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Li X, Mao JJ, Garland SN, Root J, Li SQ, Ahles T, Liou KT. Comparing sleep measures in cancer survivors: self-reported sleep diary versus objective wearable sleep tracker. Support Care Cancer 2024; 32:601. [PMID: 39167165 DOI: 10.1007/s00520-024-08788-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 08/06/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Cancer survivors are increasingly using wearable fitness trackers, but it is unclear if they match traditional self-reported sleep diaries. We aimed to compare sleep data from Fitbit and the Consensus Sleep Diary (CSD) in this group. METHODS We analyzed data from two randomized clinical trials, using both CSD and Fitbit to collect sleep outcomes: total sleep time (TST), wake time after sleep onset (WASO), number of awakenings (NWAK), time in bed (TIB), and sleep efficiency (SE). Insomnia severity was measured by Insomnia Severity Index (ISI). We used the Wilcoxon signed rank test, Spearman's rank correlation coefficients, and the Mann-Whitney test to compare sleep outcomes and assess their ability to distinguish insomnia severity levels between CSD and Fitbit data. RESULTS Among 62 participants, compared to CSD, Fitbit recorded longer TST by an average of 14.6 (SD = 84.9) minutes, longer WASO by an average of 28.7 (SD = 40.5) minutes, more NWAK by an average of 16.7 (SD = 6.6) times per night, and higher SE by an average of 7.1% (SD = 14.4); but shorter TIB by an average of 24.4 (SD = 71.5) minutes. All the differences were statistically significant (all p < 0.05), except for TST (p = 0.38). Moderate correlations were found for TST (r = 0.41, p = 0.001) and TIB (r = 0.44, p < 0.001). Compared to no/mild insomnia group, participants with clinical insomnia reported more NWAK (p = 0.009) and lower SE (p = 0.029) as measured by CSD, but there were no differences measured by Fitbit. CONCLUSIONS TST was the only similar outcome between Fitbit and CSD. Our study highlights the advantages, disadvantages, and clinical utilization of sleep trackers in oncology.
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Affiliation(s)
- Xiaotong Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, 4th Floor, New York, NY, 10065, USA
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, 4th Floor, New York, NY, 10065, USA
| | - Sheila N Garland
- Department of Psychology and Oncology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - James Root
- Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Susan Q Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, 4th Floor, New York, NY, 10065, USA
| | - Tim Ahles
- Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin T Liou
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, 4th Floor, New York, NY, 10065, USA.
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Li X, Mao JJ, Garland SN, Root J, Li SQ, Ahles T, Liou KT. Comparing sleep measures in cancer survivors: Self-reported sleep diary versus objective wearable sleep tracker. RESEARCH SQUARE 2023:rs.3.rs-3407984. [PMID: 37886444 PMCID: PMC10602054 DOI: 10.21203/rs.3.rs-3407984/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Purpose Cancer survivors are increasingly using wearable fitness trackers, but it's unclear if they match traditional self-reported sleep diaries. We aimed to compare sleep data from Fitbit and the Consensus Sleep Diary (CSD) in this group. Methods We analyzed data from two randomized clinical trials, using both CSD and Fitbit to collect sleep outcomes: total sleep time (TST), wake time after sleep onset (WASO), number of awakenings (NWAK), time in bed (TIB) and sleep efficiency (SE). Insomnia severity was measured by Insomnia Severity Index (ISI). We used the Wilcoxon Singed Ranks Test, Spearman's rank correlation coefficients, and the Mann-Whitney Test to compare sleep outcomes and assess their ability to distinguish insomnia severity levels between CSD and Fitbit data. Results Among 62 participants, compared to CSD, Fitbit recorded longer TST by an average of 14.6 (SD = 84.9) minutes, longer WASO by an average of 28.7 (SD = 40.5) minutes, more NWAK by an average of 16.7 (SD = 6.6) times per night, and higher SE by an average of 7.1% (SD = 14.4); but shorter TIB by an average of 24.4 (SD = 71.5) minutes. All the differences were statistically significant (all p < 0.05), except for TST (p = 0.38). Moderate correlations were found for TST (r = 0.41, p = 0.001) and TIB (r = 0.44, p < 0.001). Compared to no/mild insomnia group, participants with clinical insomnia reported more NWAK (p = 0.009) and lower SE (p = 0.029) as measured by CSD, but Fitbit outcomes didn't. Conclusions TST was the only similar outcome between Fitbit and CSD. Our study highlights the advantages, disadvantages, and clinical utilization of sleep trackers in oncology.
