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

Stress and sleep quality in palliative care

OBJECTIVES

Palliative care patients experience problems in sleep quality due to stress, chronic diseases, and physical and psychosocial problems. Our aim is to determine the perceived stress and sleep quality levels of our palliative care patients and their related factors.

METHODS

This cross-sectional, descriptive research was conducted between November 2023 and February 2024 at a palliative clinic located in Ankara, Turkey, that is affiliated with a training and research hospital. In the research, a data form, the Perceived Stress Scale and the Pittsburgh Sleep Quality Index were used as data collection instruments. Kolmogorov-Smirnov and Shapiro-Wilk tests, and Mann-Whitney U and Kruskal-Wallis H tests were used for the analysis.

RESULTS

The total score on the Perceived Stress Scale was determined to be 35.81±7.45. The total score for Pittsburgh Sleep Quality Index was 13.20±3.20. Significant relationships were found between insufficient self-efficacy scores and habitual sleep efficiency, daytime dysfunction and total Pittsburgh Sleep Quality Index scores. Significant relationships were found between insufficient self-efficacy scores and sleep latency, habitual sleep efficiency, daytime dysfunction and total Pittsburgh Sleep Quality Index scores.

CONCLUSIONS

This study determined that certain descriptive characteristics of palliative care patients affect their sleep quality and perceived stress level, as well as that some components of sleep quality and perceived stress level are related. Palliative care is holistic in nature, encompassing symptom management; therefore, the importance of patients' psychosocial integrity should not be overlooked. Consequently, identifying components that may hinder symptom management and addressing the patient comprehensively will be crucial.

Fatigue and sleep quality improvement through complete decongestive therapy in postmastectomy lymphedema: An investigative analysis

OBJECTIVE

To evaluate the effects of complete decongestive therapy (CDT) on cancer-related fatigue, sleep quality, and lymphedema-specific quality of life using validated and reliable questionnaires in cancer patients being commendable.

MATERIAL AND METHODS

This prospective study includes 94 patients who had postmastectomy lymphedema syndrome. The demographic characteristics of the patients were recorded. The participants' stages of lymphedema (The International Society of Lymphology), Hirai Cancer Fatigue Scale (HCFS) score, Pittsburgh Sleep Quality Index (PSQI) Global score, lymphedema-specific quality of life questionnaire (LYMQOL-ARM) score, and Global health status were recorded before and after CDT.

RESULTS

The mean age of the patients was 58.49 ± 10.96 years. Strong correlations were found between the severity of edema and global health status. There was a significant positive relationship between the HCFS score, PSQI Global score, LYMQOL-ARM score, and CDT. After decongestive physiotherapy, the majority of the lymphedema stages were downstaging (p < 0.05), respectively. There was also a trend toward improvement in general well-being (p < 0.05).

CONCLUSION

Cancer-related fatigue and sleep disturbance can persist for years after surgery in women with breast cancer. This can negatively affect the patient physically, socially and cognitively. Our study, which is the first study to investigate the HCFS score in postmastectomy patients and the relationship between PSQI Global score and CDT. The findings identify the risk factors that affect these outcomes in women with lymphedema and can provide valuable insights for targeted interventions and improved patient care.

A cross-sectional study of sleep disturbance among middle-aged cancer patients at Vietnam National Cancer Hospital

AIM

Sleep disorders are common in cancer patients and have negative consequences for patient well-being and treatment outcomes. This study aimed to investigate sleep quality and related factors in Vietnamese middle-aged cancer patients.

METHODS

A cross-sectional study was conducted on 246 middle-aged in-patient cancer patients at Vietnam National Cancer Hospital (VNCH) from 1/2021 to 7/2021. Sleep was measured by the Pittsburgh Sleep Quality Index (PSQI), with a cutoff of 5.

RESULTS

The results showed a male/female ratio of 0.85 with an average age of 52. The five most prevalent cancer types were breast, colorectal, lung, and esophagus-stomach cancer, primarily in the late stage and treated with chemotherapy. The prevalence of sleep disturbances was 58.5%. The mean PSQI score was 7.5, with sleep duration and latency of 5.4 h and 1 h, respectively. Approximately 44% of participants reported poor sleep quality, nearly 9% had daytime dysfunction, and 10.6% used sleep medication. The multivariate logistic regression results indicate that people with depression were 8.89 times more likely to have poor sleep than those without depression (95% CI:2.63-28.27, p < .001).

