1
|
Donzella SM, Deubler E, Patel AV, Phipps AI, Zhong C. Sleep and cancer mortality in the Cancer Prevention Study-II. Cancer Causes Control 2024:10.1007/s10552-024-01910-3. [PMID: 39240291 DOI: 10.1007/s10552-024-01910-3] [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: 04/16/2024] [Accepted: 08/21/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE Sleep is a multi-dimensional human function that is associated with cancer outcomes. Previous work on sleep and cancer mortality have not investigated how this relationship varies by sex and cancer site. We investigated the association of sleep duration and perceived insomnia with site-specific and overall cancer mortality among participants in the Cancer Prevention Study-II. METHODS Sleep was collected at baseline in 1982 among 1.2 million cancer-free US adults. Cancer-specific mortality was determined through 2018. We used multivariable Cox proportional hazard models to calculate hazard ratios and 95% confidence intervals for overall and site-specific cancer mortality, stratified by sex. RESULTS Among 983,105 participants (56% female) followed for a median of 27.9 person-years, there were 146,911 primary cancer deaths. Results from the adjusted model showed short (6 h/night) and long (8 h/night and 9-14 h/night) sleep duration, compared to 7 h/night, were associated with a modest 2%, 2%, and 5% higher risk of overall cancer mortality, respectively, and there was a significant non-linear trend (p-trend < 0.01). This non-linear trend was statistically significant among male (p-trend < 0.001) but not female (p-trend 0.71) participants. For male participants, short and long sleep were associated with higher risk of lung cancer mortality and long sleep was associated with higher risk of colorectal cancer mortality. Perceived insomnia was associated with a 3-7% lower risk of overall cancer mortality. CONCLUSION Sleep is important to consider in relation to sex- and site-specific cancer mortality. Future research should investigate other components of sleep in relation to cancer mortality.
Collapse
Affiliation(s)
- Sidney M Donzella
- Department of Epidemiology, University of Washington, 380 15th Ave NE, Seattle, WA, 98195, USA.
| | - Emily Deubler
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - Amanda I Phipps
- Department of Epidemiology, University of Washington, 380 15th Ave NE, Seattle, WA, 98195, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Charlie Zhong
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| |
Collapse
|
2
|
Fisher HM, Hyland KA, Miller SN, Amaden GH, Diachina A, Ulmer CS, Danforth M, LeBlanc TW, Somers TJ, Keefe FJ. Mindful Night-to-Day: A Pilot Feasibility Trial of a Mindfulness-Based Insomnia and Symptom Management Intervention for Patients with Hematologic Cancer. Behav Sleep Med 2024; 22:674-696. [PMID: 38597262 PMCID: PMC11365809 DOI: 10.1080/15402002.2024.2339819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVES Patients with hematologic cancer experience severe symptoms (i.e. insomnia, fatigue, pain, distress). Few interventions addressing insomnia and other symptoms exist for this population. Mindfulness-Based Therapy for Insomnia (MBTI) may be appropriate but has only been tested in healthy outpatients. This study aimed to develop and test an adapted MBTI protocol for hematologic cancer patients. METHODS Patient (n = 3) and clinician (n = 1) focus groups, and user-testing (N = 5) informed adaptation of Mindful Night-to-Day (MBTI+). A single-arm pilot trial (N = 32) evaluated feasibility (accrual, attrition, adherence), acceptability (intervention satisfaction), and changes to insomnia symptom severity (Insomnia Severity Index; primary outcome) and secondary outcomes (fatigue, pain, distress, pre-sleep arousal, mindfulness, symptom management self-efficacy) at baseline, post-intervention, and 1-month post-intervention. Descriptive statistics and paired sample t-tests were conducted. RESULTS Qualitative feedback informed MBTI+ content, format, and delivery. Mindfulness was used to increase symptom awareness (sleepiness vs. fatigue). Meditations and behavioral skills were applied to inpatient treatment. MBTI+ met feasibility (N = 32/12 months; 8.1% attrition; 83.8% adherence) and acceptability (M = 3.52/4.00) benchmarks. Insomnia symptom severity decreased (d = 1.20) from baseline to post-intervention, as did most secondary outcomes. CONCLUSIONS MBTI+ was feasible, acceptable, and showed promise for benefits throughout inpatient and outpatient treatment. Findings warrant further evaluation in a randomized trial.
Collapse
Affiliation(s)
- Hannah M. Fisher
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Kelly A. Hyland
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Shannon N. Miller
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Grace H. Amaden
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Allison Diachina
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Christi S. Ulmer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
- Durham Veterans Affairs (VA) Healthcare System, Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, North Carolina
| | | | - Thomas W. LeBlanc
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Tamara J. Somers
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Francis J. Keefe
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
3
|
Chen HM, Liu JH, Huang CS, Dai MF, Chien LI. Moderating Effect of Daylight Exposure on the Relationship Between Physical Activity and Sleep in Patients with Upper Digestive Cancer: An Exploratory Study. Semin Oncol Nurs 2024; 40:151659. [PMID: 38834450 DOI: 10.1016/j.soncn.2024.151659] [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: 03/31/2024] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES To examine the moderating effect of daylight exposure on physical activity and objective sleep quality, using wearable actigraph devices. METHODS We recruited 324 patients with either gastric or esophageal cancer. Actigraphs were used to measure all objective data including daylight exposure, physical activity, and sleep quality. Pearson's correlation coefficients were used to examine the relationships among demographic data, disease attributes, physical activity, daylight exposure, and sleep. The Hayes PROCESS macro with the regression bootstrapping method was employed to analyze the moderating effect of daylight exposure on the relationship between physical activity and sleep. RESULTS Sleep efficiency correlated positively with physical activity, while "wake after sleep onset" correlated negatively with physical activity and mean lux. Mean lux and light >500 lux significantly moderated the association between physical activity and sleep efficiency (P = .002 in both cases). Similarly, mean lux and light >500 lux significantly moderated the association between physical activity and "wake after sleep onset" (P = .002 and .001, respectively). CONCLUSION Both average daylight exposure and time of exposure to >500 lux act as moderators of physical activity and objective sleep quality in patients with gastric or esophageal cancer. Healthcare practitioners should encourage patients with cancer to engage in daily outdoor physical activity. Further intervention studies are needed to verify the combined effect of daytime light exposure and physical activity on improving sleep quality. IMPLICATIONS FOR NURSING PRACTICE Healthcare practitioners should encourage patients with cancer to engage in daily outdoor physical activity. Further intervention studies are needed to verify the combined effect of daytime light exposure and physical activity on improving sleep quality.
Collapse
Affiliation(s)
- Hui-Mei Chen
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan.
| | - Ju-Han Liu
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan; Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Chien-Sheng Huang
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Mei-Fen Dai
- Department of Nursing, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Ling-I Chien
- Department of Nursing, Taipei Veterans General Hospital, Taipei City, Taiwan
| |
Collapse
|
4
|
Ting A, Tsai TC, Zeitzer JM, Mendez A, Kim Y. Sleep Composition of Patients With Colorectal Cancer and Their Sleep-Partner Caregivers: Physical Health Correlates of Sleep Diary and Actigraphy Measurements. Psychooncology 2024; 33:e9302. [PMID: 39123341 PMCID: PMC11328964 DOI: 10.1002/pon.9302] [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: 07/27/2023] [Revised: 07/12/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Disturbed sleep is frequently identified in adult patients with cancer and their caregivers, with detrimental impact on physical health. Less known is the extent to which self-reported and actigraph-measured sleep patterns are similar between patients and their sleep-partner caregivers, and how these different modes of sleep measurements are related to physical health. METHODS Patients diagnosed with colorectal cancer and their sleep-partner caregivers (81 dyads) completed a questionnaire for physical functioning and collected saliva samples for seven consecutive days, from which cortisol slope was quantified. Additionally, participants completed a daily sleep diary and wore actigraph for 14 consecutive days, from which sleep duration, sleep onset latency (SOL), and duration of wake after sleep onset (WASO) were calculated. RESULTS Participants reported sleep patterns that fell within or close to the optimal range, which were similar between patients and their caregivers. Self-reported and actigraph-measured sleep duration had moderate levels of agreement (ICC = 0.604), whereas SOL and WASO had poor agreement (ICC = 0.269). Among patients, longer self-reported WASO was associated with poorer physical health and flatter cortisol slope (p ≤ 0.013). Among caregivers, longer self-reported SOL was associated with poorer physical functioning, actigraph-measured WASO was associated with steeper cortisol slope, and longer self-reported sleep markers studied than actigraph-measured were associated with poorer physical functioning (p ≤ 0.042). CONCLUSION Findings suggest that employing multiple assessment modes for sleep and physical health is vital for comprehensive understanding of sleep health. Furthermore, when addressing patients' sleep health, it may be beneficial to include their sleep-partner caregivers who may experience similar disturbed sleep.
