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Faiz SA, Knox AS, Fellman B, Jaumally BA, Pacheco GN, Das A, Mathew R, Murthy R, Litton JK, Balachandran DD, Bashoura L. Sleep disturbances based on patient reported outcomes in patients with breast cancer. Sleep Breath 2024:10.1007/s11325-024-03150-w. [PMID: 39225722 DOI: 10.1007/s11325-024-03150-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/28/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Sleep disturbances are common in patients with breast cancer, but comprehensive evaluations with patient-reported outcomes (PRO) and sleep evaluation with polysomnography (PSG) are lacking. This study describes sleep disruption using PROs and PSG to identify underlying sleep disorders. METHODS A retrospective review of patients with breast cancer undergoing formal sleep evaluation from 4/1/2009 to 7/31/2014 was performed. Clinical characteristics, PROs using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), and PSG data were reviewed. RESULTS 404 patients were identified with 43% early, 30% locally advanced and 17% metastatic disease. PSQI revealed poor sleep in 75%, and ESS demonstrated daytime sleepiness in 55%. Sleep aid use was reported by 39%, and pain medication use in 22%. Most patients (50.2%) had multiple sleep disorders. Insomnia (54.5%) was the most frequent sleep disorder, followed closely by obstructive sleep apnea (OSA) (53.7%). PSG was performed in 74%. Multivariate analysis linked poor sleep to use of sleep aids [OR 7.7, 95% CI 3.9 to 15.2], anxiety disorder [OR 4.8, 95% CI 1.7 to 14.0], and metastatic disease [OR 2.8, 95% CI 1.1 to 6.6]. Daytime sleepiness correlated with known diagnosis of OSA [OR 1.9, 95% CI 1.0 to 3.3] and sleep aid use [OR 0.6, 95% CI 0.4 to 0.9]. CONCLUSIONS Poor sleep was associated with sleep aid use, anxiety disorder and metastatic disease. Insomnia was the most common sleep disorder, followed by OSA (mostly mild). Education about sleep health and proactive screening for sleep symptoms would be beneficial in patients with breast cancer.
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Affiliation(s)
- Saadia A Faiz
- Department of Pulmonary Medicine, Unit 1462, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, 77030-1402, TX, USA.
| | - Ashley S Knox
- Department of Pulmonary Medicine, Unit 1462, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, 77030-1402, TX, USA
| | - Bryan Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bibi Aneesah Jaumally
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham, AL, USA
| | - G Nancy Pacheco
- Department of Pulmonary Medicine, Unit 1462, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, 77030-1402, TX, USA
| | - Aneesa Das
- Division of Pulmonary, Critical Care and Sleep, The Ohio State University, Columbus, OH, USA
| | - Reeba Mathew
- Divisions of Pulmonary, Critical Care Medicine and Sleep Medicine, McGovern Medical School at University of Texas Health, Houston, TX, USA
| | - Rashmi Murthy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - Jennifer K Litton
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - Diwakar D Balachandran
- Department of Pulmonary Medicine, Unit 1462, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, 77030-1402, TX, USA
| | - Lara Bashoura
- Department of Pulmonary Medicine, Unit 1462, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, 77030-1402, TX, USA
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Dils AT, O'Keefe K, Dakka N, Azar M, Chen M, Zhang A. The efficacy of cognitive behavioral therapy for mental health and quality of life among individuals diagnosed with cancer: A systematic review and meta-analysis. Cancer Med 2024; 13:e70063. [PMID: 39165223 PMCID: PMC11336377 DOI: 10.1002/cam4.70063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 07/12/2024] [Accepted: 07/20/2024] [Indexed: 08/22/2024] Open
Abstract
OBJECTIVE It has long been documented that cognitive behavioral therapy (CBT) has positive impacts on improving mental health (MH) and quality of life (QoL) in the general population, but investigations on its effect on cancer survivors remain limited, especially for QoL outcomes. The purpose of this meta-analysis is to investigate the effects of CBT as compared to control on cancer patients' MH and QoL outcomes. Control is defined in this study as standard therapy, waitlist control, and active/alternative therapy. METHODS In total, 154 clinical trials creating a sample size of 1627 individuals were collected. Analysis focusing on MH and QoL excluded 29 clinical trials resulting in a final analysis of 132 clinical trials (and 1030 effect sizes). R Statistical Software (version 4.2.2) and the robumeta package were utilized to complete analysis, which entailed robust variance estimation (RVE) in intercept-only meta-regression, and univariate meta-regression (for moderator analysis). RESULTS Across 132 clinical trials and 1030 effect size estimates, we identified that CBT moderately improves MH and QoL in cancer patients d = 0.388, 95% CI 0.294-0.483, p < 0.001. Additionally, age and delivery format can influence the efficacy of CBT in this patient population. CONCLUSIONS CBT statistically improves the MH and QoL psychosocial parameters in cancer patients with greater efficacy in younger patients. Important clinical and intervention-related factors, that is, age and delivery, should be considered when oncologists consider CBT as a psychotherapeutic intervention for individuals with cancer.
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Affiliation(s)
| | - Kathryn O'Keefe
- Central Michigan University College of MedicineSaginawMichiganUSA
| | - Nada Dakka
- Central Michigan University College of MedicineSaginawMichiganUSA
| | - Michelle Azar
- Central Michigan University College of MedicineSaginawMichiganUSA
| | - Meiyan Chen
- The University of Texas at Austin Steve Hicks School of Social WorkAustinTexasUSA
| | - Anao Zhang
- The University of Texas at Austin Steve Hicks School of Social WorkAustinTexasUSA
- University of Michigan Health, Adolescent and Young Adult Oncology ProgramAnn ArborMichiganUSA
- University of Michigan School of Social WorkAnn ArborMichiganUSA
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Carson EK, Dhillon HM, Vardy JL, Brown C, Nunes-Zlotkowski KF, Della-Fiorentina S, Khan S, Parsonson A, Roncoloato F, Pearson A, Barnes T, Kiely BE. Telehealth cognitive behaviour therapy for the management of sleep disturbance in women with early breast cancer receiving chemotherapy: a feasibility study. Support Care Cancer 2024; 32:375. [PMID: 38780707 PMCID: PMC11116244 DOI: 10.1007/s00520-024-08554-8] [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: 01/15/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Sleep quality commonly deteriorates in people receiving chemotherapy for breast cancer (BC). We aimed to determine feasibility and acceptability of telehealth-delivered cognitive behaviour therapy for insomnia (CBT-I) in people with early BC receiving (neo)adjuvant chemotherapy. METHODS Multi-centre, single arm, phase 2 feasibility trial. People with stage I-III BC received 4 sessions of telehealth CBT-I over 8 weeks, during chemotherapy. Participants completed Pittsburgh Sleep Quality Index (PSQI) and other Patient Reported Outcome Measures (PROMs) at baseline, post-program (week 9) and post-chemotherapy (week 24); and an Acceptability Questionnaire at week 9. Primary endpoint was proportion completing 4 sessions of telehealth CBT-I. RESULTS In total, 41 participants were recruited: mean age 51 years (range 31-73). All 4 CBT-I sessions were completed by 35 (85%) participants. Acceptability of the program was high and 71% reported 'the program was useful'. There was no significant difference in the number of poor sleepers (PSQI score ≥ 5) at baseline 29/40 (73%) and week 24 17/25 (68%); or in the mean PSQI score at baseline (7.43, SD 4.06) and week 24 (7.48, SD 4.41). From baseline to week 24, 7/25 (28%) participants had a ≥ 3 point improvement in sleep quality on PSQI, and 5/25 (20%) had a ≥ 3 point deterioration. There was no significant difference in mean PROM scores. CONCLUSION It is feasible to deliver telehealth CBT-I to people with early BC receiving chemotherapy. Contrary to literature predictions, sleep quality did not deteriorate. Telehealth CBT-I has a potential role in preventing and managing sleep disturbance during chemotherapy. Australian New Zealand Clinical Trials Registry (ANZCTR) registration number: ACTRN12620001379909 and date 22/12/2020.
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Affiliation(s)
- Emma-Kate Carson
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia.
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia.
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia.
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, NSW, Australia
| | - Janette L Vardy
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, NSW, Australia
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Chris Brown
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Kelly Ferrao Nunes-Zlotkowski
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, NSW, Australia
| | - Stephen Della-Fiorentina
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Southern Highlands Cancer Centre, Southern Highlands Private Hospital, Bowral, NSW, Australia
- Cancer Services, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Sarah Khan
- Southern Highlands Cancer Centre, Southern Highlands Private Hospital, Bowral, NSW, Australia
| | - Andrew Parsonson
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Felicia Roncoloato
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Antonia Pearson
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- Northern Beaches Hospital, Frenchs Forest, NSW, Australia
| | - Tristan Barnes
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia
- Northern Beaches Hospital, Frenchs Forest, NSW, Australia
| | - Belinda E Kiely
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
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Arring N, Barton DL, Lafferty C, Cox B, Conroy DA, An L. Mi Sleep Coach Mobile App to Address Insomnia Symptoms Among Cancer Survivors: Single-Arm Feasibility Study. JMIR Form Res 2024; 8:e55402. [PMID: 38669678 PMCID: PMC11087861 DOI: 10.2196/55402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Rates of sleep disturbance among survivors of cancer are more than 3 times higher than the general population. Causes of sleep disturbance among survivors are many and multifaceted, including anxiety and fear related to cancer diagnosis and treatments. Cognitive behavioral therapy for insomnia (CBT-I) is considered a first-line treatment for insomnia; However, a lack of access to trained professionals and limited insurance coverage for CBT-I services has limited patient access to these effective treatments. Evidence supports digital delivery of CBT-I (dCBT-I), but there is only limited evidence to support its use among survivors of cancer. Broad adoption of smartphone technology provides a new channel to deliver dCBT-I, but no prior studies have evaluated mobile dCBT-I interventions for survivors. To address the need for accessible and efficacious CBT-I for survivors of cancer, the Mi Sleep Coach program was developed to adapt CBT-I for delivery to survivors of cancer as a self-directed mobile health app. OBJECTIVE This single-arm feasibility study assessed the adherence, attrition, usefulness, and satisfaction of the Mi Sleep Coach app for insomnia. METHODS A 7-week, single-arm study was conducted, enrolling adult survivors of breast, prostate, or colon cancer reporting sleep disturbances. RESULTS In total, 30 participants were enrolled, with 100% completing the study and providing data through week 7. Further, 9 out of 10 app features were found to be useful by 80% (n=24) to 93% (n=28) of the 30 participants. Furthermore, 27 (90%) participants were satisfied with the Mi Sleep Coach app and 28 (93%) would recommend the use of the Mi Sleep Coach app for those with insomnia. The Insomnia Severity Index showed a decrease from baseline (18.5, SD 4.6) to week 7 (10.4, SD 4.2) of 8.1 (P<.001; Cohen d=1.5). At baseline, 25 (83%) participants scored in the moderate (n=19; 15-21) or severe (n=6; 22-28) insomnia range. At week 7, a total of 4 (13%) patients scored in the moderate (n=4) or severe (n=0) range. The number of patients taking prescription sleep medications decreased from 7 (23%) at baseline to 1 (3%; P<.001) at week 7. The number of patients taking over-the-counter sleep medications decreased from 14 (47%) at baseline to 9 (30%; P=.03) at week 7. CONCLUSIONS The Mi Sleep Coach app demonstrated high levels of program adherence and user satisfaction and had large effects on the severity of insomnia among survivors of cancer. The Mi Sleep Coach app is a promising intervention for cancer-related insomnia, and further clinical trials are warranted. If proven to significantly decrease insomnia in survivors of cancer in future randomized controlled clinical trials, this intervention would provide more survivors of cancer with easy access to evidence-based CBT-I treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT04827459; https://clinicaltrials.gov/study/NCT04827459.
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Affiliation(s)
- Noel Arring
- College of Nursing, University of Tennessee, Knoxville, TN, United States
| | - Debra L Barton
- College of Nursing, University of Tennessee, Knoxville, TN, United States
| | - Carolyn Lafferty
- College of Nursing, University of Tennessee, Knoxville, TN, United States
| | - Bryana Cox
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Deirdre A Conroy
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Lawrence An
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
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Gururaj R, Samuel SR, Kumar KV, Nagaraja R, Keogh JW. Effect of exercise based interventions on sleep and circadian rhythm in cancer survivors-a systematic review and meta-analysis. PeerJ 2024; 12:e17053. [PMID: 38468641 PMCID: PMC10926908 DOI: 10.7717/peerj.17053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/13/2024] [Indexed: 03/13/2024] Open
Abstract
Background Disrupted circadian rhythm commonly reported in cancer survivors is closely associated with cancer related fatigue, sleep disturbances and compromised quality of life. As more cancer survivors request non-pharmacological treatment strategies for the management of their chronic sleep-related symptoms, there is a need for meta-analyses of various interventions such as exercise on sleep and circadian rhythm disturbances. Methods A search for RCT's was conducted in April 2020 and updated in July 2023 using relevant keywords for cancer, sleep, circadian rhythm and exercise interventions on PubMed, Scopus, Web of Science, PEDro and CINAHL. Results Thirty-six studies were included for qualitative analysis and 26, for meta-analysis. Thirty-five studies analyzed sleep outcomes, while five analyzed circadian rhythm. RCT's studying the effect of aerobic exercise, resistance exercise, combined aerobic and resistance exercise, physical activity, yoga, or tai chi were included. Meta-analysis results showed significant exercise-related improvements on sleep quality assessed by Pittsburgh Sleep Quality index (PSQI) (SMD = -0.50 [-0.87, -0.13], p = 0.008), wake after sleep onset (WASO) (SMD = -0.29 [-0.53, -0.05], p = 0.02) and circadian rhythm, assessed by salivary cortisol levels (MD = -0.09 (95% CI [-0.13 to -0.06]) mg/dL, p < 0.001). Results of the meta-analysis indicated that exercise had no significant effect on sleep efficiency, sleep onset latency, total sleep time and circadian rhythm assessed by accelerometry values. Conclusion While some sleep and circadian rhythm outcomes (PSQI, WASO and salivary cortisol) exhibited significant improvements, it is still somewhat unclear what exercise prescriptions would optimize different sleep and circadian rhythm outcomes across a variety of groups of cancer survivors. Implication As exercise does not exacerbate cancer-related circadian rhythm and sleep disturbances, and may actually produce some significant benefits, this meta-analysis provides further evidence for cancer survivors to perform regular exercise.
