design of a randomized, controlled trial of cognitive behavioral and bright light therapy for insomnia and fatigue in women with breast cancer receiving chemotherapy

BACKGROUND

Insomnia and fatigue symptoms are common in breast cancer. Active cancer treatment, such as chemotherapy, appears to be particularly disruptive to sleep. Yet, sleep complaints often go unrecognised and under treated within routine cancer care. The abbreviated delivery of cognitive behavioral therapy for Insomnia (CBTI) and bright light therapy (BLT) may offer accessible and cost-effective sleep treatments in women receiving chemotherapy for breast cancer.

METHODS

The Sleep, Cancer and Rest (SleepCaRe) Trial is a 6-month multicentre, randomized, controlled, 2 × 2 factorial, superiority, parallel group trial. Women receiving cytotoxic chemotherapy for breast cancer at tertiary Australian hospitals will be randomly assigned 1:1:1:1 to one of four, non-pharmacological sleep interventions: (a) Sleep Hygiene and Education (SHE); (b) CBTI; (c) BLT; (d) CBT-I + BLT combined and simultaneously delivered. Each sleep intervention is delivered over 6 weeks, and will comprise an introductory session, a mid-point phone call, and regular emails. The primary (insomnia, fatigue) and secondary (health-related quality of life, rest activity rhythms, sleep-related impairment) outcomes will be assessed via online questionnaires at five time-points: baseline (t0, prior to intervention), mid-point intervention (t2, Week 4), post-intervention (t3, Week 7), 3-months (t4, Week 18), and 6-months follow-up (t5, Week 30).

CONCLUSIONS

This study will report novel data concerning the comparative and combined efficacy of CBT-I and BLT during chemotherapy. Findings will contribute to the development of evidence-based early sleep and fatigue intervention during chemotherapy for breast cancer. Clinical trial information Registered with the Australian New Zealand Clinical Trials Registry (http://anzctr.org.au/), Registration Number: ACTRN12620001133921.

Sleep Deficiency: A Symptoms Perspective: Exemplars from Chronic Heart Failure, Inflammatory Bowel Disease, and Breast Cancer

Sleep deficiency is associated with disabling daytime symptoms, including excessive daytime sleepiness (EDS) and fatigue. The purpose of this article is to discuss the contributions of sleep deficiency and sleep disorders to fatigue and EDS among people with chronic conditions. We use exemplars from the literature on chronic heart failure, inflammatory bowel disease, and breast cancer to (1) describe the prevalence of fatigue and EDS and their consequences; (2) examine the evidence for the contributions of sleep deficiency and sleep disorders to these symptoms; and (3) recommend implications for future research and practice.

Sleep and gynecological cancer outcomes: opportunities to improve quality of life and survival

Sleep is important for immune function, metabolic function and physical repair. Sleep is more commonly disrupted in women compared with men and is disrupted by surgery, chemotherapy, and cancer itself, making gynecological oncology patients at higher risk of insomnia and sleep disruption. Insomnia and sleep disruption are linked to increased pain, poorer quality of life, depression, and anxiety which can all negatively affect patient outcomes. A number of environmental, behavioral, and pharmacological interventions have been investigated to improve patient sleep and aid in the recovery process. It is vital to understand and address patient sleep quality in order to give patients the highest quality care and improve outcomes.

The Association between Sleep Quality and Fatigue in Colorectal Cancer Survivors up until Two Years after Treatment: A Cross-Sectional and Longitudinal Analysis

Simple Summary

Fatigue is a distressing complaint with high detriment to quality of life that persists in one third of colorectal cancer survivors after cancer treatment. Surprisingly, the contribution of poor sleep quality to fatigue in colorectal cancer survivors is underinvestigated. We aimed to investigate the association between sleep quality and fatigue in colorectal cancer survivors up until two years post-treatment. Results showed worse sleep quality in colorectal cancer patients was associated with higher levels of fatigue during the first two years post-treatment. The results of this study suggest that more attention for sleep quality in colorectal cancer survivors and offering sleep health interventions may lead to less fatigue and better quality of life in this group.

Abstract

Fatigue is a distressing complaint with high detriment to quality of life that persists in one-third of colorectal cancer survivors after cancer treatment. Previous studies in mixed groups of cancer patients have suggested sleep quality is associated with fatigue. We aimed to investigate this association in colorectal cancer survivors up until two years post-treatment. Data on n = 388 stage I–III colorectal cancer patients were utilized from the EnCoRe study. Sleep quality and fatigue were measured at 6 weeks and 6, 12, and 24 months post-treatment. Sleep quality was measured using the Pittsburgh Sleep Quality Index (cross-sectional analysis only) and the single-item insomnia scale from the EORTC QLQ-C30. Fatigue was measured by the Checklist Individual Strength. Linear and mixed-model regression analyses analysed associations between sleep quality and fatigue cross-sectionally and longitudinally. Longitudinal analysis revealed worsening sleep quality over time was significantly associated with increased levels of fatigue over time (β per 0.5 SD increase in the EORTC-insomnia score = 2.56, 95% Cl: 1.91, 3.22). Significant cross-sectional associations were observed between worse sleep quality and higher levels of fatigue at all time points. Worse sleep quality in colorectal cancer patients was associated with higher levels of fatigue during the first two years post-treatment.