Collapse
Affiliation(s)
- Amanda Ting
- University of Miami, Coral Gables, Florida, USA
| | | | | | | | | |
Collapse
|
5
|
Galin M, de Girolamo L, Clarisse B, Segura-Djezzar C, Glöckner F, Elia C, Réhel S, Clochon P, Doidy F, Chavant J, Etard O, Viader F, Grellard JM, Lequesne J, Joly F, Eustache F, Martin T, Giffard B, Quarck G, Perrier J. Exploration of effects of galvanic vestibular stimulation on circadian rhythms and its associations with sleep and spatial memory in patients with breast cancer: The ICANSLEEP-2 protocol. PLoS One 2024; 19:e0306462. [PMID: 39083526 PMCID: PMC11290633 DOI: 10.1371/journal.pone.0306462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 05/29/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Patients with breast cancer (BC) exhibit circadian rhythm disruptions, mainly of rest-activity rhythm (RAR), of which sleep is an essential component, and cortisol rhythm. Sleep complaints such as insomnia and cognitive impairments are prevalent in BC. In general population, sleep is known to contribute greatly to cognition. Thus, improving RAR (and particularly sleep) could help limiting cognitive impairments in BC patients. It has recently been suggested that, in addition to its essential role in spatial memory, the vestibular system contributes to RAR synchronization. Its stimulation could therefore limit both sleep disturbances and spatial memory deficits in BC. OBJECTIVES The main aim of the ICANSLEEP-2 study is to assess the effects of galvanic vestibular stimulation (GVS) on circadian rhythms. The secondary aim is to assess whether GVS improves sleep and spatial memory in BC patients. METHODS Two groups with insomnia complaints (Insomnia Severity Index > 7) will be included: a patients' group with BC (n = 50) and a healthy control group without history of cancer (n = 25). There will be two assessment sessions, before and after 2 weeks of GVS. Patients will be randomly assigned to either a GVS group or a sham group (noneffective stimulation). Controls will receive GVS. GVS effects will be quantified and compared between groups. Assessments will include actigraphy, salivary cortisol, polysomnography, a cognitive test battery (including a computer-based task for spatial memory) and validated questionnaires (for psychological functioning and sleep complaints). DISCUSSION Current methods for improving sleep in BC have had controversial outcomes regarding sleep structure. We expect GVS to offer a new mean of directly targeting RAR disruptions in BC patients, with beneficial effects on sleep structure. Given the crucial impact of sleep on cognitive functioning, notably spatial memory, improving sleep of BC patients should enhance their cognitive functioning. ETHICS AND DISSEMINATION This study received ethical approval from the Ile de France IV institutional review board on 19 April 2022 (no. ID-RCB: 2022-A00437-36). The findings yielded by this protocol will be presented at various conferences and in peer-reviewed journals. CLINICALTRIALS.GOV REGISTRATION NUMBER NCT05414357.
Collapse
Affiliation(s)
- Melvin Galin
- Neuropsychology and Imaging of Human Memory Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
- COMETE Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
| | - Laura de Girolamo
- Neuropsychology and Imaging of Human Memory Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
| | | | | | - Franka Glöckner
- Faculty of Psychology, Chair of Lifespan Developmental Neuroscience, TU Dresden, Dresden, Germany
| | - Clara Elia
- Neuropsychology and Imaging of Human Memory Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
| | - Stéphane Réhel
- Neuropsychology and Imaging of Human Memory Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
| | - Patrice Clochon
- Neuropsychology and Imaging of Human Memory Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
| | - Franck Doidy
- Neuropsychology and Imaging of Human Memory Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
| | - Julien Chavant
- Neuropsychology and Imaging of Human Memory Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
| | - Olivier Etard
- COMETE Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
| | - Fausto Viader
- Neuropsychology and Imaging of Human Memory Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
| | | | - Justine Lequesne
- Clinical Research Department, François Baclesse Center, Caen, France
| | - Florence Joly
- Clinical Research Department, François Baclesse Center, Caen, France
- Cancer and Cognition Platform, French League Against Cancer, Caen, France
- Cancer Prevention and Treatment (ANTICIPE) Research Unit, INSERM, Normandy University, Caen, France
| | - Francis Eustache
- Neuropsychology and Imaging of Human Memory Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
| | - Tristan Martin
- Movement – Interactions, Performance (MIP) Team, Faculty of Sciences and Technologies, Le Mans University, Le Mans, France
| | - Bénédicte Giffard
- Neuropsychology and Imaging of Human Memory Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
- Cancer and Cognition Platform, French League Against Cancer, Caen, France
| | - Gaëlle Quarck
- COMETE Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
| | - Joy Perrier
- Neuropsychology and Imaging of Human Memory Research Unit, GIP Cyceron-Normandy University-PSL-EPHE-INSERM-Caen University Hospital, Caen, France
| |
Collapse
|
6
|
Gu J, Wu H, Diao W, Ji Y, Li J, Huo J. Association of Sleep Duration with Risk of All-Cause and Cause-Specific Mortality Among American Adults: A Population-Based Cohort Study. Nat Sci Sleep 2024; 16:949-962. [PMID: 39011490 PMCID: PMC11249099 DOI: 10.2147/nss.s469638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024] Open
Abstract
Objective To examine potential factors affecting sleep duration and explore its association with the risk of mortality among adults in the United States. Methods The study population consisted of adults aged 26 to 79 years who participated in the National Health and Nutrition Examination Survey (NHANES) conducted from 2007 to 2016. Sleep duration was classified into three categories: short (<7 hours), optimal (7-8 hours), and long (≥9 hours). The associations between sleep duration and both all-cause mortality and cause-specific mortality (including heart disease, tumors, cerebrovascular disease, and others) were examined in the overall population and subgroups using weighted Cox regression models. Dose-response associations between sleep duration and risk of all-cause mortality were explored using restricted cubic spline (RCS) analyses. Additionally, a multinomial logistic regression analysis was conducted to investigate potential factors that influence sleep duration in adults. Results The study included a total of 24,141 subjects, with a population-weighted mean age of 48.93 years. Over 30% of the subjects exhibited unhealthy sleep habits. Fully adjusted models revealed that both short sleep duration (HR=1.169, 95% CI 1.027-1.331) and long sleep duration (HR=1.286, 95% CI 1.08-1.531), were associated with an increased risk of all-cause mortality. The RCS curves showed a U-shaped relationship between sleep duration and risk of all-cause mortality. Subgroup analyses showed a significant association between poor sleep patterns and all-cause mortality among adults aged 26-64 years, males, and non-Hispanic whites. Furthermore, multinomial logistic regression identified several predictors associated with short and long sleep durations. Conclusion Both short and long sleep duration are associated with an increased risk of all-cause mortality, with a U-shaped dose-response relationship. It is imperative to implement appropriate primary prevention strategies aimed at monitoring and providing health education to populations at risk of developing unhealthy sleep patterns.
Collapse
Affiliation(s)
- Jialin Gu
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210028, People's Republic of China
- Department of Traditional Chinese medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, People's Republic of China
| | - Hailan Wu
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210028, People's Republic of China
- Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210016, People's Republic of China
| | - Wanjing Diao
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210028, People's Republic of China
| | - Yi Ji
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210028, People's Republic of China
| | - Jianyue Li
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210028, People's Republic of China
| | - Jiege Huo
- Department of Oncology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, 210028, People's Republic of China
| |
Collapse
|
7
|
Yin P, Fan Q, Liu L, Yang M, Zhang S, Li X, Hou W, Feng Q, Wang X, Jin Z, Li F, Chen Y. Efficacy of acupuncture treatment for breast cancer-related insomnia: study protocol for a multicenter randomized controlled trial. Front Psychiatry 2024; 15:1301338. [PMID: 38846918 PMCID: PMC11153751 DOI: 10.3389/fpsyt.2024.1301338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
Background Insomnia is one of the most common symptoms among breast cancer patients, which can be present throughout all stages of breast cancer. As a non-pharmacological alternative treatment, acupuncture has been suggested to improve sleep situations in patients with cancer suffering from insomnia. However, there is a lack of well-designed, high-quality clinical evidence regarding the efficacy of acupuncture in the treatment of breast cancer-related insomnia. This study is conducted to evaluate the efficacy and safety of acupuncture treatment for breast cancer-related insomnia. Methods This study was designed as a multicenter, randomized, sham-controlled clinical trial. A total of 264 eligible patients with breast cancer-related insomnia will be randomized into an acupuncture group and a sham acupuncture group in a 1:1 ratio. In the trial, patients in the acupuncture and sham acupuncture groups will receive 12 sessions over a consecutive 4-week period. The primary outcome will be the treatment response rate of Insomnia Severity Index (ISI) at week 4; secondary outcomes include treatment remission rate of ISI, Sleep Efficiency (SE) obtained by the use of Sleep diary, treatment response rate of ISI at 8th and 16th weeks of follow-up, the mean changes of ISI, Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Quality of Life Questionnaire - Core 30 (QLQ-C30), sleep parameters recorded in Actigraphy and weekly usage of remedial drugs. Adverse events will be recorded throughout the study. All analyses will be based on the ITT principle and performed with SAS 9.4 statistical software. Discussion This trial will evaluate the clinical efficacy and safety of acupuncture for breast cancer-related insomnia. If proven effective, acupuncture will provide an effective option for patients with breast cancer-related insomnia, which will play a positive role in helping patients reduce their use of sleeping medications. Clinical trial registration ClinicalTrials.gov, identifier NCT05510700.
Collapse
Affiliation(s)
- Ping Yin
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Fan
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lumin Liu
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ming Yang
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shunxian Zhang
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu Li
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenguang Hou
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qifan Feng
- Hainan Traditional Chinese Medicine Hospital, Haikou, China
| | - Xi Wang
- Xuhui District Central Hospital of Shanghai, Shanghai, China
| | - Zhu Jin
- Shanghai Seventh People’s Hospital, Shanghai, China
| | - Fang Li
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yuelai Chen
- LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
8
|
Subramanian H, Trivedi R, Fuchsova V, Elder E, Brand A, Howle J, Mann GJ, DeFazio A, Amis T, Kairaitis K. Follow-up assessment of sleep-related symptoms in patients after treatment for cancer: responses to continuous positive airway pressure treatment for co-morbid obstructive sleep apnoea. Sleep Breath 2024; 28:725-733. [PMID: 38051468 DOI: 10.1007/s11325-023-02946-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/09/2023] [Accepted: 10/27/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE To assess changes in sleep-related symptoms in patients with breast cancer, endometrial cancer and melanoma previously examined for sleep-related symptoms and the presence of PSG (polysomnography)-determined OSA, ≥ 3 years post-treatment; and to evaluate how CPAP treatment affects sleep-related symptoms in patients previously diagnosed with OSA. METHODS Patients initially recruited from breast cancer, endometrial cancer, and melanoma follow-up clinics at Westmead Hospital (Sydney, Australia) participated in this questionnaire-based study. Demographic and change in cancer status data were collected at follow-up. Patients completed the Pittsburgh Sleep Quality Index [poor sleep quality, PSQITOTAL ≥ 5au], Insomnia Severity Index, Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire; with ΔPSQITOTAL ≥ 3au indicating a clinically meaningful change in sleep quality over follow-up. PSG-determined OSA was confirmed using the apnoea-hypopnoea index. CPAP compliance was determined via self-report (CPAP compliant, CPAP; not compliant, non-CPAP). Logistic regression models determined if changes in cancer status, AHI, cancer subgroup or CPAP treatment was predictive of ΔPSQITOTAL ≥ 3 au and p < 0.05 indicated statistical significance. RESULTS The 60 patients recruited had breast cancer (n = 22), endometrial cancer (n = 15), and melanoma (n = 23). Cancer subgroups were similarly aged, and all had median follow-up PSQITOTAL scores ≥ 5au; breast cancer patients scoring the highest (p < 0.05). The CPAP group had significantly reduced PSQITOTAL scores (p = 0.02) at follow-up, unlike the non-CPAP group. Cancer subgroups had similar median ISITOTAL, ESSTOTAL and FOSQ-10TOTAL scores at follow-up, regardless of CPAP treatment. There were no significant predictors of ΔPSQITOTAL ≥ 3 au at follow-up. CONCLUSION Sleep-related symptoms persist in patients with cancer ≥ 3 years after treatment, although these symptoms improve with CPAP. Future studies should evaluate how CPAP affects survival outcomes in cancer patients with comorbid OSA.