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Affiliation(s)
- Rachita Gururaj
- Ramaiah College of Physiotherapy, Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Stephen Rajan Samuel
- Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Cancer Control Division, Department of Surgery University of Rochester Medical Center, University of Rochester, Rochester, NY, United States of America
| | - K Vijaya Kumar
- Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ravishankar Nagaraja
- Department of Biostatistics, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, New Delhi, India
| | - Justin W.L. Keogh
- Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia, Australia
- Human Potential Centre, AUT University, Auckland, New Zealand
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Atoui S, Carli F, Bernard P, Lee L, Stein B, Charlebois P, Liberman AS. Does a multimodal prehabilitation program improve sleep quality and duration in patients undergoing colorectal resection for cancer? Pilot randomized control trial. J Behav Med 2024; 47:43-61. [PMID: 37462857 DOI: 10.1007/s10865-023-00437-3] [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: 02/23/2023] [Accepted: 07/10/2023] [Indexed: 02/15/2024]
Abstract
Sleep difficulties are a common symptom in cancer patients at different stages of treatment trajectory and may lead to numerous negative consequences for which management is required. This pilot Randomized Controlled Trial (RCT) aims to assess the potential effectiveness of home-based prehabilitation intervention (prehab) on sleep quality and parameters compared to standard care (SOC) in colorectal cancer patients during the preoperative period and up to 8 weeks after the surgery. One hundred two participants (48.3% female, mean age 65 years) scheduled for elective resection of colorectal cancer were randomized to the prehab (n = 50) or the SOC (n = 52) groups. Recruitment and retention rates were 54% and 72%, respectively. Measures were completed at the baseline and preoperative, 4- and 8-week after-surgery follow-ups. Our mixed models' analyses revealed no significant differences between groups observed over time for all subjective and objective sleep parameters. A small positive change was observed in the perceived sleep quality only at the preoperative time point for the prehabilitation group compared to the SOC group, with an effect size d = 0.11 and a confidence interval (CI) between - 2.1 and - 0.1, p = .048. Prehab group patients with high anxiety showed a significant improvement in the rate of change of sleep duration over time compared to the SOC group, with a difference of 110 min between baseline and 8 weeks after surgery (d = 0.51, 95% CI: 92.3 to 127.7, p = .02). Multimodal prehabilitation intervention is feasible in colorectal cancer patients and may improve sleep duration for patients with high anxiety symptoms. Future large-scale RCTs are needed to confirm our results.
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Affiliation(s)
- Sarah Atoui
- Division of Experimental Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Paquito Bernard
- Department of Physical Activity Sciences, Université du Québec à Montréal, Montreal, QC, Canada
- Research Centre, University Institute of Mental Health in Montreal, Montreal, QC, Canada
| | - Lawrence Lee
- Department of Surgery, McGill University Health Centre, 1650 Cedar ave, D16-116, Montreal, QC, H3G 1A4, Canada
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Barry Stein
- Department of Surgery, McGill University Health Centre, 1650 Cedar ave, D16-116, Montreal, QC, H3G 1A4, Canada
| | - Patrick Charlebois
- Department of Surgery, McGill University Health Centre, 1650 Cedar ave, D16-116, Montreal, QC, H3G 1A4, Canada
| | - A Sender Liberman
- Division of Experimental Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
- Department of Surgery, McGill University Health Centre, 1650 Cedar ave, D16-116, Montreal, QC, H3G 1A4, Canada.
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Zekibakhsh Mohammadi N, Kianimoghadam AS, Mikaeili N, Asgharian SS, Jafari M, Masjedi-Arani A. Sleep Disorders and Fatigue among Patients with MS: The Role of Depression, Stress, and Anxiety. Neurol Res Int 2024; 2024:6776758. [PMID: 38322749 PMCID: PMC10843872 DOI: 10.1155/2024/6776758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 01/07/2024] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
Sleep disorders and fatigue represent prominent symptoms frequently experienced by individuals with multiple sclerosis (MS). Some psychological factors such as depression, stress, and anxiety seem to have a relationship with such problems. This study aimed to examine the role of depression, stress, and anxiety in predicting sleep disorders and fatigue among patients with MS. Employing a cross-sectional descriptive-correlational design, the study involved a sample size of 252 participants selected through purposive sampling based on inclusion and exclusion criteria. We utilized a demographic information questionnaire along with the Mini-Sleep Questionnaire (MSQ), Fatigue Severity Scale (FSS), and Depression, Anxiety, and Stress Scale (DASS-21) to collect data and analyzed them applying SPSS22, incorporating statistical measures including Pearson correlation and regression. The results of the Pearson correlation coefficient showed that sleep disorders had a positive and significant relationship with depression (r = 0.56; P < 0.001), stress (r = 0.40; P < 0.001), and anxiety (r = 0.52; P < 0.001). There was no significant relationship between age and the development of sleep disorders in total score (r = -0.001; P < 0.985), but age had a relationship with insomnia (r = -0.146; P < 0.021) and oversleeping (r = 0.153; P < 0.015). Age and fatigue did not have a significant relationship as well (r = -0.044; P < 0.941). In addition, fatigue had a positive and significant relationship with depression (r = 0.52; P < 0.001), stress (r = 0.48; P < 0.001), and anxiety (r = 0.54; P < 0.001). The results of the regression analysis also showed that depression, stress, and anxiety predict 0.37% of the total variance of sleep disorders (F = 48.34; P < 0.001) and 0.35% of the total variance of fatigue (F = 44.64; P < 0.001). Our findings suggest that depression, stress, and anxiety play a significant role in predicting sleep disorders and fatigue among patients with MS. This study has been reported in accordance with the TREND checklist for nonrandomized trials.
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Affiliation(s)
- Nassim Zekibakhsh Mohammadi
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Amir Sam Kianimoghadam
- Department of Clinical Psychology, Religion and Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Mikaeili
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | | | - Mahdieh Jafari
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Abbas Masjedi-Arani
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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8
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Zambelli Z, Halstead EJ, Fidalgo AR, Mangar S, Dimitriou D. Telehealth delivery of adapted CBT-I for insomnia in chronic pain patients: a single arm feasibility study. Front Psychol 2024; 14:1266368. [PMID: 38274683 PMCID: PMC10808483 DOI: 10.3389/fpsyg.2023.1266368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Objectives A large proportion of individuals with chronic pain experience insomnia-related symptoms which can be persistent in nature, and negatively impact one's quality of life. This single arm trial aimed to investigate the feasibility and preliminary efficacy of CBT-I, adapted for people with chronic musculoskeletal pain, delivered via telehealth. Methods We conducted a single arm feasibility trial in which 10 adult women (M age = 50.76 years, SD = 8.03 years) with self-reported insomnia and a diagnosed chronic musculoskeletal chronic pain received six CBT-I individual treatment sessions over 6-10 weeks. Treatment was delivered via telehealth. Participants completed weekly sleep diaries, and self-reported measures of insomnia, pain, anxiety and depression pre-treatment, post-treatment, and one-month follow-up. Results The trial yielded, high levels of compliance with intervention protocols, and affirmative feedback on satisfaction which demonstrated feasibility. The enrolment rate into the study was 37% (27 participants screened, 10 participants enrolled). The intervention was associated with statistically and clinically meaningful improvements in self-reported insomnia severity. There were statistically significant improvements in sleep efficiency, wake after sleep onset, sleep onset latency, anxiety and depression. Conclusion Adapted CBT-I delivered via telehealth may be a feasible, acceptable, and efficacious therapeutic approach for individuals with co-existent sleep and chronic pain. Future trials should adopt a randomized design against usual care.
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Affiliation(s)
- Zoe Zambelli
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
| | - Elizabeth J. Halstead
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
| | | | - Stephen Mangar
- Department of Clinical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Psychology and Human Development, UCL-Institute of Education, London, United Kingdom
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Hancock J, Sirbu C, Kerr PL. Depression, Cancer, Inflammation, and Endogenous Opioids: Pathogenic Relationships and Therapeutic Options. ADVANCES IN NEUROBIOLOGY 2024; 35:435-451. [PMID: 38874735 DOI: 10.1007/978-3-031-45493-6_21] [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: 06/15/2024]
Abstract
Endogenous opioids and their associated receptors form a system that maintains survival by positively reinforcing behaviors that are vital to life. Cancer and cancer treatment side effects capitalize on this system pathogenically, leading to maladaptive biological responses (e.g., inflammation), as well as cognitive and emotional consequences, most notably depression. Psychologists who treat people with cancer frequently find depression to be a primary target for intervention. However, in people with cancer, the etiology of depression is unique and complex. This complexity necessitates that psycho-oncologists have a fundamental working knowledge of the biological substrates that underlie depression/cancer comorbidity. Building on other chapters in this volume pertaining to cancer and endogenous opioids, this chapter focuses on the clinical applications of basic scientific findings.
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Affiliation(s)
- Jennifer Hancock
- Center for Cancer Research, Charleston Area Medical Center, Charleston, WV, USA.
| | - Cristian Sirbu
- Center for Cancer Research, Charleston Area Medical Center, Charleston, WV, USA
| | - Patrick L Kerr
- West Virginia University School of Medicine-Charleston, Charleston, WV, USA
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Elia C, de Girolamo L, Clarisse B, Galin M, Rehel S, Clochon P, Doidy F, Segobin S, Viader F, Naveau M, Delcroix N, Segura-Djezzar C, Grellard JM, Lequesne J, Etard O, Martin T, Quarck G, Eustache F, Joly F, Giffard B, Perrier J. Effects of sleep disturbances and circadian rhythms modifications on cognition in breast cancer women before and after adjuvant chemotherapy: the ICANSLEEP-1 protocol. BMC Cancer 2023; 23:1178. [PMID: 38041077 PMCID: PMC10693085 DOI: 10.1186/s12885-023-11664-x] [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: 07/05/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Many patients treated for breast cancer (BC) complain about cognitive difficulties affecting their daily lives. Recently, sleep disturbances and circadian rhythm disruptions have been brought to the fore as potential contributors to cognitive difficulties in patients with BC. Yet, studies on these factors as well as their neural correlates are scarce. The purpose of the ICANSLEEP-1 (Impact of SLEEP disturbances in CANcer) study is to characterize sleep using polysomnography and its relationship with the evolution of cognitive functioning at both the behavioral and the neuroanatomical levels across treatment in BC patients treated or not with adjuvant chemotherapy. METHODS ICANSLEEP-1 is a longitudinal study including BC patients treated with adjuvant chemotherapy (n = 25) or not treated with adjuvant chemotherapy (n = 25) and healthy controls with no history of BC (n = 25) matched for age (45-65 years old) and education level. The evaluations will take place within 6 weeks after inclusion, before the initiation of chemotherapy (for BC patients who are candidates for chemotherapy) or before the first fraction of radiotherapy (for BC patients with no indication for chemotherapy) and 6 months later (corresponding to 2 weeks after the end of chemotherapy). Episodic memory, executive functions, psychological factors, and quality of life will be assessed with validated neuropsychological tests and self-questionnaires. Sleep quantity and quality will be assessed with polysomnography and circadian rhythms with both actigraphy and saliva cortisol. Grey and white matter volumes, as well as white matter microstructural integrity, will be compared across time between patients and controls and will serve to further investigate the relationship between sleep disturbances and cognitive decline. DISCUSSION Our results will help patients and clinicians to better understand sleep disturbances in BC and their relationship with cognitive functioning across treatment. This will aid the identification of more appropriate sleep therapeutic approaches adapted to BC patients. Improving sleep in BC would eventually help limit cognitive deficits and thus improve quality of life during and after treatments. TRIAL REGISTRATION NCT05414357, registered June 10, 2022. PROTOCOL VERSION Version 1.2 dated March 23, 2022.
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Affiliation(s)
- Clara Elia
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, 14000, France
| | - Laura de Girolamo
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, 14000, France
| | - Bénédicte Clarisse
- Clinical Research Department, Centre François Baclesse, Caen, 14076, France
| | - Melvin Galin
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, 14000, France
- Normandie Université, UNICAEN, INSERM, COMETE U1075, CYCERON, CHU Caen, Caen, 14000, France
| | - Stéphane Rehel
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, 14000, France
| | - Patrice Clochon
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, 14000, France
| | - Franck Doidy
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, 14000, France
| | - Shailendra Segobin
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, 14000, France
| | - Fausto Viader
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, 14000, France
- Neurology Department, CHU de Caen, Caen, 14000, France
| | - Mikaël Naveau
- Normandie Université, UNICAEN, CNRS UAR 3408, INSERM US-50, GIP Cyceron, Caen, France
| | - Nicolas Delcroix
- Normandie Université, UNICAEN, CNRS UAR 3408, INSERM US-50, GIP Cyceron, Caen, France
| | | | | | - Justine Lequesne
- Clinical Research Department, Centre François Baclesse, Caen, 14076, France
| | - Olivier Etard
- Normandie Université, UNICAEN, INSERM, COMETE U1075, CYCERON, CHU Caen, Caen, 14000, France
| | - Tristan Martin
- Faculty of Sciences and Technologies, Le Mans University, Avenue Olivier Messiaen, Movement, Interactions, Performance, Le Mans, 4334, 72000, MIP, EA, France
| | - Gaëlle Quarck
- Normandie Université, UNICAEN, INSERM, COMETE U1075, CYCERON, CHU Caen, Caen, 14000, France
| | - Francis Eustache
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, 14000, France
| | - Florence Joly
- Clinical Research Department, Centre François Baclesse, Caen, 14076, France
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, Caen, 14076, France
- ANTICIPE (Interdisciplinary Research Unit for the Prevention and Treatment of Cancer), INSERM Unit 1086, Caen, France
| | - Bénédicte Giffard
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, 14000, France
- Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, Caen, 14076, France
- Pôle des Formations et de Recherche en Santé, 2 rue des Rochambelles, Caen Cedex, CS-14032, France
| | - Joy Perrier
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, 14000, France.
