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Bi L, Zhang X, Wang L, Cai Y, Han J. Subgroups of sleep quality and associated risk factors in patients with cancer undergoing radiotherapy: A cross-sectional study based on latent profile analysis. Eur J Oncol Nurs 2024; 68:102488. [PMID: 38134497 DOI: 10.1016/j.ejon.2023.102488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/26/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To identify latent classes of sleep quality among patients with cancer undergoing radiotherapy, and to examine the predictors of different latent classes. METHODS This cross-sectional study included 238 cancer patients. The assessment instrument included the Pittsburgh Sleep Quality Index, the sleep hygiene awareness and practice scale, the MD Anderson Symptom Inventory, the Distress Thermometer and the Fear of Cancer Recurrence Questionnaire. Latent profile analysis was used to identify different sleep quality subgroups. RESULTS Three latent classes with distinct sleep characteristics were identified: good sleep quality (class 1, 66.8%), moderate sleep disturbance with high hypnotics use (class 2, 9.2%), and high sleep disturbance with low hypnotics use (class 3, 24.0%) classes. Patients who were young (P = 0.022) and diagnosed with cancer stage Ⅲ (P = 0.021) were significantly more likely to be in Class 3 than in Class 1. Patients with a senior middle school were less likely to fall into Class 2, but more likely to fall into Class 1 (P = 0.026). Those with higher sleep hygiene practice scores (P = 0.022; P < 0.001), symptom severity (P < 0.001; P < 0.001), and psychological distress (P = 0.040; P < 0.001) had a significantly higher probability of being classified in Class 2 or Class 3 than in Class 1. CONCLUSIONS Our study revealed the heterogeneity of sleep quality in patients with cancer undergoing radiotherapy; moreover, through our findings, targeted interventions may be developed to promote the sleep quality of these patients.
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Affiliation(s)
- Liuna Bi
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China.
| | - Xian Zhang
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, China.
| | - Linlin Wang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China.
| | - Yanxiu Cai
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China.
| | - Jing Han
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China; Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221006, China.
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Chiriac VF, Moşoiu DV. Insomnia in cancer patients - A survey of health-care professionals' views and current practice in Romania. J Cancer Res Ther 2023; 19:1950-1955. [PMID: 38376302 DOI: 10.4103/jcrt.jcrt_682_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/03/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Changes in the quality of sleep are reported often in cancer patients and have a major impact on general health. However, insomnia tends to be insufficiently evaluated and managed. AIM The aim of the study was to analyze the perception of clinical staff working in oncology units regarding patients' sleep disorders. Furthermore, we assessed the prevalence of insomnia in this category of professionals. MATERIALS AND METHODS The study was cross sectional and used a descriptive and correlational design. Clinical personnel working in oncology departments were invited to complete a questionnaire regarding sleep problems in patients, and optionally, the Pittsburgh sleep quality index questionnaire was administered. Correlations between age, profession, experience, and their responses were statistically analyzed. RESULTS We gathered 101 responses, with 63.4% coming from doctors. With one exception, all professionals observed changes in sleep patterns in patients, but less than a third were actively looking for these problems and only three health professionals used questionnaires. No significant differences in answers were noted based on age, profession, or experience. Regarding professionals, 45.6% of them had impaired sleep based on the Pittsburgh questionnaire results. CONCLUSION Oncology staff are aware of the existence and impact of sleep problems, but active assessment for sleep problems is low. There is a relative high prevalence of poor sleep quality among oncology staff. In order to improve the well-being of patients, the quality of sleep should be documented as part of the care plan. The existence of guidelines is desirable.
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Jakobsen G, Sjue K, Paulsen Ø, Kaasa S, Hjermstad MJ, Klepstad P. Zopiclone versus placebo for short-term treatment of insomnia in patients with advanced cancer-a double-blind, randomized placebo-controlled clinical multicenter phase IV trial. Support Care Cancer 2023; 31:60. [PMID: 36534165 PMCID: PMC9763131 DOI: 10.1007/s00520-022-07537-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Insomnia is frequent in patients with advanced cancer, and a variety of pharmacological agents is used to treat this condition. Still, few clinical trials have investigated the effectiveness of pharmacological sleep therapies in this patient group. We aimed to study the short-term effectiveness of zopiclone on sleep quality in patients with advanced cancer who report insomnia. METHODS A randomized, double-blind, placebo-controlled, parallel-group, multicenter, phase IV clinical trial in adult patients with metastatic malignant disease and insomnia. Patients were treated with zopiclone or placebo for six subsequent nights. Primary end point was patient-reported sleep quality during the final study night (NRS 0-10). Secondary end points were patient-reported sleep onset latency (SOL) and total sleep time (TST). RESULTS Forty-one patients were randomized, with 18 being analyzed in the zopiclone group and 21 in the placebo group. Median age was 66, median Karnofsky performance score was 80, and 56% were male. Mean sleep quality at end of study was 2.9 (CI 2.3 to 3.8) in the zopiclone group and 4.5 (CI 3.6 to 5.4) in the placebo group (p = 0.021). At end of study, SOL was significantly different between the treatment groups: zopiclone 29 min (CI 13 to 51) and placebo 62 min (CI 40 to 87) (p = 0.045). TST was not significantly different across groups: zopiclone 449 min (403 to 496) and placebo 411 min (CI 380 to 440) (p = 0.167). CONCLUSION Zopiclone improved short-term patient-reported sleep quality in this cohort of patients with advanced cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02807922.
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Affiliation(s)
- Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), and Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Karin Sjue
- Department of Oncology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ørnulf Paulsen
- Institute of Clinical Medicine, European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, Oslo, Norway, University of Oslo, Oslo, Norway, and Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marianne Jensen Hjermstad
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway, and European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, Oslo, Norway, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Klepstad
- Department of Anaesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, and Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
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An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research. Cancers (Basel) 2022; 14:cancers14163933. [PMID: 36010925 PMCID: PMC9406296 DOI: 10.3390/cancers14163933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary This review focuses on sleep in patients with advanced cancer. Cancer patients experience multiple symptoms and they receive concomitant medications. These are all factors that may affect sleep. In this paper, we present recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that may contribute to insomnia. Sleep is an essential aspect of health-related quality of life; therefore, it is important for health care providers to focus on sleep to improve patient care. Abstract Patients with advanced cancer experience multiple symptoms, with fluctuating intensity and severity during the disease. They use several medications, including opioids, which may affect sleep. Sleep disturbance is common in cancer patients, decreases the tolerability of other symptoms, and impairs quality of life. Despite its high prevalence and negative impact, poor sleep quality often remains unrecognized and undertreated. Given that sleep is an essential aspect of health-related quality of life, it is important to extend both the knowledge base and awareness among health care providers in this field to improve patient care. In this narrative review, we provide recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that contribute to insomnia. We also present direct implications for health care providers working in palliative care and for future research.
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Maccora J, Garland SN, Ftanou M, Day D, White M, Lopez VA, Mortimer D, Diggens J, Phillips AJK, Wallace R, Alexander M, Boyle F, Stafford L, Francis PA, Bei B, Wiley JF. 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. Contemp Clin Trials 2022; 120:106877. [PMID: 35961468 DOI: 10.1016/j.cct.2022.106877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Jordan Maccora
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | | | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Daphne Day
- Department of Oncology Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia.
| | - Michelle White
- Department of Oncology Monash Health, Melbourne, Australia; Monash University, Melbourne, Australia.
| | | | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia.
| | | | - Andrew J K Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | - Rebecca Wallace
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia.
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | | | - Lesley Stafford
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.
| | | | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia; Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC 3800, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia.
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Yoon JH, Kim EH, Park SB, Lee JY, Yoon SW. Traditional Herbal Medicine for Insomnia in Patients With Cancer: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:753140. [PMID: 34776971 PMCID: PMC8581246 DOI: 10.3389/fphar.2021.753140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Insomnia is one of the most prevalent cancer-related symptoms and has a severe impact on the quality of life. This study aimed to evaluate the efficacy and safety of traditional herbal medicine (THM) for improving sleep quality in patients with cancer. Methods: Randomized controlled trials (RCTs) evaluating orally administered THM in a cancer population with insomnia were searched using nine electronic databases up to November 30, 2020. The outcome measurements were sleep quality measured by validated questionnaire such as the Pittsburgh Sleep Quality Index (PSQI), total effective rate, and adverse effects. The included studies were appraised using the Cochrane risk of bias tool and meta-analyzed. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Results: Fourteen RCTs were included in the systematic review, and 10 RCTs were analyzed quantitatively. Compared to hypnotics, THM showed a significant improvement in sleep quality by reducing the PSQI score [mean difference (MD) -2.25, 95% confidence interval (CI) -3.46 to -1.05, I 2 = 84%] and increasing the total effective rate [risk ratio (RR) 1.26, 95% CI 1.07 to 1.48, I 2 = 70%] with low quality of evidence. Compared to placebo, THM also reduced the PSQI score significantly (MD -2.56, 95% CI -3.81 to -1.31, I 2 = 91%) with moderate quality of evidence. The most frequently used herbs were Ziziphus jujuba Mill. No serious adverse events were observed. Conclusion: This review suggests that THM may be an effective therapeutic option for insomnia in patients with cancer. However, considering the limited methodological qualities and inconsistent results of the included trials, further rigorous RCTs are required. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero], PROSPERO 2021 [CRD42021265070].
