1
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Hooke MC, Salisbury DL, Mathiason MA, Kunin-Batson AS, Blommer A, Hutter J, Mitby P, Moore I, Whitman S, Taylor O, Scheurer ME, Hockenberry MJ. Symptoms, Physical Activity, and Biomarkers in Children at the End of Leukemia Maintenance Therapy. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:386-399. [PMID: 37050865 DOI: 10.1177/27527530221148479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Background: Symptoms in children with acute lymphocytic leukemia (ALL) change over the trajectory of treatment but little is known about their symptoms as treatment ends. Physical activity may help decrease symptom distress and is vital for ongoing development. The role of biomarkers in symptom science is emerging. The purpose of the study was to explore relationships between self-report of symptoms and physical activity, actigraphy measures, and cerebrospinal fluid (CSF) biomarkers. Methods: Participants were children who were ages 3 to 18 years at the time of ALL diagnosis and were now in the last 12-week cycle of ALL maintenance. Self-reports of fatigue, sleep disturbance, depressive symptoms, and physical activity were completed by participants and parents of younger children. Participants wore a wrist actigraph continuously for the 7 days before other measurements. F2-isoprostanes and interleukin-8 were evaluated in CSF samples. Results: Among the 15 participants, self-report of symptoms and physical activity indicated levels similar to healthy peers. F2-isoprostane had a strong positive correlation with fatigue levels and with depressive symptoms. Fatigue, sleep disturbance, and depressive symptoms positively correlated with each other. Actigraph measures showed children met the CDC guidelines for 60 min of daily moderate to vigorous activity; sleep time was slightly less than healthy norms. Discussion: During maintenance therapy, most children return to healthy norms in symptom burden and physical activity. F2-isoprostane in the CSF is a biomarker for fatigue and depressive symptoms. Children who had persistent symptoms experienced them as a cluster, which confirms previous symptom cluster research.
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Affiliation(s)
- Mary C Hooke
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
- Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, MN, USA
| | | | | | | | - Audrey Blommer
- Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, MN, USA
| | - Jessica Hutter
- Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, MN, USA
| | - Pauline Mitby
- Cancer and Blood Disorders Program, Children's Minnesota, Minneapolis, MN, USA
| | - Ida Moore
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Susan Whitman
- College of Nursing, University of Arizona, Tucson, AZ, USA
| | - Olga Taylor
- Baylor College of Medicine, Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Michael E Scheurer
- Baylor College of Medicine, Texas Children's Cancer and Hematology Centers, Houston, TX, USA
| | - Marilyn J Hockenberry
- Baylor College of Medicine, Texas Children's Cancer and Hematology Centers, Houston, TX, USA
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2
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Gandy K, Chambers T, Raghubar KP, Fatih Okcu M, Chintagumpala M, Taylor O, Mahajan A, Kahalley LS, Chan W, Grosshans DR, Brown AL, Douglas Ris M. A Prospective Evaluation of Fatigue in Pediatric Brain Tumor Patients Treated With Radiation Therapy. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:358-365. [PMID: 36285825 DOI: 10.1177/275275302110560011068754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Fatigue is a well-established consequence of cranial radiotherapy in survivors of pediatric brain tumor, but less is known about acute fatigue during radiotherapy treatment. This study aimed to longitudinally evaluate fatigue in newly diagnosed pediatric patients with brain tumors during treatment. Methods: Primary caregivers of pediatric patients with brain tumors completed the proxy-reported Parent Fatigue Scale assessments prior to radiotherapy and weekly during radiotherapy treatment. The association between clinical factors and fatigue at each assessment was evaluated with multiple linear regressions. A comparison of fatigue between radiation modalities was also analyzed. Results: A total of 33 caregivers completed pre-radiation fatigue assessments, with 29 reporting fatigue during radiotherapy. Patients were aged 3 to 16 years (M = 8.32) at diagnosis and diagnosed with medulloblastoma (n = 23), primitive neuroectodermal tumor (n = 2), ependymoma (n = 1), germ cell tumor (n = 1), pineoblastoma (n = 1), atypical teratoid rhabdoid (n = 1), and other unspecific tumors (n = 3). Moderate-to-severe fatigue was reported for the majority of patients (31/33; 94%) during treatment. Craniospinal irradiation dose was the only significant predictor of fatigue (p < .05), but this association was restricted to the first week of therapy and was attenuated by therapy completion. Discussion: Although fatigue is often considered a long-term consequence of cranial radiotherapy, this pilot study demonstrates that moderate-to-severe fatigue is pervasive prior to radiotherapy and persists throughout treatment in pediatric patients with brain tumors, regardless of radiation modality or clinical factors. Additional research is warranted to establish a link between acute and long-term fatigue and develop interventions to mitigate this adverse outcome.
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Affiliation(s)
- Kellen Gandy
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Tiffany Chambers
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Kimberly P Raghubar
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Mehmet Fatih Okcu
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Murali Chintagumpala
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Olga Taylor
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Anita Mahajan
- Department of Radiation Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lisa S Kahalley
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Wenyaw Chan
- Department of Biostatistics, School of Public Health, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - David R Grosshans
- Department of Radiation Oncology, 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Austin L Brown
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Martin Douglas Ris
- Department of Pediatrics, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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3
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Secondary Narcolepsy as Worsening Sign in a Pediatric Case of Optic Pathway Glioma. CHILDREN 2022; 9:children9101455. [PMID: 36291391 PMCID: PMC9600478 DOI: 10.3390/children9101455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 12/01/2022]
Abstract
Narcolepsy, a neurologic disorder that leads to excessive daytime sleepiness, may represent a rare consequence of neoplastic lesions involving the sellar/parasellar and hypothalamic regions, the anatomical areas responsible for wakefulness. Optic pathway gliomas represent the most common neoplasm of these regions and present an excellent overall survival, while long-term neurologic impairments, such as visual loss, endocrinopathies, or sleep disorders, are the principal causes of morbidity. In this case report, we describe a non-NF1 patient suffering from a very extensive optical pathway glioma, who several years after the diagnosis in a radiological condition of stable disease, presented with severe narcolepsy, a rare complication, that led to the death of the patient.