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Michaud AL, Bice B, Miklos E, McCormick K, Medeiros-Nancarrow C, Zhou ES, Recklitis CJ. Sleep Treatment Education Program for Young Adult Cancer Survivors (STEP-YA): Protocol for an Efficacy Trial. JMIR Res Protoc 2023; 12:e52315. [PMID: 38019571 PMCID: PMC10719817 DOI: 10.2196/52315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Young adult cancer survivors (YACS) are at elevated risk for chronic insomnia, even years after completing treatment. In addition to potential health consequences, insomnia can interrupt social, educational, and vocational development just as they are trying to "make up" for time lost to cancer. Cognitive behavioral therapy for insomnia (CBTI) is recommended as first-line treatment for insomnia but remains largely unavailable to YACS due to several barriers (ie, shortage of trained providers, geographic limitations, financial limitations). Traditional CBTI has not been adapted to meet YACS' unique developmental and circadian challenges. To improve availability of effective behavioral insomnia treatment for this population, we developed the Sleep Treatment Education Program for Young Adult Cancer Survivors (STEP-YA), a low-intensity educational intervention delivered virtually online. OBJECTIVE In this phase 2 "proof of concept" trial, primary aims are to test the efficacy of STEP-YA to improve insomnia symptoms and mood in YACS and assess the utility of individualized coaching to improve treatment effects. A secondary aim will explore participant variables associated with clinically significant response to STEP-YA. METHODS This 2-arm randomized prospective trial will enroll 74 off-treatment YACS aged 20 years to 39 years with clinically significant insomnia. Each participant completes the STEP-YA intervention in a 1-on-1 synchronous online session led by a trained interventionist following a structured outline. The 90-minute intervention presents educational information on the development of insomnia after cancer and offers specific suggestions for improving insomnia symptoms. During the session, participants review the suggestions and develop a personalized sleep action plan for implementing them. After the session, participants are randomized to either the coaching condition, in which they receive 2 telephone coaching sessions, or the no-coaching condition, which offers no subsequent coaching. The Insomnia Severity Index (ISI) and the Profile of Mood States: Short Form (POMS-SF) are assessed at baseline and 4 and 8 weeks postintervention. RESULTS Enrollment began in November 2022, with 28 participants currently enrolled. We anticipate recruitment will be completed in 2024. The primary endpoint is a change in ISI score from baseline to 8 weeks postintervention. The secondary endpoint is change in mood symptoms (POMS-SF) from baseline to 8 weeks postintervention. Change scores will be treated as continuous variables. Primary analyses will use ANOVA methods. A within-subjects analysis will examine if the STEP-YA intervention is associated with significant changes in insomnia and mood over time. A 2-way ANOVA will be used to evaluate the utility of coaching sessions to improve treatment effects. CONCLUSIONS Chronic insomnia has significant negative effects on YACS' medical, educational, and psychological functioning. STEP-YA aims to address their needs; study results will determine if the intervention warrants future effectiveness and dissemination studies and if individualized coaching is necessary for adequate treatment response. TRIAL REGISTRATION ClinicalTrials.gov NCT05358951: https://clinicaltrials.gov/study/NCT05358951. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52315.
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Affiliation(s)
- Alexis L Michaud
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
- Department of Psychology, Suffolk University, Boston, MA, United States
| | - Briana Bice
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
| | - Eva Miklos
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
| | - Katherine McCormick
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
| | | | - Eric S Zhou
- Perini Family Survivors' Center, Dana Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Vargas I, Egeler M, Walker J, Benitez DD. Examining the barriers and recommendations for integrating more equitable insomnia treatment options in primary care. FRONTIERS IN SLEEP 2023; 2:1279903. [PMID: 39210962 PMCID: PMC11361330 DOI: 10.3389/frsle.2023.1279903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Chronic insomnia is the most common sleep disorder, occurring in ~32 million people in the United States per annum. Acute insomnia is even more prevalent, affecting nearly half of adults at some point each year. The prevalence of insomnia among primary care patients is even higher. The problem, however, is that most primary care providers do not feel adequately knowledgeable or equipped to treat sleep-related concerns. Many providers have never heard of or have not been trained in cognitive behavioral therapy for insomnia or CBT-I (the first line treatment for insomnia). The focus of the current review is to summarize the factors contributing to why sleep health and insomnia treatment have been mostly neglected, identify how this has contributed to disparities in sleep health among certain groups, particularly racial and ethnic minorities and discuss considerations or potential areas of exploration that may improve access to behavioral sleep health interventions, particularly in primary care.
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Affiliation(s)
- Ivan Vargas
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
| | - Mara Egeler
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
| | - Jamie Walker
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
| | - Dulce Diaz Benitez
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, United States
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Cathcart-Rake EJ, Tevaarwerk AJ, Haddad TC, D'Andre SD, Ruddy KJ. Advances in the care of breast cancer survivors. BMJ 2023; 382:e071565. [PMID: 37722731 DOI: 10.1136/bmj-2022-071565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Breast cancer survivors may experience significant after effects from diagnoses of breast cancer and cancer directed therapies. This review synthesizes the evidence about optimal management of the sequelae of a diagnosis of breast cancer. It describes the side effects of chemotherapy and endocrine therapy and evidence based strategies for management of such effects, with particular attention to effects of therapies with curative intent. It includes strategies to promote health and wellness among breast cancer survivors, along with data to support the use of integrative oncology strategies. In addition, this review examines models of survivorship care and ways in which digital tools may facilitate communication between clinicians and patients. The strategies outlined in this review are paramount to supporting breast cancer survivors' quality of life.
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Jagielo AD, Benedict C, Spiegel D. Circadian, hormonal, and sleep rhythms: effects on cancer progression implications for treatment. Front Oncol 2023; 13:1269378. [PMID: 37746277 PMCID: PMC10514358 DOI: 10.3389/fonc.2023.1269378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Circadian, hormonal, and sleep rhythm disruptions are commonly experienced concerns among cancer patients throughout the cancer care continuum. This review aims to summarize the existing literature on circadian, hormonal, and sleep rhythms in the oncological population, focusing on circadian disruption and physiological and psychological abnormalities, disease progression, and chronomodulated treatment approaches. The findings demonstrate that subjectively and objectively measured circadian rhythm disruption is associated with adverse mental health and disease outcomes in patients with cancer. Chronomodulated chemotherapy, light therapy, cognitive behavioral therapy for insomnia, and physical activity have shown evidence of effectiveness in improving sleep, and occasionally, disease outcomes.
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Affiliation(s)
- Annemarie D. Jagielo
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, CA, Stanford, CA, United States
| | - Catherine Benedict
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, CA, Stanford, CA, United States
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, CA, Stanford, CA, United States
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Li X, Bao T, Garland SN, Li SQ, Yu J, Li Y, Mao JJ. Does expectancy affect insomnia treatment response in cancer survivors receiving acupuncture and cognitive behavioral therapy? J Cancer Surviv 2023; 17:826-835. [PMID: 36462115 PMCID: PMC11223715 DOI: 10.1007/s11764-022-01272-2] [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: 12/17/2021] [Accepted: 10/07/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Insomnia negatively affects quality of life in cancer survivors. Expectations of insomnia treatment efficacy may influence response to intervention. We sought to determine whether pre-treatment outcome expectancy predicts response to two non-pharmacological interventions for insomnia among cancer survivors. METHODS We analyzed data from a randomized clinical trial that compared acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) in cancer survivors. Patient expectancy was measured by the Mao Treatment Expectancy Scale (MTES) at baseline. Insomnia severity was assessed using the Insomnia Severity Index (ISI) at treatment completion (week 8). Multivariate linear regression was used to evaluate the associations between pre-treatment expectancy and ISI score at week, 8 adjusting for co-variates. RESULTS Expectancy for acupuncture and CBT-I were similar at baseline (acupuncture: 13.3 ± 4.0; CBT-I: 13.2 ± 2.9, p = 0.17). Greater baseline expectancy scores were associated with a greater and statistically significant insomnia severity reduction at week 8 in the acupuncture group (beta coefficients [Coef.] = - 0.35, 95% confidence interval [CI] = - 0.6 to - 0.1, p = 0.016) adjusted for co-variates. Baseline expectancy was not statistically associated with insomnia severity reduction in the CBT-I group (Coef. = - 0.2, 95% CI = - 0.7 to 0.2, p = 0.31). High expectancy was significantly associated with greater proportion of treatment responders at week 8 in the acupuncture group (76% vs. 38%, p = 0.001) but not in the CBT-I group (83% vs. 70%, p = 0.21). CONCLUSIONS Higher pre-treatment outcome expectancy predicted significantly greater insomnia improvement in patients receiving acupuncture but not in those receiving CBT-I. IMPLICATIONS FOR CANCER SURVIVORS Aligning treatment provision with expected outcomes may lead to personalized non-pharmacological insomnia management for cancer survivors.
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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
| | - Ting Bao
- 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
- Departments of Psychology and Oncology, Memorial University of Newfoundland, 232 Elizabeth Avenue, St. John’s, St. John’s, Newfoundland and Labrador A1B 3X9, Canada
| | - 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
| | - Jennifer Yu
- Clinical Tinking, Nucleus Global, 300 American Metro Boulevard, Suite 140, Hamilton, New Jersey, NY 08619, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 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
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Wang D, Deng Q, Chen H, Wang M, Liu Z, Wang H, Ouyang X. Profiles of depressive symptoms and influential factors among people living with HIV in China. BMC Public Health 2023; 23:151. [PMID: 36690976 PMCID: PMC9869583 DOI: 10.1186/s12889-023-15057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Depressive symptoms are highly prevalent among people living with HIV (PLWH). We leveraged Latent Profile Analysis (LPA) to identify profiles of depressive symptoms among PLWHs. We also investigated differences in psychological factors of interest, demographic characteristics, and HIV-related factors across patients' profiles. METHODS A cross-sectional study was conducted at one hospital and two designated prison facilities in Hunan province, China. A total sample of 533 PLWHs (320 recruited from the hospital, 213 recruited from prisons) completed the survey. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9). Family function, resilience, childhood trauma, demographic characteristics, and HIV-related factors were also evaluated. We conducted LPA and multinomial logistic regression analyses to: 1) identify distinct profiles for depressive symptoms; 2) identify demographic characteristics, and HIV-related, and psychological factors predicting PLWHs' likelihood to express a specific profile. RESULTS We identified three distinct profiles of depressive symptoms among PLWHs: severe symptoms (11.8%), moderate symptoms (40.5%), and low/no symptoms (47.7%). Moderate/ severe family dysfunction, low resilience, experiencing emotional abuse and neglect were more likely to fall in the "severe symptoms" rather than the "low/no symptoms" profile. In addition, severe family dysfunction, low resilience, and experiencing emotional neglect indicated a higher likelihood of being classified in the "moderate symptoms" profile, compared to the "low/no symptoms" profile. CONCLUSION Identifying profiles of depressive symptoms among PLWHs using the PHQ-9 items allows for understanding of the distinct paths of development of depressive symptoms and for developing tailored prevention and intervention programs for PLWHs.
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Affiliation(s)
- Dongfang Wang
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- National Technology Institute On Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, China
| | - Qijian Deng
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- National Technology Institute On Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Huilin Chen
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Min Wang
- Institute for HIV/AIDS, the First Hospital of Changsha, Changsha, China
| | - Zhening Liu
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
- National Technology Institute On Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China
| | - Honghong Wang
- Xiangya Nursing School, Central South University, Changsha, China
| | - Xuan Ouyang
- Department of Psychiatry, National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China.
- National Technology Institute On Mental Disorders, the Second Xiangya Hospital of Central South University, Changsha, China.
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Jakobsen G, Sjue K, Paulsen Ø, Kaasa S, Hjermstad MJ, Klepstad P. Zopiclone versus placebo for short-term treatment of insomnia in patients with advanced cancer-a double-blind, randomized placebo-controlled clinical multicenter phase IV trial. Support Care Cancer 2023; 31:60. [PMID: 36534165 PMCID: PMC9763131 DOI: 10.1007/s00520-022-07537-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Insomnia is frequent in patients with advanced cancer, and a variety of pharmacological agents is used to treat this condition. Still, few clinical trials have investigated the effectiveness of pharmacological sleep therapies in this patient group. We aimed to study the short-term effectiveness of zopiclone on sleep quality in patients with advanced cancer who report insomnia. METHODS A randomized, double-blind, placebo-controlled, parallel-group, multicenter, phase IV clinical trial in adult patients with metastatic malignant disease and insomnia. Patients were treated with zopiclone or placebo for six subsequent nights. Primary end point was patient-reported sleep quality during the final study night (NRS 0-10). Secondary end points were patient-reported sleep onset latency (SOL) and total sleep time (TST). RESULTS Forty-one patients were randomized, with 18 being analyzed in the zopiclone group and 21 in the placebo group. Median age was 66, median Karnofsky performance score was 80, and 56% were male. Mean sleep quality at end of study was 2.9 (CI 2.3 to 3.8) in the zopiclone group and 4.5 (CI 3.6 to 5.4) in the placebo group (p = 0.021). At end of study, SOL was significantly different between the treatment groups: zopiclone 29 min (CI 13 to 51) and placebo 62 min (CI 40 to 87) (p = 0.045). TST was not significantly different across groups: zopiclone 449 min (403 to 496) and placebo 411 min (CI 380 to 440) (p = 0.167). CONCLUSION Zopiclone improved short-term patient-reported sleep quality in this cohort of patients with advanced cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02807922.