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Affiliation(s)
- Jee-Hyun Yoon
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Eun Hye Kim
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Su Bin Park
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Jee Young Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - Seong Woo Yoon
- Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
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Efficacy and Safety of Auricular Acupuncture for the Treatment of Insomnia in Breast Cancer Survivors: A Randomized Controlled Trial. Cancers (Basel) 2021; 13:cancers13164082. [PMID: 34439234 PMCID: PMC8394534 DOI: 10.3390/cancers13164082] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 01/10/2023] Open
Abstract
Among women, breast cancer is the most commonly diagnosed cancer worldwide. Sleep problems impair 40-70% of breast cancer survivors. This randomized controlled trial evaluates the effect of auricular acupuncture on sleep quality in breast cancer survivors suffering from insomnia. Fifty-two female breast cancer survivors with insomnia (mean age 55.73 ± 8.10 years) were randomized either to 10 treatments of auricular acupuncture within five weeks (n = 26), or to a single session of psychoeducation plus an insomnia advice booklet (n = 26). The primary outcome was sleep quality (measured by the Pittsburgh Sleep Quality Index) at week 5. Secondary outcomes were inflammation parameter (interleukin-6), stress, anxiety, depression, quality of life, and fatigue at week 5, and sleep quality, stress, anxiety, depression, quality of life, and fatigue 17 and 29 weeks after randomization. Intention-to-treat analysis showed a significantly stronger increase in sleep quality in the auricular acupuncture group compared to the psychoeducation group (p = 0.031; η2p = 0.094) at week 5. Furthermore, auricular acupuncture improved stress (p = 0.030; η2p = 0.094), anxiety (p = 0.001; η2p = 0.192), and fatigue (p = 0.006; η2p = 0.148) at week 5 compared to psychoeducation. No significant group difference was found concerning the other outcomes at week 5, or in any outcome at week 17 or week 29. No serious adverse events occurred during the study period. In conclusion, a semi-standardized group auricular acupuncture might be an effective and safe intervention in treating insomnia in breast cancer survivors in the short term, and may reduce stress, anxiety, and fatigue as well. Long-term effects remain questionable.
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Abstract
BACKGROUND This is an update of the original Cochrane Review first published in Issue 10, 2016. For people with advanced cancer, the prevalence of pain can be as high as 90%. Cancer pain is a distressing symptom that tends to worsen as the disease progresses. Evidence suggests that opioid pharmacotherapy is the most effective of these therapies. Hydromorphone appears to be an alternative opioid analgesic which may help relieve these symptoms. OBJECTIVES To determine the analgesic efficacy of hydromorphone in relieving cancer pain, as well as the incidence and severity of any adverse events. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and clinical trials registers in November 2020. We applied no language, document type or publication status limitations to the search. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared hydromorphone with placebo, an alternative opioid or another active control, for cancer pain in adults and children. Primary outcomes were participant-reported pain intensity and pain relief; secondary outcomes were specific adverse events, serious adverse events, quality of life, leaving the study early and death. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data. We calculated risk ratio (RR) and 95% confidence intervals (CI) for binary outcomes on an intention-to-treat (ITT) basis. We estimated mean difference (MD) between groups and 95% CI for continuous data. We used a random-effects model and assessed risk of bias for all included studies. We assessed the evidence using GRADE and created three summary of findings tables. MAIN RESULTS With four new identified studies, the review includes a total of eight studies (1283 participants, with data for 1181 participants available for analysis), which compared hydromorphone with oxycodone (four studies), morphine (three studies) or fentanyl (one study). All studies included adults with cancer pain, mean age ranged around 53 to 59 years and the proportion of men ranged from 42% to 67.4%. We judged all the studies at high risk of bias overall because they had at least one domain with high risk of bias. We found no studies including children. We did not complete a meta-analysis for the primary outcome of pain intensity due to skewed data and different comparators investigated across the studies (oxycodone, morphine and fentanyl). Comparison 1: hydromorphone compared with placebo We identified no studies comparing hydromorphone with placebo. Comparison 2: hydromorphone compared with oxycodone Participant-reported pain intensity We found no clear evidence of a difference in pain intensity (measured using a visual analogue scale (VAS)) in people treated with hydromorphone compared with those treated with oxycodone, but the evidence is very uncertain (3 RCTs, 381 participants, very low-certainty evidence). Participant-reported pain relief We found no studies reporting participant-reported pain relief. Specific adverse events We found no clear evidence of a difference in nausea (RR 1.13 95% CI 0.74 to 1.73; 3 RCTs, 622 participants), vomiting (RR 1.18, 95% CI 0.72 to 1.94; 3 RCTs, 622 participants), dizziness (RR 0.91, 95% CI 0.58 to 1.44; 2 RCTs, 441 participants) and constipation (RR 0.92, 95% CI 0.72 to 1.19; 622 participants) (all very low-certainty evidence) in people treated with hydromorphone compared with those treated with oxycodone, but the evidence is very uncertain. Quality of life We found no studies reporting quality of life. Comparison 3: hydromorphone compared with morphine Participant-reported pain intensity We found no clear evidence of a difference in pain intensity (measured using the Brief Pain Inventory (BPI) or VAS)) in people treated with hydromorphone compared with those treated with morphine, but the evidence is very uncertain (2 RCTs, 433 participants; very low-certainty evidence). Participant-reported pain relief We found no clear evidence of a difference in the number of clinically improved participants, defined by 50% or greater pain relief rate, in the hydromorphone group compared with the morphine group, but the evidence is very uncertain (RR 0.99, 95% CI 0.84 to 1.18; 1 RCT, 233 participants; very low-certainty evidence). Specific adverse events At 24 days of treatment, morphine may reduce constipation compared with hydromorphone, but the evidence is very uncertain (RR 1.56, 95% CI 1.12 to 2.17; 1 RCT, 200 participants; very low-certainty evidence). We found no clear evidence of a difference in nausea (RR 0.94, 95% CI 0.66 to 1.30; 1 RCT, 200 participants), vomiting (RR 0.87, 95% CI 0.58 to 1.31; 1 RCT, 200 participants) and dizziness (RR 1.15, 95% CI 0.71 to 1.88; 1 RCT, 200 participants) (all very low-certainty evidence) in people treated with hydromorphone compared with those treated with morphine, but the evidence is very uncertain. Quality of life We found no studies reporting quality of life. Comparison 4: hydromorphone compared with fentanyl Participant-reported pain intensity We found no clear evidence of a difference in pain intensity (measured by numerical rating scale (NRS)) at 60 minutes in people treated with hydromorphone compared with those treated with fentanyl, but the evidence is very uncertain (1 RCT, 82 participants; very low-certainty evidence). Participant-reported pain relief We found no studies reporting participant-reported pain relief. Specific adverse events We found no studies reporting specific adverse events. Quality of life We found no studies reporting quality of life. AUTHORS' CONCLUSIONS The evidence of the benefits and harms of hydromorphone compared with other analgesics is very uncertain. The studies reported some adverse events, such as nausea, vomiting, dizziness and constipation, but generally there was no clear evidence of a difference between hydromorphone and morphine, oxycodone or fentanyl for this outcome. There is insufficient evidence to support or refute the use of hydromorphone for cancer pain in comparison with other analgesics on the reported outcomes. Further research with larger sample sizes and more comprehensive outcome data collection is required.
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Affiliation(s)
- Yan Li
- Department for Anesthesiology and Pain Management, The People's Hospital of Jizhou District, Tianjin, Tianjin, China
| | - Jun Ma
- Center for Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guijun Lu
- Pain Medicine Department, Beijing Tsinghua Changgung Hospital, Bejing, China
| | - Zhi Dou
- Pain Medicine Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Roger Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Jun Xia
- Systematic Review Solutions Ltd, The Ingenuity Centre, The University of Nottingham, Nottingham, UK
| | - Sai Zhao
- Systematic Review Solutions Ltd, The Ingenuity Centre, The University of Nottingham, Nottingham, UK
| | - Sitong Dong
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Liqiang Yang
- Pain Medicine Department, Xuanwu Hospital, Capital Medical University, Beijing, China
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What makes one respond to acupuncture for insomnia? Perspectives of cancer survivors. Palliat Support Care 2021; 18:301-306. [PMID: 31571560 DOI: 10.1017/s1478951519000762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Like any therapy, acupuncture is effective for some patients, while not helpful for others. Understanding from a patients' perspective what makes one respond or not to acupuncture can help guide further intervention development. This study aimed to identify factors that influence the perception of acupuncture's therapeutic effect among cancer survivors with insomnia. METHOD We conducted post-treatment semi-structured interviews with cancer survivors who were randomized to the acupuncture group in a clinical trial for the treatment of insomnia. Survivors were categorized into Responders and Non-Responders to acupuncture treatment based on the change in the Insomnia Severity Index with a reduction of eight points or greater as the cut-off for the response. An integrated approach to data analysis was utilized by merging an a priori set of codes derived from the key ideas and a set of codes that emerged from the data through a grounded theory approach. Codes were examined for themes and patterns. RESULTS Among 28 cancer survivors interviewed, 18 (64%) were classified as Responders. Participants perceived the ability to respond to acupuncture as dependent on treatment that effectively: (1) alleviated co-morbidities contributing to insomnia, (2) supported sleep hygiene practices, and (3) provided a durable therapeutic effect. Acupuncture treatment that did not address one of these themes often detracted from positive treatment outcomes and diminished perceived benefit from acupuncture. SIGNIFICANCE OF RESULTS We identified patient-perceived contributors to response to acupuncture, such as co-morbid medical conditions, adequate support for sleep hygiene practices, and temporary therapeutic relief. Addressing these factors may improve the overall effectiveness of acupuncture for insomnia.
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Takemura N, Cheung DST, Smith R, Deng W, Ho KY, Lin J, Kwok JYY, Lam TC, Lin CC. Effectiveness of aerobic exercise and mind-body exercise in cancer patients with poor sleep quality: A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev 2020; 53:101334. [PMID: 32505970 DOI: 10.1016/j.smrv.2020.101334] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 02/02/2023]
Abstract
Exercise has promising effects on sleep disturbances and quality of life among cancer patients. Aerobic exercises (AE) and mind-body exercises (MBE) have different mechanisms for improving sleep, but whether they are effective remains unclear. This systematic review and meta-analysis is the first to examine the effectiveness of AE and MBE on sleep outcomes, specifically among cancer patients with sleep disturbances. A systematic search of several databases, from inception to January 2018, was conducted. The pooled effect sizes suggested that both AE (standardized mean difference (SMD) = 0.33, 95% confidence intervals (CI): 0.11, 0.54) and MBE (SMD = 0.18, 95% CI: 0.06, 0.30), improved sleep outcomes in cancer patients with poor sleep quality post-intervention. The effects remained significant after 3-6 months for AE, but not MBE. Due to the heterogeneity in AE, future studies should establish the optimal AE prescription. For MBE, future research should study essential components that make the intervention effect sustainable.