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4
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Kaushik P, Sharma S, Shah N, Kutty PK, Ghildiyal R. Sleep disturbances and childhood cancer- A tertiary care experience. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2022. [DOI: 10.1016/j.phoj.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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5
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Effect of virtual reality-based exercise intervention on sleep quality in children with acute lymphoblastic leukemia and healthy siblings: A randomized controlled trial. Palliat Support Care 2022; 20:455-461. [PMID: 35289266 DOI: 10.1017/s1478951522000268] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Sleep is one of the important measurements of the quality of life for children especially suffering from a chronic illness such as cancer. Our aim was to determine the changes in sleep quality and to investigate the effect of virtual reality-based exercise (VRBE) approaches on sleep in patients with acute lymphoblastic leukemia (ALL) off treatment. METHOD The participants (ALL and healthy siblings) were evaluated for sleep quality with polysomnography and "Children's Sleep Habit Questionnaire" before and after 12 weeks. The study randomized into two groups: an exercise group who received VRBE in two days in a week, 45 min of each session for 12 weeks and an control group who were managed with supportive measures. The VRBE comprised of aerobic exercise in four different games by Nintendo Wii Fit Plus®. RESULTS This randomized controlled trial was carried out on 38 participants. Before intervention, ALL patients (n = 24) and healthy siblings (n = 14) had similar sleep quality in terms of polysomnography and Children's Sleep Habit Questionnaire findings. After intervention, total time asleep (p = 0.023), respiratory disturbance index of hypopnea (p = 0.005), apnea/hypopnea index (p = 0.008), and number of apnea (p = 0.028) statistically significant improved. SIGNIFICANCE OF RESULTS Patients with ALL off treatment had similar values of sleep quality with healthy siblings. Novel types of exercises like VRBE have positive effects on sleep disorders in children with ALL and also healthy siblings. Future studies are needed comparing the different types of interventions.
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6
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Pickering L, Main KM, Feldt‐Rasmussen U, Klose M, Sehested A, Mathiasen R, Jennum P. Brain tumours in children and adolescents may affect the circadian rhythm and quality of life. Acta Paediatr 2021; 110:3376-3386. [PMID: 34432900 DOI: 10.1111/apa.16080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/15/2021] [Accepted: 08/24/2021] [Indexed: 12/22/2022]
Abstract
AIM Children with brain and cervical medulla tumours may experience circadian abnormalities and poor health. We aimed to examine their circadian rhythm, fatigue and quality of life (QoL). METHODS Children with a brain or cervical medulla tumour were recruited from the Paediatric Department, Rigshospitalet, Copenhagen, Denmark, between 2016 and 2020. They were grouped by tumour location involving the circadian regulatory system, defined as diencephalon, pineal gland, brain stem and cervical medulla, or other areas. Saliva melatonin and cortisol concentrations were measured. Sleep diaries and actigraphy assessed sleep-wake patterns. The Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale and Generic Core Scale measured fatigue and QoL. RESULTS We included 68 children (62% males) with a median age (25th-75th percentiles) of 12.2 (7.7-16.3) years. Children with tumours involving the circadian regulatory system typically had a lower melatonin peak (p=0.06) and experienced significantly more fatigue and poorer QoL. Low melatonin profiles were observed in 31% and 4% had a phase-shifted daytime peak, compared with 14% and 0%, respectively, in children with tumours located elsewhere. Children with low melatonin profiles had significantly lower inter-daily stability than those with normal profiles. CONCLUSION Tumours involving the circadian regulatory system adversely affected circadian function, fatigue and QoL.
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Affiliation(s)
- Line Pickering
- Danish Center for Sleep Medicine Department of Clinical Neurophysiology, Rigshospitalet University of Copenhagen Glostrup Denmark
| | - Katharina M. Main
- Department of Growth and Reproduction and EDMaRC, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
| | - Ulla Feldt‐Rasmussen
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
- Department of Medical Endocrinology and Metabolism, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Marianne Klose
- Department of Medical Endocrinology and Metabolism, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Astrid Sehested
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - René Mathiasen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine Department of Clinical Neurophysiology, Rigshospitalet University of Copenhagen Glostrup Denmark
- Department of Clinical Medicine Copenhagen University Copenhagen Denmark
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Sheikh IN, Roth M, Stavinoha PL. Prevalence of Sleep Disturbances in Pediatric Cancer Patients and Their Diagnosis and Management. CHILDREN (BASEL, SWITZERLAND) 2021; 8:1100. [PMID: 34943294 PMCID: PMC8700400 DOI: 10.3390/children8121100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/27/2022]
Abstract
Sleep disturbances represent an understudied yet common source of distress among pediatric cancer patients and survivors, with deleterious effects on quality of life. Sleep issues stem from multiple risk factors, yet individual contributors are difficult to isolate, consequently impeding the identification of targets for intervention. In many pediatric cancer patients, disrupted sleep and its negative impact on quality of life continue into adulthood and may affect various functional domains. This literature review highlights the types and prevalence of sleep disturbances in pediatric cancer patients during active treatment and through survivorship. Potential etiological and risk factors for disturbed sleep are summarized, including the effects of cancer and its treatment, psychosocial and family factors, as well as individual-patient aspects, such as genetics, mood and coping skills. While existing assessment and management strategies are reviewed, the literature is incomplete, and significant gaps emerge in our understanding of sleep disturbances in pediatric cancer patients and survivors. The review concludes with recommendations of areas where further research is needed. The aims of this review include increasing clinicians' awareness of sleep disturbances as a significant source of poor quality of life in pediatric cancer patients and survivors and directing researchers to gaps in our understanding of sleep disturbances in pediatric cancer patients and survivors.
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Affiliation(s)
- Irtiza N. Sheikh
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA;
| | | | - Peter L. Stavinoha
- Division of Pediatrics and Patient Care, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA;
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8
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Daniel LC, Wang M, Mulrooney DA, Srivastava DK, Schwartz LA, Edelstein K, Brinkman TM, Zhou ES, Howell RM, Gibson TM, Leisenring W, Oeffinger KC, Neglia J, Robison LL, Armstrong GT, Krull KR. Sleep, emotional distress, and physical health in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Psychooncology 2019; 28:903-912. [PMID: 30817058 DOI: 10.1002/pon.5040] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Sleep disorders are associated with psychological and physical health, although reports in long-term survivors of childhood cancer are limited. We characterized the prevalence and risk factors for behaviors consistent with sleep disorders in survivors and examined longitudinal associations with emotional distress and physical health outcomes. METHODS Survivors (n = 1933; median [IQR] age = 35 [30, 41]) and siblings (n = 380; age = 33 [27, 40]) from the Childhood Cancer Survivor Study completed measures of sleep quality, fatigue, and sleepiness. Emotional distress and physical health outcomes were assessed approximately 5 years before and after the sleep survey. Multivariable logistic or modified Poisson regression models examined associations with cancer diagnosis, treatment exposures, and emotional and physical health outcomes. RESULTS Survivors were more likely to report poor sleep efficiency (30.8% vs 24.7%; prevalence ratio [PR] = 1.26; 95% confidence interval, 1.04-1.53), daytime sleepiness (18.7% vs 14.2%; PR = 1.31 [1.01-1.71]), and sleep supplement use (13.5% vs 8.3%; PR = 1.56 [1.09-2.22]) than siblings. Survivors who developed emotional distress were more likely to report poor sleep efficiency (PR = 1.70 [1.40-2.07]), restricted sleep time (PR = 1.35 [1.12-1.62]), fatigue (PR = 2.11 [1.92-2.32]), daytime sleepiness (PR = 2.19 [1.71-2.82]), snoring (PR = 1.85 [1.08-3.16]), and more sleep medication (PR = 2.86 [2.00-4.09]) and supplement use (PR = 1.89[1.33-2.69]). Survivors reporting symptoms of insomnia (PR = 1.46 [1.02-2.08]), fatigue (PR = 1.31 [1.01-1.72]), and using sleep medications (PR = 2.16 [1.13-4.12]) were more likely to develop migraines/headaches. CONCLUSIONS Survivors report more sleep difficulties and efforts to manage sleep than siblings. These sleep behaviors are related to worsening or persistently elevated emotional distress and may result in increased risk for migraines. Behavioral interventions targeting sleep may be important for improving health outcomes.