CONCLUSION

Sleep problems are common among middle-aged people with cancer in Vietnam, especially individuals with depression. It is necessary to have more effective approaches to sleep management for cancer patients with limited resources.

Global prevalence of poor sleep quality in cancer patients: A systematic review and meta-analysis

OBJECTIVE

Poor sleep quality is common in patients with cancer, but the prevalence rates varied widely across studies. This systematic review and meta-analysis examined the pooled prevalence of poor sleep quality among patients with cancer.

METHODS

Systematic literature searches were independently conducted in the major databases (Web of Science, PubMed, EMBASE and PsycINFO). Studies that reported the prevalence of poor sleep quality in patients with cancer were analyzed using a random effects model. Funnel plots and Egger's tests were used to assess publication bias. Statistical analyses were performed using R software.

RESULTS

A total of 59 epidemiological studies involving 16,223 patients were included. The pooled prevalence of poor sleep quality in patients with cancer was 57.4% [95% confidence interval (CI): 53.3% - 61.6%]. Additionally, three comparative studies with 372 patients and 412 healthy controls were included. Compared to healthy controls, patients with cancer had a significantly higher risk for poor sleep quality [odd ratio (OR) = 3.0; 95%CI: 1.2-7.2; P < 0.05]. Subgroup analyses of the studies revealed that studies from Middle East & North Africa region and low income countries, and on gynecological cancer as well as those with a lower cut-off value of sleep quality (all P < 0.01) reported a higher prevalence of poor sleep quality. Meta-regression analyses showed that higher prevalence of poor sleep quality was associated with higher prevalence of comorbid depression (P < 0.05) and anxiety (P < 0.01), but was associated with a lower education level (P < 0.05) and alcohol use ratio (P < 0.05).

CONCLUSION

Poor sleep quality is common among patients with cancer. Considering the overall high prevalence rate and negative impact of poor sleep quality, appropriate measures to identify and improve poor sleep quality are needed to enhance the clinical outcomes in this group.

Self-Completion Questionnaire on Sleep Evaluation in Patients Undergoing Oxaliplatin Therapy: An Observational Study

Sleep is a fundamental human need; sleep disruption, in fact, causes an increase in the activity of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, metabolic effects, changes in circadian rhythms, and pro-inflammatory responses. The scientific literature is finally starting to pay attention to the central role of sleep alterations in patients health. Oxaliplatin is extensively used for the treatment of gastrointestinal cancer and other malignancies, with an increased frequency of use in recent years. This study aims to understand the effects of sleep complaints on health and quality of life in cancer patients treated with oxaliplatin. A study has been conducted through the creation and distribution of questionnaires to patients to investigate their complaints about sleep quality. We observed significant differences between males and females in evaluating sleep hygiene scores, the Pittsburgh Sleep Quality Index, and previous difficulty sleeping. Moreover, in females, stress, worries, and anxiety seem to play a negative role in the sleep hygiene score. The obtained results could improve the interest of healthcare personnel and caregivers in sleep quality in patients undergoing chemotherapy.

Sleep Quality and Associated Factors Among Adult Cancer Patients on Treatments at Tikur Anbessa Specialized Hospital Oncology Unit, Addis Ababa, Ethiopia, 2021

BACKGROUND

Patients with cancer frequently reported sleep problems during their treatments which can affect their sleep quality have an impact on patients' quality of life (QOL).

OBJECTIVE

to assess the prevalence of sleep quality and associated factors in adult cancer patients on treatment in the Oncology unit of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2021.

METHODS

institutional-based cross-sectional study design was used and data was collected by using face-to-face structured interview questionnaires from March 1 to April 1, 2021. Sleep Quality Index (PSQI) consisted of 19 items, the social support scale (OSS-3) consisted of 3 items, and the Hospital Anxiety and Depression Scale (HADS) consisted of 14 items were applied. Logistic regression including bivariate and multivariate analysis was done to examine the association between dependent and independent variables, and P< 0.05 was considered the level of significance for associations.