Sleep macro- and microstructure in breast cancer survivors

Complaints of sleep disturbance are prevalent among breast cancer (BC) patients and are predictors of quality of life. Still, electrophysiological measures of sleep are missing in patients, which prevents from understanding the pathophysiological consequences of cancer and its past treatments. Using polysomnography, sleep can be investigated in terms of macro- (e.g. awakenings, sleep stages) and micro- (i.e. cortical activity) structure. We aimed to characterize sleep complaints, and macro- and microstructure in 33 BC survivors untreated by chemotherapy and that had finished radiotherapy since at least 6 months (i.e. out of the acute effects of radiotherapy) compared to 21 healthy controls (HC). Compared to HC, BC patients had a larger number of awakenings (p = 0.008); and lower Delta power (p < 0.001), related to sleep deepening and homeostasis; greater both Alpha (p = 0.002) and Beta power (p < 0.001), related to arousal during deep sleep; and lower Theta power (p = 0.004), related to emotion regulation during dream sleep. Here we show that patients have increased cortical activity related to arousal and lower activity related to sleep homeostasis compared to controls. These results give additional insights in sleep pathophysiology of BC survivors and suggest sleep homeostasis disruption in non-advanced stages of BC.

Distinct Sleep Disturbance Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy

BACKGROUND

Patients with gastrointestinal cancers experience moderate to high levels of sleep disturbance during chemotherapy that decreases their functional status and quality of life (QOL).

OBJECTIVE

The objectives of this study were to identify subgroups of patients with gastrointestinal cancers with distinct sleep disturbance profiles and evaluate for differences among these subgroups in demographic, clinical, and sleep characteristics, as well as co-occurring symptoms and QOL outcomes.

METHODS

Patients (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct sleep disturbance profiles.

RESULTS

Three distinct sleep disturbance profiles (ie, low, high, very high) were identified. Compared with the low class, patients in the other 2 classes were significantly younger and less likely to be married and to exercise on a regular basis and received a higher number of previous treatments. Compared with the low class, patients in the other 2 classes reported higher levels of anxiety, depressive symptoms, morning and evening fatigue, and pain and lower levels of attentional function and QOL scores at enrollment.

CONCLUSIONS

This study is the first to use latent profile analysis to identify subgroups of patients with gastrointestinal cancers with distinct sleep disturbance profiles. Findings provide new insights on the associations between sleep disturbance and multiple co-occurring symptoms in these patients.

IMPLICATIONS FOR PRACTICE

Clinicians can identify patients who are at the highest risk for sleep disturbance and recommend a variety of sleep hygiene interventions (eg, establishment of a bedtime routine), as well as initiate interventions for other co-occurring symptoms.

Symptom trajectories in patients with breast cancer: An integrative review

Objective

This study aimed to synthesize the available knowledge of symptom trajectories in patients with breast cancer and identify predictors associated with these trajectories.

Methods

Whittemore and Knafl’s integrative review method was employed to guide a systematic search for literature in four databases (PubMed, Embase, Web of Science, and CINAHL). The retrieved articles’ publication time was limited to 2010 to 2020, and only peer-reviewed English articles were included.

Results

Twenty-seven articles were included. The findings of the relevant studies were analyzed using thematic analysis. They were grouped into two themes: symptom trajectories of patients with breast cancer (symptom trajectories in patients with breast cancer, in patients who underwent surgery, and in patients who received cancer-related treatment) and associated factors (socioeconomic factors, health characteristics, cancer-related treatment characteristics). Newly diagnosed patients tended to report high trajectories of depression and persistent sleep disturbance. Most patients who underwent surgery reported significant sleep disturbance and anxiety shortly after surgery. For patients who received cancer-related treatment, only a small proportion had a high level of physical activity after cancer-related therapy over time. A high body mass index, a low relationship quality, parental responsibilities, insufficient social support, a low educational background, and an unhealthy lifestyle may increase the risk of negative symptom trajectories in patients with breast cancer. Additionally, old patients were more likely to report cognitive impairment after chemotherapy, while young patients tended to report trajectories of persistent sexual dysfunction. Concurring symptoms and poor health status also contributed to adverse symptom trajectories.

Conclusion

The findings of this review add to the body of knowledge of the interindividual variability of symptom trajectories in patients with breast cancer. Despite the overall similarity in appraisal at baseline, the patients reported varied symptom trajectories over time. It is recommended that nurses consider sociodemographic, clinical and cancer-related treatment characteristics and perform targeted early preventive interventions for patients with breast cancer.

Distinct sleep disturbance profiles among patients with gynecologic cancer receiving chemotherapy

OBJECTIVE

In a sample of patients with gynecologic cancer receiving chemotherapy, we sought to identify subgroups of patients with distinct sleep disturbance profiles and assess for differences in patient characteristics and the severity of co-occurring symptoms among these subgroups.

METHODS

Adults with gynecologic cancer (n = 232) completed questionnaires six times over two chemotherapy cycles. Sleep disturbance was assessed using the General Sleep Disturbance Scale (GSDS). Clinically meaningful sleep disturbance was defined as a GSDS total score of ≥43. Subgroups of patients with distinct sleep disturbance profiles were identified using latent profile analysis. Differences in patient characteristics and co-occurring symptoms were assessed using Chi-square, Kruskal Wallis, and one-way analysis of variance.