Collapse
Affiliation(s)
- Harini Subramanian
- Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, Australia
| | - Ritu Trivedi
- Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, Australia
| | - Veronika Fuchsova
- Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, Australia
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | - Elisabeth Elder
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Breast Cancer Institute, Westmead Hospital, Westmead, Australia
| | - Alison Brand
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Department of Gynaecological Oncology, Westmead Hospital, Westmead, Australia
| | - Julie Howle
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Crown Princess Mary Cancer Centre, Westmead and Blacktown Hospitals, Blacktown, Australia
- Melanoma Institute Australia, The University of Sydney, Camperdown, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Camperdown, Australia
- Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Anna DeFazio
- Department of Gynaecological Oncology, Westmead Hospital, Westmead, Australia
- Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, Australia
- The Daffodil Centre, The University of Sydney, Camperdown, Australia
| | - Terence Amis
- Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, Australia
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Australia
| | - Kristina Kairaitis
- Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, Australia.
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia.
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, Australia.
| |
Collapse
|
9
|
Daniel LC, Wang H, Brinkman TM, Ruble K, Zhou ES, Palesh O, Stremler R, Howell R, Mulrooney DA, Crabtree VM, Mostoufi-Moab S, Oeffinger K, Neglia J, Yasui Y, Armstrong GT, Krull K. Mechanisms of sleep disturbances in long-term cancer survivors: a childhood cancer survivor study report. JNCI Cancer Spectr 2024; 8:pkae010. [PMID: 38366608 PMCID: PMC10932943 DOI: 10.1093/jncics/pkae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Sleep problems following childhood cancer treatment may persist into adulthood, exacerbating cancer-related late effects and putting survivors at risk for poor physical and psychosocial functioning. This study examines sleep in long-term survivors and their siblings to identify risk factors and disease correlates. METHODS Childhood cancer survivors (≥5 years from diagnosis; n = 12 340; 51.5% female; mean [SD] age = 39.4 [9.6] years) and siblings (n = 2395; 57.1% female; age = 44.6 [10.5] years) participating in the Childhood Cancer Survivor Study completed the Pittsburgh Sleep Quality Index (PSQI). Multivariable Poisson-error generalized estimating equation compared prevalence of binary sleep outcomes between survivors and siblings and evaluated cancer history and chronic health conditions (CHC) for associations with sleep outcomes, adjusting for age (at diagnosis and current), sex, race/ethnicity, and body mass index. RESULTS Survivors were more likely to report clinically elevated composite PSQI scores (>5; 45.1% vs 40.0%, adjusted prevalence ratio [PR] = 1.20, 95% CI = 1.13 to 1.27), symptoms of insomnia (38.8% vs 32.0%, PR = 1.26, 95% CI = 1.18 to 1.35), snoring (18.0% vs 17.4%, PR = 1.11, 95% CI = 1.01 to 1.23), and sleep medication use (13.2% vs 11.5%, PR = 1.28, 95% CI = 1.12 to 1.45) compared with siblings. Within cancer survivors, PSQI scores were similar across diagnoses. Anthracycline exposure (PR = 1.13, 95% CI = 1.03 to 1.25), abdominal radiation (PR = 1.16, 95% CI = 1.04 to 1.29), and increasing CHC burden were associated with elevated PSQI scores (PRs = 1.21-1.48). CONCLUSIONS Among survivors, sleep problems were more closely related to CHC than diagnosis or treatment history, although longitudinal research is needed to determine the direction of this association. Frequent sleep-promoting medication use suggests interest in managing sleep problems; behavioral sleep intervention is advised for long-term management.
Collapse
Affiliation(s)
- Lauren C Daniel
- Department of Psychology, Rutgers University Camden, Camden, NJ, USA
| | - Huiqi Wang
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Tara M Brinkman
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kathy Ruble
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Eric S Zhou
- Division of Sleep Medicine and Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Dana Farber Cancer Institute, Boston, MA, USA
| | - Oxana Palesh
- Department of Psychiatry, Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA
| | - Robyn Stremler
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Rebecca Howell
- Department of Radiation Physics, MD Anderson, Houston, TX, USA
| | - Daniel A Mulrooney
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Valerie M Crabtree
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Sogol Mostoufi-Moab
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin Oeffinger
- Department of Medicine, Duke University and Duke Cancer Institute, Durham, NC, USA
| | - Joseph Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Yutaka Yasui
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kevin Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Psychology and Biobehavioral Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| |
Collapse
|
10
|
Zhou ES, Recklitis CJ, Partridge AH. When Cancer Centers Snooze, Patients Lose: It is Time to Make Insomnia a Priority for Survivors. JCO Oncol Pract 2024; 20:169-172. [PMID: 37956393 DOI: 10.1200/op.23.00540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
Insomnia is a big problem for cancer survivors. Prioritizing evaluation and treatment is essential!
Collapse
Affiliation(s)
- Eric S Zhou
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Ann H Partridge
- Dana-Farber Cancer Institute, Boston, MA
- Harvard Medical School, Boston, MA
| |
Collapse
|
11
|
Powers-James C, Morse M, Narayanan S, Ramondetta L, Lopez G, Wagner R, Cohen L. Integrative Oncology Approaches to Reduce Recurrence of Disease and Improve Survival. Curr Oncol Rep 2024; 26:147-163. [PMID: 38180690 DOI: 10.1007/s11912-023-01467-5] [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] [Accepted: 10/10/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE OF REVIEW After a cancer diagnosis, patients ask what they can do in addition to the recommended treatments to increase their survival. Many turn to integrative medicine modalities and lifestyle changes to improve their chances of survival. Numerous studies have demonstrated that lifestyle changes can significantly improve survival rates for cancer patients. Less support exists for the use of natural products or supplements to improve cancer survival. In this manuscript, we review key findings and evidence in the areas of healthy eating habits, physical activity, stress management and social support, and sleep quality, as well as natural products and supplements as they relate to the cancer recurrence and survival. RECENT FINDINGS While more research is needed to fully understand the mechanisms underlying the associations between lifestyle changes and cancer survival, findings suggest that lifestyle modifications in the areas of diet, physical activity, stress management and social support, and sleep quality improve clinical cancer outcomes. This is especially true for programs that modify more than one lifestyle habit. To date, outside of supplementing with vitamin D to maintain adequate levels, conflicting conclusion within the research remain regarding the efficacy of using natural products or supplement to improve cancer recurrence of disease or cancer survival. A call for further research is warranted. Lifestyle screening and counseling should be incorporated into cancer treatment plans to help improve patient outcomes. While the scientific community strives for the pursuit of high-quality research on natural products to enhance cancer survival, transparency, dialogue, and psychological safety between patients and clinicians must continue to be emphasized. Proactive inquiry by clinicians regarding patients' supplement use will allow for an informed discussion of the benefits and risks of natural products and supplements, as well as a re-emphasis of the evidence supporting diet and other lifestyle habits to increase survival.
Collapse
Affiliation(s)
- Catherine Powers-James
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | - Meroë Morse
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Santhosshi Narayanan
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Lois Ramondetta
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Gabriel Lopez
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Richard Wagner
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Lorenzo Cohen
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| |
Collapse
|
12
|
Walker II WH, Liu JA, Meléndez-Fernández OH, May LE, Kisamore CO, Brundage KM, Nelson RJ, DeVries AC. Social enrichment alters the response of brain leukocytes to chemotherapy and tumor development in aged mice. Heliyon 2024; 10:e23366. [PMID: 38148808 PMCID: PMC10750159 DOI: 10.1016/j.heliyon.2023.e23366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Aging is a risk factor for the development of breast cancer. Foundational science studies have supported associations among neuroinflammation, breast cancer, and chemotherapy, but to date, these associations are based on studies using young adult rodents. The current study examined the neuroinflammatory effects of chemotherapy in aged, tumor-naïve and tumor-bearing mice with or without social enrichment. Mice received two intravenous injections of doxorubicin (A) and cyclophosphamide (C) at a two-week interval. Brain immune cells were enriched/assessed via flow cytometry, seven days following the second chemotherapy injection. Social enrichment enhanced peripheral immune cell trafficking in aged tumor-naive mice treated with AC. Group housed aged tumor bearing mice receiving AC had reduced percentage of IL-6+ monocytes and granulocytes relative to their singly housed counterparts. Notably, group housing aged experimental mice with young cage partners significantly reduced TNF + monocytes, tumor volume, and tumor mass. These data illustrate the importance of social enrichment in attenuating neuroinflammation and are the first to demonstrate that social support with young housing partners reduces tumor growth in aged mice.