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Affiliation(s)
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center
| | | | | | | | - Tim Ahles
- Memorial Sloan Kettering Cancer Center
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Cheng WH, Teo RH, Cheng LJ, Lau Y, Lau ST. Global prevalence of sleep disturbances among breast cancer survivors: A systematic review with meta-analysis. Sleep Health 2023; 9:704-716. [PMID: 37453906 DOI: 10.1016/j.sleh.2023.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 07/18/2023]
Abstract
Breast cancer is a common cancer in which patients are highly susceptible to different sleep disturbances. However, current evidence lacked consistency in methodologies in investigating the prevalence of sleep disturbances among breast cancer survivors. The review aims to (1) investigate the global prevalence of sleep disturbances among breast cancer survivors; and (2) investigate the factors influencing the prevalence estimates. A comprehensive search was conducted in 8 databases using a 3-step approach, up to January 2022. The Newcastle-Ottawa Scale and Cochrane risk of bias tool were used to evaluate the quality of individual studies. Meta-analysis, meta-regression, and subgroup analysis were performed using R software. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations criteria. A total of 51 studies were selected involving 28,036 breast cancer survivors across 17 countries. The global prevalence of poor sleep quality was 62%, different severities of insomnia were 3%-32%, and excessive daytime sleepiness was 24%. Subgroup analyses showed that a significantly higher prevalence of poor sleep quality was found in breast cancer survivors during treatment compared with pre- or post-treatment. No significant covariates were found in a series of meta-regression analyses. The majority (73.5%) of individual studies were high quality but the certainty of the evidence was low or very low according to Grading of Recommendations, Assessment, Development, and Evaluations criteria. More than half of breast cancer survivors have sleep disturbances, so developing a strategic intervention is warranted. Given the low or very low certainty of the evidence, a robust design for large-scale research is crucial in the future.
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Affiliation(s)
- Wen Hui Cheng
- Nursing Division, Singapore General Hospital, Singapore Health Services, Singapore
| | - Rui Hong Teo
- Nursing Division, Singapore General Hospital, Singapore Health Services, Singapore
| | - Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Hwang Y, Conley S, Jeon S, Redeker NS, Sanft T, Knobf MT. Factors associated with sleep health in young women after breast cancer treatment. Res Nurs Health 2022; 45:680-692. [DOI: 10.1002/nur.22264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Youri Hwang
- School of Nursing Yale University Orange Connecticut USA
| | | | - Sangchoon Jeon
- School of Nursing Yale University Orange Connecticut USA
| | | | - Tara Sanft
- School of Medicine Yale University New Haven Connecticut USA
| | - M. Tish Knobf
- School of Nursing Yale University Orange Connecticut USA
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Berisha A, Shutkind K, Borniger JC. Sleep Disruption and Cancer: Chicken or the Egg? Front Neurosci 2022; 16:856235. [PMID: 35663547 PMCID: PMC9160986 DOI: 10.3389/fnins.2022.856235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep is a nearly ubiquitous phenomenon across the phylogenetic tree, highlighting its essential role in ensuring fitness across evolutionary time. Consequently, chronic disruption of the duration, timing, or structure of sleep can cause widespread problems in multiple physiological systems, including those that regulate energy balance, immune function, and cognitive capacity, among others. Many, if not all these systems, become altered throughout the course of cancer initiation, growth, metastatic spread, treatment, and recurrence. Recent work has demonstrated how changes in sleep influence the development of chronic diseases, including cancer, in both humans and animal models. A common finding is that for some cancers (e.g., breast), chronic disruption of sleep/wake states prior to disease onset is associated with an increased risk for cancer development. Additionally, sleep disruption after cancer initiation is often associated with worse outcomes. Recently, evidence suggesting that cancer itself can affect neuronal circuits controlling sleep and wakefulness has accumulated. Patients with cancer often report difficulty falling asleep, difficulty staying asleep, and severe fatigue, during and even years after treatment. In addition to the psychological stress associated with cancer, cancer itself may alter sleep homeostasis through changes to host physiology and via currently undefined mechanisms. Moreover, cancer treatments (e.g., chemotherapy, radiation, hormonal, and surgical) may further worsen sleep problems through complex biological processes yet to be fully understood. This results in a "chicken or the egg" phenomenon, where it is unclear whether sleep disruption promotes cancer or cancer reciprocally disrupts sleep. This review will discuss existing evidence for both hypotheses and present a framework through which the interactions between sleep and cancer can be dissociated and causally investigated.