RESULTS

Four distinct sleep disturbance profiles were identified: Low (18.5%), Moderate (43.6%), High (29.3%), and Very High (8.6%). Compared to the Low class, patients in the other three classes had lower functional status scores and higher levels of depressive symptoms, trait anxiety, and morning and evening fatigue. Compared to the Low class, patients in the Very High class were younger, had a higher body mass index, and were more likely to report a diagnosis of depression or back pain.

CONCLUSIONS

Over 80% of the patients with gynecologic cancer reported sleep disturbance that persisted over two cycles of chemotherapy. Patients in the Very High class experienced problems with both sleep initiation and maintenance. Clinicians should routinely assess sleep disturbance alongside depression, anxiety, and fatigue. Interventions that target the underlying mechanisms of these co-occurring symptoms are warranted.

Characteristics associated with inter-individual variability in financial distress in patients with breast cancer prior to and for 12 months following surgery

PURPOSE

To evaluate for inter-individual differences in financial distress and identify demographic, clinical, and symptom characteristics associated with higher levels of financial distress.

METHODS

Patients (n = 387) were enrolled prior to breast cancer surgery and followed for 12 months. Financial distress was measured using a 0 (no problem) to 10 (severe problem) numeric rating scale. Hierarchical linear modeling was used to evaluate for inter-individual differences in trajectories of financial distress and characteristics associated with financial distress at enrollment and over 12 months.

RESULTS

Patients' mean age was 55.0 (± 11.7) years and the majority underwent breast conservation surgery (80.6%). Mean financial distress score prior to surgery was 3.3 (± 3.4; range 0 to 10). Unconditional model for financial distress demonstrated no significant changes over time (-0.006/month). Younger age, lower income, receipt of an axillary lymph node dissection and adjuvant chemotherapy, and lower attentional function were associated with higher preoperative levels of financial distress.

CONCLUSION

Risk factors identified in this study can be used to inform clinicians regarding the need to initiate financial discussions and social work referrals for some patients. Additional clinical or system level interventions should be considered for vulnerable groups with these risk factors.

Are Sleep Complaints Related to Cognitive Functioning in Non-Central Nervous System Cancer? A Systematic Review

Patients with non-central nervous system (CNS) cancer frequently report cognitive complaints, that are recurrent and affect their quality of life. In order to improve supportive care of these cognitive difficulties, it is important to identify associated factors. Sleep disturbance is a good candidate to study, as patients with non-CNS cancer frequently report sleep disorders, and sleep plays a key role in cognitive functioning. The objective of the present systematic review was to summarize the results of studies evaluating the relationship between cognition and sleep in non-CNS cancer, and to highlight the need for further studies. PubMed [Medline] and Scopus databases were screened from April to November 2020 for studies published in English evaluating the association between cognition and sleep in adults with non-CNS cancer. The characteristics and risk of bias for each of the 30 included studies have been reported. Greater cognitive complaints in patients with non-CNS cancer were related to poorer self-reported sleep quality in almost all studies (n = 22/24). By contrast, around half of the studies reported a significant association between poorer neuropsychological performances and sleep complaints (n = 5/11). The studies were found to have several limitations, such as the lack of a control group, which would have shed the light on the period of occurrence of this association (e.g. after cancer diagnosis or after cancer treatments). Our review also identified factors that may influence the relationship between cognition and sleep. Recommendations are given for improving the methodology of future studies and extending the impact of their results.

Distinct employment interference profiles in patients with breast cancer prior to and for 12 months following surgery

PURPOSE

To identify subgroups of female breast cancer patients with distinct self-reported employment interference (EI) profiles and determine which demographic, clinical, and symptom characteristics, and quality of life outcomes were associated with subgroup membership.

METHODS

Women with breast cancer (n = 385) were assessed for changes in EI over ten times, from prior to, through 12 months after breast cancer surgery. Latent profile analysis (LPA) was used to identify subgroups of patients with distinct EI profiles.

RESULTS

Three distinct EI profiles (i.e., None - 26.2% (n = 101), Low - 42.6% (n = 164), High - 31.2% (n = 120)) were identified. Compared to the None and Low groups, patients in the High group were more likely to be younger. Higher proportions in the High group were non-White, pre-menopausal prior to surgery, had more advanced stage disease, had received an axillary lymph node dissection, had received neoadjuvant chemotherapy, had received adjuvant chemotherapy, and had a re-excision or mastectomy on the affected breast within 6 months after surgery. In addition, these patients had lower quality of life scores. Compared to the None group, the High group had higher levels of trait and state anxiety, depressive symptoms, fatigue and sleep disturbance and lower levels of cognitive function.

CONCLUSIONS

This study provides new knowledge regarding EI profiles among women in the year following breast cancer surgery. The non-modifiable risk factors (e.g., younger age, being non-White, having more advanced stage disease) can inform current screening procedures. The potentially modifiable risk factors can be used to develop interventions to improve employment outcomes of breast cancer patients.

Data-science-based subgroup analysis of persistent pain during 3 years after breast cancer surgery: A prospective cohort study

BACKGROUND

Persistent pain extending beyond 6 months after breast cancer surgery when adjuvant therapies have ended is a recognised phenomenon. The evolution of postsurgery pain is therefore of interest for future patient management in terms of possible prognoses for distinct groups of patients to enable better patient information.

OBJECTIVE(S)

An analysis aimed to identify subgroups of patients who share similar time courses of postoperative persistent pain.