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Affiliation(s)
- Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), and Cancer Clinic, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Karin Sjue
- Department of Oncology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ørnulf Paulsen
- Institute of Clinical Medicine, European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, Oslo, Norway, University of Oslo, Oslo, Norway, and Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | - Stein Kaasa
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marianne Jensen Hjermstad
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway, and European Palliative Care Research Centre, Department of Oncology, Oslo University Hospital, Oslo, Norway, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Pål Klepstad
- Department of Anaesthesiology and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, and Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology NTNU, Trondheim, Norway
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Luo X, Xiao P, Li L, Duan Y, Sk CA, Xie J. Research progress in circadian rhythms in the application of psychological rehabilitation of cancer patients. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1740-1747. [PMID: 36748386 PMCID: PMC10930277 DOI: 10.11817/j.issn.1672-7347.2022.220245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 02/08/2023]
Abstract
The psychological distress of cancer patients seriously affects their therapeutic effects. Effective psychological rehabilitation of cancer patients significantly improves their survival chance and quality of life. Circadian rhythm results from adaptation to the environment during the organism's evolution. When the endogenous clock system is disrupted or the external environment is changed, the body and the environment are out of synchronization, and the circadian rhythm will be disrupted. Circadian rhythm disorder is a common phenomenon in cancer patients, and the changes of circadian rhythm are closely related to their psychological distress. Many studies believe that the circadian rhythm disorder of cancer patients may directly or indirectly affect their psychology through various mechanisms, and targeted intervention by regulating the circadian rhythm of patients may be an essential means to promote the psychological rehabilitation.
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Affiliation(s)
- Xiaofei Luo
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013.
- Xiangya Nursing School, Central South University, Changsha 410013.
| | - Panpan Xiao
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Lijun Li
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Yinglong Duan
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Cheng Andy Sk
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Jianfei Xie
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013.
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King AL, Shuboni-Mulligan DD, Vera E, Crandon S, Acquaye AA, Boris L, Burton E, Choi A, Christ A, Grajkowska E, Jammula V, Leeper HE, Lollo N, Penas-Prado M, Reyes J, Theeler B, Wall K, Wu J, Gilbert MR, Armstrong TS. Exploring the prevalence and burden of sleep disturbance in primary brain tumor patients. Neurooncol Pract 2022; 9:526-535. [PMID: 36388423 PMCID: PMC9665069 DOI: 10.1093/nop/npac049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Sleep disturbance (SD) is common in patients with cancer and has been associated with worse clinical outcomes. This cross-sectional study explored the prevalence of SD in a primary brain tumor (PBT) population, identified associated demographic and clinical characteristics, and investigated co-occurrence of SD with other symptoms and mood disturbance. METHODS Demographic, clinical characteristics, MD Anderson Symptom Inventory-Brain Tumor, and Patient Reported Outcome Measurement Information System Depression and Anxiety Short-Forms were collected from PBT patients at study entry. Descriptive statistics, Chi-square tests, and independent t-tests were used to report results. RESULTS The sample included 424 patients (58% male, 81% Caucasian) with a mean age of 49 years (range 18-81) and 58% with high-grade gliomas. Moderate-severe SD was reported in 19% of patients and was associated with younger age, poor Karnofsky Performance Status, tumor progression on MRI, and active corticosteroid use. Those with moderate-severe SD had higher overall symptom burden and reported more moderate-severe symptoms. These individuals also reported higher severity in affective and mood disturbance domains, with 3 to 4 times higher prevalence of depressive and anxiety symptoms, respectively. The most frequently co-occurring symptoms with SD were, drowsiness, and distress, though other symptoms typically associated with tumor progression also frequently co-occurred. CONCLUSIONS PBT patients with moderate-severe SD are more symptomatic, have worse mood disturbance, and have several co-occurring symptoms. Targeting interventions for sleep could potentially alleviate other co-occurring symptoms, which may improve life quality for PBT patients. Future longitudinal work examining objective and detailed subjective sleep reports, as well as underlying genetic risk factors, will be important.
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Affiliation(s)
- Amanda L King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Dorela D Shuboni-Mulligan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alvina A Acquaye
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa Boris
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, Maryland, USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexa Christ
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Varna Jammula
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Heather E Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicole Lollo
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Brett Theeler
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Kathleen Wall
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc., Frederick, Maryland, USA
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Perrier J, Giffard B, Wu LM, Savard J, Amidi A. Editorial: Sleep and circadian rhythms in cancer patients and their relationship with quality of life. Front Neurosci 2022; 16:1060184. [DOI: 10.3389/fnins.2022.1060184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022] Open
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Rehman A, Drake CL, Shiramizu V, Fleming L. Sleep reactivity predicts insomnia in patients diagnosed with breast cancer. J Clin Sleep Med 2022; 18:2597-2604. [PMID: 35912701 PMCID: PMC9622996 DOI: 10.5664/jcsm.10170] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the role of sleep reactivity as a predictor of insomnia in patients diagnosed with breast cancer. METHODS A total of 173 women with breast cancer participated and were followed up over a period of 9 months. At baseline, participants were assigned to a high (n = 114) or low (n = 59) sleep reactivity group, based on their responses to the Ford Insomnia Response to Stress Test (FIRST). We assessed whether these FIRST groupings (high/low sleep reactivity) predicted changes in insomnia over time using the Insomnia Severity Index. We also tested if these FIRST groupings predicted insomnia disorder (using Insomnia Severity Index cutoffs) at 3 different time points (T3, T6, and T9). RESULTS Individuals with high sleep reactivity were more likely to experience a worsening of insomnia. Using logistic regression, we also found that FIRST grouping predicted insomnia disorder. Results remained significant after controlling for estimated premorbid sleep, age, and whether someone had chemotherapy. CONCLUSIONS Our study shows that sleep reactivity may be a robust predictor of insomnia within breast cancer populations. Sleep reactivity should be considered in routine clinical assessments as a reliable way to identify patients at risk of developing insomnia. This would facilitate early sleep intervention for those patients who are considered high risk. CITATION Rehman A, Drake CL, Shiramizu V, Fleming L. Sleep reactivity predicts insomnia in patients diagnosed with breast cancer. J Clin Sleep Med. 2022;18(11):2597-2604.
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Affiliation(s)
- Aliyah Rehman
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Christopher L. Drake
- Henry Ford Health System, Sleep Disorders and Research Center, Detroit, Michigan
| | - Victor Shiramizu
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Leanne Fleming
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom
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22
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David MC, Mattos MS, Souto JJ, Brito SA, Leite ES, Valença EN, Galdino GS, Sampaio PG, Moura DM, Miguel MA, Araújo JF, Franco CI, Matos RJ. Changes in the rest-activity rhythm in migraine patients are associated with anxiety symptoms. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2022; 44:611-620. [PMID: 36683002 PMCID: PMC9851770 DOI: 10.47626/1516-4446-2021-2367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/06/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To characterize rest-activity rhythm in chronic migraine (CM) and to investigate the relationship between this rhythm and depressive and anxiety symptoms in patients with CM. METHODS This was a study of adults aged 20 to 40 years. The rest-activity rhythm of patients with CM (n=23) and non-headache controls (NH, n=23) was assessed by actigraphy for 15 days, and they completed the following assessments: Visual Analogue Scale for pain intensity; Headache Diary; Headache Impact Test-6; Morningness-Eveningness Questionnaire; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Beck Depression Inventory; and State-Trait Anxiety Inventory. RESULTS Patients with CM showed less activity over 24 hours and more fragmented sleep. Reduced interdaily stability of the rest-activity rhythm was observed, with less robustness of this rhythm in the CM group. Multiple linear regressions revealed a significant association between the rest-activity rhythm and trait anxiety variables in patients with CM, specifically regarding the relative amplitude of the cycle, activity throughout 24 hours and during sleep, and robustness of the rest-activity rhythm. CONCLUSIONS Our findings provide evidence that the robustness of the rest-activity rhythm, activity throughout 24 hours, and sleep fragmentation are associated with trait anxiety in patients with CM.
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Affiliation(s)
- Mírian C.M.M. David
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento (Posneuro), Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Marina S.B. Mattos
- Departamento de Fisioterapia, Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brazil
| | - Jandirlly J.S. Souto
- Programa de Pós-Graduação em Psicologia Social, Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil
| | - Sarah A.C.F. Brito
- Departamento de Fisioterapia, Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brazil
| | - Etcheverry S. Leite
- Departamento de Fisioterapia, Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brazil
| | | | - Gilma S. Galdino
- Departamento de Fisioterapia, Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brazil
| | - Patrick G.G. Sampaio
- Faculdade de Ciências Médicas de Campina Grande (FCM-CG), Centro Universitário UNIFACISA, Campina Grande, PB, Brazil
| | - Daniel M.C. Moura
- Faculdade de Ciências Médicas de Campina Grande (FCM-CG), Centro Universitário UNIFACISA, Campina Grande, PB, Brazil
| | - Mário A.L. Miguel
- Departamento de Fisiologia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - John F. Araújo
- Departamento de Fisiologia, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Carlúcia I.F. Franco
- Departamento de Fisioterapia, Universidade Estadual da Paraíba (UEPB), Campina Grande, PB, Brazil
| | - Rhowena J.B. Matos
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento (Posneuro), Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil,Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia (UFRB), Santo Antônio de Jesus, BA, Brazil,Correspondence: Rhowena Jane Barbosa de Matos, Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia (UFRB), Av. Carlos Amaral, 1015, Cajueiro, CEP 44574-490, Santo Antônio de Jesus, BA, Brazil. E-mail:
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Fraile-Martinez O, Alvarez-Mon MA, Garcia-Montero C, Pekarek L, Guijarro LG, Lahera G, Saez MA, Monserrat J, Motogo D, Quintero J, Alvarez-Mon M, Ortega MA. Understanding the basis of major depressive disorder in oncological patients: Biological links, clinical management, challenges, and lifestyle medicine. Front Oncol 2022; 12:956923. [PMID: 36185233 PMCID: PMC9524231 DOI: 10.3389/fonc.2022.956923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
In recent years, the incidence of different types of cancer and patient survival have been rising, as well as their prevalence. The increase in survival in recent years exposes the patients to a set of stressful factors such as more rigorous follow-up and more aggressive therapeutic regimens that, added to the diagnosis of the disease itself, cause an increase in the incidence of depressive disorders. These alterations have important consequences for the patients, reducing their average survival and quality of life, and for these reasons, special emphasis has been placed on developing numerous screening tests and early recognition of depressive symptoms. Despite that cancer and major depressive disorder are complex and heterogeneous entities, they also share many critical pathophysiological mechanisms, aiding to explain this complex relationship from a biological perspective. Moreover, a growing body of evidence is supporting the relevant role of lifestyle habits in the prevention and management of both depression and cancer. Therefore, the present study aims to perform a thorough review of the intricate relationship between depression and cancer, with a special focus on its biological links, clinical management, challenges, and the central role of lifestyle medicine as adjunctive and preventive approaches to improve the quality of life of these patients.
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Affiliation(s)
- Oscar Fraile-Martinez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Miguel A. Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- *Correspondence: Miguel A. Alvarez-Mon, ;
| | - Cielo Garcia-Montero
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Leonel Pekarek
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Oncology Service, Guadalajara University Hospital, Guadalajara, Spain
| | - Luis G. Guijarro
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Unit of Biochemistry and Molecular Biology, Department of System Biology, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas (CIBEREHD), University of Alcalá, Alcala de Henares, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Psychiatry Service, Center for Biomedical Research in the Mental Health Network, University Hospital Príncipe de Asturias Centro de Investigación Biomédica en Red en el Área temática de Salud Mental (CIBERSAM), Alcalá de Henares, Spain
| | - Miguel A. Saez
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Pathological Anatomy Service, Central University Hospital of Defence-UAH Madrid, Alcala de Henares, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Domitila Motogo
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
| | - Javier Quintero
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
- Department of Legal Medicine and Psychiatry, Complutense University, Madrid, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Immune System Diseases-Rheumatology, Oncology Service an Internal Medicine, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas (CIBEREHD), University Hospital Príncipe de Asturias, Alcala de Henares, Spain
| | - Miguel A. Ortega
- Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, Spain
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
- Cancer Registry and Pathology Department, Principe de Asturias University Hospital, Alcala de Henares, Spain
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Xu R, Gu Q, Xiao S, Zhao P, Ding Z. Patient-reported gastrointestinal symptoms following surgery for gastric cancer and the relative risk factors. Front Oncol 2022; 12:951485. [PMID: 36185286 PMCID: PMC9516295 DOI: 10.3389/fonc.2022.951485] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/23/2022] [Indexed: 12/09/2022] Open
Abstract
PurposeThe study aims to assess the incidence of short-term patient-reported postoperative gastrointestinal symptoms (PGISs) after gastric cancer surgery and explore the relative risk factors for the symptoms.MethodsPatients with radical gastrectomy were included for this retrospective and observational study. Symptoms extracted from the MD Anderson Symptom Inventory Gastrointestinal Cancer Module (MDASI-GI) were collected in postdischarge week (PDW) 1 and postoperative month (POM) 1. The distributing states of symptoms were analyzed in PDW1 and POM1. Logistic regression models were used to identify risk factors for PGISs.ResultsAmong 356 patients with complete interviews, 156 (43.8%) patients reported abdominal distention in PDW1, which was significantly higher than patients in POM1 [103 (28.9%), p < 0.001]. Pain (15.2% vs. 9.8%), dysphagia (5.6% vs. 7.0%), diarrhea (3.7% vs. 3.4%), and vomiting (2.5% vs. 2.8%) had no significant differences between PDW1 and POM1. Logistic models found that risk factors for PGISs were total gastrectomy [odds ratio (OR): 1.948; 95% CI: 1.097–3.459; p = 0.023] and disturbed sleep (OR: 3.116; 95% CI: 1.831–5.303; p < 0.001) in PDW1 and female gender (OR: 1.726; 95% CI: 1.071–2.782; p = 0.025), total gastrectomy (OR: 1.729; 95% CI: 1.055–2.834; p = 0.030), and disturbed sleep (OR: 3.533; 95% CI: 1.757–7.106; p < 0.001) in POM1.ConclusionsThe main symptom after gastric cancer surgery was abdominal distention. The relative risk factors for gastrointestinal symptoms after gastric cancer surgery were total gastrectomy and disturbed sleep. Timely symptom intervention may improve the quality of life of postgastrectomy patients.