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Affiliation(s)
- Lauren C Daniel
- Department of Psychology, Rutgers University-Camden, Camden, New Jersey
| | - Mingjuan Wang
- Department of Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Deo Kumar Srivastava
- Department of Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Lisa A Schwartz
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kim Edelstein
- Pencer Brain Tumor Centre, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Tara M Brinkman
- Department of Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Eric S Zhou
- Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rebecca M Howell
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Todd M Gibson
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Wendy Leisenring
- Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kevin C Oeffinger
- Division of Medical Oncology, Departments of Medicine and Community and Family Medicine, Duke University Medical Center, Durham, North Carolina
| | - Joseph Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Kevin R Krull
- Department of Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee
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9
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Nunes MDR, Nascimento LC, Fernandes AM, Batalha L, De Campos C, Gonçalves A, Leite ACAB, de Andrade Alvarenga W, de Lima RAG, Jacob E. Pain, sleep patterns and health-related quality of life in paediatric patients with cancer. Eur J Cancer Care (Engl) 2019; 28:e13029. [PMID: 30828888 DOI: 10.1111/ecc.13029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/10/2019] [Accepted: 01/17/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare sleep and health-related quality of life (HRQOL) in children and adolescents with cancer who had pain, with those who had no pain during hospitalisation. METHOD A prospective comparative study was used to collect data from paediatric oncology units in three countries (Portugal, Brazil, USA). Participants (n = 118; 8-18 years) completed the Quality of Life Inventory (PedsQL) Cancer module, which includes a pain subscale, and wore a wrist actigraph for at least 72 hr. RESULTS Almost half of the participants (48.3%) reported having pain. Sleep patterns were not affected by pain. Girls, adolescents and patients diagnosed with leukaemia/lymphoma who reported pain, had significantly lower HRQOL scores. Low sleep duration and HRQOL were found, irrespectively of pain status. CONCLUSIONS The low sleep duration and HRQOL score in children and adolescents with cancer highlight the importance of physical and psychosocial nursing interventions during hospitalisation. The mediating effect of gender, age and diagnoses on the relation between pain and HRQOL needs to be further understood.
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Affiliation(s)
| | | | | | - Luis Batalha
- UICISA:E, Nursing School of Coimbra, Coimbra, Portugal
| | | | - Ana Gonçalves
- UICISA:E, Nursing School of Coimbra, Coimbra, Portugal
| | | | | | | | - Eufemia Jacob
- School of Nursing, University of California Los Angeles, Los Angeles, California
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10
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Sleep disorders in children with brain tumors: a pilot study based on a sleep disorder questionnaire. Childs Nerv Syst 2018; 34:1535-1540. [PMID: 29700571 DOI: 10.1007/s00381-018-3809-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/17/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study is to compare the prevalence of sleep disorders (SD) between children treated for brain tumors and healthy children, and to define the type of SD. METHODS A case-control study was performed from October 2014 to April 2015. Inclusion criteria were patients between 2 and 16 years with "cases" defined as children affected by central nervous system tumors at least 3 months after the end of treatment (surgery and/or radiotherapy and/or chemotherapy) at the time of evaluation and "controls" as healthy children. Children's sleep quality was assessed with a questionnaire administered to parents (Child's Sleep Habits Questionnaire, CSHQ). A total score greater than 41 is suggestive for the presence of disturbed sleep. The risk of SD was estimated by the odds ratio (OR) and their 95% confidence intervals (95% CI) through logistic regression models. RESULTS Twenty-nine cases and 87 controls (in a 1:3 model) were enrolled, for a total of 116 subjects. The prevalence of SD resulted of 82.8% among cases and 64.4% in controls. A statistically significant difference between the two groups (OR 2.65; 95% CI 0.92-7.65) was not reached. Analyzing singular disturbances, parasomnias and night awakenings showed a statistically significant difference between the two groups (OR 4.32; 95% CI 1.08-17.34). CONCLUSIONS Our study revealed a trend toward SD in children with brain tumor when compared to healthy population. Hovewer, analyzing specific subtypes of SD some significant differences were obtained. A significant difference was obtained only for specific subtypes of SD. Further investigations could better define the real burden of SD.
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11
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Graef DM, Crabtree VM, Srivastava DK, Li C, Pritchard M, Hinds PS, Mandrell B. Sleep and mood during hospitalization for high-dose chemotherapy and hematopoietic rescue in pediatric medulloblastoma. Psychooncology 2018; 27:1847-1853. [PMID: 29663636 DOI: 10.1002/pon.4737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Disrupted sleep is common in pediatric cancer, which is associated with psychological distress and may impact neural recovery. Information regarding sleep during pediatric brain tumor treatment is limited. This study aimed to describe objective sleep-wake patterns and examine the sleep-mood relation in youth hospitalized for intensive chemotherapy and stem cell rescue. METHODS Participants included 37 patients (M age = 9.6 ± 4.2 years) enrolled on a medulloblastoma protocol (SJMB03) and their parents. Respondents completed a mood disturbance measure on 3 days, and patients wore an actigraph for 5 days as an objective estimate of sleep-wake patterns. General linear mixed models examined the relation between nocturnal sleep and next-day mood, as well as mood and that night's sleep. RESULTS Sleep duration was deficient, sleep efficiency was poor, and daytime napping was common, with large between-subjects variability. There were minimal mood concerns across all days. The sleep and next-day mood relationship was nonsignificant (P > .05). Greater parent-reported child mood disturbance on day 2 was associated with decreased same-night sleep (P < .001) and greater patient-reported mood disturbance was associated with greater same-night sleep latency (P = .036). CONCLUSIONS Patients with medulloblastoma are vulnerable to disturbed sleep during hospitalization, and mood may be an important correlate to consider. Sleep and mood are modifiable factors that may be targeted to maximize daytime functioning.