DESIGN

Prospective cohort study.

SETTING

Helsinki University Hospital, Finland, between 2006 and 2010.

PATIENTS

A total of 763 women treated for breast cancer at the Helsinki University Hospital.

INTERVENTIONS

Employing a data science approach in a nonredundant reanalysis of data published previously, pain ratings acquired at 6, 12, 24 and 36 months after breast cancer surgery, were analysed for a group structure of the temporal courses of pain. Unsupervised automated evolutionary (genetic) algorithms were used for patient cluster detection in the pain ratings and for Gaussian mixture modelling of the slopes of the linear relationship between pain ratings and acquisition times.

MAIN OUTCOME MEASURES

Clusters or groups of patients sharing patterns in the time courses of pain between 6 and 36 months after breast cancer surgery.

RESULTS

Three groups of patients with distinct time courses of pain were identified as the best solutions for both clustering of the pain ratings and multimodal modelling of the slopes of their temporal trends. In two clusters/groups, pain decreased or remained stable and the two approaches suggested/identified similar subgroups representing 80/763 and 86/763 of the patients, respectively, in whom rather high pain levels tended to further increase over time.

CONCLUSION

In the majority of patients, pain after breast cancer surgery decreased rapidly and disappeared or the intensity decreased over 3 years. However, in about a tenth of patients, moderate-to-severe pain tended to increase during the 3-year follow-up.

Prescribed Walking for Glycemic Control and Symptom Management in Patients Without Diabetes Undergoing Chemotherapy

BACKGROUND

Hyperglycemia may potentiate symptom experiences. Exercise is a nonpharmacological intervention that can potentially improve glycemic control and mitigate symptom experiences in patients undergoing chemotherapy for cancer.

OBJECTIVES

The primary objective was to assess the feasibility of patients engaging in a walking exercise study for 6 months. We also evaluated the effects of a prescribed walking program on glycemic control and for changes over time in the severity of pain, fatigue, depression, and sleep disturbance in patients undergoing chemotherapy for breast, lung, gynecologic, or gastrointestinal cancer.

METHODS

A randomized pilot intervention study was conducted to evaluate differences within and between a prescribed walking program intervention group and a control group. All patients were followed for 6 months, had glycosylated hemoglobin A1c measured at enrollment and 6 months, and completed symptom questionnaires at enrollment, 3 months, and 6 months. Data were analyzed using descriptive statistics and analysis of covariance.

RESULTS

Most of the patients who enrolled completed the 6-month study. The few who withdrew expressed feeling overwhelmed. The sample was predominately non-Hispanic White female patients with breast cancer with a normal-to-slightly-overweight body mass index. The intervention group had a slight decrease in glycosylated hemoglobin A1c at 6 months. In addition, at 6 months, compared to the control group, the intervention group had significantly less sleep disturbance and depression. No other within- or between-group differences were found.

DISCUSSION

It is feasible for patients undergoing chemotherapy to participate in a prescribed walking program. Exercise, such as walking, may decrease hyperglycemia and symptom severity. Additional research with larger samples is warranted.

The Italian version of the General Sleep Disturbance Scale (GSDS-IT): Psychometric properties in a sample with hip and knee replacement

OBJECTIVE

To use the Italian version of the General Sleep Disturbance Scale (GSDS-IT) to assess the psychometric properties in a sample of orthopedic patients.

METHODS

Participants were divided into sleepless and non-sleepless according to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V). Reliability was assessed with Cronbach's alpha. To evaluate responsiveness, the scale was administered a second time after the rehabilitation program.

RESULTS

The scale was administered to the 158 patients recruited. The GSDS-IT had good internal consistency (Cronbach's α of 0.752) and good responsiveness (ICC of 0.78). The optimal cut-off point for the GSDS-IT was 48.5.

CONCLUSION

The GSDS-IT was demonstrated to be a valid and rapid tool to detect the presence of sleep disorders in a clinical setting in patients admitted to an intensive care unit and allowed the detection of the onset one week after admission and persisting until the time of discharge.

Identification of subgroups of chemotherapy patients with distinct sleep disturbance profiles and associated co-occurring symptoms

STUDY OBJECTIVES

Purposes of this study were to identify subgroups of patients with distinct sleep disturbance profiles and to evaluate for differences in demographic, clinical, and various sleep characteristics, as well for differences in the severity of co-occurring symptoms among these subgroups.

METHODS

Outpatients with breast, gynecological, gastrointestinal, or lung cancer (n = 1331) completed questionnaires six times over two chemotherapy cycles. Self-reported sleep disturbance was evaluated using the General Sleep Disturbance Scale (GSDS). Latent profile analysis was used to identify distinct subgroups.

RESULTS

Three latent classes with distinct sleep disturbance profiles were identified (Low [25.5%], High [50.8%], Very High [24.0%]) across the six assessments. Approximately 75% of the patients had a mean total GSDS score that was above the clinically meaningful cutoff score of at least 43 across all six assessments. Compared to the Low class, patients in High and Very High classes were significantly younger, had a lower functional status, had higher levels of comorbidity, and were more likely to be female, more likely to have childcare responsibilities, less likely to be employed, and less likely to have gastrointestinal cancer. For all of the GSDS subscale and total scores, significant differences among the latent classes followed the expected pattern (Low < High < Very High). For trait and state anxiety, depressive symptoms, morning and evening fatigue, decrements in attentional function, and decrements in morning and evening energy, significant differences among the latent classes followed the expected pattern (Low < High < Very High).