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Affiliation(s)
- Adrian Berisha
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, United States
| | - Kyle Shutkind
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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Longitudinal Analysis of Sleep Disturbance in Breast Cancer Survivors. Nurs Res 2022; 71:177-188. [PMID: 35026802 PMCID: PMC9038645 DOI: 10.1097/nnr.0000000000000578] [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: 01/16/2023]
Abstract
BACKGROUND Breast cancer survivors (BCS) often report poor sleep quality and wakefulness throughout the night as the greatest challenges experienced during and posttreatment. OBJECTIVES This study aimed to elucidate characteristics of sleep disturbances and determine potential predictors that affect sleep disturbances in BCS for 2 years postchemotherapy. METHODS This is a secondary analysis of data from the EPIGEN study, which longitudinally examined sociodemographic and cancer-related factors, lifestyle, symptom characteristics, and epigenetic factors at baseline prior to chemotherapy (T1), the midpoint (T2), 6-month (T3), 1-year (T4), and 2-year (T5) time points postchemotherapy. Temporal lifestyle changes, symptom characteristics, and epigenetic factors were explored using linear mixed-effects models with a random intercept. A linear regression model was fitted to identify significant predictors of sleep disturbances at each time point. RESULTS In 74 BCS with an average age of 51 years and 70% non-Hispanic White, BCS experienced severe sleep disturbances at T2, which gradually improved over time. Significant temporal changes in midsleep awakenings, early awakenings, and fatigue at work were observed, with disturbances being elevated at T2. Anxiety (T1, T2, and T4), fatigue (T3 and T4), and perceived stress (T3) were significant predictors after adjusting for radiation therapy, surgery, and adjuvant endocrine therapy. DISCUSSION This study highlights that predictors of sleep disturbances change over time, with anxiety being a factor earlier in the treatment trajectory (prechemotherapy) and continuing over time with fatigue and perceived stress being involved later in the treatment trajectory. Our results indicate that symptom management strategies to address sleep disturbances should be tailored to the temporal factors that may change in severity during active treatment and early survivorship period. Findings gained from this study on sleep disturbance patterns and the potential risk factors can be incorporated into clinical practice in planning education and developing interventions.
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Borniger JC. Cancer as a tool for preclinical psychoneuroimmunology. Brain Behav Immun Health 2021; 18:100351. [PMID: 34988496 PMCID: PMC8710415 DOI: 10.1016/j.bbih.2021.100351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/03/2021] [Accepted: 09/17/2021] [Indexed: 12/20/2022] Open
Abstract
Cancer represents a novel homeostatic challenge to the host system. How the brain senses and responds to changes in peripheral physiology elicited by tumor growth is a largely untapped area of research. This is especially relevant given the widespread prevalence of systemic problems that people with various types of cancer experience. These include disruptions in sleep/wake cycles, cognitive function, depression, and changes in appetite/food intake, among others. Critically, many of these problems are evident prior to diagnosis, indicating that their etiology is potentially distinct from the effects of cancer treatment or the stress of a cancer diagnosis. Psychoneuroimmunology (PNI) is well equipped to tackle these types of problems, as it uses approaches from multiple disciplines to understand how specific stimuli (endogenous and environmental) are transduced into neural, endocrine, and immune signals that ultimately regulate health and behavior. In this article, I first provide a brief historical perspective of cancer and PNI, introduce the idea of cancer as a systemic homeostatic challenge, and provide examples from preclinical literature supporting this hypothesis. Given the rise of advanced tools in neuroscience (e.g., calcium imaging), we can now monitor and manipulate genetically defined neural circuits over the extended time scales necessary to disentangle distal communication between peripheral tumors and the brain.