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Affiliation(s)
- Danielle M Graef
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Chenghong Li
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michele Pritchard
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Pamela S Hinds
- Department of Nursing Research and Quality Outcomes, Children's National Health System, Memphis, TN, USA.,Department of Pediatrics, George Washington University Washington, District of Columbia, Washington, DC, USA
| | - Belinda Mandrell
- Department of Pediatric Medicine, Division of Nursing Research, St. Jude Children's Research Hospital, Memphis, TN, USA
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12
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Merz EL, Tomfohr-Madsen L. Sleep Disruption in Pediatric Cancer Survivors: Conceptual Framework and Opportunities for Clinical Assessment and Behavioral Treatment. Am J Lifestyle Med 2016; 12:311-323. [PMID: 32063816 DOI: 10.1177/1559827616681725] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/31/2016] [Accepted: 11/09/2016] [Indexed: 12/18/2022] Open
Abstract
Sleep disruption is a commonly reported consequence of cancer and its treatment in pediatric patients and survivors. This review summarizes common sleep concerns in this population and introduces a multidimensional framework of risk factors specific to childhood cancer that may interact to develop and maintain disrupted sleep. Based on the extant literature, parameters of the cancer and its treatment, physical and social environmental conditions both during and after treatment, changes to family behavior and norms, psychological factors and traumatic stress, and reduced physical activity are hypothesized to be the most pertinent risk factors for disrupted sleep in this population. Potential clinical assessment strategies and behavioral interventions relevant to these considerations are discussed, with reference to the behavioral model of insomnia. The review concludes by offering directions for research and clinical practice, including developing and testing comprehensive assessment tools, intervention effectiveness studies in both oncology and primary care clinics, and efforts to increase patient-provider communication about sleep in pediatric oncology.
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Affiliation(s)
- Erin L Merz
- Department of Psychology, California State University, Dominguez Hills, Carson, California (ELM).,Department of Psychology, University of Calgary and Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada (LTM)
| | - Lianne Tomfohr-Madsen
- Department of Psychology, California State University, Dominguez Hills, Carson, California (ELM).,Department of Psychology, University of Calgary and Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada (LTM)
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13
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Allen JM, Graef DM, Ehrentraut JH, Tynes BL, Crabtree VM. Sleep and Pain in Pediatric Illness: A Conceptual Review. CNS Neurosci Ther 2016; 22:880-893. [PMID: 27421251 PMCID: PMC6492850 DOI: 10.1111/cns.12583] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sleep disruption is a common comorbidity of pediatric pain. Consequences of pain and disrupted sleep, evidence for the pain-sleep relation, and how aspects of illness, treatment, and pharmacological pain management may contribute to or exacerbate these issues are presented. AIMS This conceptual review explored the relation between pain and sleep in children diagnosed with chronic medical or developmental conditions. The goal of this review is to expand upon the literature by examining common themes in sleep disturbances associated with painful conditions across multiple pediatric illnesses. Populations reviewed include youth with intellectual and developmental disabilities (IDD), migraines, cystic fibrosis (CF), sickle cell disease (SCD), cancer, juvenile idiopathic arthritis (JIA), juvenile fibromyalgia (JFM), and functional gastrointestinal disorders (FGIDs). RESULTS Consistent evidence demonstrates that children with medical or developmental conditions are more vulnerable to experiencing pain and subjective sleep complaints than healthy peers. Objective sleep concerns are common but often under-studied. Evidence of the pain-sleep relationship exists, particularly in pediatric SCD, IDD, and JIA, with a dearth of studies directly examining this relation in pediatric cancer, JFM, CF, and FGIDs. Findings suggest that assessing and treating pain and sleep disruption is important when optimizing functional outcomes. CONCLUSION It is essential that research further examine objective sleep, elucidate the pain-sleep relationship, consider physiological and psychosocial mechanisms of this relationship, and investigate nonpharmacological interventions aimed at improving pain and sleep in vulnerable pediatric populations.
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Affiliation(s)
- Jennifer M Allen
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Danielle M Graef
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Brooklee L Tynes
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Valerie M Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Setoyama A, Ikeda M, Kamibeppu K. Objective assessment of sleep status and its correlates in hospitalized children with cancer: Exploratory study. Pediatr Int 2016; 58:842-9. [PMID: 26767328 DOI: 10.1111/ped.12927] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 12/04/2015] [Accepted: 01/13/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children with cancer are known to have sleep problems. Although hospitalization and psychosocial factors are considered to be the factors affecting children's sleep, few studies have confirmed these effects. The aims of this study were to describe the sleep status of hospitalized children with cancer and to explore the correlates. METHODS The sleep status of 11 hospitalized children (aged 2-12 years) with cancer was measured using actigraph and sleep diary during hospitalization and a short home stay. Possible correlates were assessed using a questionnaire. RESULTS The participants had significantly longer sleep onset latency, earlier bedtime, and poorer self-evaluated sleep quality during hospitalization than the short home stay. They had shorter total sleep time, longer wake time after sleep onset, and less sleep efficiency at home, compared with healthy historical controls. Children's age, symptoms, hospitalization period, Cognitive Fatigue, Procedural Anxiety, Treatment Anxiety, Social Anxiety, and Separation Anxiety, as well as caregiver anxiety, Receptive and Focused Attitude, and Regimented Attitude were significantly correlated with sleep variables. CONCLUSIONS Hospitalization decreased self-evaluated sleep quality, and difficulty falling asleep. The sleep of the participants at home was disturbed compared with that of healthy children. Hospitalization, patient characteristics, disease-related, and some psychosocial factors were associated with sleep variables. Medical professionals should develop a favorable environment for falling asleep in hospital for individual children. Children with cancer in the early period of hospitalization need increased care to facilitate good sleep.
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Affiliation(s)
- Ami Setoyama
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mari Ikeda
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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15
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Jacola LM, Conklin HM, Scoggins MA, Ashford JM, Merchant TE, Mandrell BN, Ogg RJ, Curtis E, Wise MS, Indelicato DJ, Crabtree VM. Investigating the Role of Hypothalamic Tumor Involvement in Sleep and Cognitive Outcomes Among Children Treated for Craniopharyngioma. J Pediatr Psychol 2016; 41:610-22. [PMID: 27189690 PMCID: PMC4913761 DOI: 10.1093/jpepsy/jsw026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 01/25/2016] [Accepted: 01/25/2016] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Despite excellent survival prognosis, children treated for craniopharyngioma experience significant morbidity. We examined the role of hypothalamic involvement (HI) in excessive daytime sleepiness (EDS) and attention regulation in children enrolled on a Phase II trial of limited surgery and proton therapy. METHODS Participants completed a sleep evaluation (N = 62) and a continuous performance test (CPT) during functional magnetic resonance imaging (fMRI; n = 29) prior to proton therapy. RESULTS EDS was identified in 76% of the patients and was significantly related to increased HI extent (p = .04). There was no relationship between CPT performance during fMRI and HI or EDS. Visual examination of group composite fMRI images revealed greater spatial extent of activation in frontal cortical regions in patients with EDS, consistent with a compensatory activation hypothesis. CONCLUSION Routine screening for sleep problems during therapy is indicated for children with craniopharyngioma, to optimize the timing of interventions and reduce long-term morbidity.