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An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research. Cancers (Basel) 2022; 14:cancers14163933. [PMID: 36010925 PMCID: PMC9406296 DOI: 10.3390/cancers14163933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary This review focuses on sleep in patients with advanced cancer. Cancer patients experience multiple symptoms and they receive concomitant medications. These are all factors that may affect sleep. In this paper, we present recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that may contribute to insomnia. Sleep is an essential aspect of health-related quality of life; therefore, it is important for health care providers to focus on sleep to improve patient care. Abstract Patients with advanced cancer experience multiple symptoms, with fluctuating intensity and severity during the disease. They use several medications, including opioids, which may affect sleep. Sleep disturbance is common in cancer patients, decreases the tolerability of other symptoms, and impairs quality of life. Despite its high prevalence and negative impact, poor sleep quality often remains unrecognized and undertreated. Given that sleep is an essential aspect of health-related quality of life, it is important to extend both the knowledge base and awareness among health care providers in this field to improve patient care. In this narrative review, we provide recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that contribute to insomnia. We also present direct implications for health care providers working in palliative care and for future research.
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Vaughan E, Ftanou M, Lewin J, Murnane A, Berger I, Wiley JF, Hickey M, Bullen D, Jefford M, Goldin J, Stonehouse J, Thompson K. AYA 'Can-Sleep' programme: protocol for a stepped-care, cognitive behavioural therapy-based approach to the management of sleep difficulties in adolescents and young adults with cancer. Pilot Feasibility Stud 2022; 8:159. [PMID: 35902975 PMCID: PMC9331489 DOI: 10.1186/s40814-022-01128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/15/2022] [Indexed: 11/27/2022] Open
Abstract
Background Sleep problems are reported in up to 50% of adolescents and young adults (AYA) with cancer. Cognitive behavioural therapy for insomnia (CBTi) is considered the gold-standard treatment. In the AYA population, CBTi is associated with improvements in insomnia, daytime sleepiness, fatigue and quality of life. In adults, stepped-care interventions can improve accessibility to CBTi. This study aims to evaluate the acceptability and feasibility of a stepped-care CBTi programme in AYA with cancer. Methods and analysis AYA (target N = 80) aged 16–25 with a diagnosis of cancer will be screened using the Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS). When sleep difficulties are identified by the ISI and/or ESS, they will be screened for obstructive sleep apnoea and restless leg syndrome and referred to a sleep service if indicated. The remainder with sleep difficulties will be offered a stepped-care sleep programme including CBT self-management and coaching (first step). Participants will then be rescreened at 5 weeks, and those with ongoing sleep difficulties will be offered individualised CBT (second step). Recruitment and retention rates, adherence to intervention and time taken to deliver screening and intervention will be collected to assess the feasibility of the programme. AYA and clinicians will complete evaluation surveys to assess the acceptability of the AYA Can-Sleep programme. Discussion We seek to contribute to the evidence base regarding screening and treatment of sleep difficulties in the AYA population by implementing the AYA Can-Sleep programme and determining its feasibility and acceptability as an approach to care in an Adolescent & Young Adult Cancer Service.
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Affiliation(s)
- Emma Vaughan
- Psychosocial Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Maria Ftanou
- Psychosocial Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Jeremy Lewin
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andrew Murnane
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ilana Berger
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Joshua F Wiley
- Behavioural Medicine Unit, Monash University, Melbourne, Victoria, Australia
| | - Martha Hickey
- Women's Gynaecology Research Centre, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Dani Bullen
- Psychosocial Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Jefford
- University of Melbourne, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Health Services Research & Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jeremy Goldin
- Respiratory Medicine and Sleep Disorders, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jeremy Stonehouse
- Respiratory Medicine and Sleep Disorders, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,University of Melbourne, Melbourne, Victoria, Australia.
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Evaluating Patterns and Factors Related to Sleep Disturbances in Prostate Cancer Patients. Healthcare (Basel) 2022; 10:healthcare10050832. [PMID: 35627969 PMCID: PMC9140820 DOI: 10.3390/healthcare10050832] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Prostate cancer patients may experience disturbed sleep as a result of their diagnosis or treatment. This study sought to evaluate disturbed sleep and excessive daytime sleepiness in newly diagnosed patients and those receiving androgen deprivation therapy (ADT). This study was conducted with 74 patients. Subjective data using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) and actigraphy data on ADT/ADT-naïve patients were collected. The prevalence of poor sleep quality, determined from PSQI and ESS scores, was 50% and 16.7% respectively. Those on ADT (n = 20) had poorer sleep quality as determined by significantly higher PSQI scores (70 vs. 40% scoring > 5) and were more likely to have poor sleep quality, sleep latency, and sleep efficiency than ADT-naïve patients (n = 40). Actigraphy data showed that ADT patients slept significantly longer (7.7 vs. 6.8 h), experienced a higher Fragmentation Index (48.3 vs. 37.4%), and had longer daytime nap duration (64.1 vs. 45.2 min) than ADT-naïve patients. The use of objective measures such as actigraphy in the clinical arena is recommended and may be used as a valuable tool for research into sleep assessment in prostate cancer patients.
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Fox RS, Gaumond JS, Zee PC, Kaiser K, Tanner EJ, Ancoli-Israel S, Siddique J, Penedo FJ, Wu LM, Reid KJ, Parthasarathy S, Badger TA, Rini C, Ong JC. Optimizing a Behavioral Sleep Intervention for Gynecologic Cancer Survivors: Study Design and Protocol. Front Neurosci 2022; 16:818718. [PMID: 35310101 PMCID: PMC8931410 DOI: 10.3389/fnins.2022.818718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep difficulties, particularly symptoms of insomnia and circadian disruption, are among the primary complaints of gynecologic cancer survivors before, during, and after treatment. Moreover, difficulty sleeping has been linked to poorer health-related quality of life and elevated symptom burden in this population. Although leading behavioral sleep interventions have demonstrated efficacy among cancer survivors, up to 50% of survivors are non-adherent to these treatments, likely because these interventions require labor-intensive behavior and lifestyle changes. Therefore, there is a need for more effective and acceptable approaches to diminish sleep disturbance among cancer survivors. This manuscript describes the methodology of a two-part study guided by the Multiphase Optimization Strategy (MOST) framework to identify a streamlined behavioral sleep intervention for gynecologic cancer survivors. Three candidate intervention components previously shown to decrease sleep disturbance will be evaluated, including sleep restriction, stimulus control, and systematic bright light exposure. Participants will be adult women with a history of non-metastatic gynecologic cancer who have completed primary treatment and who report current poor sleep quality. Fifteen participants will be recruited for Part 1 of the study, which will utilize qualitative methods to identify barriers to and facilitators of intervention adherence. Results will inform changes to the delivery of the candidate intervention components to promote adherence in Part 2, where 80 participants will be recruited and randomized to one of eight conditions reflecting every possible combination of the three candidate intervention components in a full factorial design. Participants will complete assessments at baseline, post-intervention, and 3-months post-intervention. Part 2 results will identify the combination of candidate intervention components that yields the most efficacious yet efficient 6-week intervention for diminishing sleep disturbance. This is the first known study to apply the MOST framework to optimize a behavioral sleep intervention and will yield a resource-efficient treatment to diminish sleep disturbance, improve health-related quality of life, and decrease symptom burden among gynecologic cancer survivors. ClinicalTrials.gov Identifier: NCT05044975.
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Affiliation(s)
- Rina S. Fox
- Division of Community and Systems Health Science, University of Arizona College of Nursing, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- *Correspondence: Rina S. Fox,
| | - Julia S. Gaumond
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Phyllis C. Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Karen Kaiser
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
| | - Edward J. Tanner
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Juned Siddique
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Frank J. Penedo
- Department of Medicine and Psychology and Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Lisa M. Wu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - Kathryn J. Reid
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sairam Parthasarathy
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, AZ, United States
- University of Arizona Health Sciences – Center for Sleep and Circadian Science, University of Arizona, Tucson, AZ, United States
| | - Terry A. Badger
- Division of Community and Systems Health Science, University of Arizona College of Nursing, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
| | - Christine Rini
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
| | - Jason C. Ong
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Nox Health, Suwanee, GA, United States
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Carroll JE, Bower JE, Ganz PA. Cancer-related accelerated ageing and biobehavioural modifiers: a framework for research and clinical care. Nat Rev Clin Oncol 2022; 19:173-187. [PMID: 34873313 PMCID: PMC9974153 DOI: 10.1038/s41571-021-00580-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 12/15/2022]
Abstract
A growing body of evidence indicates that patients with cancer who receive cytotoxic treatments (such as chemotherapy or radiotherapy) have an increased risk of accelerated physical and cognitive ageing. Furthermore, accelerated biological ageing is a suspected driving force behind many of these observed effects. In this Review, we describe the mechanisms of biological ageing and how they apply to patients with cancer. We highlight the important role of specific behavioural factors, namely stress, sleep and lifestyle-related factors such as physical activity, weight management, diet and substance use, in the accelerated ageing of patients with cancer and cancer survivors. We also present a framework of how modifiable behaviours could operate to either increase the risk of accelerated ageing, provide protection, or promote resilience at both the biological level and in terms of patient-reported outcomes.
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Affiliation(s)
- Judith E Carroll
- Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behaviour, University of California, Los Angeles, CA, USA.
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA.
| | - Julienne E Bower
- Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behaviour, University of California, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Patricia A Ganz
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
- Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Department of Medicine (Hematology-Oncology), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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The relationship between sleep hygiene, mood, and insomnia symptoms in men with prostate cancer. Support Care Cancer 2022; 30:4055-4064. [PMID: 35064327 DOI: 10.1007/s00520-021-06680-1] [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] [Received: 06/28/2021] [Accepted: 11/03/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE Insomnia symptoms are commonly experienced by men after prostate cancer (PCa) treatment. Here we explored how sleep hygiene behaviours and psychological symptoms are associated with insomnia symptoms in PCa patients. METHODS An online survey was posted on social media and sent to mailing lists of PCa and general cancer organisations. The survey collected information on demographic, sleep hygiene, and psychological symptoms using validated questionnaires. RESULTS Data from 142 participants were compared based on the absence (age = 68.3 ± 8.9 years) and presence (age = 66.6 ± 9.0 years) of insomnia symptoms. Participants with insomnia symptoms had significantly higher levels of anxiety, depression, fatigue, and sleepiness as well as poorer sleep hygiene than those without insomnia symptoms. Control variables (age, number of comorbidities, and BMI) accounted for 11.9% of the variance in insomnia symptoms. Including treatment history contributed to an additional 1.6% of the variance in insomnia symptoms. Adding sleepiness, fatigue, anxiety, and depressive symptoms to the model explained an additional 44.6% of the variance in insomnia symptoms. Furthermore, including the sleep hygiene item 'I think, plan, or worry when I am in bed' and 'I sleep in an uncomfortable bedroom' explained an additional 3.6% of the variance in insomnia symptoms. CONCLUSIONS Poor sleep hygiene, fatigue, sleepiness, anxiety, and depressive symptoms were all associated with worse insomnia symptoms in PCa patients. Improving sleep hygiene and treating psychological conditions may potentially help prevent and/or alleviate insomnia symptoms in PCa patients.
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A multidisciplinary perspective on the complex interactions between sleep, circadian, and metabolic disruption in cancer patients. Cancer Metastasis Rev 2021; 40:1055-1071. [PMID: 34958429 PMCID: PMC8825432 DOI: 10.1007/s10555-021-10010-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/08/2021] [Indexed: 01/24/2023]
Abstract
Sleep is a basic need that is frequently set aside in modern societies. This leads to profound but complex physiological maladaptations in the body commonly referred to as circadian disruption, which recently has been characterized as a carcinogenic factor and reason for poor treatment outcomes, shortened survival, and reduced quality of life in cancer patients. As sleep and circadian physiology in cancer patients spans several disciplines including nursing science, neurology, oncology, molecular biology and medical technology, there is a lack of comprehensive and integrated approaches to deal with this serious and growing issue and at best a fractionated understanding of only part of the problem among researchers within each of these segments. Here, we take a multidisciplinary approach to comprehensively review the diagnosis and impact of sleep and circadian disruption in cancer patients. We discuss recent discoveries on molecular regulation of the circadian clock in healthy and malignant cells, the neurological and endocrine pathways controlling sleep and circadian rhythmicity, and their inputs to and outputs from the organism. The benefits and drawbacks of the various technologies, devices, and instruments used to assess sleep and circadian function, as well as the known consequences of sleep disruption and how sleep can be corrected in cancer patients, will be analyzed. We will throughout the review highlight the extensive crosstalk between sleep, circadian rhythms, and metabolic pathways involved in malignancy and identify current knowledge gaps and barriers for addressing the issue of sleep and circadian disruption in cancer patients. By addressing these issues, we hope to provide a foundation for further research as well as better and more effective care for the patients in the future.
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Bonhof CS, Van de Poll-Franse LV, de Hingh IH, Nefs G, Vreugdenhil G, Mols F. Association between peripheral neuropathy and sleep quality among colorectal cancer patients from diagnosis until 2-year follow-up: results from the PROFILES registry. J Cancer Surviv 2021; 17:894-905. [PMID: 34799785 DOI: 10.1007/s11764-021-01130-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/05/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Studies on the association between peripheral neuropathy (PN) and patient-reported outcomes have mostly overlooked sleep quality. Therefore, we aimed to assess the association between PN and sleep quality in a population-based sample of colorectal cancer (CRC) patients up 2 years after diagnosis. METHODS All newly diagnosed CRC patients from four Dutch hospitals were eligible for participation. Patients (N = 340) completed questionnaires about PN (EORTC QLQ-CIPN20) and sleep (PSQI) before initial treatment (baseline) and 1 and 2 years after diagnosis. RESULTS Patients who developed sensory PN (n = 76) or motor PN (n = 79) after treatment more often reported poor sleeping scores (PSQI > 5) compared with those who did not develop SPN or MPN at 1-year (SPN: 38% vs. 261%, MPN: 37% vs. 14%) and 2-year follow-up (SPN: 38 vs. 23%, MPN: 37% vs. 18%) (all p < 0.05). Overall, results showed that among patients who did not develop SPN or MPN, sleep quality improved after baseline, while among patients with SPN or MPN, sleep quality did not improve at one and two years after diagnosis. CONCLUSIONS Both SPN and MPN were significantly associated with the course of sleep quality among CRC patients up to 2 years after diagnosis. Clinicians should be encouraged to discuss sleep quality with their patients who either report PN or are at risk of developing PN. IMPLICATIONS FOR CANCER SURVIVORS Improving sleep quality among survivors with PN is important, either by reducing PN symptoms or directly targeting sleep.