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Affiliation(s)
- Naomi Takemura
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Robert Smith
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wen Deng
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ka Yan Ho
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Jingxia Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Tai-Chung Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chia-Chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong; Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong; School of Nursing, College of Nursing, Taipei Medical University, Taiwan.
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Nzwalo I, Aboim MA, Joaquim N, Marreiros A, Nzwalo H. Systematic Review of the Prevalence, Predictors, and Treatment of Insomnia in Palliative Care. Am J Hosp Palliat Care 2020; 37:957-969. [DOI: 10.1177/1049909120907021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction:The primary function of palliative care is to improve quality of life. The recognition and treatment of symptoms causing suffering is central to the achievement of this goal. Insomnia reduces quality of life of patients under palliative care. Knowledge about prevalence, associated factors, and treatment of insomnia in palliative care is scarce.Methodology:Literature review about the prevalence, predictors, and treatment options of insomnia in palliative care patients. Primary sources of investigation were identified and selected through Pubmed and Scopus databases. The research was complemented by reference search in identified articles and selected reviews. OpenGrey and Google Scholar were used for searching grey literature. Study quality analysis was based on the Newcastle-Ottawa Scale.Results:A total of 65 studies were included in the review. Most studies had acceptable /good quality. The prevalence of insomnia in the included studies ranged from 2.1% to 100%, with a median overall prevalence of 49.5%. Sociodemographic factors such as age; clinical characteristics such as functional status, disease stage, pain, and use of specific drugs, including opioids; psychological factors such as anxiety/depression; and spiritual factors such as feelings of well-being were identified as predictors. The treatment options identified were biological (pharmacological and nonpharmacological), psychological (visualization, relaxation), and spiritual (prayer).Conclusions:The systematic review showed that the prevalence of insomnia is high, with at least one in 3 patients affected in most studies. Insomnia’s risk factors and treatment in palliative care are both associated to physical, psychological, social, and spiritual factors, reflecting its true holistic nature.
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Affiliation(s)
- Isa Nzwalo
- Institute for Health Sciences, Catholic University of Portugal, Lisbon, Portugal
- Unidade de Cuidados de Saúde Personalizados Mar, Tavira, Portugal
| | | | - Natércia Joaquim
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Algarve, Portugal
- Algarve Biomedical Center, Algarve, Portugal
| | - Ana Marreiros
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Algarve, Portugal
- Algarve Biomedical Center, Algarve, Portugal
| | - Hipólito Nzwalo
- Faculty of Medicine and Biomedical Sciences, University of Algarve, Algarve, Portugal
- Algarve Biomedical Center, Algarve, Portugal
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12
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A screening method for sleep disturbances at the end-of-life. Palliat Support Care 2020; 18:468-472. [PMID: 32026797 DOI: 10.1017/s1478951520000024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate sleep disturbances and to verify the accuracy of three screening tests to detect them in patients at the end-of-life admitted in a hospital palliative care unit. METHOD The level of sleep disturbances was evaluated through the Pittsburgh Sleep Quality Index (PSQI) in 150 palliative patients. This questionnaire was the criterion variable for testing the three screening tests used: Edmonton Symptom Assessment System (ESAS-Sleep subscale); the single question "How much do you worry about your sleep problems?" which is answered on a scale of 0-10 (Sleep-Worry-Q) and another single question: "Do you think you have sleep problems?" with two response categories, Yes/No (Sleep-Problem-Q). RESULTS According to the PSQI (cut-off point: 8), 87% of patients presented sleep disturbances. The ESAS-Sleep (cut-off point: 3) showed a sensitivity of 0.87, a specificity of 0.58, and an AUC of 0.729; the Sleep-Worry-Q (cut-off point: 4) showed a sensitivity of 0.95, a specificity of 0.68, and an AUC of 0.854; the Sleep-Problem-Q obtained a sensitivity of 0.92 and a specificity of 0.65. SIGNIFICANCE OF RESULTS Patients at the end-of-life, near the time of death, have high levels of sleep disturbances that can be detected early, with better diagnostic accuracy, with the Sleep-Worry-Q. Although from a clinical point of view, the application of the Sleep-Problem-Q may be more advantageous, as it presents good diagnostic accuracy, greater simplicity, and brevity.
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13
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Tan X, Xiong H, Gui S, Wan Y, Yan W, Wang D, Tong L, Zeng G. Effects of cognitive education on the perceived control and symptom distress of lung cancer patients receiving chemotherapy: A randomised controlled trial. Eur J Cancer Care (Engl) 2019; 28:e13120. [PMID: 31184792 DOI: 10.1111/ecc.13120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 04/28/2019] [Accepted: 05/14/2019] [Indexed: 11/26/2022]
Abstract
AIM A randomised controlled trial (RCT) was implemented to verify the feasibility and acceptability of cognitive education in the format of mind maps for increasing perceived control and decreasing the symptom distress of lung cancer patients who were receiving chemotherapy. METHODS A total of 136 lung cancer patients who were receiving chemotherapy were randomised using stratified blocks (1:1 ratio, from March 2016 to April 2017). The intervention group was given cognitive education in the format of mind maps. The control group was provided conventional education. The primary outcomes were perceived control, including cancer experience and cancer efficacy; the secondary outcomes included symptom distress (arising from fatigue, distress, sleep disturbance, poor appetite, drowsiness, shortness of breath, etc.). The Mann-Whitney U test, chi-squared test, two-sample t test and repeated measurement analysis of variance were used. RESULTS Ninety-four patients completed the final study. The results of the repeated measurement analysis of variance indicated that at the 8th or 12th week following cognitive education intervention in the format of mind maps, the cancer experience, cancer efficacy (except personal efficacy) and symptom distress (arising from fatigue, distress, sleep disturbance, and sadness and its total scores) of the patients in the intervention group were considerably improved compared with those of the control group (p < 0.05). The longer the intervention was, the higher the level of the patients' perceived control was and the lower the degree of patient symptom distress was (p < 0.05). CONCLUSIONS Our findings suggest that cognitive education in the format of mind maps could improve perceived control and decrease the symptom distress of lung cancer patients who were receiving chemotherapy and that it was feasible and acceptable. Cognitive education in the format of mind maps was found to be an effective teaching tool for lung cancer patients who were receiving chemotherapy.
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Affiliation(s)
- Xing Tan
- School of Nursing, University of South China, Hengyang, China.,People's Hospital of Longhua District, Shenzhen, China
| | - Haihan Xiong
- People's Hospital of Longhua District, Shenzhen, China
| | - Sijie Gui
- Queen Mary School, Nanchang University, Nanchang, China
| | - Yanping Wan
- School of Nursing, University of South China, Hengyang, China
| | - Wenjing Yan
- School of Nursing, University of South China, Hengyang, China
| | - Dian Wang
- School of Nursing, University of South China, Hengyang, China
| | - Lingling Tong
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China
| | - Guqing Zeng
- School of Nursing, University of South China, Hengyang, China
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14
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Jakobsen G, Engstrøm M, Paulsen Ø, Sjue K, Raj SX, Thronæs M, Hjermstad MJ, Kaasa S, Fayers P, Klepstad P. Zopiclone versus placebo for short-term treatment of insomnia in patients with advanced cancer: study protocol for a double-blind, randomized, placebo-controlled, clinical multicenter trial. Trials 2018; 19:707. [PMID: 30591073 PMCID: PMC6307135 DOI: 10.1186/s13063-018-3088-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/30/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the high prevalence of insomnia in patients with advanced cancer, there are no randomized controlled trials on pharmacological interventions for insomnia in this group of patients. A variety of pharmacological agents is recommended to manage sleep disturbance for insomnia in the general population, but their efficacy and safety in adults with advanced cancer are not established. Thus, there is a need to evaluate the effectiveness of medications for insomnia in order to improve the evidence in patients with advanced cancer. One of the most used sleep medications at present in patients with cancer is zopiclone. METHODS This is a randomized, double-blind, placebo-controlled, parallel-group, multicenter trial. A total of 100 patients with metastatic cancer who report insomnia will be randomly allocated to zopiclone or placebo. The treatment duration with zopiclone/placebo is 6 consecutive nights. The primary endpoint is patient-reported sleep quality during the final study night (night 6) assessed on a numerical rating scale of 0-10, where 0 = Best sleep and 10 = Worst possible sleep. Secondary endpoints include the mean patient-reported total sleep time and sleep onset latency during the final study night (night 6). DISCUSSION Results from this study on treatment of insomnia in advanced cancer will contribute to clinical decision-making and improve the treatment of sleep disturbance in this patient cohort. TRIAL REGISTRATION ClinicalTrials.gov, NCT02807922 . Registered on 21 June 2016.
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Affiliation(s)
- Gunnhild Jakobsen
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway. .,Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Morten Engstrøm
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs hospital, Trondheim, Norway
| | - Ørnulf Paulsen
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.,Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | - Karin Sjue
- Department of Oncology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Sunil X Raj
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.,Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Morten Thronæs
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology and St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.,Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Marianne Jensen Hjermstad
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Fayers
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Pål Klepstad
- Department of Anaesthesiology and Intensive Care Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
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15
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Sagha Zadeh R, Capezuti E, Eshelman P, Woody N, Tiffany J, Krieger AC. Non-pharmacological solutions to sleep and circadian rhythm disruption: voiced bedside experiences of hospice and end-of-life staff caregivers. BMC Palliat Care 2018; 17:131. [PMID: 30579339 PMCID: PMC6303860 DOI: 10.1186/s12904-018-0385-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/09/2018] [Indexed: 12/29/2022] Open
Abstract
Background Sleep disturbance is a significant issue, particularly for patients with advanced terminal illness. Currently, there are no practice-based recommended approaches for managing sleep and circadian disruptions in this population. To address this gap, a cross-sectional focus group study was performed engaging 32 staff members at four hospices/end-of-life programs in three demographically diverse counties in New York State. Methods Participants responded to structured open-ended questions. Responses were transcribed and subjected to qualitative content analysis. The themes and recommendations for improved practice that emerged were tabulated using Atlas TI qualitative software. Results This report details the experiences of hospice and end-of-life care staff in managing sleep and circadian disruptions affecting patients and analyzes their recommendations for improving care. Caregivers involved in the study described potential interventions that would improve sleep and reduce circadian disruptions. They particularly highlighted a need for improved evaluation and monitoring systems, as well as sleep education programs for both formal and informal caregivers. Conclusions The voiced experiences of frontline hospice and end-of-life caregivers confirmed that disruption in sleep and circadian rhythms is a common issue for their patients and is not effectively addressed in current research and practice. The caregivers’ recommendations focused on management strategies and underscored the need for well-tested interventions to promote sleep in patients receiving end-of-life care. Additional research is needed to examine the effectiveness of systematic programs that can be easily integrated into the end-of-life care process to attenuate sleep disturbances.