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Cho O, Hwang K. Association between sleep quality, anxiety and depression among Korean breast cancer survivors. Nurs Open 2021; 8:1030-1037. [PMID: 34482659 PMCID: PMC8046065 DOI: 10.1002/nop2.710] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/16/2020] [Accepted: 11/03/2020] [Indexed: 11/07/2022] Open
Abstract
AIM This study aimed to examine the sleep pattern of breast cancer survivors and anxiety and depression associated with sleep quality to provide evidence-based information for the development of interventions to improve sleep disorders in these survivors. DESIGN A cross-sectional study. METHODS The subjects were 266 breast cancer survivors in South Korea. Structured questionnaires regarding sleep quality, anxiety and depression were used. The data were analysed using t test, ANOVA and multiple regression analysis. RESULTS Sleep duration and sleep disturbance were found to affect anxiety, whereas sleep latency and subjective sleep quality were found to affect depression. These results suggest that various factors affecting sleep quality should be considered when providing care for anxiety and depression in breast cancer survivors.
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Affiliation(s)
- Ok‐Hee Cho
- Department of Nursing, College of Nursing and HealthKongju National UniversityGongju‐siKorea
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Putri DSR, Makiyah SNN. Factors Affecting Sleep Quality of Breast Cancer Patients with Chemotherapy. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Poor sleep quality becomes the effect of chemotherapy in breast cancer patients.
AIM: This study aimed to examine the factors that influence breast cancer patients’ sleep quality undergoing chemotherapy.
METHODS: This research used an observational method with cross-sectional design. There were 26 breast cancer patients undergoing chemotherapy at Djojonegoro Regional Hospital in Temanggung, Central Java. The characteristics of the respondent are recorded, including the demographic characteristics, respondents’ sleep quality, and the physiological status data of the respondent. The researchers use the Pittsburgh Sleep Quality Index (PSQI) to measure sleep quality. Data were analyzed using Kendall’s Tau and Spearman’s rank correlation test and the Pearson Product-Moment Correlation test.
RESULTS: The result showed that breast cancer patients’ sleep quality is classified as poor with PSQI score of 10.96 ± 3.13. The average age of the respondent was 50.08 ± 7.31 years. The major characteristic of the respondent were 80.77% had married, 42.30% had elementary education, 61.54% did not work, and 61.54% had Rp 0, - income. Based on breast cancer patients undergoing chemotherapy, the respondents lived in rice field environment (42.30%), diagnosed with breast cancer <1 year (69.23%), had <1 year chemotherapy (96.15%), had under mastectomy on the left breast (80.76%), and underwent chemotherapy as much as 7.23 ± 4.80 times. Based on sleep quality, the respondents lived with nuclear family (61.54%), had no comorbidities (76.92%), did not consume other drugs (100%), did not consume sleeping pills (80.76%), and used lights during sleep (65.38%). There is a correlation between sleep quality and age and with whom the respondent lives in the same house.
CONCLUSION: It was concluded that breast cancer patients undergoing chemotherapy had poor sleep quality, and the factors related to sleep quality were age and with whom the respondent lived in the same house.