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Affiliation(s)
- Cynthia S Bonhof
- CoRPS - Center of Research On Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands. .,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
| | - Lonneke V Van de Poll-Franse
- CoRPS - Center of Research On Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ignace H de Hingh
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.,Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Giesje Nefs
- CoRPS - Center of Research On Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.,Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Diabeter, National Treatment and Research Center for Children, Adolescents and Adults With Type 1 Diabetes, Rotterdam, The Netherlands
| | - Gerard Vreugdenhil
- Department of Internal Medicine, Máxima Medical Centre, Eindhoven, The Netherlands
| | - Floortje Mols
- CoRPS - Center of Research On Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
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Sleep Disorders in Cancer-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111696. [PMID: 34770209 PMCID: PMC8583058 DOI: 10.3390/ijerph182111696] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/07/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Sleep disorders, especially insomnia, are very common in different kinds of cancers, but their prevalence and incidence are not well-known. Disturbed sleep in cancer is caused by different reasons and usually appears as a comorbid disorder to different somatic and psychiatric diagnoses, psychological disturbances and treatment methods. There can be many different predictors for sleep disturbances in these vulnerable groups, such as pre-existing sleep disorders, caused by the mental status in cancer or as side effect of the cancer treatment. METHODS A systematic literature review of 8073 studies was conducted on the topic of sleep and sleep disorders in cancer patients. The articles were identified though PubMed, PsycInfo and Web of Knowledge, and a total number of 89 publications were qualified for analysis. RESULTS The identified eighty-nine studies were analyzed on the topic of sleep and sleep disorders in cancer, twenty-six studies on sleep and fatigue in cancer and sixty-one studies on the topic of sleep disorders in cancer. The prevalence of sleep disturbences and/or sleep disorders in cancer was up to 95%. DISCUSSION Sleep disturbances and sleep disorders (such as insomnia, OSAS, narcolepsy and RLS; REM-SBD) in cancer patients can be associated with different conditions. Side effects of cancer treatment and cancer-related psychological dysfunctions can be instigated by sleep disturbances and sleep disorders in these patients, especially insomnia and OSAS are common. An evidence-based treatment is necessary for concomitant mental and/or physical states.
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Bulls HW, Hoogland AI, Small BJ, Kennedy B, James BW, Arboleda BL, Shahzad MMK, Gonzalez BD, Jim HSL. Lagged Relationships Among Chemotherapy-Induced Peripheral Neuropathy, Sleep Quality, and Physical Activity During and After Chemotherapy. Ann Behav Med 2021; 55:844-852. [PMID: 33196081 PMCID: PMC8382147 DOI: 10.1093/abm/kaaa101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is well-documented and can become chronic for up to a third of patients. CIPN management is hampered by limited pharmacological options. Thus, identifying modifiable behaviors that influence CIPN may help inform future interventions. PURPOSE The purpose of the current study was to examine bidirectional relationships between sleep quality, physical activity, and CIPN during and after chemotherapy. METHODS Participants were 138 women with gynecologic cancer (M age = 61, 94% white, 96% non-Hispanic), collected as part of an ongoing study. Assessments occurred at postcycle 1, postcycle 6, and 6- and 12-month postchemotherapy. CIPN (EORTC-CIPN20), sleep quality (PSQI), and physical activity (IPAQ) were assessed via self-report. Objective physical activity was assessed via wrist actigraphy. Latent change score models were used to examine lagged relationships between CIPN, sleep quality, and physical activity pairs. RESULTS Over the study period, sleep quality was found to contribute to CIPN (p = .001), but not the reverse (p > .05). Bidirectional relationships were observed between CIPN and both objective and subjective walking (ps ≤ .001). Illustrations of these relationships showed that patients with less CIPN early in treatment demonstrate more substantial increases in walking over time, while those with higher CIPN demonstrate more consistent levels of walking during and after treatment. CONCLUSIONS These findings suggest that worse sleep quality and lower walking levels may contribute to the course and maintenance of CIPN. Future investigation should evaluate the impact of early interventions aimed at improving sleep quality and encouraging physical activity in patients treated with chemotherapy.
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Nelson AM, Hyland KA, Small B, Kennedy B, Mishra A, Hoogland AI, Bulls HW, Jim HSL, Jacobsen PB. Contribution of Sleep Disruption and Sedentary Behavior to Fatigue in Survivors of Allogeneic Hematopoietic Cell Transplant. Ann Behav Med 2021; 55:870-878. [PMID: 33410478 DOI: 10.1093/abm/kaaa110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fatigue is a prominent quality of life concern among recipients of hematopoietic cell transplantation (HCT). PURPOSE The present study investigated whether objectively measured sleep efficiency and sedentary behavior are related to greater reports of fatigue. METHODS Eighty-two allogeneic HCT recipients who were 1-5 years post-transplant and returning for a follow-up visit participated (age M = 56, 52% female, 56% leukemia). They wore an actigraph assessing sleep efficiency and sedentary behavior for one week and completed an electronic log assessing fatigue each evening during the same period. RESULTS Twenty-six percent of patients reported clinically meaningful fatigue. On average, fatigue was mild (M = 2.5 on 0-10 scale, SD = 2.0), sleep was disturbed (sleep efficiency M = 78.9%, SD = 8.9), and patients spent the majority of time in sedentary (M = 55.4%, SD = 10.2) or light (M = 35.9%, SD = 8.6) activity. Multilevel model analysis of between-person differences indicated that patients who experienced less efficient sleep the previous evening provided greater evening reports of average fatigue, b = -0.06, 95% CI (-0.11, -0.01). Similarly, within-person analyses indicated that when patients experienced less efficient sleep the previous evening or were more sedentary as compared to their average, they provided greater evening reports of average fatigue, b = -0.02, 95% CI (-0.05, -0.004); b = 4.46, 95% CI (1.95, 6.97), respectively. CONCLUSIONS Findings demonstrate that poor sleep and daily sedentary behavior are related to evening reports of fatigue and should be considered modifiable targets for intervention.
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Affiliation(s)
- Ashley M Nelson
- Department of Psychiatry, Harvard Medical School/Massachusetts General Hospital, MA, USA
| | - Kelly A Hyland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Brent Small
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.,School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Brittany Kennedy
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Asmita Mishra
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Hailey W Bulls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Paul B Jacobsen
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
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Willis KD, Ravyts SG, Lanoye A, Loughan AR. Sleep disturbance in primary brain tumor: prevalence, risk factors, and patient preferences. Support Care Cancer 2021; 30:741-748. [PMID: 34368887 PMCID: PMC8349701 DOI: 10.1007/s00520-021-06476-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/27/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE Primary brain tumor (PBT) patients report sleep disturbance due to their disease and treatment, yet few studies have utilized validated measures to understand the extent of patients' concerns and preferences for treatment. The purpose of this quality improvement project was to determine the prevalence and associated risk factors of sleep disturbance among PBT patients in our clinic and to evaluate interest in treatment for sleep disturbance. METHODS PBT patients completed validated measures of sleep disturbance and health during routine neuro-oncology visits. Patients also reported on sleep-related symptom management and their preferences for pharmacological and/or behavioral treatment. RESULTS Sleep disturbance was common, with 61.5% of PBT patients (N = 119; Mage = 52.60 years; 50% male) reporting poor sleep quality and 21.5% endorsing symptoms of insomnia. Insomnia could be explained by increased fatigue and corticosteroid use; sleep quality could be explained by fatigue. Patients in our clinic with higher grade tumors, significant sleep disturbance, of minority racial/ethnic status, and those not already taking sleep medications were more likely to report their symptoms and were not well-addressed by their medical team. Patients indicated a similar interest in pharmacological and behavioral treatment, warranting the availability of both in our clinic. CONCLUSIONS Findings indicate a high prevalence of sleep disturbance in PBT patients, highlighting the need for increased screening, monitoring, and treatment in our neuro-oncology clinic. Future research would benefit from assessing the efficacy of behavioral treatments for sleep disturbance in this population.
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Affiliation(s)
- Kelcie D Willis
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Scott G Ravyts
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Autumn Lanoye
- Massey Cancer Center, Virginia Commonwealth University, VA, Richmond, USA.,Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ashlee R Loughan
- Massey Cancer Center, Virginia Commonwealth University, VA, Richmond, USA. .,Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
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Ho KY, Lam KKW, Xia W, Chung JOK, Cheung AT, Ho LLK, Chiu SY, Chan GCF, Li WHC. Psychometric properties of the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) among Hong Kong Chinese childhood cancer survivors. Health Qual Life Outcomes 2021; 19:176. [PMID: 34229705 PMCID: PMC8261921 DOI: 10.1186/s12955-021-01803-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/10/2021] [Indexed: 02/23/2023] Open
Abstract
Background Sleep disruption is a prevalent symptom reported by survivors of childhood cancer. However, there is no validated instrument for assessing this symptom in this population group. To bridge the literature gap, this study translated and adapted the Pittsburgh Sleep Quality Index (PSQI) for Hong Kong Chinese cancer survivors and examined its psychometric properties and factor structure. Methods A convenience sample of 402 Hong Kong Chinese childhood cancer survivors aged 6–18 years were asked to complete the Chinese version of the PSQI, Center for Epidemiologic Studies Depression Scale for Children (CES-DC), Fatigue Scale-Child (FS-C)/Fatigue Scale-Adolescent (FS-A), and Pediatric Quality of Life Inventory (PedsQL). To assess known-group validity, 50 pediatric cancer patients and 50 healthy counterparts were recruited. A sample of 40 children were invited to respond by phone to the PSQI 2 weeks later to assess test–retest reliability. A cutoff score for the translated PSQI used with the survivors was determined using receiver operating characteristic analysis. Results The Chinese version of the PSQI had a Cronbach alpha of 0.71, with an intraclass correlation coefficient of 0.90. Childhood cancer survivors showed significantly lower mean PSQI scores than children with cancer, and significantly higher mean scores than healthy counterparts. This reflected that childhood cancer survivors had a better sleep quality than children with cancer, but a poorer sleep quality than healthy counterparts. We observed positive correlations between PSQI and CES-DC scores and between PSQI and FS-A/FS-C scores, but a negative correlation between PSQI and PedsQL scores. The results supported that the Chinese version of the PSQI showed convergent validity. Confirmatory factor analysis showed that the translated PSQI data best fit a three-factor model. The best cutoff score to detect insomnia was 5, with a sensitivity of 0.81 and specificity of 0.70. Conclusion The Chinese version of the PSQI is a reliable and valid instrument to assess subjective sleep quality among Hong Kong Chinese childhood cancer survivors. The validated PSQI could be used in clinical settings to provide early assessments for sleep disruption. Appropriate interventions can therefore be provided to minimize its associated long-term healthcare cost. Trial registration This study was registered in ClinicalTrials.gov with the reference number NCT03858218.
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Affiliation(s)
- K Y Ho
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR.
| | - Katherine K W Lam
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR.
| | - W Xia
- School of Nursing, Sun Yan-Sen University of Medical Sciences, Guangzhou, China
| | - J O K Chung
- School of Nursing, Hong Kong Polytechnic University, Hung Hom, Hong Kong, SAR
| | - Ankie T Cheung
- School of Nursing, University of Hong Kong, Pok Fu Lam, Hong Kong, SAR
| | - Laurie L K Ho
- School of Nursing, University of Hong Kong, Pok Fu Lam, Hong Kong, SAR
| | - S Y Chiu
- Hong Kong Children's Hospital, Kowloon Bay, Hong Kong, SAR
| | | | - William H C Li
- School of Nursing, University of Hong Kong, Pok Fu Lam, Hong Kong, SAR
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Riley KE, Garland SN, Mao JJ, Applebaum AJ, Li QS, Gehrman PR, DuHamel KN, Verrico Z. Hyperarousal and Insomnia in Survivors of Cancer. Int J Behav Med 2021; 28:683-691. [PMID: 33629219 DOI: 10.1007/s12529-021-09962-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cancer survivors are prone to insomnia due to the physical and psychological sequelae of cancer and treatment. Individuals with insomnia may present symptoms of hyperarousal. Cancer survivors with insomnia and trait hyperarousal may require different clinical treatments than patients with insomnia without trait hyperarousal. To our knowledge, no study has examined these factors previously. This study examined the relation between insomnia and trait hyperarousal in cancer survivors. METHODS The sample included 160 individuals with previous cancer diagnoses who met DSM-5 criteria for insomnia disorder. Measures were collected with cross-sectional batteries of questionnaires, including the Insomnia Severity Index (ISI) and Hyperarousal Scale (HAS). This study is based on baseline data collected in a randomized clinical trial comparing CBT-I to acupuncture for cancer survivors with insomnia (Garland, Gehrman, Barg, Xie, & Mao, 2016). RESULTS Hyperarousal was positively associated with insomnia (ISI total score) in bivariate correlations (r = .350, p < .01) and linear regressions (F = 22.06, p < .001). In bivariate correlations, hyperarousal was related to perceptions about the consequences of disturbed sleep rather than reported sleep patterns. For example, hyperarousal was positively related to reported satisfaction (r = .159, p < .05) and worry about sleep (r = .415, p < .01), but not to falling asleep, staying asleep, or awakening too early. In regressions, younger age, insomnia duration, and worry about sleep were uniquely associated with hyperarousal when adjusting for insomnia (B = 0.200, B = 0.177, B = -0.182, p < .05). CONCLUSIONS Hyperarousal is associated with psychological appraisal of insomnia rather than reported sleep pattern. Younger age and longer duration of insomnia are associated with trait hyperarousal. These findings suggest targeting trait hyperarousal with amplified psychological treatment may lead to more personalized, effective treatment for insomnia.