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Affiliation(s)
- Rana Sagha Zadeh
- Health Design Innovations Lab (affiliated with Cornell's Institute for Healthy Futures), Design and Environmental Analysis, Cornell University, 2425 Martha Van Rensselaer Hall, Ithaca, NY, 14853-4401, USA.
| | - Elizabeth Capezuti
- W.R. Hearst Foundation Chair in Gerontology, Hunter College of the City University of New York, New York, NY, USA
| | - Paul Eshelman
- Health Design Innovations Lab (affiliated with Cornell's Institute for Healthy Futures), Design and Environmental Analysis, Cornell University, 2425 Martha Van Rensselaer Hall, Ithaca, NY, 14853-4401, USA
| | - Nicole Woody
- Healthcare Strategy & Operations Consultant, New York, NY, USA
| | - Jennifer Tiffany
- Cornell University Cooperative Extension-NYC Programs, Outreach and Community Engagement, Bronfenbrenner Center for Translational Research, Ithaca, NY, USA
| | - Ana C Krieger
- Center for Sleep Medicine, Weill Cornell Medical Center, New York, NY, USA
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16
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Hasuo H, Fujii R, Uchitani K, Sakuma H, Kanbara K, Fukunaga M. Intravenous Chlorpromazine for the Short-Term Treatment of Insomnia in End-Stage Cancer Patients With Difficulty in Oral Administration. J Pain Palliat Care Pharmacother 2018; 32:134-140. [PMID: 30380977 DOI: 10.1080/15360288.2018.1525468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objective of the study was to evaluate effectiveness and safety of intravenous chlorpromazine for the short-term treatment of insomnia in end-stage cancer patients. Insomnia occurs as one of distressing symptoms in 70% of end-stage cancer patients. End-stage cancer patients often have difficulty in oral administration because of disease progress. We retrospectively evaluated 30 end-stage cancer patients with difficulty in oral administration who received intravenous chlorpromazine for the short-term treatment of insomnia. A primary end point was sleep quality based on St. Mary's Hospital Sleep Questionnaire 3 days after the treatment. Improved sleep quality was observed on the day after the treatment and later (P < .001), and the effective rate mean was 0.63 (95% confidential interval: 0.45-0.81) 3 days after the treatment. Increased total sleep time and decreased sleep latency time were observed 3 days after the treatment (P < .001); however, no improvement in depth of sleep was achieved (P = .231). There was no adverse event except for two delirium cases. The study indicated that intravenous chlorpromazine can be applied safely and effectively for the short-term treatment of insomnia in end-stage cancer patients with difficulty in oral administration.
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17
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Feasibility of a Cognitive-Behavioral and Environmental Intervention for Sleep-Wake Difficulties in Community-Dwelling Cancer Patients Receiving Palliative Care. Cancer Nurs 2018; 42:396-409. [PMID: 29762213 DOI: 10.1097/ncc.0000000000000603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND High rates of sleep-wake difficulties have been found in patients with cancer receiving palliative care. Pharmacotherapy is the most frequently used treatment option to manage these difficulties despite numerous adverse effects and the absence of empirical evidence of its efficacy and innocuity in palliative care. OBJECTIVE This pilot study aimed to assess the feasibility and acceptability of a cognitive-behavioral and environmental intervention (CBT-E) to improve insomnia and hypersomnolence in patients with a poor functioning level and to collect preliminary data on its effects. METHODS Six patients with cancer receiving palliative care (Eastern Cooperative Oncology Group score 2-3), who had insomnia and/or hypersomnolence, received 1 CBT-E individual session at home. They applied the strategies for 3 weeks. Patients completed the Insomnia Severity Index, the Epworth Sleepiness Scale, a daily sleep diary, and a 24-hour actigraphic recording (7 days) at pretreatment and posttreatment, in addition to a semistructured interview (posttreatment). RESULTS Participants found strategies easy to apply most of the time, and none was rated as impossible to use because of their health condition. However, their adherence and satisfaction toward CBT-E were highly variable. Results on the effects of CBT-E were heterogeneous, but improvements were observed in patients with a persistent insomnia disorder. CONCLUSIONS The CBT-E protocol tested among this highly selected sample was fairly well received and suggested positive outcomes in some patients, particularly those with an insomnia complaint alone. IMPLICATIONS Efforts should be pursued to adapt CBT-E and develop other nonpharmacological interventions, in order to provide an alternative to pharmacotherapy for sleep-wake difficulties in this population.
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18
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Zeichner SB, Zeichner RL, Gogineni K, Shatil S, Ioachimescu O. Cognitive Behavioral Therapy for Insomnia, Mindfulness, and Yoga in Patients With Breast Cancer with Sleep Disturbance: A Literature Review. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2017; 11:1178223417745564. [PMID: 29434470 PMCID: PMC5802619 DOI: 10.1177/1178223417745564] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/23/2017] [Indexed: 11/16/2022]
Abstract
The number of patients with breast cancer diagnosed with sleep disturbance has grown substantially within the United States over the past 20 years. Meanwhile, there have been significant improvements in the psychological treatment of sleep disturbance in patients with breast cancer. More specifically, cognitive behavioral therapy for insomnia (CBT-I), mindfulness, and yoga have shown to be 3 promising treatments with varying degrees of benefit, supporting data, and inherent limitations. In this article, we will outline the treatment approach for sleep disturbance in patients with breast cancer and conduct a comprehensive review of CBT-I, mindfulness, and yoga as they pertain to this patient population.
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Affiliation(s)
- Simon B Zeichner
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Rachel L Zeichner
- Sleep Medicine Center, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA.,Atlanta VA Clinic, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA
| | - Keerthi Gogineni
- Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Sharon Shatil
- Sleep Medicine Center, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA
| | - Octavian Ioachimescu
- Sleep Medicine Center, Atlanta Veterans Affairs Health Care System, Decatur, GA, USA.,Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
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19
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Ji YB, Bo CL, Xue XJ, Weng EM, Gao GC, Dai BB, Ding KW, Xu CP. Association of Inflammatory Cytokines With the Symptom Cluster of Pain, Fatigue, Depression, and Sleep Disturbance in Chinese Patients With Cancer. J Pain Symptom Manage 2017; 54:843-852. [PMID: 28797869 DOI: 10.1016/j.jpainsymman.2017.05.003] [Citation(s) in RCA: 47] [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: 12/19/2016] [Revised: 04/30/2017] [Accepted: 05/25/2017] [Indexed: 02/01/2023]
Abstract
CONTEXT Pain, fatigue, depression, and sleep disturbance are common in patients with cancer and usually co-occur as a symptom cluster. However, the mechanism underlying this symptom cluster is unclear. OBJECTIVES This study aimed to identify subgroups of cluster symptoms, compare demographic and clinical characteristics between subgroups, and examine the associations between inflammatory cytokines and cluster symptoms. METHODS Participants were 170 Chinese inpatients with cancer from two tertiary hospitals. Inflammatory markers including interleukin-6 (IL-6), interleukin-1 receptor antagonist, and tumor necrosis factor alpha were measured. Intergroup differences and associations of inflammatory cytokines with the cluster symptoms were examined with one-way analyses of variance and logistic regression. RESULTS Based on cluster analysis, participants were categorized into Subgroup 1 (all low symptoms), Subgroup 2 (low pain and moderate fatigue), or Subgroup 3 (moderate-to-high on all symptoms). The three subgroups differed significantly in Eastern Cooperative Oncology Group (ECOG) performance status, sex, residence, current treatment, education, economic status, and inflammatory cytokines levels (all P < 0.05). Compared with Subgroup 1, Subgroup 3 had a significantly poorer ECOG physical performance status and higher IL-6 levels, were more often treated with combined chemoradiotherapy, and were more likely to be rural residents. IL-6 and ECOG physical performance status were significantly associated with 1.246-fold (95% CI 1.114-1.396) and 31.831-fold (95% CI 6.017-168.385) increased risk of Subgroup 3. CONCLUSION Our findings suggest that IL-6 levels are associated with cluster symptoms in cancer patients. Clinicians should identify patients at risk for more severe symptoms and formulate novel target interventions to improve symptom management.
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Affiliation(s)
- Yan-Bo Ji
- Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, China
| | - Chun-Lu Bo
- School of Nursing, Cheeloo Health Science Center, Shandong University, Jinan, Shandong Province, China
| | - Xiu-Juan Xue
- Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, China
| | - En-Ming Weng
- Yanggu No. 2 People's Hospital, Liaocheng, Shandong Province, China
| | - Guang-Chao Gao
- School of Nursing, Taishan Medical College, Tai'an, Shandong Province, China
| | - Bei-Bei Dai
- School of Nursing, Taishan Medical College, Tai'an, Shandong Province, China
| | - Kai-Wen Ding
- School of Nursing, Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Cui-Ping Xu
- Qianfoshan Hospital, Shandong University, Jinan, Shandong Province, China.