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Al Maqbali M. Sleep disturbance among Arabic breast cancer survivors. Support Care Cancer 2021; 29:5179-5186. [PMID: 33629187 DOI: 10.1007/s00520-021-06088-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Sleep disturbance is the most common and distressing cancer symptom that negatively affects the quality of life (QoL). The main objective of this study is to determine the prevalence of sleep disturbance among Arabic women with breast cancer, post-treatment, and assess their sleep disturbance in relation to health-related QoL, demographics and treatment characteristics. METHODS In this study, cross-sectional data were collected using the Pittsburgh Sleep Quality Index (PSQI: 19-items) and the Functional Assessment of Cancer Therapy-General (FACT-G: 27 items). Demographic information and treatment characteristics were also collected. RESULTS A total of 133 women who had been diagnosed with breast cancer agreed to participate in the study. Approximately three-quarters (73.7%; n = 98) of the participants was reported as poor sleepers (PSQI ˃ 5). The worse mean score of the PSQI component was the sleep latency with the highest score (M = 1.71, SD = 0.93). There were significant relationships between poor sleep and treatment (patients receiving both chemotherapy and radiotherapy) and with comorbidities (asthma, anaemia, hypertension/heart failure, diabetes/heart diseases) (P < 0.05). Those experiencing poor sleep had the lowest QoL among the cancer patients. CONCLUSION Sleep disturbance is a significant problem for Arabic patients diagnosed with breast cancer. The result suggests that sleep disturbance should be routinely assessed in clinical settings. Further research should develop an intervention for management to reduce sleep disturbance and improve sleep quality in cancer patients.
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Affiliation(s)
- Mohammed Al Maqbali
- Al Buraimi Hospital, Ministry of Health Oman, Al Buraimi, Oman. .,School of Applied Social and Policy Sciences, Ulster University Magee Campus, Londonderry, UK.
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Fordham B, Sugavanam T, Edwards K, Hemming K, Howick J, Copsey B, Lee H, Kaidesoja M, Kirtley S, Hopewell S, das Nair R, Howard R, Stallard P, Hamer-Hunt J, Cooper Z, Lamb SE. Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis. Health Technol Assess 2021; 25:1-378. [PMID: 33629950 PMCID: PMC7957459 DOI: 10.3310/hta25090] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. OBJECTIVES This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy. DATA SOURCES The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. REVIEW METHODS Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. RESULTS A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. LIMITATIONS Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. CONCLUSION Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. FUTURE WORK Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. STUDY REGISTRATION This study is registered as PROSPERO CRD42017078690. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Thavapriya Sugavanam
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Katherine Edwards
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jeremy Howick
- Faculty of Philosophy, University of Oxford, Oxford, UK
| | - Bethan Copsey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Milla Kaidesoja
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roshan das Nair
- Department of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
- Institute of Mental Health, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK
| | | | | | - Zafra Cooper
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Hirschey R, Nyrop KA, Mayer DK. Healthy Behaviors: Prevalence of Uptake Among Cancer Survivors. Clin J Oncol Nurs 2020; 24:19-29. [PMID: 32945809 DOI: 10.1188/20.cjon.s2.19-29] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although most cancer survivors adhere to recommendations to refrain from tobacco and minimize alcohol use, survivors of certain cancers are not meeting these recommendations. In addition, most cancer survivors do not achieve optimal recommendations for diet and physical activity, further decreasing survivor health and quality of life. Sun protective and sleep behaviors also tend to be suboptimal among survivors. Uptake of age-appropriate vaccinations is variable among survivors. OBJECTIVES The purpose of this article is to review the prevalence of healthy behavior uptake among cancer survivors and provide nurses with an overview of effective interventions, strategies, and resources to help patients improve these behaviors. METHODS An expert panel was convened to conduct an integrative review and synthesis on the state of the science of healthy behavior uptake among cancer survivors. FINDINGS Not meeting recommendations for healthy lifestyle behaviors increases the risk of second cancers and mortality and decreases overall health and quality of life. Healthy lifestyle behaviors can contribute to improved function, quality of life, and overall survival for cancer survivors. Nurses can help survivors to understand and improve their behaviors.