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Affiliation(s)
| | | | | | | | | | | | | | - Elizabeth Curtis
- Indiana University School of Medicine, Indiana University-Purdue University
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Darezzo Rodrigues Nunes M, Jacob E, Adlard K, Secola R, Nascimento L. Fatigue and Sleep Experiences at Home in Children and Adolescents With Cancer. Oncol Nurs Forum 2016; 42:498-506. [PMID: 26302278 DOI: 10.1188/15.onf.498-506] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To (a) investigate fatigue and sleep patterns of children and adolescents at home and (b) examine factors associated with fatigue and sleep.. DESIGN Descriptive with repeated measures
. SETTING Homes of study participants in Los Angeles and Orange, California
. SAMPLE 35 children and adolescents with cancer. METHODS Data were collected using the PedsQL Multidimensional Fatigue Scale, which was completed once at home by each participant, and sleep actigraphs, which were worn for five days at home following discharge from hospitalization
. MAIN RESEARCH VARIABLES General fatigue, cognitive fatigue, sleep-rest fatigue, sleep duration, sleep quantity, sleep efficiency, and wake after sleep onset
. FINDINGS More than half of the participants had problems with fatigue at home. Significant correlations were found between sleep/rest fatigue and sleep duration. Factors that affected fatigue were age, gender, and cancer diagnosis. Adolescents had more problems with fatigue than children, and female patients had more problems with fatigue than male patients. Patients with sarcoma had more problems with fatigue than those with leukemia, lymphoma, and other cancer diagnoses. Adolescents slept less than children. CONCLUSIONS Children and adolescents with cancer have fatigue and sleep problems at home that vary by age, gender, and cancer diagnosis
. IMPLICATIONS FOR NURSING Data from the current study support the need for nurses to provide teaching about fatigue and sleep at home in children and adolescents with cancer. Future studies are needed to examine interventions that may alleviate fatigue and improve sleep at home
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Lee S, Narendran G, Tomfohr-Madsen L, Schulte F. A systematic review of sleep in hospitalized pediatric cancer patients. Psychooncology 2016; 26:1059-1069. [DOI: 10.1002/pon.4149] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 02/07/2016] [Accepted: 03/30/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Soeun Lee
- Department of Psychology; University of Guelph; Guelph ON Canada
| | - Gaya Narendran
- Cumming School of Medicine; University of Calgary; Calgary AB Canada
| | - Lianne Tomfohr-Madsen
- Department of Psychology; University of Calgary; Calgary AB Canada
- Alberta Children's Hospital Research Institute; Calgary AB Canada
| | - Fiona Schulte
- Alberta Children's Hospital Research Institute; Calgary AB Canada
- Haemotology, Oncology, and Blood and Marrow Transplant Program; Alberta Children's Hospital; Calgary AB Canada
- Department of Paediatrics; University of Calgary; Calgary AB Canada
- Department of Oncology; University of Calgary; Calgary AB Canada
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Daniel LC, Schwartz LA, Mindell JA, Tucker CA, Barakat LP. Initial Validation of the Sleep Disturbances in Pediatric Cancer Model. J Pediatr Psychol 2016; 41:588-99. [PMID: 26994058 DOI: 10.1093/jpepsy/jsw008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 01/23/2016] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE : The current study evaluates content validity of the Sleep Disturbance in Pediatric Cancer (SDPC) model using qualitative and quantitative stakeholder input. METHODS : Parents of children (aged: 3-12 years) with acute lymphoblastic leukemia (n = 20) and medical providers (n = 6) participated in semi-structured interviews about child sleep during cancer treatment. They also rated SDPC model component importance on a 0-4 scale and selected the most relevant sleep-related intervention targets. RESULTS : Qualitatively, parents and providers endorsed that changes in the child's psychosocial, environmental, and biological processes affect sleep. Stakeholders rated most model components (parent: 32 of 40; provider: 39 of 41) as important (>2) to child sleep. Parents were most interested in interventions targeting difficulty falling asleep and providers selected irregular sleep habits/scheduling, though groups did not differ significantly. CONCLUSIONS : Stakeholders supported SDPC content validity. The model will inform subsequent measure and intervention development focusing on biological and behavioral factors most salient to sleep disturbances in pediatric cancer.
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Affiliation(s)
- Lauren C Daniel
- Division of Oncology, The Children's Hospital of Philadelphia,
| | - Lisa A Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania
| | - Jodi A Mindell
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Division of Pulmonary Medicine, The Children's Hospital of Philadelphia, Department of Psychology, Saint Joseph's University, and
| | - Carole A Tucker
- College of Public Health, Departments of Physical Therapy and Electrical and Computer Engineering, Temple University
| | - Lamia P Barakat
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania
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Zhou ES, Manley PE, Marcus KJ, Recklitis CJ. Medical and Psychosocial Correlates of Insomnia Symptoms in Adult Survivors of Pediatric Brain Tumors. J Pediatr Psychol 2015; 41:623-30. [DOI: 10.1093/jpepsy/jsv071] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/14/2015] [Indexed: 11/14/2022] Open
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Brimeyer C, Adams L, Zhu L, Srivastava DK, Wise M, Hudson MM, Crabtree VM. Sleep complaints in survivors of pediatric brain tumors. Support Care Cancer 2015; 24:23-31. [PMID: 25895632 DOI: 10.1007/s00520-015-2713-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 03/23/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Pediatric brain tumor survivors have increased risk of sleep problems, particularly excessive daytime sleepiness (EDS). Few studies have examined sleep disturbances in this population. METHODS 153 children and adolescents ages 8-18 and their parents completed questionnaires (Modified Epworth Sleepiness Scale, Kosair Children's Hospital Sleep Questionnaire, Children's Report of Sleep Patterns, Children's Sleep Hygiene Scale) during clinic visits. Participants were at least 5 years from diagnosis and 2 years post-treatment. Group differences in age at diagnosis, body mass index, type of treatment received, and tumor location were examined. RESULTS One-third of adolescents and one-fifth of children reported EDS. Children and parents had fair concordance (kappa coefficient = .64) in their report of EDS, while adolescents and parents had poor concordance (kappa coefficient = .37). Per parents, most children slept 8 to 9 h per night. Poor bedtime routines were reported for children, while adolescents endorsed poor sleep stability. Extended weekend sleep was reported across age groups. A BMI in the obese range was related to higher parent-reported EDS in children. Sleep-disordered breathing was associated with elevated BMI in adolescents. CONCLUSIONS While survivors reported achieving recommended amounts of sleep each night, 20 to 30% reported EDS. Poor concordance among parent and adolescent report highlights the importance of obtaining self-report when assessing sleep concerns. Obesity is a modifiable factor in reducing symptoms of EDS in this population. Finally, the lack of association between EDS and brain tumor location, BMI, or treatment received was unexpected and warrants further investigation.
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Affiliation(s)
- Chasity Brimeyer
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, USA
- Jane B. Pettit Pain Management and Headache Center, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Leah Adams
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Liang Zhu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Merrill Wise
- Methodist Healthcare Sleep Disorders Center, Memphis, TN, USA
| | - Melissa M Hudson
- Departments of Oncology and Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Valerie McLaughlin Crabtree
- Department of Psychology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 101, Memphis, TN, USA.