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Bernatchez MS, Savard J, Ivers H. Disruptions in sleep-wake cycles in community-dwelling cancer patients receiving palliative care and their correlates. Chronobiol Int 2017; 35:49-62. [PMID: 29144172 DOI: 10.1080/07420528.2017.1381615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Significant disruptions in sleep-wake cycles have been found in advanced cancer patients in prior research. However, much remains to be known about specific sleep-wake cycle variables that are impaired in patients with a significantly altered performance status. More studies are also needed to explore the extent to which disrupted sleep-wake cycles are related to physical and psychological symptoms, time to death, maladaptive sleep behaviors, quality of life and 24-h light exposure. This study conducted in palliative cancer patients was aimed at characterizing patients' sleep-wake cycles using various circadian parameters (i.e. amplitude, acrophase, mesor, up-mesor, down-mesor, rhythmicity coefficient). It also aimed to compare rest-activity rhythm variables of participants with a performance status of 2 vs. 3 on the Eastern Cooperative Oncology Group scale (ECOG) and to evaluate the relationships of sleep-wake cycle parameters with several possible correlates. The sample was composed of 55 community-dwelling cancer patients receiving palliative care with an ECOG of 2 or 3. Circadian parameters were assessed using an actigraphic device for seven consecutive 24-h periods. A light recording and a daily pain diary were completed for the same period. A battery of self-report scales was also administered. A dampened circadian rhythm, a low mean activity level, an early mean time of peak activity during the day, a late starting time of activity during the morning and an early time of decline of activity during the evening were observed. In addition, a less rhythmic sleep-wake cycle was associated with a shorter time to death (from the first home visit) and with a lower 24-h light exposure. Sleep-wake cycles are markedly disrupted in palliative cancer patients, especially, near the end of life. Effective non-pharmacological interventions are needed to improve patients' circadian rhythms, including perhaps bright light therapy.
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Affiliation(s)
| | - Josée Savard
- b CHU de Québec-Université Laval Research Center , Quebec City, Quebec, Canada
| | - Hans Ivers
- c Laval University Cancer Research Center , Quebec City, Quebec, Canada
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Sato K, Miyashita M, Morita T, Tsuneto S, Shima Y. End-of-Life Medical Treatments in the Last Two Weeks of Life in Palliative Care Units in Japan, 2005–2006: A Nationwide Retrospective Cohort Survey. J Palliat Med 2016; 19:1188-1196. [DOI: 10.1089/jpm.2016.0108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kazuki Sato
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Adult Nursing/Palliative Care Nursing, School of Health, Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Adult Nursing/Palliative Care Nursing, School of Health, Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Satoru Tsuneto
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
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Abstract
BACKGROUND Cancer pain is an important and distressing symptom that tends to increase in frequency and intensity as the cancer advances. For people with advanced cancer, the prevalence of pain can be as high as 90%. It has been estimated that 30% to 50% of people with cancer categorise their pain as moderate to severe, with between 75% and 90% of people with cancer experiencing pain that they describe as having a major impact on their daily life. Epidemiological studies suggest that approximately 15% of people with cancer pain fail to experience acceptable pain relief with conventional management. Uncontrolled pain can lead to physical and psychological distress and can, consequently, have a drastic effect on people's quality of life. OBJECTIVES To determine the analgesic efficacy of hydromorphone in relieving cancer pain, as well as the incidence and severity of any adverse events. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and clinical trials registers up to April 2016. There were no language, document type or publication status limitations applied in the search. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared hydromorphone with placebo or other active pain medication for cancer pain in both adults and children. The four main outcomes selected have previously been identified as important to people with cancer; pain no worse than mild pain, and the impact of the treatment on consciousness, appetite and thirst. We did not consider physician-, nurse- or carer-reported measures of pain. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We used a random-effects model and assessed the risk of bias for all included studies. A meta-analysis was not completed on any of the primary outcomes in this review due to the lack of data. We assessed the evidence using GRADE and created two 'Summary of findings' tables. MAIN RESULTS We included four studies (604 adult participants), which compared hydromorphone to oxycodone (two studies) or morphine (two studies). Overall, the included studies were at low or unclear risk of bias, rated unclear due to unknown status of blinding of outcome assessment; we rated three studies at high risk of bias for potential conflict of interest. Data for 504 participants were available for analysis. We collected data on endpoint participant-reported pain intensity measured with a visual analogue scale (VAS) (mean ± standard deviation (SD): hydromorphone 28.86 ± 17.08, n = 19; oxycodone 30.30 ± 25.33, n = 12; scale from 0 to 100 with higher score indicating worse pain), and Brief Pain Inventory (BPI) 24 hours worst pain subscale (mean ± SD: hydromorphone 3.5 ± 2.9, n = 99; morphine 4.3 ± 3.0, n = 101, scale from 0 to 10 with higher score indicating worse pain). The data demonstrated a similar effect between groups with both comparisons. The pain intensity data showed that participants in all four trials achieved no worse than mild pain. There were several adverse events: some were the expected opioid adverse effects such as nausea, constipation and vomiting; others were not typical opioid adverse effects (for example, decreased appetite, dizziness and pyrexia, as shown in Table 1 in the main review), but generally showed no difference between groups. There were three deaths in the morphine group during the trial period, considered to be due to disease progression and unrelated to the drug. Three trials had over 10% dropout, but the reason and proportion of dropout was balanced between groups. The overall quality of evidence was very low mainly due to high risk of bias, imprecision of effect estimates and publication bias. There were no data available for children or for several participant-important outcomes, including participant-reported pain relief and treatment impact on consciousness, appetite or thirst. AUTHORS' CONCLUSIONS This review indicated little difference between hydromorphone and other opioids in terms of analgesic efficacy. Data gathered in this review showed that hydromorphone had a similar effect on participant-reported pain intensity as reported for oxycodone and morphine. Participants generally achieved no worse than mild pain after taking hydromorphone, which is comparable with the other drugs. It produced a consistent analgesic effect through the night and could be considered for use in people with cancer pain experiencing sleep disturbance. However, the overall quality of evidence was very low mainly due to risk of bias, imprecision of effect estimates and publication bias. This review only included four studies with limited sample size and a range of study designs. Data for some important outcomes, such as impact of the treatment on consciousness, appetite or thirst, were not available. Therefore, we were unable to demonstrate superiority or inferiority of hydromorphone in comparison with other analgesics for these outcomes. We recommend that further research with larger sample sizes and more comprehensive outcome data collection is required.
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Affiliation(s)
- Yan J Bao
- Guang'anmen Hospital, China Academy of Chinese Medical SciencesDepartment of OncologyBeixiange 5BeijingChina100053
| | - Wei Hou
- Guang'anmen Hospital, China Academy of Chinese Medical SciencesDepartment of OncologyBeixiange 5BeijingChina100053
| | - Xiang Y Kong
- China Academy of Chinese Medical SciencesInstitute of Chinese Materia MedicaNanxiaojie, Dongzhimennei AveBeijingChina100700
| | - Liping Yang
- Guang'anmen Hospital, China Academy of Chinese Medical SciencesDepartment of NephrologyBeixiange 5BeijingChina100053
| | - Jun Xia
- Systematic Review Solutions Ltd89 Russell DriveNottinghamUK264000
| | - Bao J Hua
- Guang'anmen Hospital, China Academy of Chinese Medical SciencesDepartment of OncologyBeixiange 5BeijingChina100053
| | - Roger Knaggs
- University of NottinghamSchool of PharmacyUniversity ParkNottinghamUKNG7 2RD
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Kaneishi K, Kawabata M, Morita T. Single-Dose Subcutaneous Benzodiazepines for Insomnia in Patients With Advanced Cancer. J Pain Symptom Manage 2015; 49:e1-2. [PMID: 25827855 DOI: 10.1016/j.jpainsymman.2015.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 02/13/2015] [Accepted: 02/15/2015] [Indexed: 11/22/2022]
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Akman T, Yavuzsen T, Sevgen Z, Ellidokuz H, Yilmaz AU. Evaluation of sleep disorders in cancer patients based on Pittsburgh Sleep Quality Index. Eur J Cancer Care (Engl) 2015; 24:553-9. [PMID: 25727241 DOI: 10.1111/ecc.12296] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 11/28/2022]
Abstract
Insomnia, poor sleep quality and short sleep durations are the most common problems seen in cancer patients. More studies are needed about sleep disorders in cancer patients. In our study, we aimed to investigate the prevalence of sleep disorders and the impact of these problems on the quality of life in cancer patients. Pittsburgh Sleep Quality Index (PSQI) was given to a total of 314 patients. The psychometric evaluation of the Turkish version of PSQI in cancer patients revealed that 127 (40.4%) patients had global PSQI scores >5, indicating poor sleep quality. There was no statistically significant relationship between PSQI scores and sexuality, marital status, cancer stage and chemotherapy type (P > 0.05); while the patients with bone and visceral metastasis had much lower PSQI scores (P = 0.006). Patients with Eastern Cooperative Oncology Group performance scores of 3 or more had also significantly lower PSQI scores (P = 0.02). In conclusion, PSQI questionnaire may be used to evaluate the sleep disorders in cancer patients. Consistent use of multi-item measures such as PSQI with established reliability and validity would improve our understanding of difficulties experienced by cancer patients with chronic insomnia.
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Affiliation(s)
- Tulay Akman
- Tepecik Education and Research Hospital, Division of Medical Oncology, Izmir, Turkey
| | - Tugba Yavuzsen
- Dokuz Eylul University Medical School, Division of Medical Oncology, Izmir, Turkey
| | - Zeynep Sevgen
- Dokuz Eylul University Medical School, Department of Internal Medicine, Izmir, Turkey
| | - Hulya Ellidokuz
- Dokuz Eylul University Medical School, Department of Preventive Oncology, Izmir, Turkey
| | - Ahmet Ugur Yilmaz
- Medical Park, Izmir University, Division of Medical Oncology, Izmir, Turkey
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Morris BA, Thorndike FP, Ritterband LM, Glozier N, Dunn J, Chambers SK. Sleep disturbance in cancer patients and caregivers who contact telephone-based help services. Support Care Cancer 2014; 23:1113-20. [PMID: 25297467 DOI: 10.1007/s00520-014-2458-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/21/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Insomnia is highly prevalent in people who are affected by cancer. However, options available to receive support for insomnia are limited. Telephone-based help services, such as cancer helplines, may be ideally placed to meet unmet needs regarding insomnia after cancer. The present study describes the prevalence and predictors of insomnia in patients and caregivers who call cancer helplines seeking support. METHODS Participants (N = 500 patients, N = 234 caregivers) were recruited through an Australian state-based telephone-delivered cancer helpline. In addition to routine screening with the Distress Thermometer, participants were administered the Insomnia Severity Index. RESULTS Most participants were female, older than 50 years of age, and were three (caregivers) to four (patients) months post-diagnosis. Insomnia symptoms were reported by 59.4 % of patients and 62.9 % of caregivers, with moderate to severe levels of insomnia reported by 27 % of patients and 30 % of caregivers. Insomnia was predicted by distress level for both patients (β = .31, p < .001) and caregivers (β = .32, p < .001) and age for patients only (β = -.13, p < .01). CONCLUSIONS Insomnia symptoms are common in patients and caregivers who call cancer helplines and appear to be related to distress. Telephone-based helplines have the potential to act as the first line of support in a stepped care approach addressing insomnia.