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Fatigue and Sleep Disturbance in Arabic Cancer Patients After Completion of Therapy. Cancer Nurs 2020; 44:378-387. [DOI: 10.1097/ncc.0000000000000825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Zaki NFW, Sabri YM, Farouk O, Abdelfatah A, Spence DW, Bahammam AS, Pandi-Perumal SR. Depressive Symptoms, Sleep Profiles and Serum Melatonin Levels in a Sample of Breast Cancer Patients. Nat Sci Sleep 2020; 12:135-149. [PMID: 32104121 PMCID: PMC7025675 DOI: 10.2147/nss.s206768] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 12/02/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chronobiological changes have been detected in various physiological functions of patients with breast cancer, suggesting dysregulation in the pineal gland and melatonin secretion. This study aimed to assess and measure serum melatonin levels pre- and postoperatively in patients who had been diagnosed for the first time with breast cancer. METHODS A sample of first-time breast cancer patients, consisting of 45 women aged 25-65 years, was evaluated and psychometric assessment was completed using the Beck Depression Inventory (BDI), Insomnia Severity Index (White, Weinberg et al) and the Epworth Sleepiness Scale (Cardoso, Spence et al). The Morningness-Eveningness questionnaire (MEQ) was used to assess the chronotype. Serum melatonin levels were measured by radioimmunoassay. RESULTS Morning and moderately morning chronotypes were prevalent among the sample (25%, 45.8%, respectively). The finding of a mean BDI score of 13.5±11.2 indicated that depressive symptoms were prevalent among the sample. Despite the finding that a mean of the participants apparently had no symptoms of daytime sleepiness (the mean and standard deviations of the ESS were 7.5±4.4), scores on the ISI (a mean of 16.7±SD 7.3) indicated that insomnia symptoms were prevalent in the sample. Melatonin levels showed an inverse relationship with insomnia severity as measured by the ISI and depression severity, as assessed by the BDI. The postoperative melatonin levels were higher than the preoperative levels. Additionally, the psychometric profile differed among various pathological types of breast cancer according to their hormone receptor profile. CONCLUSION Serum melatonin levels correlated significantly with self-reported sleep quality and psychometric profiles of depression in the present sample of breast cancer patients. The melatonin assay, which is relatively easy to carry out, provided a convenient, objective measure of an important biological correlate of sleep quality and depression. This assay thus represented a confirmatory alternative to the self-report instruments, which may sometimes be unreliable. Future studies should further evaluate the utility of melatonin measures in psychiatric and sleep complaints of breast cancer patients.
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Affiliation(s)
- Nevin FW Zaki
- Sleep Research Unit, Department of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Department of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Yomna M Sabri
- Department of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Omar Farouk
- Mansoura University Oncology Center, Mansoura, Egypt
| | - Amany Abdelfatah
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Ahmed S Bahammam
- University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
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Fekih-Romdhane F, Achouri L, Hakiri A, Jaidane O, Rahal K, Cheour M. Hopelessness is associated with poor sleep quality after breast cancer surgery among Tunisian women. Curr Probl Cancer 2020; 44:100504. [DOI: 10.1016/j.currproblcancer.2019.100504] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/06/2019] [Accepted: 09/09/2019] [Indexed: 11/30/2022]
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Walker WH, Borniger JC. Molecular Mechanisms of Cancer-Induced Sleep Disruption. Int J Mol Sci 2019; 20:E2780. [PMID: 31174326 PMCID: PMC6600154 DOI: 10.3390/ijms20112780] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 02/07/2023] Open
Abstract
Sleep is essential for health. Indeed, poor sleep is consistently linked to the development of systemic disease, including depression, metabolic syndrome, and cognitive impairments. Further evidence has accumulated suggesting the role of sleep in cancer initiation and progression (primarily breast cancer). Indeed, patients with cancer and cancer survivors frequently experience poor sleep, manifesting as insomnia, circadian misalignment, hypersomnia, somnolence syndrome, hot flushes, and nightmares. These problems are associated with a reduction in the patients' quality of life and increased mortality. Due to the heterogeneity among cancers, treatment regimens, patient populations and lifestyle factors, the etiology of cancer-induced sleep disruption is largely unknown. Here, we discuss recent advances in understanding the pathways linking cancer and the brain and how this leads to altered sleep patterns. We describe a conceptual framework where tumors disrupt normal homeostatic processes, resulting in aberrant changes in physiology and behavior that are detrimental to health. Finally, we discuss how this knowledge can be leveraged to develop novel therapeutic approaches for cancer-associated sleep disruption, with special emphasis on host-tumor interactions.