Collapse
Affiliation(s)
- William H. Walker II
- Department of Neuroscience, Rockefeller Neuroscience Institute, USA
- West Virginia University Cancer Institute, USA
| | - Jennifer A. Liu
- Department of Neuroscience, Rockefeller Neuroscience Institute, USA
| | | | - Laura E. May
- Department of Neuroscience, Rockefeller Neuroscience Institute, USA
| | | | - Kathleen M. Brundage
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University, Morgantown, WV, 26506, USA
| | - Randy J. Nelson
- Department of Neuroscience, Rockefeller Neuroscience Institute, USA
- West Virginia University Cancer Institute, USA
| | - A. Courtney DeVries
- Department of Neuroscience, Rockefeller Neuroscience Institute, USA
- West Virginia University Cancer Institute, USA
- Department of Medicine, USA
| |
Collapse
|
13
|
Bock K, Peltzer J, Liu W, Colgrove Y, Smirnova I, Siengsukon C. Sleep quality and lymphedema in breast cancer survivors: a mixed method analysis. J Cancer Surviv 2024:10.1007/s11764-023-01516-9. [PMID: 38183577 DOI: 10.1007/s11764-023-01516-9] [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: 05/21/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE The purpose of this convergent mixed methods study was to assess the perceptions and characteristics of sleep in breast cancer survivors (BCSs) and elucidate perceptions of sleep among BCS with lymphedema. METHODS Participants were BCS with and without lymphedema. Both groups completed the Pittsburgh Sleep Quality Index (PSQI), PROMIS® Sleep Disturbance (8a short form), and wore an actigraph on their wrist to capture sleep/wake cycles for 7 days/nights while logging their sleep using a sleep diary. The coefficient of variation of sleep efficiency was calculated from the sleep diary to assess intraindividual variability. In addition, a subsample of BCS with lymphedema participated in a semi-structured qualitative interview. The qualitative data was analyzed separately, and the themes were applied to provide a more nuanced explanation of the quantitative outcomes. RESULTS The BCS with lymphedema (n=23) had a significant difference in PSQI (p=0.002), PROMIS® Sleep Disturbance (p=0.084), and sleep efficiency coefficient of variation (p=0.014) compared to BCS without lymphedema (n=23). There were no statistically significant differences between groups in the actigraphy results. BCS with lymphedema perceived that lymphedema management contributed to their sleep disturbance, further exacerbating their mind/body fatigue. CONCLUSION This study provides the foundation for future research to investigate the integration of sleep interventions with lymphedema management for holistic survivorship care for BCS with lymphedema. IMPLICATIONS FOR CANCER SURVIVORS An innovative sleep health intervention designed to consider the unique factors contributing to sleep disturbance in BCS with lymphedema will fill a gap in their post-cancer treatment quality of life.
Collapse
Affiliation(s)
- Karen Bock
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Jill Peltzer
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Wen Liu
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Yvonne Colgrove
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Irina Smirnova
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| | - Catherine Siengsukon
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
14
|
Treacy T, O'Meara Y, Galligan MC, Henry AL, Lensen SF, Higgins MJ, Hickey M, Brennan DJ. The Sleepio After Cancer (SAC) study. Digital cognitive behavioural therapy for insomnia (dCBT-I) in women cancer patients - Trial protocol of a randomised controlled trial. Contemp Clin Trials 2024; 136:107337. [PMID: 37741507 DOI: 10.1016/j.cct.2023.107337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
AIMS This study will assess the efficacy of digital CBT for insomnia (dCBT-I) compared to sleep hygiene education (SHE) for the management of insomnia in women with cancer. BACKGROUND 30% of patients with cancer meet insomnia diagnostic criteria and this can be detrimental to health outcomes. Insomnia disorder comprises a dissatisfaction with sleep quantity or quality characterized by difficulty initiating sleep, frequent awakenings, or early morning wakening without the ability to return to sleep, at least 3 nights per week, for at least 3 months, causing significant impairment or distress in areas of functioning. METHODS We will recruit 308 women with a current or prior cancer diagnosis who are currently experiencing insomnia; defined as a score of 16 or less on the Sleep Condition Indicator (SCI). Participants will be randomised to dCBT-I or SHE. dCBT-I will be delivered online via 6 sessions. SHE will be provided in an online format. Assessments of sleep and other related parameters, through validated questionnaires, will be taken at 12 and 24 weeks following intervention. Once 24 week assessments are completed, participants will crossover to the alternate arm (either SHE or dCBT-I) and undergo a final assessment at week 36. OUTCOMES The primary outcome will be the mean continuous change in SCI score in the intervention arm compared to the control arm at 24 weeks. Additionally, the proportion of women with an SCI > 16 at 24 weeks will be assessed. Secondary outcomes include fatigue, sleep related quality of life, depression, anxiety, and hot flush interference. REGISTRATION This study is registered on ClinicalTrials.gov with number NCT05816460.
Collapse
Affiliation(s)
- Teresa Treacy
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Yvvonne O'Meara
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Marie C Galligan
- UCD Clinical Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Sarah F Lensen
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Michaela J Higgins
- Dept. of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Martha Hickey
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Melbourne, VIC, Australia
| | - Donal J Brennan
- Living Well Cancer Programme, UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland; UCD Gynaecological Oncology Group, UCD School of Medicine, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, Belfield, Dublin 4, Ireland
| |
Collapse
|
15
|
Nair NM, Vaughn CB, Ochs-Balcom HM, Nie J, Trevisan M, Freudenheim JL. Sleep duration and mortality among breast cancer survivors in the Western New York Exposures and Breast Cancer (WEB) Study. Cancer Causes Control 2024; 35:103-109. [PMID: 37594683 DOI: 10.1007/s10552-023-01774-z] [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: 09/23/2022] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE There is increasing evidence that sleep duration may affect breast cancer survival through effects on circadian function, influencing disease progression. However, further investigation of this association is needed. METHODS In a population-based, prospective cohort study of women from the Western New York Exposures and Breast Cancer Study, we examined mortality outcomes with invasive breast cancer identified using the National Death Index. Cox proportion hazards ratios with 95% confidence intervals were used to estimate risk of all-cause (AC) and breast cancer-specific (BC) mortality associated with self-reported usual sleep duration with adjustment for age, race/ethnicity, years of education, body mass index (BMI), menopausal status, pack-years of smoking, tumor stage, and estrogen-receptor (ER) status. We further examined associations within strata of BMI, tumor stage, menopausal status, and ER status. RESULTS A sample of 817 patients with breast cancer were followed for a median of 18.7 years, during which 339 deaths were reported, including 132 breast cancer-specific deaths. Those who reported shorter or longer sleep tended to have a slightly higher BMI, to be less proportionately non-Hispanic White, to report a previous history of benign breast disease, and to have consumed more alcohol during their lifetime. We found no significant associations between sleep duration and AC or BC mortality, including within stratified analyses. CONCLUSION Sleep duration was not associated with either AC or BC mortality including within strata of BMI, tumor stage, menopausal status, or ER status.
Collapse
Affiliation(s)
- Nisha M Nair
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
| | | | - Heather M Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Jing Nie
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Maurizio Trevisan
- Health Sciences, Vin University, Hanoi, Vietnam
- Università Campus Biomedico, Rome, Italy
| | - Jo L Freudenheim
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
16
|
Balachandran DD, Bashoura L, Sheshadri A, Manzullo E, Faiz SA. The Impact of Immunotherapy on Sleep and Circadian Rhythms in Patients with Cancer. Front Oncol 2023; 13:1295267. [PMID: 38090501 PMCID: PMC10711041 DOI: 10.3389/fonc.2023.1295267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/06/2023] [Indexed: 02/01/2024] Open
Abstract
Immunotherapy has revolutionized treatments for both early and advanced cancers, and as their role evolves, their impact on sleep and circadian rhythms continues to unfold. The recognition, evaluation, and treatment of sleep and circadian rhythm disturbance leads to improved symptom management, quality of life and treatment outcomes. An intricate complex relationship exists in the microenvironment with immunity, sleep and the tumor, and these may further vary based on the cancer, addition of standard chemotherapy, and pre-existing patient factors. Sleep and circadian rhythms may offer tools to better utilize immunotherapy in the care of cancer patients, leading to better treatment outcome, reduced symptom burden, and increased quality of life.
Collapse
Affiliation(s)
- Diwakar D. Balachandran
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lara Bashoura
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ellen Manzullo
- Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saadia A. Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| |
Collapse
|
17
|
Day AT, Prestwood CA, Emmett TR, Eary RL, Salley JR, Cerda V, Mayfield Arnold E, Lee SC, Tiro JA. Unmet Needs and Receipt of Supportive Care Services in Head and Neck Cancer Patients Prior to Oncologic Treatment: A Prospective, Cross-Sectional Pilot Study. Ann Otol Rhinol Laryngol 2023; 132:1361-1372. [PMID: 36890749 DOI: 10.1177/00034894231154182] [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] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To characterize the supportive care (SC) needs and receipt of SC services among head and neck cancer (HNC) patients prior to oncologic treatment and to explore the influence of social determinants of health on these outcomes. MATERIALS AND METHODS Newly diagnosed HNC patients were surveyed via telephone prior to oncologic treatment between 10/2019 and 1/2021 using a prospective, cross-sectional, bi-institutional, pilot study design. The primary study outcome was unmet SC needs (Supportive Care Needs Survey-Short Form34 [SCNS-SF34]). Hospital type (university- vs county safety-net) was explored as an exposure. Descriptive statistics were performed using STATA16 (College Station, TX). RESULTS Among 158 potentially eligible patients, 129 were successfully contacted, 78 met the study criteria, and 50 completed the survey. The mean age was 61, 58% exhibited clinical stage III-IV disease, and 68% and 32% were treated at the university and county safety-net hospital, respectively. Patients were surveyed a median of 20 days after their first oncology visit and 17 days prior to initiation of oncology treatment. They had a median of 24 total needs (11 were met and 13 were unmet) and preferred to see a median of 4 SC services but received care from none. County safety-net patients had comparatively more unmet needs than university patients (14.5 vs 11.5, P = .04). CONCLUSION Pretreatment HNC patients at a bi-institutional academic medical center report a high number of unmet SC needs with corollary poor receipt of available SC services. Novel interventions to address this significant gap in care are needed.