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Affiliation(s)
- Bronwyn A Morris
- Griffith Health Institute, Griffith University, Building G05 2.44, Gold Coast Campus, Brisbane, QLD, 4222, Australia
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Renom-Guiteras A, Planas J, Farriols C, Mojal S, Miralles R, Silvent MA, Ruiz-Ripoll AI. Insomnia among patients with advanced disease during admission in a Palliative Care Unit: a prospective observational study on its frequency and association with psychological, physical and environmental factors. BMC Palliat Care 2014; 13:40. [PMID: 25136263 PMCID: PMC4135052 DOI: 10.1186/1472-684x-13-40] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 08/04/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND THE AIMS OF THIS STUDY WERE 1) to assess the frequency of insomnia among patients during admission in a Palliative Care Unit (PCU); 2) to study the association between emotional distress and insomnia, taking physical, environmental and other psychological factors into account. METHODS Prospective observational study including patients consecutively admitted to a PCU during eight months, excluding those with severe cognitive problems or too low performance status. Insomnia was assessed by asking a single question and by using the Sleep Disturbance Scale (SDS), and emotional distress using the Hospital Anxiety and Depression Scale (HADS). Physical, environmental and other psychological factors potentially interfering with sleep quality were evaluated. Association between insomnia and the factors evaluated was studied using univariate and multivariate regression analyses. RESULTS 61 patients were included (mean age 71.5 years; 95% with oncological disease); 38 (62%) answered "yes" to the insomnia single question and 29 (47%) showed moderate to severe insomnia according to the SDS. 65% showed clinically significant emotional distress and 79% had nocturnal rumination. The physical symptoms most often mentioned as interfering with sleep quality were pain (69%) and dyspnoea (36%). 77% reported at least one environmental disturbance. In the univariate analysis, answering "yes" to the insomnia single question was significantly associated with higher HADS score, anxiety, nocturnal rumination, clear knowledge of the diagnosis, higher performance status and dyspnoea; moderate to severe insomnia was significantly associated with nocturnal rumination, higher performance status, environmental disturbances and daytime sleepiness. In the multivariate regression analysis, answering "yes" to the single question was associated with dyspnoea (OR 7.2 [1.65-31.27]; p = 0.009), nocturnal rumination (OR 5.5 [1.05-28.49]; p = 0.04) and higher performance status (OR 14.3 [1.62-125.43]; p = 0.017), and moderate to severe insomnia with nocturnal rumination (OR 5.6 [1.1-29.1]; p = 0.041), and inversely associated with daytime sleepiness (OR 0.25 [0.07-0.9]; p = 0.043). CONCLUSIONS Insomnia was highly frequent. Several physical, psychological and environmental factors seemed to influence insomnia. Within the multimodal management of insomnia, the assessment of nocturnal rumination may be of particular interest, irrespective of emotional distress. Further studies with larger sample sizes could confirm this result.
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Affiliation(s)
- Anna Renom-Guiteras
- School of Nursing Science and Institute of General Practice and Family Medicine, Faculty of Health, University of Witten/Herdecke, 50 Alfred-Herrhausen-Str, 58448 Witten, Germany ; Geriatric Service, Hospital de l'Esperança, Centre Fòrum, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - José Planas
- Palliative Care Unit, Department of Medical Oncology, Hospital de l'Esperança, Parc de Salut Mar, Barcelona, Spain ; Universitat Autònoma de Barcelona, Barcelona, Spain ; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Cristina Farriols
- Palliative Care Unit, Department of Medical Oncology, Hospital de l'Esperança, Parc de Salut Mar, Barcelona, Spain ; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sergi Mojal
- Scientific and Technical Services, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Ramón Miralles
- Geriatric Service, Hospital de l'Esperança, Centre Fòrum, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain ; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria A Silvent
- Palliative Care Unit, Department of Medical Oncology, Hospital de l'Esperança, Parc de Salut Mar, Barcelona, Spain
| | - Ada I Ruiz-Ripoll
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain ; Department of Psychiatry, Institute of Neuropsychiatry and Addiction, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
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Shin SH, Lee HS, Kim YS, Choi YJ, Kim SH, Kwon HC, Oh SY, Kang JH, Sohn CH, Lee SM, Baek JH, Min YJ, Kim C, Chung JS. Clinical Usefulness of Hydromorphone-OROS in Improving Sleep Disturbances in Korean Cancer Patients: A Multicenter, Prospective, Open-Label Study. Cancer Res Treat 2014; 46:331-8. [PMID: 25043822 PMCID: PMC4206066 DOI: 10.4143/crt.2013.130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/01/2013] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate the efficacy of hydromorphone-OROS (HM-OROS) in reducing sleep disturbance and relieving cancer pain. Materials and Methods One hundred twenty cancer patients with pain (numeric rating scale [NRS] ≥ 4) and sleep disturbance (NRS ≥ 4) were evaluated. The initial HM-OROS dosing was based on previous opioid dose (HM-OROS:oral morphine=1:5). Dose adjustment of the study drug was permitted at the investigator’s discretion. Pain intensity, number of breakthrough pain episodes, and quality of sleep were evaluated. Results A total of 120 patients received at least one dose of HM-OROS; 74 of them completed the final assessment. Compared to the previous opioids, HM-OROS reduced the average pain NRS from 5.3 to 4.1 (p < 0.01), worst pain NRS from 6.7 to 5.4 (p < 0.01), sleep disturbance NRS from 5.9 to 4.1 (p < 0.01), incidence of breakthrough pain at night from 2.63 to 1.53 times (p < 0.001), and immediate-release opioids use for the management of breakthrough pain from 0.83 to 0.39 times per night (p = 0.001). Of the 74 patients who completed the treatment, 83.7% indicated that they preferred HM-OROS to the previous medication. The adverse events (AEs) were somnolence, asthenia, constipation, dizziness, and nausea. Conclusion HM-OROS was efficacious in reducing cancer pain and associated sleep disturbances. The AEs were manageable.
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Affiliation(s)
- Seong Hoon Shin
- Division of Hemato-Oncology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Ho Sup Lee
- Division of Hemato-Oncology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Yang Soo Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Young Jin Choi
- Division of Hemato-Oncology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Sung Hyun Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyuk Chan Kwon
- Division of Hemato-Oncology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Sung Yong Oh
- Division of Hemato-Oncology, Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Jung Hun Kang
- Division of Hemato-Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chang Hak Sohn
- Division of Hemato-Oncology, Department of Internal Medicine, Inje University Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Min Lee
- Division of Hemato-Oncology, Department of Internal Medicine, Inje University Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jin Ho Baek
- Division of Hemato-Oncology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Young Joo Min
- Division of Hemato-Oncology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Choongrak Kim
- Departments of Statistics, National Research Laboratory for Computational Proteomics and Biophysics, Pusan National University, Busan, Korea ; Departments of Physics, National Research Laboratory for Computational Proteomics and Biophysics, Pusan National University, Busan, Korea ; Interdisciplinary Research Program of Bioinformatics, Pusan National University, Busan, Korea
| | - Joo Seop Chung
- Division of Hemato-Oncology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Howell D, Oliver TK, Keller-Olaman S, Davidson JR, Garland S, Samuels C, Savard J, Harris C, Aubin M, Olson K, Sussman J, MacFarlane J, Taylor C. Sleep disturbance in adults with cancer: a systematic review of evidence for best practices in assessment and management for clinical practice. Ann Oncol 2014; 25:791-800. [PMID: 24287882 DOI: 10.1093/annonc/mdt506] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Sleep disturbance is prevalent in cancer with detrimental effects on health outcomes. Sleep problems are seldom identified or addressed in cancer practice. The purpose of this review was to identify the evidence base for the assessment and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) for oncology practice. The search of the health literature included grey literature data sources and empirical databases from June 2004 to June 2012. The evidence was reviewed by a Canadian Sleep Expert Panel, comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers and guideline methodologists to develop clinical practice recommendations for pan-Canadian use reported in a separate paper. Three clinical practice guidelines and 12 randomized, controlled trials were identified as the main source of evidence. Additional guidelines and systematic reviews were also reviewed for evidence-based recommendations on the assessment and management of insomnia not necessarily in cancer. A need to routinely screen for sleep disturbances was identified and the randomized, controlled trial (RCT) evidence suggests benefits for cognitive behavioural therapy for improving sleep quality in cancer. Sleep disturbance is a prevalent problem in cancer that needs greater recognition in clinical practice and in future research.