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Affiliation(s)
- William H Walker
- Department of Neuroscience, West Virginia University, Morgantown, WV 26506, USA.
| | - Jeremy C Borniger
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Ehlers DK, Fanning J, Salerno EA, Aguiñaga S, Cosman J, Severson J, Kramer AF, McAuley E. Replacing sedentary time with physical activity or sleep: effects on cancer-related cognitive impairment in breast cancer survivors. BMC Cancer 2018; 18:685. [PMID: 29940894 PMCID: PMC6019533 DOI: 10.1186/s12885-018-4603-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/18/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Evidence suggests reallocating daily sedentary time to physical activity or sleep confers important health benefits in cancer survivors. Despite emerging research suggesting physical activity as a treatment for cancer-related cognitive impairment (CRCI), little is known about the interactive effects of behaviors across the 24-h period. The present purpose was to examine the cognitive effects of reallocating sedentary time to light-intensity physical activity, moderate-to-vigorous physical activity (MVPA), or sleep in breast cancer survivors. METHODS Breast cancer survivors (N = 271, Mage = 57.81 ± 9.50 years) completed iPad-based questionnaires and cognitive tasks assessing demographics, health history, executive function, and processing speed (Task-Switch, Trail Making). Participants wore an accelerometer for seven consecutive days to measure their sedentary, physical activity, and sleep behaviors. Single effects (each behavior individually) and partition (controlling for other behaviors) models were used to examine associations among behaviors and cognitive performance. Isotemporal substitution models were used to test the cognitive effects of substituting 30 min of sedentary time with 30 min of light-intensity activity, MVPA, and sleep. RESULTS MVPA was associated with faster Task-switch reaction time in the partition models (stay: B = - 35.31, p = 0.02; switch: B = - 48.24, p = 0.004). Replacing 30 min of sedentary time with 30 min of MVPA yielded faster reaction times on Task-Switch stay (B = - 29.37, p = 0.04) and switch (B = - 39.49, p = 0.02) trials. In Trails A single effects models, sedentary behavior was associated with faster completion (B = - 0.97, p = 0.03) and light-intensity activity with slower completion (B = 1.25, p = 0.006). No single effects were observed relative to Trails B completion (all p > 0.05). Only the effect of MVPA was significant in the partition models (Trails A: B = - 3.55, p = 0.03; Trails B: B = - 4.46, p = 0.049). Replacing sedentary time with light-intensity activity was associated with slower Trails A (B = 1.55 p = 0.002) and Trails B (B = 1.69, p = 0.02) completion. Replacing light activity with MVPA yielded faster Trails A (B = - 4.35, p = 0.02) and Trails B (B = - 5.23, p = 0.03) completion. CONCLUSIONS Findings support previous research suggesting MVPA may be needed to improve cognitive function in breast cancer survivors. Trails findings underscore the need to dissect sedentary contexts to better understand the impact of daily behavioral patterns on CRCI. Additional research investigating the cognitive impacts of behaviors across the 24-h period is warranted. TRIAL REGISTRATION This study is registered with United States ClinicalTrials.gov ( NCT02523677 ; 8/14/2015).