Collapse
Affiliation(s)
- Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Courtney A Prestwood
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Thomas R Emmett
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rebecca L Eary
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jordan R Salley
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Vanessa Cerda
- Department of Population and Data Sciences; UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Simon Craddock Lee
- Department of Population and Data Sciences; UT Southwestern Medical Center, Dallas, TX, USA
| | - Jasmin A Tiro
- Department of Population and Data Sciences; UT Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
18
|
Beverly Hery CM, Janse SA, Van Zee KJ, Naftalis EZ, Paskett ED, Naughton MJ. Factors associated with insomnia symptoms over three years among premenopausal women with breast cancer. Breast Cancer Res Treat 2023; 202:155-165. [PMID: 37542630 PMCID: PMC10504151 DOI: 10.1007/s10549-023-07058-z] [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: 01/27/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE We examined longitudinal trends and factors associated with insomnia over 3 years in a cohort of young breast cancer patients. METHODS Women with stage I-III breast cancer at ≤ 45 years were recruited at five institutions from New York, Texas, and North Carolina, within 8 months of diagnosis (n = 836). Participants completed questionnaires every 6 months for 3 years. Linear mixed-effects models were used to examine insomnia over time, using the Women's Health Initiative Insomnia Rating Scale (WHIIRS). We evaluated the relations of insomnia with demographic (age, race, education, income, employment, marital status), clinical (cancer stage, histologic grade, chemotherapy, radiation, hormone therapy, surgery, tumor size, body mass index, hot flashes), and social/behavioral variables (smoking status, social support, physical activity, depressive symptoms). RESULTS At baseline, 57% of participants met or exceeded the cut-off for clinical insomnia (WHIIRS score ≥ 9). Insomnia symptoms were most prevalent at baseline (p < 0.0001), but decreased significantly throughout follow-up (p < 0.001). However, 42% of participants still experienced insomnia symptoms 3 years after diagnosis. In multivariable models, older age (p = 0.02), hot flashes (p < 0.0001), and depressive symptoms (p < 0.0001) remained significantly associated with insomnia over time. CONCLUSIONS Insomnia symptoms were most frequent closer to breast cancer diagnosis and treatment, but persisted for some women who were older and those reporting higher hot flashes and depressive symptoms. Survivorship care should include assessing insomnia symptoms, particularly during and immediately after primary treatment. Implementing early interventions for sleep problems may benefit young breast cancer survivors and improve their quality of life.
Collapse
Affiliation(s)
- Chloe M Beverly Hery
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, 43210, USA.
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
| | - Sarah A Janse
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA
| | - Kimberly J Van Zee
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Elizabeth Z Naftalis
- Director of Breast Services, Health Texas Community Health Services Corporate, Dallas, TX, 75001, USA
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Michelle J Naughton
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| |
Collapse
|
19
|
Gouldthorpe C, Power J, Davies A. Circadian rhythm disorders in patients with advanced cancer: a scoping review. Front Oncol 2023; 13:1240284. [PMID: 37829342 PMCID: PMC10565850 DOI: 10.3389/fonc.2023.1240284] [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: 06/14/2023] [Accepted: 08/16/2023] [Indexed: 10/14/2023] Open
Abstract
Circadian rhythms can be demonstrated in several biomarkers and behavioural activities, with rhythmical patterns occurring roughly over a 24-h period. Circadian disorders occur in patients with cancer and may be associated with poor clinical outcomes. This scoping review aimed to identify circadian rhythm research and reporting practices, circadian rhythm patterns, circadian rhythm disorders, and relevant associations of circadian rhythm disorders in patients with advanced cancer. Studies involved adult patients with locally advanced or metastatic cancer and used objective measures of circadian rhythmicity. Two independent authors completed initial screening of title and abstracts, full text reviews, data extraction, and data checking. A total of 98 articles were highlighted in the scoping review, which utilised physical activity measures (actigraphy and polysomnography), biomarkers (cortisol and melatonin), or a combination. Several circadian rhythms are commonly disordered amongst patients with advanced cancer and have significant implications for symptom burden, quality of life, and survival. It remains unclear which patients are most at risk of a circadian rhythm disorder. Significant heterogeneity exists in research and reporting practices. Standardising this approach may address discrepancies in the current literature and allow for research to focus on the most relevant parameters and approaches to improving circadian rhythmicity.
Collapse
Affiliation(s)
- Craig Gouldthorpe
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice and Care Services, Dublin, Ireland
| | - Jenny Power
- Academic Department of Palliative Medicine, Our Lady’s Hospice and Care Services, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Andrew Davies
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice and Care Services, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| |
Collapse
|
20
|
Goerge A, Sanderson M, Flewellen C, Busen K, Nechuta S. The Role of Spirituality on Physical Activity and Sleep Among African American Long-Term Breast Cancer Survivors. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01791-3. [PMID: 37721666 PMCID: PMC11246726 DOI: 10.1007/s40615-023-01791-3] [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: 06/06/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND African Americans with chronic conditions have reported the importance of spirituality in their lives. Aspects of spirituality have been shown to be related to physical activity (PA) and sleep, and PA and sleep affect quality of life (QOL). This study examined the association between spirituality, PA, and sleep in long-term African American breast cancer survivors. METHODS This cross-sectional study included 323 breast cancer survivors who previously participated in a case-only study. During 2015-2016, participants completed a questionnaire focused on survivorship that used validated measures for spirituality, PA, and sleep. Adjusted binary and multinomial logistic regression models estimated odds ratios (aORs) and 95% confidence intervals (CIs) for the associations of spirituality with total PA, meeting PA guidelines, sleep duration, and sleep medication. RESULTS The mean age at diagnosis was 54.8 (SD = 9.89) years. The range of spirituality scores was 7-48 (median = 44). Among participants who had a score ≥ 44, 59% had high total PA, 61% met PA guidelines, 59% had high sleep duration, and 55% did not use sleep medication. Higher spirituality score was associated with higher total PA (aOR for ≥ 681 min/week: 1.90, 95% CI: 1.03-3.50), meeting PA guidelines (aOR: 1.78, 95% CI: 1.06-2.98), sleep duration > 7 h/night (aOR: 1.72, 95% CI 1.05-2.83), and lack of sleep medication use (aOR: 0.45, 95% CI: 0.24-0.84). CONCLUSION In African American long-term breast cancer survivors, a higher spirituality score increased the likelihood of greater PA and high sleep duration. These results indicate that interventions surrounding spirituality may benefit the QOL of African American breast cancer survivors.
Collapse
Affiliation(s)
- Ally Goerge
- College of Health Professions, School of Interdisciplinary Health, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA
| | - Maureen Sanderson
- Meharry Medical College, School of Medicine, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Cristen Flewellen
- Meharry Medical College, School of Medicine, 1005 Dr. DB Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Katherine Busen
- College of Health Professions, School of Interdisciplinary Health, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA
| | - Sarah Nechuta
- College of Health Professions, School of Interdisciplinary Health, Grand Valley State University, 500 Lafayette Street, Grand Rapids, MI, 49503, USA.
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
González-Santos Á, Lopez-Garzon M, Gil-Gutiérrez R, Salinas-Asensio MDM, Postigo-Martin P, Cantarero-Villanueva I. Nonlinear, Multicomponent Physical Exercise With Heart Rate Variability-Guided Prescription in Women With Breast Cancer During Treatment: Feasibility and Preliminary Results (ATOPE Study). Phys Ther 2023; 103:pzad070. [PMID: 37347987 PMCID: PMC10506849 DOI: 10.1093/ptj/pzad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE The purpose of this study was to examine the feasibility, safety, adherence, and preliminary efficacy of the ATOPE program during radiotherapy (RT) or chemotherapy (CT) for women with breast cancer. METHODS This single-blind, pretest-posttest feasibility study included 38 women with breast cancer at the beginning of their treatment. The ATOPE program consisted of 12 to 18 sessions of a multimodal physical exercise program, prescribed based on daily heart rate variability and clinimetric assessments using the ATOPE+ mHealth system. Overall health was assessed with quality of life, autonomous balance, and body composition, whereas health-related fitness was measured through functional capacity, physical activity levels, and upper and lower limb strength. RESULTS The rates of recruitment, retention, and adherence were 52.35, 73.68, and 84.37%, respectively, and the satisfaction rating was 9.2 out of a possible 10 points. The perceived health status change score was 3.83 points, scored on a -5 to 5 point scale. No adverse effects were found. Compliance results showed that the ATOPE+ mHealth system was used on 73.38% of the days, and the Fitbit bracelet (Google, Mountain View, CA, USA) was used on 84.91% of the days. Women stayed physically active 55% of days. Regarding preliminary results, for overall health, the percentage of body fat in the RT group decreased by 1.93%, whereas it increased by 5.03% in the CT group. Lower limb strength increased in the RT group, specifically knee extensor isometric strength (6.07%), isokinetic knee flexors 180 degree/second (1.53%), and isokinetic knee extensors 300 degree/second (4.53%), in contrast with the reductions found in the CT group (11.07, 18.67, and 14.89%, respectively). CONCLUSION The ATOPE program, through nonlinear prescription based on daily monitoring with the ATOPE+ mHealth system, is feasible and safe for application during breast cancer treatment. The results suggest that the overall health can be maintained or even improved regarding most variables. IMPACT This study focused on the feasibility, safety, and completion of a physical therapist-led program at early diagnosis for adults with breast cancer. The multimodal, supervised, tailored, nonlinear physical exercise program is feasible and safe, showed a good completion rate, and was able to prevent the quality-of-life deficits that are often triggered by systemic breast cancer treatment. This study highlights the importance of daily morning assessments using the ATOPE+ mHealth system in patients with breast cancer to prescribe nonlinear physical exercise.