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Affiliation(s)
- D Howell
- University Health Network & Faculty of Nursing, University of Toronto, Toronto; Canadian Partnership Against Cancer, Toronto.
| | - T K Oliver
- Canadian Partnership Against Cancer, Toronto
| | - S Keller-Olaman
- Dalla Lana School of Public Health, University of Toronto, Toronto
| | - J R Davidson
- Departments of Psychology and Oncology, Queen's University, Kingston; Kingston Family Health Team, Kingston
| | - S Garland
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary; Department of Psychology, University of Calgary, Calgary
| | - C Samuels
- Centre for Sleep and Human Performance in Calgary, Calgary
| | - J Savard
- School of Psychology, Université Laval, Quebec City
| | - C Harris
- Department of Psychology and Psychosocial Oncology Program, The Ottawa Hospital Cancer Centre, Ottawa
| | - M Aubin
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City
| | - K Olson
- Faculty of Nursing, University of Alberta, Alberta
| | - J Sussman
- Department of Oncology, Juravinski Cancer Centre, Hamilton
| | - J MacFarlane
- Department of Pediatrics & Psychiatry, University of Toronto, Toronto; MedSleep (Network of Clinics), Toronto
| | - C Taylor
- Department of Nursing, Cape Breton University, Sydney, Canada
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Gonçalves F, Almeida A, Antunes C, Cardoso M, Carvalho M, Claro M, Coimbra F, Diniz I, Fonseca B, Fradique E, Gonçalves E, Gonçalves F, Gonçalves M, Magalhães A, Pina P, Pires C, Silva P, Silva R, Silva R, Tavares F, Teixeira L. Symptoms other than pain in palliative care in Portugal. Am J Hosp Palliat Care 2014; 32:335-40. [PMID: 24463203 DOI: 10.1177/1049909114520715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the burden of patients' symptoms other than pain and their treatment by Portuguese palliative care teams. METHODS Of the 21 Portuguese palliative care teams identified, 10 accepted to participate. Data from all patients observed on the 18th week of 2011 were collected. RESULTS One hundred and sixty-four patients were included in this study. One hundred and fifty-one patients (92%) had cancer. The patients' median age was 71 years (16-95) and 84 (51%) were females. The main symptoms were fatigue (116 [85%]) and depression/sadness (107 [65%]). Many different drugs were used for symptom control and other aims. Symptoms and drugs used here are similar to those practiced in other countries. CONCLUSION The practice of palliative care in Portugal seems to be similar to those in other countries.
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Affiliation(s)
- Ferraz Gonçalves
- Department of Palliative Care, Instituto Português de Oncologia, Porto, Portugal
| | - Ana Almeida
- Department of Palliative Care, Instituto Português de Oncologia, Porto, Portugal
| | - Catarina Antunes
- Department of Palliative Care, Hospital do Mar, Lisboa, Portugal
| | - Maria Cardoso
- Department of Palliative Care, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Margarida Carvalho
- Department of Palliative Care, Hospital do Litoral Alentejano, Santiago do Cacém, Portugal
| | - Maria Claro
- Department of Palliative Care, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Francisca Coimbra
- Department of Palliative Care, Instituto Português de Oncologia, Lisboa, Lisboa, Portugal
| | - Inês Diniz
- Department of Palliative Care, Hospital do Mar, Lisboa, Portugal
| | - Bruno Fonseca
- Department of Palliative Care, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Emília Fradique
- Department of Palliative Care, Hospital de St. Maria, Lisboa, Portugal
| | - Edna Gonçalves
- Department of Palliative Care, Centro Hospitalar de S. João, Porto, Portugal
| | - Florbela Gonçalves
- Department of Palliative Care, Instituto Português de Oncologia, Coimbra, Coimbra, Portugal
| | - Maria Gonçalves
- Department of Palliative Care, Hospital do Litoral Alentejano, Santiago do Cacém, Portugal
| | - Américo Magalhães
- Department of Palliative Care, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Paulo Pina
- Department of Palliative Care, Instituto Português de Oncologia, Lisboa, Lisboa, Portugal
| | - Conceição Pires
- Department of Palliative Care, Centro Hospitalar de S. João, Porto, Portugal
| | - Paula Silva
- Department of Palliative Care, Instituto Português de Oncologia, Porto, Portugal
| | - Ricardo Silva
- Department of Palliative Care, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Rui Silva
- Department of Palliative Care, Instituto Português de Oncologia, Coimbra, Coimbra, Portugal
| | - Filipa Tavares
- Department of Palliative Care, Hospital de St. Maria, Lisboa, Portugal
| | - Laura Teixeira
- Department of Palliative Care, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
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Abstract
Insomnia increases cancer symptom burden and impairs quality of life. The lack of standard definitions and treatment guidelines makes management difficult. Insomnia is common in most cancers but appears particularly so in lung, breast, and head and neck tumors. Older women seem most susceptible. Insomnia not only affects patients with cancer but also caregivers and families. Systematic screening is important. Few validated assessment scales are available. Nonpharmacologic therapies like cognitive behavioral therapy may help. New nonbenzodiazepine hypnotics may have some therapeutic advantages over older agents. Management of associated or contributory symptoms like fatigue, pain, and hot flashes with appropriate symptom-specific agents is important. Successful management may have a significant positive impact on global quality of life.
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Affiliation(s)
- Raghava R Induru
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland, OH, USA
- Department of Solid Tumor Oncology, Section of Palliative Medicine and Supportive Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Declan Walsh
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland, OH, USA
- Department of Solid Tumor Oncology, Section of Palliative Medicine and Supportive Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
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Yang CH, Chiu YW, Huang CT, Haung YW, Chuang HY. A comprehensive approach in hospice shared care in Taiwan: Nonelderly patients have more physical, psychosocial and spiritual suffering. Kaohsiung J Med Sci 2013; 29:444-50. [DOI: 10.1016/j.kjms.2012.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022] Open
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Akyuz RG, Ugur O, Elcigil A. Sleep Quality in Lung Cancer Patients. Asian Pac J Cancer Prev 2013; 14:2909-13. [DOI: 10.7314/apjcp.2013.14.5.2909] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Howell D, Oliver TK, Keller-Olaman S, Davidson J, Garland S, Samuels C, Savard J, Harris C, Aubin M, Olson K, Sussman J, Macfarlane J, Taylor C. A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer. Support Care Cancer 2013; 21:2695-706. [PMID: 23708820 DOI: 10.1007/s00520-013-1823-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aims to provide recommendations on the optimal strategies and interventions for the prevention, screening, assessment, and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) in adult cancer populations. METHODS A systematic search of the published health literature was conducted to identify randomized controlled trials, clinical practice guidelines, systematic reviews, and other guidance documents. The Sleep Disturbance Expert Panel [comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers, and guideline methodologists] reviewed, discussed, and approved the final version of the guideline. Health care professionals across Canada were asked to provide feedback through an external review process. RESULTS Three clinical practice guidelines and 12 randomized controlled trials were identified as the evidence base. Overall, despite the paucity of evidence, the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using standardized screening tools on a routine basis. While prevention of sleep disturbance is the desired objective, cognitive behavioral therapies are effective in improving sleep outcomes. As part of the external review with 16 health care providers, 81 % indicated that they agreed with the recommendations as written. CONCLUSIONS Sleep difficulty is a prevalent problem in cancer populations that needs greater recognition by health professionals. Prevention, screening, assessment, and treatment strategies supported by the best available evidence are critical. Recommendations and care path algorithms for practice are offered.
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Affiliation(s)
- Doris Howell
- University Health Network (Princess Margaret Hospital), 610 University Avenue PMH, Room 15-617, Toronto, ON, Canada,
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Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: a pilot randomized controlled trial. J Cancer Surviv 2013; 7:165-82. [PMID: 23338490 PMCID: PMC3622018 DOI: 10.1007/s11764-012-0252-8] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 11/09/2012] [Indexed: 12/22/2022]
Abstract
Purpose After completing treatment, cancer survivors may suffer from a multitude of physical and mental health impairments, resulting in compromised quality of life. This exploratory study investigated whether two mind–body interventions, i.e., Mind–Body Bridging (MBB) and Mindfulness Meditation (MM), could improve posttreatment cancer survivors’ self-reported sleep disturbance and comorbid symptoms, as compared to sleep hygiene education (SHE) as an active control. Methods This randomized controlled trial examined 57 cancer survivors with clinically significant self-reported sleep disturbance, randomly assigned to receive MBB, MM, or SHE. All interventions were conducted in three sessions, once per week. Patient-reported outcomes were assessed via the Medical Outcomes Study Sleep Scale and other indicators of psychosocial functioning relevant to quality of life, stress, depression, mindfulness, self-compassion, and well-being. Results Mixed effects model analysis revealed that mean sleep disturbance symptoms in the MBB (p = .0029) and MM (p = .0499) groups were lower than in the SHE group, indicating that both mind–body interventions improved sleep. In addition, compared with the SHE group, the MBB group showed reductions in self-reported depression symptoms (p = .040) and improvements in overall levels of mindfulness (p = .018), self-compassion (p = .028), and well-being (p = .019) at postintervention. Conclusions This study provides preliminary evidence that brief sleep-focused MBB and MM are promising interventions for sleep disturbance in cancer survivors. Integrating MBB or MM into posttreatment supportive plans should enhance care of cancer survivors with sleep disturbance. Because MBB produced additional secondary benefits, MBB may serve as a promising multipurpose intervention for posttreatment cancer survivors suffering from sleep disturbance and other comorbid symptoms. Implications for Cancer Survivors Two brief sleep-focused mind–body interventions investigated in the study were effective in reducing sleep disturbance and one of them further improved other psychosocial aspects of the cancer survivors’ life. Management of sleep problems in survivors is a high priority issue that demands more attention in cancer survivorship.
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Abstract
OBJECTIVES : The objectives of this study were to describe sleep quality and evaluate the association of sleep quality with delirium onset among patients enrolled in hospice. DESIGN : The study utilized secondary data from a prospective, observational, longitudinal study. SETTING : Veterans enrolled in hospice were recruited from the Portland Veterans Affairs Medical Center, Portland, Oregon. PARTICIPANTS : The cohort consisted of 105 patients, of whom 73% had at least one sleep measurement. MEASUREMENTS : Sleep quality was measured with the Pittsburgh Sleep Quality Index. Delirium was measured with the Confusion Assessment Method. Other important variables were recorded from the medical record and/or longitudinal interviews with patients and their caregivers. Cox regression was used to estimate hazard ratios (HRs) to measure the association between sleep quality and delirium onset. RESULTS : Of the patients who could be assessed, 44% had poor average sleep quality and 58% reported at least one episode of poor sleep. Overall, sleep quality did not appear to worsen as patients neared death although an increasing number of patients were unable to report on sleep quality. Poor sleep quality was associated with an increased risk of developing delirium, with an HR of 2.37 (95% CI: 1.50-3.74), for every one point worsening in the sleep quality score on a 4-point scale. CONCLUSIONS : Poor sleep quality was common among Veteran patients enrolled in hospice. These findings may help guide decision making between clinicians, patients, and families regarding the likely impact of sleep disturbance and may help identify patients at higher risk of developing delirium.