CONCLUSIONS

Clinicians need to perform in-depth assessments of sleep disturbance and co-occurring symptoms to identify high-risk patients and recommend appropriate interventions.

Quality of Sleep in Patients with Cancer: A Cross-sectional Observational Study

Background:

Insomnia and poor sleep quality are common problems in patients with cancer. It interferes with the coping ability, symptoms, and treatment outcomes. The Pittsburgh Sleep Quality Index (PSQI) is a reliable, valid instrument to assess the quality of sleep in patients with cancer.

Patients and Methods:

The study was conducted at the department of medical oncology of a tertiary cancer care center. Consecutive eligible participants were recruited and evaluated for sleep quality using PSQI questionnaire. The questionnaire was administered only once with the questions evaluating to the quality of sleep over the last 1 month. A PSQI total score of ≤5 was suggestive of good quality of sleep and a score of >5 was indicative of poor quality of sleep.

Results:

Ninety-two consecutive consenting cancer patients admitted for chemotherapy participated in the study. Thirty-one (33.7%) patients had early cancer and 35 (38%) patients had Stage IV metastatic disease. Thirty-six (39.1%) patients reported sleep of <6 h and 30 (32.6%) patients had impaired functioning during day due to sleepiness. Fifty-three (57.6%) patients had poor total PSQI score, of which 39 (73.5%) were female and 14 (26.5%) were male. The study showed no correlation of the PSQI scores with the stage of the disease, and the prior treatment received.

Conclusions:

The study showed that Indian cancer patients have short sleep duration and poor quality of sleep. A higher prevalence of sleep disturbances was seen among female cancer patients. PSQI questionnaire can be a cost-effective way of screening cancer patients for poor quality of sleep.

Poor preoperative sleep quality is a risk factor for severe postoperative pain after breast cancer surgery: A prospective cohort study

The aim of this study was to assess the effect of preoperative sleep quality on acute postoperative pain in breast cancer patients.The Pittsburgh Sleep Quality Index questionnaire (PSQI) was used to assess the overall sleep status of women scheduled for unilateral modified radical mastectomy in the past month. Based on the responses, patients were allocated to good sleep group or poor sleep group. Postoperatively, acute pain was assessed using the numerical rating score in the first 24 hours; in addition, the requirement of analgesics and the incidence of postoperative complications were recorded.A total of 108 breast surgery patients were enrolled. Based on the PSQI results, 55 (51%) patients were allocated to poor sleep group and 53 (49%) to good sleep group. Pain scores were similar in the 2 groups at the end of surgery (P = .589); however, poor sleep group reported higher postoperative pain scores than the good sleep group at 2 (P = .002), 6 (P < .001), 12 (P < .001), and 24 (P = .002) hours after surgery. The incidence of severe pain in the poor sleep group was higher than that in the good sleep group (27% vs 8%, P = .018), and the ratio of participants who required rescued analgesics was greater in the poor sleep group (52% vs 22%, P = .002). In addition, patients with poor sleep quality had more postoperative complications and longer hospital stay.In this study, breast cancer patients with poor preoperative sleep quality reported more severe postoperative pain, required more analgesics, experienced more complications, and had longer hospital stay.

Insomnia in breast cancer: a prospective observational study

STUDY OBJECTIVES

Insomnia in cancer patients is prevalent, persistent, and confers risk for physical and psychological disorder. We must better understand how insomnia develops in cancer patients and explore the main contributors to its chronicity so that insomnia management protocols can be integrated more effectively within cancer care. This study monitors the etiology of insomnia in breast cancer patients and identifies risk factors for its persistence.

METHODS

One hundred seventy-three females with newly diagnosed, non-metastatic breast cancer were tracked from diagnosis for 12 months. Participants completed monthly sleep assessments using the Insomnia Severity Index (ISI) and 3 monthly health-related quality-of-life assessments using the European Organisation for Research and Treatment of Cancer - Breast (EORTC QLQ-C30-BR23) scale. Clinical data on disease status and treatment regimens were also assessed.

RESULTS

Prior to diagnosis, 25% of participants reported sleep disturbance, including 8% with insomnia syndrome (IS). Prevalence increased at cancer diagnosis to 46% (18% IS) and remained stable thereafter at around 50% (21% IS). We also explored sleep status transitions. The most common pattern was to remain a good sleeper (34%-49%) or to persist with insomnia (23%-46%). Seventy-seven percent of good sleepers developed insomnia during the 12-month period and 54% went into insomnia remission. Chemotherapy (odds ratio = 0.08, 95% confidence interval [CI] 0.02-0.29, p < .001) and pre-diagnosis ISI scores (odds ratio = 1.13/unit increase in pre-diagnosis sleep score, 95% CI 1.05-1.21, p = .001) were identified as the main risk factors for persistent insomnia.

CONCLUSIONS

These data advance our understanding of insomnia etiology in cancer patients and help identify those who should be prioritized for insomnia management protocols.

Incidence of sleep problems and their mediating role on depression and anxious preoccupation in patients with resected, non-advanced cancer: data from NEOcoping study

BACKGROUND

Our study analyzes the incidence of sleep problems and their mediating role on depression and anxious preoccupation in patients with resected, non-advanced cancer.