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Affiliation(s)
| | - Jason Fanning
- Wake Forest School of Medicine, Winston-Salem, NC USA
| | | | - Susan Aguiñaga
- University of Illinois at Urbana-Champaign, Urbana, IL USA
| | | | | | - Arthur F. Kramer
- University of Illinois at Urbana-Champaign, Urbana, IL USA
- Northeastern University, Boston, MA USA
| | - Edward McAuley
- University of Illinois at Urbana-Champaign, Urbana, IL USA
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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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Abstract
ABSTRACTObjective:Sleep can affect quality of life (QoL) during cancer survivorship, and symptoms related to poor sleep can be exacerbated. We examined the prevalence, severity, and nature of subjective sleep complaints in women surviving stage I-III breast cancer who were 1-10 years posttreatment. We also examined the demographic, medical, physical, and psychosocial correlates of poor sleep in these women in order to identify the subgroups that may be most in need of intervention. METHOD A total of 200 patients at a comprehensive cancer center who were 1-10 years posttreatment for primary stage I-III breast cancer with no evidence of disease at the time of enrollment completed a battery of questionnaires on demographics, sleep, physical symptoms, mood, cancer-specific fears, and QoL. RESULTS The women had a mean age of 57 years (SD = 10.0), with a mean of 63.3 months (SD = 28.8) of post-cancer treatment. Some 38% of these patients were identified as having poor-quality sleep. Women with poor sleep took longer to fall asleep, had more awakenings, and acquired 2 hours less sleep per night than those with good sleep. They also had a lower QoL, greater severity of pain, more concerns about health and recurrence, and increased vasomotor symptoms (p < 0.05). Daytime sleepiness and depression were found to be not significantly correlated with sleep quality. SIGNIFICANCE OF RESULTS Many breast cancer survivors had severe subjective insomnia, and several breast cancer survivor subgroups were identified as having members who might be most in need of sleep-improvement interventions. Addressing physical symptoms (e.g., vasomotor symptoms and pain) and providing education about the behavioral, social, environmental, and medical factors that affect sleep could result in substantial improvement in the life course of breast cancer survivors.
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Poor sleep quality, depression and hope before breast cancer surgery. Appl Nurs Res 2016; 34:7-11. [PMID: 28342628 DOI: 10.1016/j.apnr.2016.11.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/11/2016] [Accepted: 11/12/2016] [Indexed: 01/04/2023]
Abstract
AIM This study aims to identify the predictors of poor sleep quality and the associations between depression, hope and sleep in a sample of 156 women with breast cancer prior to surgery. BACKGROUND The care and treatment of breast cancer is among the most important scientific challenges in public health. Sleep disturbances and depression are the important complaint of cancer patients. However, they are often neglected. Patients diagnosed with breast cancer also experience prejudice, fear of death, suffering, mutilation, fear of lymphedema, as well as feelings of social devaluation leading to hopelessness Several studies point to hope as an effective strategy to help patients cope with difficulties and achieve their goals, especially patients with cancer. METHODS This is a report of baseline data extracted from a longitudinal study. DATA COLLECTION TOOLS Pittsburgh Sleep Quality Index, Beck Depression Inventory, and the Herth Hope Index. Data were analyzed with the Spearman's Rank Correlation test and Multiple Logistic Regression analysis. RESULTS The majority of women had tumors in initial stages (78.7%), reported poor sleep quality (58.9%), and had moderate to severe or severe depression (27.2%). Significant correlations were found between hope and depression (Spearman r=-0.4341), and between sleep quality and depression (Spearman r=0.3938). Significant associations were found between poor sleep quality and pain, symptoms of menopause and depression. Depression and symptoms of menopause were independent predictors of poor sleep quality. CONCLUSION The evaluation of sleep quality, depression and hope should be implemented in clinical practice. Increased hope lessens depression and may positively affect sleep quality, all of which improves quality of life for women with breast cancer.
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Brant J, Blaseg K, Aders K, Oliver D, Gray E, Dudley W. Navigating the Transition From Cancer Care to Primary Care: Assistance of a Survivorship Care Plan. Oncol Nurs Forum 2016; 43:710-719. [DOI: 10.1188/16.onf.710-719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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