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Abstract
Sleep-wake disturbances, particularly insomnia, are among the most prevalent and distressing symptoms experienced by patients with cancer. As a result of extensive interdisciplinary research conducted since 2000, cognitive-behavioral therapy now is considered the standard of care for the treatment of insomnia in the general population and also has been upgraded to "likely to be effective" in the Oncology Nursing Society Putting Evidence Into Practice weight of evidence category. Cognitive-behavioral therapy is a multicomponent psychological and behavioral treatment designed to eliminate the perpetuating factors of insomnia. The most frequently used strategies are stimulus control, sleep restriction and relaxation therapies, paradoxical intention, sleep hygiene, and cognitive restructuring. Although this insomnia treatment recommendation has been well publicized, the nursing literature has not effectively translated the theories and principles of cognitive-behavioral therapy into practical guidelines or considerations for use by oncology staff nurses and advanced practitioners. This article attempts to demystify cognitive-behavioral therapy and provide nurses at different levels of practice a foundation from which to evaluate and potentially deliver this promising insomnia intervention.
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Affiliation(s)
- Susan Crump Woodward
- Clark and Daughtrey Medical Group, Center for Cancer Care & Research, Lakeland, FL, USA.
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In the midnight hour: Cancer and nightmares. A review of theories and interventions in psycho-oncology. Palliat Support Care 2011; 9:191-200. [PMID: 24468487 DOI: 10.1017/s147895151100006x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The purposes of this study were: (1) to explore cancer patients' complaints of poor sleep, which often involve a combination of somatic symptoms and nightmares; and (2) to understand these sleep disturbances in the light of modern dream theories and intervention modalities. METHOD The literature search originated with several major articles (Revonsuo, 2000; Krakow & Zadra, 2006; Hobson, 2009) which then opened up the search through their references. We also used the database PubMed, and employed the following key words: cancer, nightmares/dreams, sleep disturbances, and dream theory. The literature search covered the interval between 1900 (Freud, 1900) and 2009. Our criteria for selecting studies included the most recent major review articles on the neuroscience of sleep and dreams; articles reviewing sleep disturbances in cancer patients and relevant treatments; and articles reviewing interventions for traumatic dreams. Approximately 30 articles were deemed worthy of inclusion. RESULTS Thirty article/books/chapters met the criteria for relevance related to key theories and clinical interventions related to nightmares and traumatic dreams of cancer patients. Key concepts involve threat simulation theory and imagery rehearsal therapy in regard to theoretical and interventional paradigms significantly generalizable to cancer patients. The dream material included in this article presents patients' attempts to deal with complex threats such as intense dependency/ loss of self-sufficiency, disfigurement, and death. This is especially true with regard to the doctor-patient relationship at all stages of the illness and disease. Imagery rehearsal can facilitate empowerment in light of highly threatening and conflictual cancer-related dreams in which the patient feels helpless and victimized. SIGNIFICANCE OF RESULTS This review offers a new lens on current dream theories and understanding of sleep disturbance in cancer patients as well as their familes and medical caregivers. Modern theories lead to opportunities for intervention that can both relieve symptoms and improve communication between medical caregivers and patients and families.
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Khan L, Uy C, Nguyen J, Chow E, Zhang L, Zeng L, Salvo N, Culleton S, Jon F, Wong K, Danjoux C, Tsao M, Barnes E, Sahgal A, Holden L. Self-reported rates of sleep disturbance in patients with symptomatic bone metastases attending an outpatient radiotherapy clinic. J Palliat Med 2011; 14:708-14. [PMID: 21554034 DOI: 10.1089/jpm.2010.0491] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To examine the reported rates and predictive factors for sleep disturbance in patients with bone metastases. METHODS Patients with symptomatic bone metastases treated with palliative radiotherapy (RT) were eligible. At initial consultation, demographic information, baseline Brief Pain Inventory (BPI) questionnaire, and analgesic consumption were recorded. The BPI functional interference sleep item was categorized into none (0), mild (1-3), moderate (4-6), and severe (7-10). Follow-up BPI was collected in person or via telephone post-RT at week 4, 8, and 12. Subgroup analysis for BPI between responders and nonresponders was performed. Ordinal logistic regression analysis was used to search for the relationship between sleep disturbance and other covariates. RESULTS Four hundred patients were enrolled between May 2003 and June 2007. Two hundred thirty-five males (59%) were accrued. The median age was 68 years old (range, 30-91). Within the study population, primary cancer sites included breast (25%), lung (25%), prostate (24%), bladder (4%), pancreas/gastric (3%), and other primaries (18%). In the BPI functional interference items, the mean baseline score for sleep disturbance was 4.8. When categorized in terms of severity, 99 (25%) patients had moderate sleep disturbance and 144 (36%) patients had severe sleep disturbance, respectively. There was an improvement in sleep scores for both responders and nonresponders at week 4 and 8, but scores worsened for nonresponders at week 12. CONCLUSION Age, Karnofsky Performance Scale (KPS), pain score, and lung primary were the significant variables associated with sleep disturbance. The scores for sleep disturbance improved significantly post-RT in responders at week 4 and 12.
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Affiliation(s)
- Luluel Khan
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Delgado-Guay M, Yennurajalingam S, Parsons H, Palmer JL, Bruera E. Association between self-reported sleep disturbance and other symptoms in patients with advanced cancer. J Pain Symptom Manage 2011; 41:819-27. [PMID: 21306864 DOI: 10.1016/j.jpainsymman.2010.07.015] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 07/23/2010] [Accepted: 07/29/2010] [Indexed: 11/18/2022]
Abstract
CONTEXT Sleep disturbance (SD) is a significant source of distress for patients with cancer. Studies of patients with advanced cancer receiving palliative care to identify symptoms associated with the severity of SD are limited. OBJECTIVES In this study, we sought to identify the symptoms measured by the Edmonton Symptom Assessment Scale (ESAS) that are associated with SD, as measured by the Pittsburgh Sleep Quality Index (PSQI). Secondary aims of the study were to determine the association between occurrences of SD with occurrences of other symptoms and screening performance of the ESAS-Sleep item against the PSQI. METHODS We reviewed the completed ESAS and PSQI assessments of 101 patients with advanced cancer who were receiving palliative care and had been admitted to prospective clinical trials previously initiated by us. Patients with a PSQI score of ≥ 5 were considered to have an SD. The frequency and severity of the ESAS symptoms items, their correlation with each other, the PSQI score, and the screening performance of the ESAS-Sleep item were calculated. RESULTS The median age of patients was 60 years. Most were white non-Hispanic (73%), had lung or breast cancer (41%), and were diagnosed with SD (85%). The PSQI score was correlated with the ESAS items of pain (r=0.27, P=0.006), dyspnea (r=0.25, P<0.001), well-being (r=0.35, P<0.0001), and sleep (r=0.44, P<0.0001). Compared with patients without SD, those with SD were more likely to report pain (P=0.0132), depression (P=0.019), anxiety (P=0.01), and a poorer sense of well-being (P=0.035). An ESAS-Sleep item cutoff score of ≥ 3 (of 10) resulted in a sensitivity of 74% and a specificity of 73%. CONCLUSION SD is associated with increased frequency of pain, depression, anxiety, and a worse sense of well-being. These four symptoms should be assessed in all patients with advanced cancer with a complaint of SD. The ideal cutoff point of the ESAS-Sleep item for screening for SD is a score of ≥ 3. More research is needed to better characterize this frequent and distressing syndrome.
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Affiliation(s)
- Marvin Delgado-Guay
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Affiliation(s)
- Brenda Hearson
- Winnipeg Regional Health Authority Palliative Care Program, Winnipeg, Manitoba, Canada
| | - Jo-Ann V Sawatzky
- Faculty of Nursing, Helen Glass Centre for Nursing University of Manitoba Winnipeg, Manitoba, Canada
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Lis CG, Gupta D, Grutsch JF. The relationship between insomnia and patient satisfaction with quality of life in cancer. Support Care Cancer 2007; 16:261-6. [PMID: 17684773 DOI: 10.1007/s00520-007-0314-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Accepted: 07/11/2007] [Indexed: 11/12/2022]
Abstract
GOALS OF WORK Insomnia is the most common sleep disorder in patients with advanced cancer. The goal of this study was to investigate the relationship between insomnia and patient satisfaction with quality of life (QoL) in cancer. MATERIALS AND METHODS A case series of 954 cancer patients treated at Cancer Treatment Centers of America was investigated. Insomnia was measured using the EORTC QLQ-C30 insomnia subscale. Patient satisfaction with QoL was measured using the Ferrans and Powers Quality of Life Index (QLI). The relationship between insomnia and QLI was evaluated using multivariate analysis of variance and multiple regression analysis. RESULTS Of 954 patients, 579 were females and 375 males, with the median age at presentation of 56 years (range, 20-90 years). Most common cancers were breast (26%), colorectal (19%), and lung (16%). After controlling for the effects of age and treatment history, every 10-unit increase in insomnia was statistically significantly associated with 0.67-, 0.17-, 0.42-, 0.20-, and 0.42-unit decline in QLI health/physical, social/economic, psychological/spiritual, family, and overall QoL functioning, respectively. CONCLUSIONS We found that insomnia is strongly correlated with patient satisfaction with QoL in cancer. Future studies should evaluate the impact of integrative cancer care services on patient satisfaction with QoL.
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Affiliation(s)
- Christopher G Lis
- Office of Research, Cancer Treatment Centers of America (CTCA), Midwestern Regional Medical Center, Zion, IL 60099, USA
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