METHODS

A multi-institutional, prospective, observational study was conducted with 750 participants of 14 hospitals in Spain. Participants' socio-demographic and clinical characteristics were collected using a standardized self-report form and using EORTC QoL-QLQ-C30, BSI, Mini-MAC questionnaires.

RESULTS

In women, sleep problems, depression and anxious preoccupation were observed in 65, 41 and 21%, respectively. In men, sleep problems, depression and anxious preoccupation were reported in 51, 29 and 61%, respectively. More sleep problems, depression and anxious preoccupation were found among women than males. Depression was a significant predictor of anxious preoccupation. In males, sleep problems partially mediated this association. This was not confirmed in women.

CONCLUSION

Our findings point toward the importance of developing interventions that decrease depression and sleep problems in cancer.

Optimism outweighs neuroticism and anxiety sensitivity to predict insomnia symptoms in women after surgery for breast cancer

PURPOSE

Insomnia symptoms are common among women who have undergone surgery for breast cancer. Personality traits are also believed to have an impact on sleep. However, there are no reports to address the effects of personality traits on sleep in women with breast cancer. This study examined the separate and competing roles of neuroticism, anxiety sensitivity, and optimism in predicting post-surgery insomnia symptoms.

METHODS

Women with breast cancer (n = 749) were enrolled the week prior to surgery and required to complete a demographic questionnaire, the Chinese version of Neuroticism subscale of NEO-Five Factor Inventory (CV-N-NEO-FFI), Anxiety Sensitivity Index-3 (CV-ASI-3), and Life Orientation Test-Revised (CV-LOT-R). Four weeks post-surgery, the Chinese version of Insomnia Severity Index (CV-ISI) was administered to evaluate insomnia symptoms.

RESULTS

Neuroticism (β = 0.317, p < 0.001), anxiety sensitivity (β = 0.220, p < 0.001), and optimism (β = - 0.332, p < 0.001) could predict post-surgery insomnia symptoms. When putting them together into one stepwise regression, optimism (β = - 0.215, p < 0.001) became the statistically most important predictor for insomnia symptoms. Optimism suppressed the predictions of insomnia symptoms provided by neuroticism (β = 0.114, p < 0.001) and anxiety sensitivity (β = 0.079, p < 0.001).

CONCLUSION

Neuroticism and anxiety sensitivity positively predicted insomnia, but optimism negatively predicted insomnia. In particular, optimism plays a more important role in post-surgery insomnia symptoms in women with breast cancer compared to neuroticism and anxiety sensitivity. Sleep intervention in women with breast cancer should focus on enhancing their optimism level.

Biomarkers as Common Data Elements for Symptom and Self-Management Science

PURPOSE

Biomarkers as common data elements (CDEs) are important for the characterization of biobehavioral symptoms given that once a biologic moderator or mediator is identified, biologically based strategies can be investigated for treatment efforts. Just as a symptom inventory reflects a symptom experience, a biomarker is an indicator of the symptom, though not the symptom per se. The purposes of this position paper are to (a) identify a "minimum set" of biomarkers for consideration as CDEs in symptom and self-management science, specifically biochemical biomarkers; (b) evaluate the benefits and limitations of such a limited array of biomarkers with implications for symptom science; (c) propose a strategy for the collection of the endorsed minimum set of biologic samples to be employed as CDEs for symptom science; and (d) conceptualize this minimum set of biomarkers consistent with National Institute of Nursing Research (NINR) symptoms of fatigue, depression, cognition, pain, and sleep disturbance.

DESIGN AND METHODS

From May 2016 through January 2017, a working group consisting of a subset of the Directors of the NINR Centers of Excellence funded by P20 or P30 mechanisms and NINR staff met bimonthly via telephone to develop this position paper suggesting the addition of biomarkers as CDEs. The full group of Directors reviewed drafts, provided critiques and suggestions, recommended the minimum set of biomarkers, and approved the completed document. Best practices for selecting, identifying, and using biological CDEs as well as challenges to the use of biological CDEs for symptom and self-management science are described. Current platforms for sample outcome sharing are presented. Finally, biological CDEs for symptom and self-management science are proposed along with implications for future research and use of CDEs in these areas.

FINDINGS

The recommended minimum set of biomarker CDEs include pro- and anti-inflammatory cytokines, a hypothalamic-pituitary-adrenal axis marker, cortisol, the neuropeptide brain-derived neurotrophic factor, and DNA polymorphisms.

CONCLUSIONS

It is anticipated that this minimum set of biomarker CDEs will be refined as knowledge regarding biologic mechanisms underlying symptom and self-management science further develop. The incorporation of biological CDEs may provide insights into mechanisms of symptoms, effectiveness of proposed interventions, and applicability of chosen theoretical frameworks. Similarly, as for the previously suggested NINR CDEs for behavioral symptoms and self-management of chronic conditions, biological CDEs offer the potential for collaborative efforts that will strengthen symptom and self-management science.

CLINICAL RELEVANCE

The use of biomarker CDEs in biobehavioral symptoms research will facilitate the reproducibility and generalizability of research findings and benefit symptom and self-management science.

Cluster Analysis of Symptoms of Bangladeshi Women with Breast Cancer

Background:

Breast cancer (BC) patients may experience multiple symptoms due to the disease itself, cancer treatment or combination of both.