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21
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Hooke MC, Gilchrist L, Foster L, Langevin M, Lee J. Yoga for Children and Adolescents After Completing Cancer Treatment. J Pediatr Oncol Nurs 2015; 33:64-73. [DOI: 10.1177/1043454214563936] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Survivors of childhood cancer may experience persistent symptoms, including fatigue, sleep disturbance, and balance impairment. Yoga is a complementary therapy that improves fatigue, sleep, and quality of life in adult cancer survivors. Using a one group, repeated measures design, we evaluated the feasibility of a yoga program and assessed if cancer survivor participants ages 10 to 17 years (n = 13) had significantly less fatigue and anxiety, and better balance and sleep, after a 6-week yoga intervention compared with a 6-week pre-intervention wait period. Study recruitment was challenging with a 32% enrollment rate; yoga attendance was 90%. None of the scores for anxiety, fatigue, sleep, and balance had significant changes during the wait period. After the 6-week yoga program, children (n = 7) had a significant decrease in anxiety score ( P = .04) while adolescent scores (n = 7) showed a decreasing trend ( P = .10). Scores for fatigue, sleep, and balance remained stable post-intervention. Fatigue and balance scores were below norms for health children/adolescents while sleep and anxiety scores were similar to healthy peers.
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Affiliation(s)
- Mary C. Hooke
- University of Minnesota School of Nursing, Minneapolis, MN, USA
- Children’s Hospital and Clinics of Minnesota, Minneapolis, MN, USA
| | - Laura Gilchrist
- Children’s Hospital and Clinics of Minnesota, Minneapolis, MN, USA
| | - Laurie Foster
- Children’s Hospital and Clinics of Minnesota, Minneapolis, MN, USA
| | - Mary Langevin
- Children’s Hospital and Clinics of Minnesota, Minneapolis, MN, USA
| | - Jill Lee
- University of Minnesota Children’s Hospital, Minneapolis, MN, USA
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Desaulniers G, Riley L, Vangle K, Gilleland J, Higgins M, Wasilewski-Masker K. Self-Reported Sleep Problems in Adolescent Survivors of Childhood Cancer. Clin J Oncol Nurs 2015; 19:81-8. [DOI: 10.1188/15.cjon.81-88] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Walter LM, Nixon GM, Davey MJ, Downie PA, Horne RSC. Sleep and fatigue in pediatric oncology: A review of the literature. Sleep Med Rev 2015; 24:71-82. [PMID: 25679070 DOI: 10.1016/j.smrv.2015.01.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 12/24/2014] [Accepted: 01/05/2015] [Indexed: 02/06/2023]
Abstract
Cancer in children has detrimental effects on sleep patterns and sleep quality, which in turn impacts on the perception of, and the ability to cope with, the emotional and physical challenges associated with both the disease and its treatment. This places an added burden on their quality of life that can last many years beyond diagnosis and treatment. In addition to the effect of the cancer itself, surgery, chemotherapy and radiotherapy can all contribute both short and long term to sleep disruption. Sleep disorders have also been associated with pain, fatigue, medication and hospitalisation in children suffering from cancer. This review will explore the relationship between childhood cancer and associated sleep disorders, in the acute stage of diagnosis, during treatment and in the years following. We will discuss the possible causes and the current treatment modalities used to treat sleep disorders in children with cancer, and in childhood cancer survivors. It has been estimated that the recent advances in treatment have improved the overall five year survival rate for all childhood cancers to over 80%, with some cancers achieving a near 100% cure rate such as early stage Wilms' tumour. Thus, recognition and appropriate treatment of associated sleep disorders is essential to optimise long term quality of life.
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Affiliation(s)
- Lisa M Walter
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, Monash University, Melbourne, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
| | - Gillian M Nixon
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, Monash University, Melbourne, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Margot J Davey
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, Monash University, Melbourne, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Peter A Downie
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia; Children's Cancer Centre, Monash Children's Hospital, Melbourne, Victoria, Australia
| | - Rosemary S C Horne
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, Monash University, Melbourne, Victoria, Australia; Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
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Incorporating measures of sleep quality into cancer studies. Support Care Cancer 2014; 23:1145-55. [PMID: 25510361 DOI: 10.1007/s00520-014-2537-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/21/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION/BACKGROUND Sleep disturbance may influence the development of cancer and responses to treatment. It is also closely tied to recovery and quality of life in cancer patients, survivors, and caregivers, and recent studies have begun to show beneficial effects of sleep-promoting interventions. Despite the importance of sleep to cancer and its treatment and the availability of numerous tools for measuring sleep quality and quantity, sleep measurements are underutilized in cancer studies. METHODS This review, written for cancer researchers interested in incorporating sleep measures into their studies, is designed to raise awareness about the importance of sleep and suggests strategies for including sleep evaluation in cancer studies. CONCLUSIONS Inclusion of readily available sleep measures may ultimately improve cancer care by facilitating studies that lead to a greater understanding of how sleep and sleep disturbance influence all aspects of cancer care and the patient experience.
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Macartney G, VanDenKerkhof E, Harrison MB, Stacey D. Symptom experience and quality of life in pediatric brain tumor survivors: a cross-sectional study. J Pain Symptom Manage 2014; 48:957-67. [PMID: 24704799 DOI: 10.1016/j.jpainsymman.2013.12.243] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/15/2013] [Accepted: 12/19/2013] [Indexed: 11/30/2022]
Abstract
CONTEXT Little is known about the symptom experience and quality of life of children and youths who have completed treatment for a pediatric brain tumor. OBJECTIVES This study describes the symptom experience and health-related quality of life of children who have survived a brain tumor. METHODS This observational cross-sectional study used a convenience sample of 50 children who were being followed in ambulatory care after they had completed brain tumor treatment. Their symptom experience was measured using the Memorial Symptom Assessment Scale, and health-related quality of life was measured using the Pediatric Quality of Life Inventory. RESULTS The median number of symptoms reported by the participants was six. The most prevalent symptoms were lack of energy (52%), feeling drowsy (40%), difficulty with sleep (38%), lack of concentration (36%), and headaches (36%). Among those reporting symptoms, the most distressing symptoms were pain (14%), headaches (12%), lack of energy (8%), and difficulty with sleep (8%). Four symptoms-lack of energy, concentration, pain, and shortness of breath-explained most of the variance in the Pediatric Quality of Life Inventory subscales and total scores. CONCLUSION Pediatric brain tumor survivors experience many symptoms after treatment. Care providers should be particularly diligent screening for symptoms, including pain, headaches, lack of energy, and sleep problems, as these symptoms may be particularly distressing for children.