Collapse
Affiliation(s)
- Ángela González-Santos
- Department of Physical Therapy, Faculty of Health Sciences, BIO277 Group, University of Granada, Granada, Spain
- Sport and Health Research Center (IMUDs), Granada, Spain
- A02-Cuídate, Instituto de Investigación Biosanitaria, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), Granada, Spain
| | - Maria Lopez-Garzon
- Department of Physical Therapy, Faculty of Health Sciences, BIO277 Group, University of Granada, Granada, Spain
- Sport and Health Research Center (IMUDs), Granada, Spain
- A02-Cuídate, Instituto de Investigación Biosanitaria, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), Granada, Spain
| | - Rocío Gil-Gutiérrez
- Department of Nursing, Faculty of Health Sciences, CTS436 Group, University of Granada, Granada, Spain
- MP07-Bases Fisiopatología y Terapéutica Médica, Instituto de Investigación Biosanitaria, Granada, Spain
| | | | - Paula Postigo-Martin
- Department of Physical Therapy, Faculty of Health Sciences, BIO277 Group, University of Granada, Granada, Spain
- Sport and Health Research Center (IMUDs), Granada, Spain
- A02-Cuídate, Instituto de Investigación Biosanitaria, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), Granada, Spain
| | - Irene Cantarero-Villanueva
- Department of Physical Therapy, Faculty of Health Sciences, BIO277 Group, University of Granada, Granada, Spain
- Sport and Health Research Center (IMUDs), Granada, Spain
- A02-Cuídate, Instituto de Investigación Biosanitaria, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), Granada, Spain
| |
Collapse
|
23
|
Zhao F, Freeman JQ, Jaskowiak N, Fleming GF, Nanda R, Lauderdale DS, Olopade OI, Huo D. Stress, Isolation, and Sleep Quality among Breast Cancer Survivors throughout the COVID-19 Pandemic: A Longitudinal Study in a Multi-Ethnic Cohort. RESEARCH SQUARE 2023:rs.3.rs-3231825. [PMID: 37609132 PMCID: PMC10441518 DOI: 10.21203/rs.3.rs-3231825/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Purpose This study examined how stress, isolation, and sleep quality were impacted throughout the COVID-19 pandemic among breast cancer survivors (BCS). Methods BCS enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort were surveyed in 2020, 2021, and 2022. An 11-item isolation/stress score was repeatedly measured in each survey and its changes were examined through mixed-effects models. Sleep quality was assessed in 2022 by the Insomnia Severity Index (ISI). Results In total, 1899 BCS responded (response rate: 62.8%), of whom 69% were White and 24% Black (median time since diagnosis: 5.1 years, IQR: 2.3-9.2). The isolation/stress score decreased significantly from 2020 to 2022 for White BCS, but only started declining for Black BCS in 2022. Consequently, although there were no significant racial difference in 2020, Black BCS had significantly higher isolation/stress scores in 2021 and 2022 (P < .01), while it became nonsignificant after adjusting for socioeconomic factors. BCS who were single, on Medicaid, without a high school degree, or with annual household income <$35,000 had significantly higher isolation/stress scores. Regarding sleep quality, 48% of BCS reported clinically-significant insomnia (ISI ≥ 8), and insomnia was strongly associated with higher isolation/stress scores (P-trend < .001). Conclusions Our findings suggested that the isolation/stress level improved among BCS as the pandemic subsided, but this positive trend was not observed equally across racial/ethnic groups potentially due to lack of resources. Implications for Cancer Survivors Additional resources, such as access to counseling services and sleep assistance programs, might support the post-pandemic recovery of undersevered BCS.
Collapse
|
24
|
Lee S, Ma C, Shi Q, Meyers J, Kumar P, Couture F, Kuebler P, Krishnamurthi S, Lewis D, Tan B, O'Reilly EM, Shields AF, Meyerhardt JA. Sleep and cancer recurrence and survival in patients with resected Stage III colon cancer: findings from CALGB/SWOG 80702 (Alliance). Br J Cancer 2023; 129:283-290. [PMID: 37179438 PMCID: PMC10338523 DOI: 10.1038/s41416-023-02290-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND We sought to assess the influences of sleep duration, sleep adequacy, and daytime sleepiness on survival outcomes among Stage III colon cancer patients. METHODS We conducted a prospective observational study of 1175 Stage III colon cancer patients enrolled in the CALGB/SWOG 80702 randomised adjuvant chemotherapy trial who completed a self-reported questionnaire on dietary and lifestyle habits 14-16 months post-randomisation. The primary endpoint was disease-free survival (DFS), and secondary was overall survival (OS). Multivariate analyses were adjusted for baseline sociodemographic, clinical, dietary and lifestyle factors. RESULTS Patients sleeping ≥9 h-relative to 7 h-experienced a worse hazard ratio (HR) of 1.62 (95% confidence interval (CI), 1.01-2.58) for DFS. In addition, those sleeping the least (≤5 h) or the most (≥ 9 h) experienced worse HRs for OS of 2.14 (95% CI, 1.14-4.03) and 2.34 (95% CI, 1.26-4.33), respectively. Self-reported sleep adequacy and daytime sleepiness showed no significant correlations with outcomes. CONCLUSIONS Among resected Stage III colon cancer patients who received uniform treatment and follow-up within a nationwide randomised clinical trial, very long and very short sleep durations were significantly associated with increased mortality. Interventions targeting optimising sleep health among indicated colon cancer patients may be an important method by which more comprehensive care can be delivered. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01150045.
Collapse
Affiliation(s)
| | - Chao Ma
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey Meyers
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | | | | | - Philip Kuebler
- Columbus NCI Community Oncology Research Program, Columbus, OH, USA
| | | | | | - Benjamin Tan
- Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA
| | - Eileen M O'Reilly
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, NY, USA
| | | | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA.
| |
Collapse
|
25
|
Perrier J, Galin M, Denise P, Giffard B, Quarck G. Tackling Insomnia Symptoms through Vestibular Stimulation in Patients with Breast Cancer: A Perspective Paper. Cancers (Basel) 2023; 15:cancers15112904. [PMID: 37296867 DOI: 10.3390/cancers15112904] [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: 03/28/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
Insomnia symptoms are common among patients with breast cancer (BC; 20-70%) and are predictors of cancer progression and quality of life. Studies have highlighted sleep structure modifications, including increased awakenings and reduced sleep efficiency and total sleep time. Such modifications may result from circadian rhythm alterations consistently reported in this pathology and known as carcinogenic factors, including lower melatonin levels, a flattened diurnal cortisol pattern, and lower rest-activity rhythm amplitude and robustness. Cognitive behavioral therapy and physical activity are the most commonly used non-pharmacological interventions to counter insomnia difficulties in patients with BC. However, their effects on sleep structure remain unclear. Moreover, such approaches may be difficult to implement shortly after chemotherapy. Innovatively, vestibular stimulation would be particularly suited to tackling insomnia symptoms. Indeed, recent reports have shown that vestibular stimulation could resynchronize circadian rhythms and improve deep sleep in healthy volunteers. Moreover, vestibular dysfunction has been reported following chemotherapy. This perspective paper aims to support the evidence of using galvanic vestibular stimulation to resynchronize circadian rhythms and reduce insomnia symptoms in patients with BC, with beneficial effects on quality of life and, potentially, survival.
Collapse
Affiliation(s)
- Joy Perrier
- Neuropsychologie et Imagerie de la Mémoire Humaine U1077, EPHE, INSERM, CHU de Caen, GIP Cyceron, PSL Université, Normandie Univ, Université de Caen Normandie, 14000 Caen, France
| | - Melvin Galin
- Neuropsychologie et Imagerie de la Mémoire Humaine U1077, EPHE, INSERM, CHU de Caen, GIP Cyceron, PSL Université, Normandie Univ, Université de Caen Normandie, 14000 Caen, France
- COMETE U1075, INSERM, CYCERON, CHU de Caen, Normandie Univ, Université de Caen Normandie, 14000 Caen, France
| | - Pierre Denise
- COMETE U1075, INSERM, CYCERON, CHU de Caen, Normandie Univ, Université de Caen Normandie, 14000 Caen, France
| | - Bénédicte Giffard
- Neuropsychologie et Imagerie de la Mémoire Humaine U1077, EPHE, INSERM, CHU de Caen, GIP Cyceron, PSL Université, Normandie Univ, Université de Caen Normandie, 14000 Caen, France
| | - Gaëlle Quarck
- COMETE U1075, INSERM, CYCERON, CHU de Caen, Normandie Univ, Université de Caen Normandie, 14000 Caen, France
| |
Collapse
|
26
|
Winkler F, Venkatesh HS, Amit M, Batchelor T, Demir IE, Deneen B, Gutmann DH, Hervey-Jumper S, Kuner T, Mabbott D, Platten M, Rolls A, Sloan EK, Wang TC, Wick W, Venkataramani V, Monje M. Cancer neuroscience: State of the field, emerging directions. Cell 2023; 186:1689-1707. [PMID: 37059069 PMCID: PMC10107403 DOI: 10.1016/j.cell.2023.02.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 04/16/2023]
Abstract
The nervous system governs both ontogeny and oncology. Regulating organogenesis during development, maintaining homeostasis, and promoting plasticity throughout life, the nervous system plays parallel roles in the regulation of cancers. Foundational discoveries have elucidated direct paracrine and electrochemical communication between neurons and cancer cells, as well as indirect interactions through neural effects on the immune system and stromal cells in the tumor microenvironment in a wide range of malignancies. Nervous system-cancer interactions can regulate oncogenesis, growth, invasion and metastatic spread, treatment resistance, stimulation of tumor-promoting inflammation, and impairment of anti-cancer immunity. Progress in cancer neuroscience may create an important new pillar of cancer therapy.