RESULTS

A total of 264 sampled adult cancer patients on treatments were included in this study, with a response rate of 93.61%. About 26.5% of the participants' age distribution was between 40 to 49 years, and 68.6% were female. 59.8% of the study participants were married. Concerning education, about 48.9% of participants attended primary and secondary school and 45% of participants were unemployed. Overall, 53.79% of individuals had poor sleep quality. Low income ((AOR=5.36 CI 95% (2.23, 12.90), fatigue (AOR=2.89 CI 95(1.32, 6.33), pain (AOR 3.82 C I95 % (1.84, 7.93), poor of social support (AOR =3.20 CI 95% (1.43, 6.74), anxiety (AOR=3.48 CI 95% (1.44, 8.38) and depression (AOR 2.87 CI 95 % (1.05-7.391) were all associated with poor sleep quality.

CONCLUSION

This study revealed a high prevalence of poor sleep quality, which was significantly associated with factors like low income, fatigue, pain, poor social support, anxiety, and depression among cancer patients on treatments.

"Sleep Quality and Depression Level in Nurses in COVID-19 Pandemic"

The COVID-19 spread rapidly all over the world and pandemic process has negatively affected nurses. Sleep disorders and depression are among these negative effects. Managers' awareness of problems experienced by nurses and taking precautions will increase employee and patient satisfaction and provide quality patient care. The study was conducted in descriptive, cross-sectional and correlational design to explain nurses' sleep quality and depression levels and relationship between them during the COVID-19 pandemic with 142 nurses who completed Personel Information Form, Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Index (BDI). Sleep quality of nurses (64.8%) was poor, 33.1% had depression, and high school education, having a chronic illness and PSQI score increased the risk of depression level of nurses. Results highlight COVID-19 pandemic affected nurses' sleep quality and depression levels. All managers should be pioneers in providing psychological support to nurses and preparing and implementing a program for prevention of insomnia and depression.

Effect of Complete Decongestive Therapy on Lymphoedema, Sleep Quality and Quality of Life in Metastatic Breast Cancer Patient – A Case Study

Lymphoedema is the accumulation of fluids with the high-protein content in the intercellular space, which is the most common complication seen in patients with breast cancer. In this study, we discuss the case of a 67-year-old female operated case of the left modified radical mastectomy in 2012. After 9 years, she had recurrence on the right side and diagnosed with metastatic breast cancer Stage 3 B. She developed lymphoedema on the same side for which she was referred to physiotherapy for further management. Along with radiation treatment, physiotherapy intervention such as complete decongestive therapy (CDT) for lymphoedema was initiated for 10 days which included multilayer lymphoedema bandaging, manual lymphatic drainage and exercise therapy. At the beginning, volume difference was 1688 ml then on the 5th day, it was 1133 ml, and on the 10th day, it was 802 ml noted. There was significant reduction in the volume of the involved limb that led to improvement in the score of sleep quality and quality of life (QOL). The major aims of CDT are to improve lymph circulation and to prevent lymphatic stasis which improves the QOL and sleep quality. Patient education and counselling along with home programme of bandaging played a major role in the recovery of the patient. CDT plays an important role in reducing lymphoedema and improving the sleep quality and QOL in metastatic breast cancer patient.

Sleep Quality and Associated Factors Among Adult Cancer Patients Under Treatment at Oncology Units in Amhara Region, Ethiopia

INTRODUCTION

Poor sleep quality, a common, under-diagnosed, and under-treated problem in cancer patients, has negative physical and psychological consequences, but its prevalence and associated factors are not well studied in Ethiopia. Thus, the present study aimed to assess the prevalence of sleep quality and its associated factors among adult cancer patients receiving treatment at oncology units in Amhara region, Ethiopia.

METHODS AND MATERIALS

An institution-based cross-sectional study was conducted among adult patients with cancer under treatment at the oncology units in the Amhara region from April 12 to May 12/2021. A systematic random sampling technique was used to select 423 samples. Data were collected using a structured Interviewer-administered questionnaire. Sleep quality and depression were assessed by the Pittsburgh Sleep Quality Index and depression subscale of Hospital Anxiety and Depression Scale, respectively. Bivariable and multivariable logistic regression analyses were computed, considering p < 0.25 to select candidate variables for multivariable analysis and p < 0.05 to be statistically significant in the final model.

RESULTS

A total of 410 cancer patients participated in this study. The mean of the participant's age was 44.2 (range: 20-77) years. More than half (52.7%) of participants received chemotherapy and the remaining were treated with a combination of treatments. Two-hundred ninety-three (71.5%) of participants had poor sleep quality and 28.5% had good sleep quality. The factors found to be significantly associated with poor sleep quality were advanced age [AOR = 1.037, 95% CI: (1.012-1.062)]; having depressive symptoms [AOR = 2.862, 95% CI: (1.133, 7.228)]; having distant metastasis cancer [AOR = 3.758, 95% CI: (1.585, 8.909)]; and increased severity of pain [AOR = 1.331, 95% CI: (1.106, 1.601)].