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Affiliation(s)
- Gail Macartney
- Nursing Research & Knowledge Translation, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
| | - Elizabeth VanDenKerkhof
- School of Nursing, Queen's University, Kingston, Ontario, Canada; Department of Anesthesiology & Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - Margaret B Harrison
- School of Nursing, Queen's University, Kingston, Ontario, Canada; Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Changes in sleep and fatigue in newly treated pediatric oncology patients. Support Care Cancer 2014; 23:393-401. [PMID: 25112560 DOI: 10.1007/s00520-014-2356-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 07/21/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Fatigue has been reported as one of the most distressing symptoms in oncology patients, yet few have investigated the longitudinal course of sleep and fatigue in newly diagnosed pediatric oncology patients. PROCEDURE To longitudinally assess presence and changes of sleep complaints and fatigue, we administered questionnaires designed to measure sleep complaints, sleep habits, daytime sleepiness, and fatigue to parents of pediatric oncology patients ages 2-18 and to pediatric oncology patients, themselves, ages 8-18 within 30 days of diagnosis (n = 170) and again 8 weeks later (n = 153). RESULTS Bedtimes, wake times, and sleep duration remained relatively stable across the first 8 weeks of treatment. Sleep duration and fatigue were not related for the entire sample, though children's self-reported sleep duration was positively correlated with fatigue only at the baseline time point. Parent reports of fatigue significantly decreased for leukemia patients but remained rather high for solid tumor and brain tumor patients. CONCLUSIONS Because fatigue remained high for solid tumor and brain tumor patients across the initial 8 weeks of treatment, this may highlight the need for intervention in this patient population.
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Herbert AR, de Lima J, Fitzgerald DA, Seton C, Waters KA, Collins JJ. Exploratory study of sleeping patterns in children admitted to hospital. J Paediatr Child Health 2014; 50:632-8. [PMID: 24893889 DOI: 10.1111/jpc.12617] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2014] [Indexed: 11/27/2022]
Abstract
AIMS Sleep is considered an important time of healing and restoration during illness. The primary aim of this study was to determine the prevalence of self-reported sleep disturbance in children admitted to a tertiary children's hospital with a variety of medical diagnoses. METHODS Parents of children admitted to the hospital, aged between 1 and 18 years, were asked to complete a sleep diary during one night of their child's hospital stay. Children older than 12 years were asked to complete a diary independently. Descriptive statistics were used to summarise the data. RESULTS Overall, 107 children were surveyed for one hospital inpatient night. The overall prevalence of poor sleep was 52.3%. The wide age range and variety of diagnosis limited further detailed analysis of specific causes of this problem. Poor sleep prior to admission was the strongest predictor of poor sleep in hospital suggesting that these children already had an underlying sleep problem. Unprompted awakenings were predominantly due to toileting (17.8%) or were spontaneous (17.8%). Factors specific to the hospital environment that woke children were nursing cares (25.2%), alarms (12.1%) and pain (12.1%). CONCLUSIONS Children admitted to hospital have a higher prevalence of poor sleep compared with healthy children in the community. Children were woken frequently by both external noise and attention provided by hospital staff. Education of hospital staff about the importance of sleep for children and factors that affect children's sleep may reduce the negative impact of hospitalisation on children's sleep.
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Affiliation(s)
- Anthony R Herbert
- Paediatric Palliative Care Service, Division of Oncology, Royal Children's Hospital, Brisbane, Queensland, Australia; Discipline of Paediatrics and Child Health, School of Medicine, University of Queensland, Brisbane, Queensland, Australia; Department of Pain Medicine and Palliative Care, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Tham SW, Holley AL, Zhou C, Clarke GN, Palermo TM. Longitudinal course and risk factors for fatigue in adolescents: the mediating role of sleep disturbances. J Pediatr Psychol 2013; 38:1070-80. [PMID: 23860262 DOI: 10.1093/jpepsy/jst051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study (1) examines fatigue over 1 year in adolescents with chronic pain (n = 61) and depressive disorders (n = 51) compared with healthy adolescents (n = 60), (2) identifies longitudinal risk factors, and (3) tests sleep disturbances as a mediator between depression and fatigue. METHODS Adolescents completed questionnaires at baseline, 6, and 12 months. Mixed effects models examined associations between risk factors and fatigue; structural equation modeling assessed contemporaneous and longitudinal mediation. RESULTS Results revealed fatigue persisted at 1 year follow-up, with adolescents in the clinical samples experiencing greater fatigue than healthy youth at all time points (ps < .001). Age, baseline depression, and baseline sleep disturbances predicted longitudinal fatigue for the total sample (ps < .05), with variation in predictors by subgroup. Sleep quality mediated the contemporaneous effects of depression on fatigue in the clinical samples (ps < .05). CONCLUSIONS Findings underscore the longitudinal course of fatigue and suggest that improving sleep disturbances may reduce fatigue in clinical samples.
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Affiliation(s)
- See Wan Tham
- M.B.B.S, Senior Fellow & Acting Instructor, Dept. of Anesthesiology & Pain Medicine, Seattle Children's Hospital, 4800 Sand Point Way, Seattle, WA 98105, USA.
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Palesh O, Peppone L, Innominato PF, Janelsins M, Jeong M, Sprod L, Savard J, Rotatori M, Kesler S, Telli M, Mustian K. Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer. Nat Sci Sleep 2012; 4:151-162. [PMID: 23486503 PMCID: PMC3593248 DOI: 10.2147/nss.s18895] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Sleep problems are highly prevalent in cancer patients undergoing chemotherapy. This article reviews existing evidence on etiology, associated symptoms, and management of sleep problems associated with chemotherapy treatment during cancer. It also discusses limitations and methodological issues of current research. The existing literature suggests that subjectively and objectively measured sleep problems are the highest during the chemotherapy phase of cancer treatments. A possibly involved mechanism reviewed here includes the rise in the circulating proinflammatory cytokines and the associated disruption in circadian rhythm in the development and maintenance of sleep dysregulation in cancer patients during chemotherapy. Various approaches to the management of sleep problems during chemotherapy are discussed with behavioral intervention showing promise. Exercise, including yoga, also appear to be effective and safe at least for subclinical levels of sleep problems in cancer patients. Numerous challenges are associated with conducting research on sleep in cancer patients during chemotherapy treatments and they are discussed in this review. Dedicated intervention trials, methodologically sound and sufficiently powered, are needed to test current and novel treatments of sleep problems in cancer patients receiving chemotherapy. Optimal management of sleep problems in patients with cancer receiving treatment may improve not only the well-being of patients, but also their prognosis given the emerging experimental and clinical evidence suggesting that sleep disruption might adversely impact treatment and recovery from cancer.
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Affiliation(s)
- Oxana Palesh
- Stanford University School of Medicine, Stanford, CA, USA
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Abstract
Approximately three-fourths of all pediatric cancer patients will be long-term survivors; however, there can be a steep cost for cancer survivorship. Cancer treatment involves exposure to chemotherapy, surgical intervention, and radiation, which can cause lasting long-term toxicities. Children with brain tumors have the highest prevalence of long-term morbidities. These effects can be attributed to direct neurologic damage to the developing brain caused by tumor, hydrocephalus, surgical removal of the tumor, and the effects of irradiation. The late effects experienced by childhood cancer survivors involve multiple domains, one of which is sleep disorders. Sleep dysfunction has an increased prevalence in the pediatric cancer survivor population. These issues are disruptive to patients and cause a decrease in quality of life. This review focuses on sleep disorders that occur in pediatric cancer survivors and discusses the possible causes, the assessments used to determine specific sleep disorders, and treatment modalities used to ameliorate this dysfunction with the hope of improving patient's quality of life.