Aim:

The aim of the present study was to express multiple symptoms experienced by the patients with BC as clusters.

Methods:

This was a retrospective study. We examined symptom profiles of 120 patients with BC who attended the Centre for Palliative Care, Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh, from January 2009 to December 2013. We included all case sheets of BC patients, which had documentation of needed information. Following symptoms were analyzed: pain, nausea, loss of appetite, constipation, weakness, cough, breathlessness, sleeplessness, lymphedema, sadness, anxiety, and depression. Hierarchical cluster analysis was used to identify the natural groupings within the set.

Results:

We could identify three clusters, namely (1) “neuropsychiatric,” (2) “gastro-respiratory,” and (3) “miscellaneous” symptom clusters. The symptoms in cluster 2 comprised of cough, breathlessness, nausea, and constipation. Cluster 1 was characterized by pain, depression, anxiety, weakness, sleeplessness, and loss of appetite. Cluster 2 was comprised of cough, breathlessness, nausea, and constipation. Cluster 3 consisted of two symptoms lymphedema and sadness. The results revealed that the multiple symptoms of patients with BC experienced had been clustered together. Neuropsychiatric symptoms and weakness formed a significant strong relationship with each other.

Conclusion:

Knowledge obtained from this study could be beneficial for better understanding, assessment, and management of symptom clusters in women with BC. It may also help patients to plan ahead for them to seek management of concurrent symptoms to improve their quality of life.

Alterations and Interdependence in Self-Reported Sleep-Wake Parameters of Patient-Caregiver Dyads During Adjuvant Chemotherapy for Breast Cancer

PURPOSE/OBJECTIVES

To longitudinally explore changes, similarities, differences, and interrelations in the sleep-wake parameters of patient-caregiver dyads throughout adjuvant chemotherapy for breast cancer.
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DESIGN

Observational, repeated-measures, dyadic study.
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SETTING

Four ambulatory oncology clinics in Scotland.
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SAMPLE

48 dyads consisting of patients and their primary informal caregivers.
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METHODS

Four dyadic, self-reported sleep-wake assessments took place before chemo-therapy (T0), during chemotherapy cycles 1 (T1) and 4 (T2), and after chemotherapy (T3). Dyads completed the Pittsburgh Sleep Quality Index. Multilevel hierarchical linear modeling was used to explore dyadic data.
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MAIN RESEARCH VARIABLES

Perceived sleep quality, sleep onset latency (SOL), total sleep time, habitual sleep efficiency, wake after sleep onset, daily disturbance, daytime napping duration, overall sleep-wake impairment.
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FINDINGS

The majority of dyads had at least one poor sleeper throughout the study; 25%-35% were dyads of concurrent poor sleepers. Curvilinear patterns of change were evident for patients' (but not caregivers') sleep-wake parameters, steadily deteriorating from pre- to midtreatment, then leveling off close to baseline. Average trajectories were significantly different between the dyad members but indicative of a trend for concurrent deterioration at T2. Dyad members' perceived sleep quality, SOL, and overall sleep-wake impairment were closely interrelated; wake variables remained uncoupled.
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CONCLUSIONS

Despite overall differences in magnitude, sleep problems may be concurrently present in both dyad members, covary, and peak midway through chemotherapy. 
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IMPLICATIONS FOR NURSING

Dyadic sleep assessments can shed light on potential areas of sleep interaction to enable interventions to support care dyads at risk of sleep distress during chemotherapy for breast cancer.

Association between poor clinical prognosis and sleep duration among breast cancer patients

Objective:

to investigate the association between clinical progression and the quality and duration of sleep in women with breast cancer.

Method:

longitudinal study, with 114 participants, conducted in a hospital in Brazil. The instruments used were: questionnaire for sociodemographic and clinical characterization, Pittsburgh Sleep Quality Index; Beck Depression Inventory and Herth Hope Scale. Data were analyzed through descriptive statistics and survival analyses (outcome: poor clinical progression), using the Kaplan-Meier curve, Log-rank test and Cox proportional model.

Results:

a higher probability of poor clinical progression was verified in women with sleep durations of less than six hours or nine hours and over (p=.0173).

Conclusion:

the results suggest the importance of further studies that seek to verify whether the quantitative management of sleep disorders would have an impact on the progression of breast cancer. Women should be encouraged to report sleep problems to nurses.

Sleep problems in breast cancer survivors 1-10 years posttreatment

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.

Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapy

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.

Factors associated with poor sleep quality in women with cancer

Objectives

to analyze the factors associated with poor sleep quality, its characteristics and components in women with breast cancer prior to surgery for removing the tumor and throughout the follow-up.

Method

longitudinal study in a teaching hospital, with a sample of 102 women. The following were used: a questionnaire for sociodemographic and clinical characterization, the Pittsburgh Sleep Quality Index; the Beck Depression Inventory; and the Herth Hope Scale. Data collection covered from prior to the surgery for removal of the tumor (T0) to T1, on average 3.2 months; T2, on average 6.1 months; and T3, on average 12.4 months. Descriptive statistics and the Generalized Estimating Equations model were used.

Results

depression and pain contributed to the increase in the score of the Pittsburgh Sleep Quality Index, and hope, to the reduction of the score - independently - throughout follow-up. Sleep disturbances were the component with the highest score throughout follow-up.