Collapse
Affiliation(s)
- Frank Winkler
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg and Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Humsa S Venkatesh
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Moran Amit
- Department of Head and Neck Surgery, MD Anderson Cancer Center and The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Tracy Batchelor
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ihsan Ekin Demir
- Department of Surgery, Technical University of Munich, Munich, Germany
| | - Benjamin Deneen
- Center for Stem Cells and Regenerative Medicine, Baylor College of Medicine, Houston, TX, USA
| | - David H Gutmann
- Department of Neurology, Washington University, St Louis, MO, USA
| | - Shawn Hervey-Jumper
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas Kuner
- Department of Functional Neuroanatomy, University of Heidelberg, Heidelberg, Germany
| | - Donald Mabbott
- Department of Psychology, University of Toronto and Neuroscience & Mental Health Program, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Asya Rolls
- Department of Immunology, Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Erica K Sloan
- Monash Institute of Pharmaceutical Sciences, Drug Discovery Biology Theme, Monash University, Parkville, VIC, Australia
| | - Timothy C Wang
- Department of Medicine, Division of Digestive and Gastrointestinal Diseases, Columbia University, New York, NY, USA
| | - Wolfgang Wick
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg and Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Varun Venkataramani
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg and Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Functional Neuroanatomy, University of Heidelberg, Heidelberg, Germany.
| | - Michelle Monje
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA; Howard Hughes Medical Institute, Stanford University, Stanford, CA, USA.
| |
Collapse
|
27
|
D'cunha K, Park Y, Protani MM, Reeves MM. Circadian rhythm disrupting behaviours and cancer outcomes in breast cancer survivors: a systematic review. Breast Cancer Res Treat 2023; 198:413-421. [PMID: 36422754 PMCID: PMC10036454 DOI: 10.1007/s10549-022-06792-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 10/30/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Circadian rhythm disruptors (e.g., night-shift work) are risk factors for breast cancer, however studies on their association with prognosis is limited. A small but growing body of research suggests that altered sleep patterns and eating behaviours are potential mechanistic links between circadian rhythm disruptors and breast cancer. We therefore systematically summarised literature examining the influence of circadian rhythm disrupting behaviours on cancer outcomes in women with breast cancer. METHODS A systematic search of five databases from inception to January 2021 was conducted. Original research published in English, assessing the relationship between post-diagnosis sleep patters and eating behaviours, and breast cancer outcomes were considered. Risk of bias was assessed using the Newcastle-Ottawa Assessment Scale for Cohort Studies. RESULTS Eight studies published original evidence addressing sleep duration and/or quality (k = 7) and, eating time and frequency (k = 1). Longer sleep duration (≥ 9 h versus [referent range] 6-8 h) was consistently associated with increased risk of all outcomes of interest (HR range: 1.37-2.33). There was limited evidence to suggest that measures of better sleep quality are associated with lower risk of all-cause mortality (HR range: 0.29-0.97). Shorter nightly fasting duration (< 13 h versus ≥ 13 h) was associated with higher risk of all breast cancer outcomes (HR range: 1.21-1.36). CONCLUSION Our review suggests that circadian rhythm disrupting behaviours may influence cancer outcomes in women with breast cancer. While causality remains unclear, to further understand these associations future research directions have been identified. Additional well-designed studies, examining other exposures (e.g., light exposure, temporal eating patterns), biomarkers, and patient-reported outcomes, in diverse populations (e.g., breast cancer subtype-specific, socio-demographic diversity) are warranted.
Collapse
Affiliation(s)
- Kelly D'cunha
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Melinda M Protani
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Marina M Reeves
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
28
|
Cabrera Jaime S, Martinez C, Gonzalo Bachiller V, Zarza Arnau N, Martin Maldonado L, Belén Manrique Palles A, Artiga Sarrion I, Tierno Sanchez N, Julià Torras J, Sancho JM, Cabrera Jaime L. Participatory action research intervention for improving sleep in inpatients with cancer. J Clin Nurs 2023; 32:1218-1229. [PMID: 35289008 DOI: 10.1111/jocn.16279] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/18/2022] [Accepted: 02/14/2022] [Indexed: 12/01/2022]
Abstract
AIM To design and implement a plan to improve oncohaematological patients' sleep. BACKGROUND The hospital environment can compromise inpatients' sleep, negatively impacting on health outcomes and patient satisfaction. DESIGN AND METHOD The improvement plan was designed in collaboration with 18 professionals, 3 patients and 3 accompanying relatives. The study designed followed the SQUIRE 2.0 guidelines. Outcome variables were self-reported patient satisfaction regarding sleep, measured using a 30-item, ad hoc questionnaire and a 10-point visual analogue scale, completed by 318 oncohaematological inpatients (pre-intervention n = 120, post-intervention, n = 198) in a comprehensive cancer centre in Spain from 2017 to 2019. RESULTS Overall, 61.5% (n = 190) of the inpatients reported sleep alterations, and 92.6% reported interruptions in their nightly sleep. Half slept less than 6 h/night, but 58.0% said they felt rested upon waking, despite the interruptions. These outcomes were similar before and after the intervention. The improvement plan identified four domains for work (professionals, care procedures, instruments/environment and patients/relatives), 10 areas for improvement and 35 actions for implementation. However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10-point scale. The intervention significantly improved variables related to professionals' behaviour, including noise during the shift change, conversations at the control desk and the use of corridor lights. Sleep disturbances were mainly caused by pain/discomfort and infuser alarms, and collectively they decreased significantly after the intervention (p = .008). However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10-point scale. CONCLUSIONS Pain, clinical devices and noise made by professionals are the main causes of sleep disturbances. Involving professionals in decision-making to improve patients' sleep have a positive impact on noise levels. RELEVANCE TO CLINICAL PRACTICE This study proposes new strategies for improving sleep by increasing staff awareness and changing attitudes towards patients' sleep. Nurses should be involved in addressing sleep disturbances during hospitalization.
Collapse
Affiliation(s)
- Sandra Cabrera Jaime
- Nursing Research, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
- GRIN Group, IDIBELL, Institute of Biomedical Research, University of Barcelona, Nursing School, Campus of Health Sciences, Barcelona, Spain
| | - Cristina Martinez
- Tobacco Control Unit, Cancer Control and Prevention Programme, Catalan Institute of Oncology (ICO), Barcelona, Spain
- Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Barcelona, Spain
- Nursing Departament, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
- Centre for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | | | - Nuria Zarza Arnau
- Nursing Department, Catalan Institute of Oncology-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Luis Martin Maldonado
- Nursing Department, Catalan Institute of Oncology-Hospital Germans Trias i Pujol, Badalona, Spain
| | | | | | - Noelia Tierno Sanchez
- Nursing Department, Catalan Institute of Oncology-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Joaquim Julià Torras
- Palliative Medicine Departament, Catalan Institute of Oncology-Hospital Germans Trias i Pujol, Badalona, Spain
| | - Juan Manuel Sancho
- Hematology Department, ICO-Hospital Germans Trias i Pujol, Institut de Recerca Josep Carreras, Universitat Autònoma de Barcelona, Badalona, Spain
| | | |
Collapse
|
29
|
Kos M, Brouwer CG, van Laarhoven HW, Hopman MT, van Oijen MG, Buffart LM. The association between wearable device metrics and clinical outcomes in oncology: a systematic review with evidence synthesis and meta-analysis. Crit Rev Oncol Hematol 2023; 185:103979. [PMID: 37001837 DOI: 10.1016/j.critrevonc.2023.103979] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The emerging study of wearable devices (WDs) in patients with cancer provides opportunities to harness real-time patient data for predicting clinical outcomes. We conducted a systematic review with best evidence synthesis to examine the association between WD metrics and clinical outcomes in patients with cancer. METHODS MEDLINE and Embase were searched from inception until June 2022. Risk of bias assessment and best evidence synthesis were performed and, If possible, meta-analysis was conducted. RESULTS A total of 34 studies was included. We found moderate-to-strong evidence for associations between circadian rest-activity metrics and OS. Disrupted I<O was associated with increased hazard for death (HR 2.08; 95 %CI: 1.50-2.88). For most associations there was insufficient evidence due to lack of studies (n = 32) or inconsistent results (n = 14). CONCLUSION Meta-analysis was greatly hampered due to heterogeneity and different methodology used between studies. Studies primarily designed to investigate the association between WD metrics and clinical outcomes are warranted.
Collapse
|
30
|
Pinucci I, Maraone A, Tarsitani L, Pasquini M. Insomnia among Cancer Patients in the Real World: Optimising Treatments and Tailored Therapies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3785. [PMID: 36900794 PMCID: PMC10001409 DOI: 10.3390/ijerph20053785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Insomnia is commonly reported by cancer patients. Its multifaceted pathophysiology makes this symptom a complex challenge for the clinician, who should bear in mind the manifold world of causes and consequences of sleep disturbances in these patients and the importance of accurate treatment that should consider the frequent co-prescription of multiple medications. With our work, we aim to provide a tool to better master the treatment of this symptom in cancer patients, considering the gap between clinical and pharmacodynamic knowledge about the efficacy of different molecules and evidence-based prescribing. METHODS A narrative review of the studies investigating the pharmacological treatment of insomnia in cancer patients was conducted. Three hundred and seventy-six randomised controlled trials (RCTs), systematic reviews and meta-analyses were identified through PubMed. Only publications that investigated the efficacy of the pharmacological treatment of insomnia symptoms in cancer patient were considered. RESULTS Among the 376 publications that were individuated, fifteen studies were eligible for inclusion in the review and were described. Pharmacological treatments were outlined, with a broad look at specific clinical situations. CONCLUSIONS The management of insomnia in cancer patients should be personalised, as is already the case for the treatment of pain, taking into account both the pathophysiology and the other medical treatments prescribed to these patients.