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Beebe DW. A brief primer on sleep for pediatric and child clinical neuropsychologists. Child Neuropsychol 2011; 18:313-38. [PMID: 21954988 DOI: 10.1080/09297049.2011.602014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sleep problems are common in the children seen by pediatric and child clinical neuropsychologists, and these problems have the potential to significantly impact the child and his or her family. All are treatable to some degree, and some respond extremely well to existing treatments. This article provides a brief overview of the impact, nature, screening, and treatment for childhood sleep problems, with a particular emphasis on issues relevant to practicing neuropsychologists.
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Affiliation(s)
- Dean W Beebe
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Vallance K, Yang J, Li J, Crabtree VM, Hinds PS, Mandrell BN. Disturbed Sleep in Pediatric Patients With Leukemia: The Potential Role of Interleukin-6 (-174GC) and Tumor Necrosis Factor (-308GA) Polymorphism. Oncol Nurs Forum 2011; 38:E365-72. [DOI: 10.1188/11.onf.e365-e372] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Untreated sleep disturbances and sleep disorders pose significant adverse daytime consequences and place children at considerable risk for poor health outcomes. Sleep disturbances occur at a greater frequency in children with acute and chronic medical conditions compared with otherwise healthy peers. Sleep disturbances in medically ill children can be associated with sleep disorders, comorbid with acute and chronic conditions, or secondary to underlying disease-related mechanisms, treatment regimens, or hospitalization. Clinical management should include a multidisciplinary approach with particular emphasis on routine, regular sleep assessments and prevention of daytime consequences, and promotion of healthy sleep habits and health outcomes.
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Walker AJ, Johnson KP, Miaskowski C, Gedaly-Duff V. Nocturnal sleep-wake parameters of adolescents at home following cancer chemotherapy. Biol Res Nurs 2011; 14:236-41. [PMID: 21613338 DOI: 10.1177/1099800411408414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this descriptive, longitudinal study was to describe objective nocturnal sleep-wake parameters of adolescents at home after receiving chemotherapy in the hospital or outpatient clinic and explore differences in sleep variables by age, gender, and corticosteroid use. METHODS We collected 7 days of wrist actigraphy and sleep diary data from 48 adolescents (10-19 years) who were receiving cancer chemotherapy for a primary or secondary cancer or a relapse. The actigraphic sleep variables included rest interval (i.e., time in bed), sleep onset, sleep offset, sleep duration, total sleep time (TST), wake after sleep onset (WASO), and %WASO. RESULTS Of the 48 adolescents, 38 had at least five nights of scored actigraphy and were included in analyses. Older (13-18 years) adolescents went to bed later and had fewer minutes of TST than younger adolescents (10-12 years). Exploratory analyses revealed no differences between adolescents who were taking oral corticosteroids (i.e., prednisone, dexamethasone) and those who were not or between males and females. CONCLUSION These adolescents had sleep durations that met or exceeded the recommended sleep duration for their age groups but experienced significant WASO. Further research is needed to estimate sleep needs of adolescents during chemotherapy and determine factors that contribute to nocturnal wake-time so that targeted interventions can be designed to improve sleep quality.
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Affiliation(s)
- Amy J Walker
- Department of Family and Child Nursing, University of Washington, Seattle, WA 98195, USA.
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Boergers J, Koinis-Mitchell D. Sleep and culture in children with medical conditions. J Pediatr Psychol 2010; 35:915-26. [PMID: 20332222 DOI: 10.1093/jpepsy/jsq016] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES To provide an integrative review of the existing literature on the interrelationships among sleep, culture, and medical conditions in children. METHODS A comprehensive literature search was conducted using PubMed, Medline, and PsychINFO computerized databases and bibliographies of relevant articles. RESULTS Children with chronic illnesses experience more sleep problems than healthy children. Cultural beliefs and practices are likely to impact the sleep of children with chronic illnesses. Few studies have examined cultural factors affecting the relationship between sleep and illness, but existing evidence suggests the relationship between sleep and illness is exacerbated for diverse groups. CONCLUSIONS Sleep is of critical importance to children with chronic illnesses. Cultural factors can predispose children both to sleep problems and to certain medical conditions. Additional research is needed to address the limitations of the existing literature, and to develop culturally sensitive interventions to treat sleep problems in children with chronic illnesses.
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Affiliation(s)
- Julie Boergers
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley-Hasbro Children's Research Center, Providence, RI 02903, USA.
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Hockenberry MJ, Hooke MC, Gregurich M, McCarthy K, Sambuco G, Krull K. Symptom clusters in children and adolescents receiving cisplatin, doxorubicin, or ifosfamide. Oncol Nurs Forum 2010; 37:E16-27. [PMID: 20044328 DOI: 10.1188/10.onf.e16-e27] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the influence of the proposed symptom cluster of fatigue, nausea and vomiting, and sleep disturbances on clinical outcomes defined as behavior changes, depression, and performance status in children and adolescents before and after receiving cisplatin, doxorubicin, or ifosfamide chemotherapy. DESIGN A prospective, descriptive, within-group, before-and-after-chemotherapy design was used. SETTING Two major childhood cancer treatment hospitals in the United States. SAMPLE 67 patients aged 7-18 years who were receiving chemotherapy courses of cisplatin, doxorubicin, or ifosfamide. METHODS Fatigue, depression, behavior, and performance assessments were completed on the first day of cisplatin, doxorubicin, or ifosfamide therapy and one week later. Patients wore a wrist actigraph on the nondominant hand during the course of therapy and for 48 hours after discharge from the hospital. Nausea and vomiting were measured every 24 hours during the course of therapy and for 48 hours after discharge. A linear mixed model was used to evaluate the influence of the symptom cluster. Regression analysis was used to examine the associations between performance status and the symptom cluster. Principal component analysis with varimax rotation was used to produce the correlation of sleep symptoms. MAIN RESEARCH VARIABLES Fatigue, nausea and vomiting, sleep disturbances, behavior, depression, and performance. FINDINGS Adolescents with the cluster of increased fatigue and sleep disturbances experienced more depressive symptoms and behavior changes. Children with higher levels of fatigue had increased depressive symptoms. The more fatigue parents perceived in their children or adolescents, the more behavior and emotional difficulties were reported. CONCLUSIONS Fatigue, sleep disturbance, and nausea and vomiting, when clustered, impacted depressive symptoms and behavior changes in adolescents after chemotherapy. In children, fatigue alone impacted depressive symptoms and behavior changes. IMPLICATIONS FOR NURSING Symptom clusters can have a significant impact on children's and adolescents' quality of life during cancer treatment. Early recognition and intervention for these symptoms are an important nursing role.
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Affiliation(s)
- Marilyn J Hockenberry
- Department of Pediatrics, Section of Hematology/Oncology, Texas Children's Cancer Center at Texas Children's Hospital, Houston, USA.
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