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Affiliation(s)
- Kristen E Riley
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA.,Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuyen Rd, Piscataway, NJ, 08854, USA
| | - Sheila N Garland
- Department of Psychology, Memorial University of Newfoundland, 232 Elizabeth Avenue, St. John's, St. John's, Newfoundland and Labrador, A1B 3X9, Canada
| | - Jun J Mao
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA
| | - Allison J Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA
| | - Q Susan Li
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA
| | - Philip R Gehrman
- Perelman School of Medicine, University of Pennsylvania, 3600 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Katherine N DuHamel
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA
| | - Zoe Verrico
- Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuyen Rd, Piscataway, NJ, 08854, USA.
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Mandelblatt JS, Zhou X, Small BJ, Ahn J, Zhai W, Ahles T, Extermann M, Graham D, Jacobsen PB, Jim H, McDonald BC, Patel SJ, Root JC, Saykin AJ, Cohen HJ, Carroll JE. Deficit Accumulation Frailty Trajectories of Older Breast Cancer Survivors and Non-Cancer Controls: The Thinking and Living With Cancer Study. J Natl Cancer Inst 2021; 113:1053-1064. [PMID: 33484565 DOI: 10.1093/jnci/djab003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/27/2020] [Accepted: 01/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We evaluated deficit accumulation and how deficits affected cognition and physical activity among breast cancer survivors and non-cancer controls. METHODS Newly diagnosed nonmetastatic survivors (n = 353) and matched non-cancer controls (n = 355) ages 60-98 years without neurological impairments were assessed presystemic therapy (or at enrollment for controls) from August 2010 to December 2016 and followed for 36 months. Scores on a 42-item index were analyzed in growth-mixture models to determine deficit accumulation trajectories separately and combined for survivors and controls. Multilevel models tested associations between trajectory and cognition (FACT-Cog and neuropsychological tests) and physical activity (IPAQ-SF) for survivors and controls. RESULTS Deficit accumulation scores were in the robust range, but survivors had higher scores (95% confidence intervals [CI]) than controls at 36 months (0.18, 95% CI = 0.16 to 0.19, vs 0.16, 95% CI = 0.14 to 0.17; P = .001), and averages included diverse deficit trajectories. Survivors who were robust but became frailer (8.8%) had similar baseline characteristics to those remaining robust (76.2%) but experienced a 9.6-point decline self-reported cognition (decline of 9.6 vs 3.2 points; P = .04) and a 769 MET minutes per week decline in physical activity (P < .001). Survivors who started and remained prefrail (15.0%) had self-reported and objective cognitive problems. At baseline, frail controls (9.5%) differed from robust controls (83.7%) on deficits and self-reported cognition (P < .001). Within combined trajectories, frail survivors had more sleep disturbances than frail controls (48.6% [SD = 17.4%] vs 25.0% [SD = 8.2%]; P = .05). CONCLUSIONS Most survivors and controls remained robust, and there were similar proportions on a frail trajectory. However, there were differences in deficit patterns between survivors and controls. Survivor deficit accumulation trajectory was associated with patient-reported outcomes. Additional research is needed to understand how breast cancer and its treatments affect deficit accumulation.
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Affiliation(s)
- Jeanne S Mandelblatt
- Department of Oncology, Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Xingtao Zhou
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Health Outcome and Behavior Program and Biostatistics Resource Core, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, Tampa, FL, USA
| | - Jaeil Ahn
- Department of Biostatistics, Bioinformatics, and Biomathematics, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Wanting Zhai
- Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Martine Extermann
- Department of Oncology, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | | | - Paul B Jacobsen
- Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, USA
| | - Brenna C McDonald
- Department of Radiology and Imaging Sciences and the Melvin and Bren Simon Cancer Center, Center for Neuroimaging, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sunita J Patel
- Departments of Population Sciences and Supportive Care Medicine, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - James C Root
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Departments of Psychiatry and Anesthesiology, Weill Medical College of Cornell University, New York, NY, USA
| | - Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Harvey Jay Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Judith E Carroll
- UCLA Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Jonsson Comprehensive Cancer Center, and Cousins Center for Psychoneuroimmunology, Los Angeles, CA, USA
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Marion LP, Ivers H, Savard J. Feasibility of a Preventive Intervention for Insomnia in Women with Breast Cancer Receiving Chemotherapy. Behav Sleep Med 2021; 19:70-82. [PMID: 31873040 DOI: 10.1080/15402002.2019.1707203] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective/Background: Breast cancer patients display high rates of insomnia and chemotherapy treatments appear to contribute significantly to the development of sleep disturbances among this population. The efficacy of cognitive-behavioral therapy for insomnia (CBT-I) is now well established for treating insomnia comorbid with cancer but is not widely accessible and is also fairly costly. Its capacity to prevent the onset of insomnia symptoms in cancer patients who are at a high risk of developing these difficulties remains to be demonstrated. The purpose of this study was to assess the feasibility of a brief self-administered preventive intervention of insomnia in breast cancer patients about to undergo chemotherapy. Participants/Methods: A sample of 20 women with breast cancer and with no insomnia were recruited and received the preventive intervention, taking the form of a short booklet, at their first chemotherapy treatment. One month later, a semi-structured phone interview was conducted to assess their satisfaction with different aspects of the booklet (e.g., format, content) and their adherence to the proposed strategies and to collect qualitative information. A 3-month follow-up evaluation was also conducted. Results: Patients reported a higher level of satisfaction than expected (mean score corresponding to "a lot" on the scale) and a moderate level of adherence falling only slightly under the hypothesized level. The open comments collected corroborated the good acceptability of this minimal preventive CBT-I in breast cancer patients initiating chemotherapy. Conclusions: Overall, findings of this study confirm that a self-administered preventive intervention for insomnia is feasible and a promising approach in breast cancer patients about to initiate chemotherapy.
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Affiliation(s)
- Louis-Philippe Marion
- School of Psychology, Université Laval , Québec, Canada.,CHU de Québec-Université Laval Research Center , Québec, Canada.,Université Laval Cancer Research Center , Québec, Québec, Canada
| | - Hans Ivers
- School of Psychology, Université Laval , Québec, Canada.,CHU de Québec-Université Laval Research Center , Québec, Canada.,Université Laval Cancer Research Center , Québec, Québec, Canada
| | - Josée Savard
- School of Psychology, Université Laval , Québec, Canada.,CHU de Québec-Université Laval Research Center , Québec, Canada.,Université Laval Cancer Research Center , Québec, Québec, Canada
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41
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Chan NY, Chan JWY, Li SX, Wing YK. Non-pharmacological Approaches for Management of Insomnia. Neurotherapeutics 2021; 18:32-43. [PMID: 33821446 PMCID: PMC8116473 DOI: 10.1007/s13311-021-01029-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
Insomnia is a prevalent sleep problem associated with a constellation of negative health-related outcomes and significant socioeconomic burden. It commonly co-occurs with psychiatric and medical conditions, which may further exacerbate these comorbid conditions and hinder treatment response. There is much empirical evidence to support the clinical efficacy of non-pharmacological treatment for insomnia, especially cognitive behavioral therapy for insomnia (CBT-I), in managing insomnia in a wide range of populations. This article reviews the research on the efficacy of CBT-I for primary insomnia and insomnia comorbid with other psychiatric and medical conditions, the empirical evidence regarding different CBT-I treatment modalities, the implementation of CBT-I across different age groups, and some initial evidence on the sequential combination of insomnia treatments. A brief overview of other non-pharmacological treatment with regard to complementary alternative medicine is also provided.
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Affiliation(s)
- Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Departments of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Joey Wing Yan Chan
- Li Chiu Kong Family Sleep Assessment Unit, Departments of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Departments of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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42
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Perlis ML, Pigeon WR, Grandner MA, Bishop TM, Riemann D, Ellis JG, Teel JR, Posner DA. Why Treat Insomnia? J Prim Care Community Health 2021; 12:21501327211014084. [PMID: 34009054 PMCID: PMC8138281 DOI: 10.1177/21501327211014084] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 12/20/2022] Open
Abstract
"Why treat insomnia?" This question grows out of the perspective that insomnia is a symptom that should only receive targeted treatment when temporary relief is needed or until more comprehensive gains may be achieved with therapy for the parent or precipitating medical or psychiatric disorders. This perspective, however, is untenable given recent data regarding the prevalence, course, consequences, and costs of insomnia. Further, the emerging data that the treatment of insomnia may promote better medical and mental health (alone or in combination with other therapies) strongly suggests that the question is no longer "why treat insomnia," but rather "when isn't insomnia treatment indicated?" This perspective was recently catalyzed with the American College of Physicians' recommendation that chronic insomnia should be treated and that the first line treatment should be cognitive-behavioral therapy for insomnia (CBT-I).
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Affiliation(s)
| | - Wilfred R. Pigeon
- University of Rochester,
Rochester, NY, USA
- Center of Excellence for Suicide
Prevention Canandaigua VA Medical Center, Canandaigua, NY, USA
| | - Michael A. Grandner
- University of Rochester,
Rochester, NY, USA
- Center of Excellence for Suicide
Prevention Canandaigua VA Medical Center, Canandaigua, NY, USA
| | - Todd M. Bishop
- University of Rochester,
Rochester, NY, USA
- Center of Excellence for Suicide
Prevention Canandaigua VA Medical Center, Canandaigua, NY, USA
| | | | - Jason G. Ellis
- Northumbria University, Newcastle
upon Tyne, Tyne and Wear, UK
| | | | - Donn A. Posner
- Stanford University School of
Medicine, Stanford, CA, USA
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43
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Shahrokhi M, Ghaeli P, Arya P, Shakiba A, Noormandi A, Soleimani M, Esfandbod M. Comparing the Effects of Melatonin and Zolpidem on Sleep Quality, Depression, and Anxiety in PatientsWithColorectalCancerUndergoingChemotherapy. Basic Clin Neurosci 2021; 12:105-114. [PMID: 33995933 PMCID: PMC8114863 DOI: 10.32598/bcn.12.1.1650.2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/25/2019] [Accepted: 11/21/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction: Patients with cancer may have many complications involving their psychosomatic systems, such as sleep disturbance, depression, and anxiety. Thus, many research studies were conducted to reduce these complications. Zolpidem, as a short-term non-benzodiazepine treatment of insomnia, and melatonin as a chronobiological functionregulatory hormone, are commonly used for improving sleep quality. This randomized clinical trial aims to compare the effects of zolpidem and melatonin on sleep quality, depression, and anxiety in patients with colorectal cancer. Methods: In this single-blinded trial, 90 patients with colorectal cancer undergoing chemotherapy who had obtained a score of 5 or higher on the Pittsburgh Sleep Quality Index (PSQI) were randomly divided into two groups (n=45). One group was treated with 10 mg zolpidem at bedtime, and the other group received 6 mg melatonin at bedtime for 30 days. PSQI on weeks 0, 4, 8, Groningen sleep quality scale, Hamilton rating scale for depression, and Hamilton anxiety rating scale questionnaires were performed to assess patients on weeks 0, 4, and 8. The outcome was then analyzed, and P≤0.05 was considered statistically significant. Results: Both zolpidem and melatonin had significant impacts on sleep quality in week 4 (P<0.05). After stopping the treatments, the conditions were noticeably reversed on week 8 (P<0.05). Zolpidem and melatonin were relatively similar in affecting sleep duration, latency, efficiency, and disturbance. None of the two study medications had any considerable influence on anxiety and depression. Conclusion: Melatonin and zolpidem are promising agents for treating sleep complications and, to some extent, depression, and anxiety in cancer patients, according to the present study. However, further clinical trials are recommended to confirm the results of this study.
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Affiliation(s)
- Maryam Shahrokhi
- Department of clinical pharmacy, Faculty of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| | - Padideh Ghaeli
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Pantea Arya
- Department of Psychiatry, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alia Shakiba
- Psychiatry and Psychoogy Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Noormandi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Soleimani
- Department of Psychiatry, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Esfandbod
- Hematology-Oncology and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Samuel SR, Gururaj R, Kumar KV, Vira P, Saxena PUP, Keogh JWL. Randomized control trial evidence for the benefits of massage and relaxation therapy on sleep in cancer survivors-a systematic review. J Cancer Surviv 2020; 15:799-810. [PMID: 33269414 PMCID: PMC8448699 DOI: 10.1007/s11764-020-00972-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/17/2020] [Indexed: 12/02/2022]
Abstract
Purpose Cancer survivors may experience sleep disturbances during and after their cancer treatments. While pharmacological approaches are commonly used to address sleep disturbances, they may have a number of adverse effects. This review studied the effect of two non-pharmacological interventions (massage and relaxation therapy) on sleep disturbances in cancer survivors. Methods A search for randomised controlled trials (RCTs) was conducted on PubMed, Scopus, Web of Science, PEDro, and CINAHL using relevant keywords. Results The search yielded 371 articles, with 4 RCTs studying massage therapy and 3 RCTs studying relaxation therapy included for qualitative analysis. Massage therapy studies showed statistically significant improvement in self-reported sleep questionnaires and objectively recorded long sleep episodes, as assessed via an accelerometer. No significant improvements in sleep outcomes were observed in the relaxation therapy studies, although there were trends for improved self-reported sleep quality. Conclusion While massage therapy provided by massage therapists may have some potential for improving sleep outcomes for cancer survivors, there is no such current evidence regarding relaxation therapy. Implications for Cancer Survivors Cancer survivors who experience sleep disturbances may benefit from regular sessions with a massage therapist. However, future studies should examine the long-term feasibility of massage therapist–delivered services, particularly for cancer survivors with limited finances, and determine if benefits can be obtained if massage is provided by non-certified individuals. Relaxation therapy appears to be safe for cancer survivors, but future RCTs involving larger sample sizes need to be conducted to better determine its feasibility and efficacy.