CONCLUSION

The study found a high prevalence of poor sleep quality among cancer patients. Early screening and management of sleep problems are crucial in patients with cancer.

Geriatric Syndrome Screening: Implementing an Evidence-Based Process in Hospitalized Older Adults With Cancer

BACKGROUND

Oncology nurses are in a key position to screen patients for geriatric syndromes that can disproportionately affect older adults with cancer. Early recognition can promote informed decision-making, initiation of interventions, and tolerance of treatment.

OBJECTIVES

This study aimed to implement a nursing-sensitive screening process to identify types and frequency of geriatric syndromes in hospitalized older adult patients with cancer.

METHODS

Nurses were trained to screen for geriatric syndromes using the SPICES tool (sleep disorders, problems with eating or feeding, incontinence, confusion, evidence of falls, and skin breakdown). The electronic health record was leveraged to facilitate documentation and provide a geriatric syndrome profile for each patient.

FINDINGS

Results demonstrated ability of staff nurses to lead an evidence-based practice initiative and the challenges faced. Adherence to SPICES screening was 47%. About 80% of patients had two or more geriatric syndrome issues.

The characteristics and related factors of insomnia among postoperative patients with gastric cancer: a cross-sectional survey

Purpose

This study aims to explore the characteristics and related factors of insomnia of patients after operation for gastric cancer.

Methods

A cross-sectional survey was carried out and finally 115 patients with insomnia after operation for gastric cancer were included. The general information, gastric cancer-related information, sleep quality, and other symptoms were investigated.

Results

① The Pittsburgh sleep quality index score of most insomnia patients after gastric cancer surgery was 11-15 points, and the sleep quality rating was “poor”. ② The sleep quality of patients with insomnia after surgery for gastric cancer is related to the number of chemotherapy cycles, fatigue, and depression. ③ The probability of reduced sleep quality with the number of chemotherapy cycles >6 is 3.640 times that of ≤6. The probability of reduced sleep quality during moderate to severe fatigue was 4.390 times that of patients with no or mild fatigue.

Conclusion

Attention to related factors may be associated with improvement of sleep quality in patients with gastric cancer after surgery.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-021-06295-6.

The effect of melatonin on sleep quality and insomnia in patients with cancer: a systematic review study

BACKGROUND

Considering the importance of sleep in the treatment success and quality of life in patients with cancer, it is necessary to seek effective solutions to improve their sleep quality. In this regard, a comprehensive review of the effect of melatonin on sleep can be very useful to provide an evidence-based clinical guide. Therefore, the aim of the present systematic review was to investigate effect of melatonin on sleep quality and insomnia in patients with cancer.

METHODS

The present systematic review was conducted in 2021. To find evidence related to the study objective, Iranian databases (SID, Magiran) and international databases (Google scholar, Web of Science, ProQuest, Medline via PubMed, Scopus) were searched using specified keywords (Melatonin, Sleep, insomnia, Cancer, Neoplasms, Carcinomas, Tumor, Carcinomatosis, Carcinomatoses, Sarcomas) from the beginning of the establishment of the mentioned databases until 31st December of 2020. After primary and secondary screening, and selection of studies according to inclusion and exclusion criteria, information obtained from studies were extracted in a checklist with items such as author (year), study design, sample size, age, melatonin dose, duration of intervention, results, and conclusion.

RESULTS

From 295 articles found, finally six relevant studies entered the review process. The intervention used in the studies included oral melatonin administration. The minimum and maximum dose of melatonin was 3 mg and 20 mg, respectively, which was taken by patients for 10 days and to four months, usually every night before bedtime in studies. The results of the review showed that melatonin had a significant effect on sleep quality and insomnia in four studies. However, two studies showed no significant improvement on sleep quality after the intervention and melatonin administration, although melatonin had significant effect on increasing sleep efficiency in the short term.

CONCLUSIONS

The present review study showed that melatonin may be effective in improving sleep quality and insomnia in patients with cancer. It is suggested to carry out further extensive and detailed studies to achieve the most effective and safest method of melatonin administration in terms of dose and duration of use in order to improve sleep quality among patients with cancer.