Conclusion

the presence of depression and pain, prior to the surgery, contributed to the increase in the global score of the Pittsburgh Sleep Quality Index, which indicates worse quality of sleep throughout follow-up; greater hope, in its turn, influenced the reduction of the score of the Pittsburgh Sleep Quality Index.

Surgical Oncology: Evolution of Postoperative Fatigue and Factors Related to Its Severity

BACKGROUND

Fatigue has been reported by many patients undergoing surgery and is associated with a negative prognosis. The factors associated with postoperative fatigue and its evolution during the postoperative period are unclear. Adequate fatigue measurement instruments are necessary to obtain reliable evaluations and to direct effective care to control fatigue in this patient population.

OBJECTIVES

This article describes the evolution of postoperative fatigue in patients with cancer as well as related factors.

METHODS

A review of the literature using the CINAHL® and PubMed databases was undertaken.

FINDINGS

The prevalence of moderate and severe fatigue varies during the postoperative period, with a reduction in the 12 months after surgery. Various factors (e.g., stress, anxiety, depression, pain, changes in sleep patterns) seem to influence the severity of fatigue. More evidence is needed to explore the relationship between immediate postoperative fatigue and the evolution of fatigue during the period following surgical treatment for cancer.

What Factors Affect the Insomnia Symptom Trajectories in Women With Nonmetastatic Breast Cancer?

OBJECTIVES

This study sought to identify the trajectories of insomnia symptoms in Chinese women with nonmetastatic breast cancer and further determine the effects of sociodemographic, disease, and psychological variables on different insomnia symptoms.

METHODS

A total of 287 female breast cancer patients were recruited to complete measures of cognitive emotion regulation strategies, perceived social support, and insomnia symptoms at six time points from the week after diagnosis to four months after surgery.

RESULTS

Four distinct classes of insomnia symptom trajectories were identified using growth mixture modeling and were named low sustained class (n = 128, 44.60%), high sustained class (n = 33, 11.50%), moderate sustained class (n = 64, 22.30%), and decreasing class (n = 62, 21.60%). Patients in these trajectory classes differed in demographic characteristics (age, education, employment, and monthly income), pathologic stage, and psychological characteristics (perceived social support and cognitive emotion regulation strategies). Patients with less than nine years of education (adjusted odds ratio = 2.61-4.10) or higher levels of self-blame (adjusted odds ratio = 1.80-2.14) are most likely to belong to the high sustained, moderate sustained, and decreasing classes.

CONCLUSION

Four latent trajectories may be a reliable and valuable approach in analyzing insomnia symptoms in breast cancer patients. Heterogeneity should be considered to allow more attention to be paid on patients in high and moderate sustained class. Education and cognitive emotion regulation strategies are important factors for the onset and development of insomnia symptoms.

Poor sleep quality, depression and hope before breast cancer surgery

AIM

This study aims to identify the predictors of poor sleep quality and the associations between depression, hope and sleep in a sample of 156 women with breast cancer prior to surgery.

BACKGROUND

The care and treatment of breast cancer is among the most important scientific challenges in public health. Sleep disturbances and depression are the important complaint of cancer patients. However, they are often neglected. Patients diagnosed with breast cancer also experience prejudice, fear of death, suffering, mutilation, fear of lymphedema, as well as feelings of social devaluation leading to hopelessness Several studies point to hope as an effective strategy to help patients cope with difficulties and achieve their goals, especially patients with cancer.

METHODS

This is a report of baseline data extracted from a longitudinal study.

DATA COLLECTION TOOLS

Pittsburgh Sleep Quality Index, Beck Depression Inventory, and the Herth Hope Index. Data were analyzed with the Spearman's Rank Correlation test and Multiple Logistic Regression analysis.

RESULTS

The majority of women had tumors in initial stages (78.7%), reported poor sleep quality (58.9%), and had moderate to severe or severe depression (27.2%). Significant correlations were found between hope and depression (Spearman r=-0.4341), and between sleep quality and depression (Spearman r=0.3938). Significant associations were found between poor sleep quality and pain, symptoms of menopause and depression. Depression and symptoms of menopause were independent predictors of poor sleep quality.

CONCLUSION

The evaluation of sleep quality, depression and hope should be implemented in clinical practice. Increased hope lessens depression and may positively affect sleep quality, all of which improves quality of life for women with breast cancer.

Variação longitudinal da qualidade do sono em mulheres com câncer de mama

Resumo Objetivo: Comparar a qualidade do sono, a depressão e a esperança em mulheres com câncer de mama ao longo de aproximadamente um ano. Métodos: Estudo longitudinal, com 107 mulheres, em hospital universitário. Foram utilizados os instrumentos: questionário de caracterização sociodemográfica e clínica; Índice de Qualidade do Sono de Pittsburgh; Inventário de Depressão de Beck e Escala de Esperança de Herth. Os dados foram coletados em T0, antes da cirurgia de retirada do tumor, e após a mesma em: T1, em média 3,2 meses; T2, em média 6,1 meses; em T3, em média 12,4 meses. Resultados: A má qualidade do sono persistiu ao longo do seguimento; a esperança aumentou em T1; a proporção de mulheres com depressão moderada e grave elevou-se em T3. Houve correlação significativa entre os escores indicativos de qualidade do sono, de depressão e de esperança nos quatro tempos. Conclusão: Os achados deste estudo indicam a importância do seguimento por tempo prolongado.