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Affiliation(s)
- Stephen Rajan Samuel
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Rachita Gururaj
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - K Vijaya Kumar
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.
| | - Prina Vira
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - P U Prakash Saxena
- Department of Radiation Oncology at Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Justin William Leslie Keogh
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.,Human Potential Centre, AUT University, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, Australia
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45
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Chen Q, Terhorst L, Lowery-Allison A, Cheng H, Tsung A, Layshock M, Buysse DJ, Geller DA, Marsh JW, Wang Y, Steel JL. Sleep problems in advanced cancer patients and their caregivers: Who is disturbing whom? J Behav Med 2020; 43:614-622. [PMID: 31435891 PMCID: PMC7035154 DOI: 10.1007/s10865-019-00088-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/29/2019] [Indexed: 12/25/2022]
Abstract
Background The aims of the study were to understand sleep problems and their effects in advanced cancer patients and spousal and intimate partner caregivers and to examine the directionality of the link between patients' and caregivers' sleep problems. Methods Fifty-four advanced cancer patients and their spousal and intimate partners were administered a battery of questionnaires that included the Pittsburgh Sleep Quality Index and the Center for Epidemiological Studies at the patients' cancer diagnosis and at 2, 4, and 6 months after diagnosis. Results Patients' and caregivers' sleep duration was significantly related. Using cross-lagged panel analyses, caregivers' sleep quality significantly predicted patients' sleep quality and patients' sleep quality subsequently predicted caregivers' sleep quality. Patients' sleep latency significantly was found to significantly predict caregivers' sleep latency. Conclusion Patients diagnosed with cancer and their intimate partners have poor sleep quality and sleep patterns are related.
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Affiliation(s)
- Qi Chen
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy and Health and Community Systems, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Hannah Cheng
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allan Tsung
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mikhaila Layshock
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Geller
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - James W Marsh
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yisi Wang
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer L Steel
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Surgery, Psychiatry, and Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for Excellence in Behavioral Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue; Montefiore 7S, Pittsburgh, PA, 15213, USA.
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Arem H, Scott R, Greenberg D, Kaltman R, Lieberman D, Lewin D. Assessing Breast Cancer Survivors' Perceptions of Using Voice-Activated Technology to Address Insomnia: Feasibility Study Featuring Focus Groups and In-Depth Interviews. JMIR Cancer 2020; 6:e15859. [PMID: 32348274 PMCID: PMC7284406 DOI: 10.2196/15859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/06/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022] Open
Abstract
Background Breast cancer survivors (BCSs) are a growing population with a higher prevalence of insomnia than women of the same age without a history of cancer. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be effective in this population, but it is not widely available to those who need it. Objective This study aimed to better understand BCSs’ experiences with insomnia and to explore the feasibility and acceptability of delivering CBT-I using a virtual assistant (Amazon Alexa). Methods We first conducted a formative phase with 2 focus groups and 3 in-depth interviews to understand BCSs’ perceptions of insomnia as well as their interest in and comfort with using a virtual assistant to learn about CBT-I. We then developed a prototype incorporating participant preferences and CBT-I components and demonstrated it in group and individual settings to BCSs to evaluate acceptability, interest, perceived feasibility, educational potential, and usability of the prototype. We also collected open-ended feedback on the content and used frequencies to describe the quantitative data. Results We recruited 11 BCSs with insomnia in the formative phase and 14 BCSs in the prototype demonstration. In formative work, anxiety, fear, and hot flashes were identified as causes of insomnia. After prototype demonstration, nearly 79% (11/14) of participants reported an interest in and perceived feasibility of using the virtual assistant to record sleep patterns. Approximately two-thirds of the participants thought lifestyle modification (9/14, 64%) and sleep restriction (9/14, 64%) would be feasible and were interested in this feature of the program (10/14, 71% and 9/14, 64%, respectively). Relaxation exercises were rated as interesting and feasible using the virtual assistant by 71% (10/14) of the participants. Usability was rated as better than average, and all women reported that they would recommend the program to friends and family. Conclusions This virtual assistant prototype delivering CBT-I components by using a smart speaker was rated as feasible and acceptable, suggesting that this prototype should be fully developed and tested for efficacy in the BCS population. If efficacy is shown in this population, the prototype should also be adapted for other high-risk populations.
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Affiliation(s)
- Hannah Arem
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States.,George Washington Cancer Center, Washington, DC, United States
| | - Remle Scott
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | | | - Rebecca Kaltman
- Division of Hematology and Oncology, Medical Faculty Associates, George Washington University, Washington, DC, United States
| | - Daniel Lieberman
- Department of Psychiatry and Behavioral Sciences, Medical Faculty Associates, George Washington University, Washington, DC, United States
| | - Daniel Lewin
- Children's National Health System, Washington, DC, United States
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Youn S, Kim C, Lee J, Yeo S, Suh S, Chung S. Development of Dysfunctional Beliefs and Attitude about Sleep Scale for Cancer Patients. Behav Sleep Med 2020; 18:287-297. [PMID: 30789064 DOI: 10.1080/15402002.2019.1578773] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Study objectives: This study aimed to develop a scale utilizing the original Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale that measured maladaptive cognitions associated with sleep that is especially sensitive to cancer patients. In addition to the original scale, we added two additional items that reflected cancer-specific dysfunctional beliefs about sleep. Methods: Participants consisted of 337 cancer patients (mean age 54.0 ± 11.8 years, 32.0% men). All participants completed the DBAS-16, two cancer specific items, and the Insomnia Severity Index. Item-to-total-score correlations, internal consistency, item selection, and factor structure were examined. Results: The DBAS-16 was found to be reliable, and internal consistency was also adequate when adding two cancer-specific questions (Cronbach's alpha = 0.89). A total of 14 items were selected, and a four-factor model was selected using exploratory factor analysis (Tucker-Lewis index = 0.86, root mean square error of approximation = 0.08). The four factors were (a) sleep expectations, (b) worry about insomnia, (c) perceived consequences of insomnia and medication, and (d) two cancer-related items. The modified 14 items of the Cancer-related DBAS (C-DBAS-14) well differentiated cancer patients with and without insomnia. Conclusions: The C-DBAS-14 is a promising measure that has adequate internal consistency. It is also sensitive to sleep-related cognitions in cancer patients and can discriminate patients with cancer who are experiencing insomnia from those who are good sleepers. The enhanced utility of the shortened 14-item scale tailored specifically to cancer patients may be useful in both clinical practice and research settings.Abbreviations: CBT: cognitive behavioral therapy; C-DBAS-14: Cancer-Related Dysfunctional Beliefs and Attitude about Sleep; C-DBS: Cancer-Related Dysfunctional Beliefs about Sleep; DBAS-16: Dysfunctional Beliefs and Attitudes about Sleep; ISI: Insomnia Severity Index.
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Affiliation(s)
- Soyoung Youn
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Changnam Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joohee Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungook Yeo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Barton DL, Atherton PJ, Satele DV, Qin R, Dakhil S, Pipe T, Hobday T, Fee-Schroeder K, Loprinzi CL. A randomized phase II trial evaluating two non-pharmacologic interventions in cancer survivors for the treatment of sleep-wake disturbances: NCCTG N07C4 (Alliance). Support Care Cancer 2020; 28:6085-6094. [PMID: 32307658 DOI: 10.1007/s00520-020-05461-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/04/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Sleep disturbance is a prevalent problem for cancer survivors and effective behavioral treatments are not widely used for this population. This study evaluated home-based sleep interventions based on cognitive behavioral therapy for insomnia (CBT-I). METHODS This phase II randomized controlled trial evaluated two manualized interventions over 7 weeks. The intervention group received sleep hygiene information, stimulus control, sleep restriction, and a bedtime imagery audio recording. The control group was similar, but without sleep restriction and used audio recordings of bedtime short stories instead of imagery. Eligibility included adult cancer survivors who had trouble falling asleep or falling back to sleep on 3 of 7 days. Patients with diagnoses of sleep or mental health disorders were excluded. The primary endpoint was change in time to fall asleep or falling back to sleep after awakening, from baseline to week 7. Two-sample T tests evaluated differences between arms for this endpoint. RESULTS Ninety-three of 168 planned participants were enrolled from 20 institutions. The study closed early for poor accrual. Baseline time to sleep was 45 min and 52 min for the intervention and control group, respectively. At 7 weeks, both groups improved, the intervention group to 26 min and control group to 30 min, a non-significant difference between groups (p = 0.85). Secondary outcomes improved in both groups with no significant differences between arms. CONCLUSIONS Improvement in sleep outcomes in both arms was consistent with other CBT-I interventions delivered through alternative approaches to provider-delivered therapy. More research on optimal scalable delivery of CBT-I is needed. CLINICAL RELEVANCE This study supports the effectiveness of CBT-I based behavioral interventions for sleep but also the need for better delivery methods to improve uptake and effect size. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00993928.
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Affiliation(s)
- Debra L Barton
- University of Michigan School of Nursing, 400 N. Ingalls, Room 4320, Ann Arbor, MI, 48109-5482, USA.
| | - Pamela J Atherton
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Daniel V Satele
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Rui Qin
- Janssen Pharmaceuticals, Raritan, NJ, Belgium
| | | | - Teri Pipe
- Arizona State University, Tempe, AZ, USA
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Bean HR, Stafford L, Little R, Diggens J, Ftanou M, Alexander M, Francis PA, Bei B, Wiley JF. Light-enhanced cognitive behavioural therapy for sleep and fatigue: study protocol for a randomised controlled trial during chemotherapy for breast cancer. Trials 2020; 21:295. [PMID: 32216832 PMCID: PMC7099834 DOI: 10.1186/s13063-020-4196-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with breast cancer experience a significantly higher prevalence of sleep disturbance and insomnia than the general population. The experience of persistent sleep disturbance places these women at a higher risk of psychological and physical morbidity and a reduced quality of life. Treatment for sleep in this population is not part of routine care and is often managed inadequately. This randomised controlled trial will examine the combined effects of cognitive behavioural therapy (CBT) and bright light therapy (BLT) on the symptoms of insomnia, fatigue and mental health. METHOD/DESIGN Women diagnosed with breast cancer who receive intravenous chemotherapy treatment at a quaternary referral metropolitan cancer centre in Melbourne, Australia, will be recruited. Recruitment will occur after diagnosis and prior to completion of chemotherapy. Eligible women will be randomised to the combined CBT and BLT intervention (CBT+) or relaxation audio-enhanced treatment as usual (TAU+). The CBT+ group will receive one face-to-face session on sleep strategies, one subsequent telephone call, and seven email packages containing CBT-based information and strategies. CBT+ participants will also wear Luminette® light glasses for 20 min each morning for the 6-week duration of the intervention. Women in TAU+ will receive two relaxation audio tracks via email. Outcomes will be measured at multiple points throughout the 6 weeks. Primary outcomes will be symptoms of insomnia and sleep efficiency, measured using the Insomnia Severity Index and a self-reported sleep diary. Secondary outcomes include objective measures of sleep assessed using the ActiGraph wGT3X-BT, and sleep-related complaints, fatigue and mental health, all assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS). Data will also be collected on potential treatment moderators and mechanisms and adherence to treatment. There will be 3-month follow-up measurements of insomnia symptoms, fatigue, sleep-related impairment, sleep disturbance, depression and anxiety. DISCUSSION This is the first randomised controlled trial to combine CBT and BLT for the treatment of sleep disturbance in women with breast cancer. This novel design addresses the multiple causal factors for sleep complaints in this population. Results from this trial will advance knowledge in this field and may have important clinical implications for how best to treat sleep disturbance and insomnia in this population. If effective, the largely email-based format of the intervention would allow for relatively easy translation. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12618001255279. Retrospectively registered on 25 July 2018.
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Affiliation(s)
- Helena R Bean
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC, 3800, Australia
| | - Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Ruth Little
- Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia
| | | | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marliese Alexander
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | | | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC, 3800, Australia
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk, Melbourne, VIC, 3800, Australia.
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Dieperink KB, Elnegaard CM, Winther B, Lohman A, Zerlang I, Möller S, Zangger G. Preliminary validation of the insomnia severity index in Danish outpatients with a medical condition. J Patient Rep Outcomes 2020; 4:18. [PMID: 32124114 PMCID: PMC7052094 DOI: 10.1186/s41687-020-0182-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 02/14/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose Insomnia is a frequent sleeping disorder in the general and clinical population. With an increasing proportion of health care services being provided as outpatient care, a short, valid and reliable tool is needed to identify insomnia in medical patients under outpatient care in Denmark. The Insomnia Severity Index (ISI) could be the needed tool if found valid and reliable. Hence, the aim of this study is to evaluate elements of the psychometric properties of the Danish version of ISI (ISI-DK). Methods Outpatients from three hospital wards and one rehabilitation center were asked to complete the ISI-DK twice, 2 weeks apart. Internal consistency, discriminative validity, test-retest reliability, and measurement error was assessed. Results The ISI-DK was completed by 249 (79.0%) participants the first time, and 163 (65.5%) the second time. Respondents had a mean age of 58.2 years (SD 13.5) and 63.5% were women. All but one of the discriminative hypotheses was accepted. Internal consistency was high in the global scale at 0.90 and good with Cronbach’s alpha at 0.75–0.88 in the proposed subscales. The test-retest reliability was good, as the intraclass correlation was 0.90 (95% CI: 0.87; 0.93). Ceiling and floor effects were low < 4.4%. Standard error of measurement was 2.52 and smallest detectable change 6.99. Conclusion This preliminary assessment showed encouraging results supporting the ISI-DK as a valid and reliable tool for screening insomnia severity in Danish outpatients with a medical condition, but further assessments are needed.
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Affiliation(s)
- Karin Brochstedt Dieperink
- Department of Oncology, Odense University Hospital, Odense, Denmark. .,REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Odense, Denmark. .,Academy of Geriatric Cancer Research, AgeCare, Odense University Hospital, Southern Boulevard 29, DK-5000, Odense C, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Caroline Matilde Elnegaard
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Bodil Winther
- Department of Oncology, Lillebaelt Hospital, Vejle, Denmark
| | - Anna Lohman
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | - Ida Zerlang
- Department of Oncology, Regional Hospital West Jutland, Herning, Denmark
| | - Sören Möller
- OPEN - Open Patient data Explorative Network Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Graziella Zangger
- REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Odense, Denmark
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