Collapse
|
31
|
Kim Y, Ting A, Steel JL, Tsai TC. Protocol of a dyadic sleep intervention for adult patients with cancer and their sleep-partner caregivers. Contemp Clin Trials Commun 2023; 32:101064. [PMID: 36704757 PMCID: PMC9871738 DOI: 10.1016/j.conctc.2023.101064] [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: 09/14/2022] [Revised: 12/02/2022] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Background Sleep disturbance is common and problematic among both patients with cancer and their sleep partner caregivers. Although 70% of the general adult population sleep in the same bed with a significant other, as do adult cancer patients and their spousal/partner caregivers, and one's sleep affect the partner's sleep, existing psychobehavioral interventions have targeted patients' and caregivers' sleep problems independently. Methods We developed a new sleep intervention, My Sleep Our Sleep (MSOS), for both adult patients with cancer and their sleep-partner caregivers together. This protocol is to test the feasibility and acceptability as well as to provide preliminary efficacy of the MSOS intervention, which is a dyadic intervention designed to reduce sleep disturbance and improving sleep quality of both adult cancer patients and their sleep-partner caregivers (dyads). The intervention will be delivered weekly for 4 weeks. Questionnaire and daily sleep logs will be collected at baseline (T1) and one-week after conclusion of the intervention (T2). Satisfaction with the intervention will be assessed weekly for 4 weeks. Results We estimate 43 dyads be enrolled (43 patients and 43 sleep-partner caregivers). We expect >75% of eligible and screened dyads will enroll within the enrollment period, >80% of enrolled dyads will complete the intervention, and >80% of participants will report satisfaction across all acceptability measures. We also expect MSOS will reveal a small-to-medium effect on sleep efficiency (primary outcome), overall sleep disturbance, subjective sleep quality, and insomnia severity (secondary outcomes). Conclusions Results will inform the feasibility and acceptability of conducting a dyadic sleep intervention, and provide preliminary efficacy data to guide further refinement of the intervention content and procedure for adult patients with cancer and their sleep-partner caregivers. Trial registration NCT04712604 Clinicaltrials.gov.
Collapse
Affiliation(s)
- Youngmee Kim
- Department of Psychology, University of Miami, Coral Gables, FL, USA,Corresponding author. Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA.
| | - Amanda Ting
- Department of Psychology, Palo Alto VA, Palo Alto, CA, USA
| | - Jennifer L. Steel
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas C. Tsai
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| |
Collapse
|
32
|
Prognostication in Advanced Cancer by Combining Actigraphy-Derived Rest-Activity and Sleep Parameters with Routine Clinical Data: An Exploratory Machine Learning Study. Cancers (Basel) 2023; 15:cancers15020503. [PMID: 36672452 PMCID: PMC9856985 DOI: 10.3390/cancers15020503] [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: 08/10/2022] [Revised: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
Survival prediction is integral to oncology and palliative care, yet robust prognostic models remain elusive. We assessed the feasibility of combining actigraphy, sleep diary data, and routine clinical parameters to prognosticate. Fifty adult outpatients with advanced cancer and estimated prognosis of <1 year were recruited. Patients were required to wear an Actiwatch® (wrist actigraph) for 8 days, and complete a sleep diary. Univariate and regularised multivariate regression methods were used to identify predictors from 66 variables and construct predictive models of survival. A total of 49 patients completed the study, and 34 patients died within 1 year. Forty-two patients had disrupted rest-activity rhythms (dichotomy index (I < O ≤ 97.5%) but I < O did not have prognostic value in univariate analyses. The Lasso regularised derived algorithm was optimal and able to differentiate participants with shorter/longer survival (log rank p < 0.0001). Predictors associated with increased survival time were: time of awakening sleep efficiency, subjective sleep quality, clinician’s estimate of survival and global health status score, and haemoglobin. A shorter survival time was associated with self-reported sleep disturbance, neutrophil count, serum urea, creatinine, and C-reactive protein. Applying machine learning to actigraphy and sleep data combined with routine clinical data is a promising approach for the development of prognostic tools.
Collapse
|
33
|
Jafri S, Hansen E, Fuenmayor R, Case AA. Medical Cannabis for Insomnia in a Patient With Advanced Breast Cancer. J Pain Symptom Manage 2023; 65:e497-e502. [PMID: 36641008 DOI: 10.1016/j.jpainsymman.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/27/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023]
Affiliation(s)
- Saba Jafri
- Department of Palliative and Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Eric Hansen
- Department of Palliative and Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Ryan Fuenmayor
- Department of Palliative and Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Amy A Case
- Department of Palliative and Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
| |
Collapse
|
34
|
Palesh O, Tolby LT, Hofmeister EN, Fisher S, Solomon NL, Sackeyfio S, Berek JS, Kurian AW, Cassidy-Eagle E, Schapira L. Symptoms and survivorship needs differences between "good sleepers" and "bad sleepers" in survivors of breast and gynecologic cancers. Sleep Med 2022; 100:49-55. [PMID: 36007431 PMCID: PMC10931244 DOI: 10.1016/j.sleep.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/10/2022] [Accepted: 07/03/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Although 80% of cancer survivors report symptoms of insomnia, only 28-43% meet DSM-5 criteria for this diagnosis. We sought to characterize the association between patient-reported insomnia symptoms, patient outcomes, and supportive care variables, as well as explore clinically meaningful insomnia thresholds in a sample of women diagnosed with breast and gynecologic cancers. METHODS From July 2018-March 2019, all breast and gynecologic cancer survivors seen at the Stanford Women's Cancer Center were approached and invited to participate in the study (15% declined). Of those who consented, 273 survivors completed an online survey related to their sleep (ISI), quality of life (FACT-G), distress (PHQ-4), supportive care needs (SCNS-SF34), and symptom severity (MDASI). Survivors who scored <8 on ISI were categorized as "good sleepers," survivors with ISI ≥8 were categorized as "bad sleepers." RESULTS 126 (46.2%) of survivors were "good sleepers," 147 (53.8%) were "bad sleepers." Good sleepers were older than bad sleepers (p < .05) but did not differ in any other demographic or any medical variables. Using hierarchical linear regression models, we found that good sleep (ISI <8) was associated with higher quality of life, lower psychological distress, increased social support, lower symptom severity, and lower supportive care needs, after accounting for demographic, medical, and treatment variables. The findings were largely replicated with an ISI cut off of 15. CONCLUSIONS Among women treated for breast and gynecologic cancers, survivors who were good sleepers had better psychosocial outcomes, fewer supportive care needs, and lower symptom severity compared to those who reported insomnia symptoms. Results also indicate that degree of sleep impairment, whether mild or severe, has similarly poor associations with most aspects of patient functioning and symptomatic burden. Further research is needed to determine causality of these findings.
Collapse
Affiliation(s)
- Oxana Palesh
- Department of Psychiatry, Massey Cancer Center, Virginia Commonwealth University, United States.
| | - Leah T Tolby
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Elisa N Hofmeister
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Sophie Fisher
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Natalie L Solomon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Sarah Sackeyfio
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Jonathan S Berek
- Stanford Cancer Institute, Stanford University School of Medicine, United States
| | - Allison W Kurian
- Stanford Cancer Institute, Stanford University School of Medicine, United States
| | - Erin Cassidy-Eagle
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, United States
| | - Lidia Schapira
- Stanford Cancer Institute, Stanford University School of Medicine, United States
| |
Collapse
|
35
|
Perndorfer C, Soriano EC, Siegel SD, Spencer RMC, Otto AK, Laurenceau JP. Fear of Cancer Recurrence and Sleep in Couples Coping With Early-Stage Breast Cancer. Ann Behav Med 2022; 56:1131-1143. [PMID: 35551585 PMCID: PMC9635995 DOI: 10.1093/abm/kaac018] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fear of cancer recurrence (FCR) and sleep disturbance are common in cancer survivors. Yet, little research has examined their relationship, and even less is known about what links may exist between these variables among the intimate partners of cancer survivors. PURPOSE This study examines the relationship between FCR and sleep disturbance in breast cancer survivors and their partners. Using daily sleep data collected at two distinct periods early in survivorship-the completion of adjuvant treatment and the first post-treatment mammogram-higher survivor and partner FCR was hypothesized to predict greater sleep disturbance. METHODS Breast cancer survivors and intimate partners (N = 76 couples; 152 individuals) each reported sleep duration, sleep quality, sleep onset latency, and wake after sleep onset each morning of two 21-day sleep diary bursts during the first year post-diagnosis. Three validated measures formed latent FCR factors for survivors and partners, which were used to predict average daily sleep. RESULTS Across both sleep diary bursts, survivor FCR was associated with their own reduced sleep duration, reduced sleep quality, and greater sleep onset latency. Survivor FCR was also associated with their partners' reduced sleep quality and greater sleep onset latency. Partner FCR was associated with their own reduced sleep duration, reduced sleep quality, and greater sleep onset latency. Partner FCR was also associated with survivors' reduced sleep quality. CONCLUSIONS Findings revealed intrapersonal and interpersonal associations between FCR and sleep disturbance, addressing gaps in knowledge on FCR and an outcome with known short- and long-term implications for health and mortality.
Collapse
Affiliation(s)
- Christine Perndorfer
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE 19716,USA
| | - Emily C Soriano
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE 19716,USA
| | - Scott D Siegel
- Value Institute, Helen F. Graham Cancer Center and Research Institute, Newark, DE 19713,USA
| | - Rebecca M C Spencer
- Department of Psychological & Brain Sciences, University of Massachusetts Amherst, Amherst, MA 01003,USA
| | - Amy K Otto
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | | |
Collapse
|
36
|
Sleep disturbance in cancer survivors with lymphedema: a scoping review. Support Care Cancer 2022; 30:9647-9657. [PMID: 36201052 DOI: 10.1007/s00520-022-07378-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/26/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE The purpose of this study is to identify the amount and scope of knowledge on sleep disturbance in cancer survivors who have lymphedema. The research question investigated was "what are the known sleep disturbances in cancer survivors with lymphedema?" METHODS A literature search was performed on February 15 to March 27, 2021, in four databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and structure recommended by Arksey and O'Malley. An iterative process of study selection was performed by two reviewers for abstract and full-text review. The Joanna Briggs Institute's critical appraisal tools were used to analyze study quality. RESULTS One hundred twenty-one unique references were reviewed, and seven met the inclusion criteria. One article had the primary aim of assessing sleep and noted that the presence of lymphedema did increase the risk for sleep disturbance. Four cross-sectional studies compared sleep quality between cancer survivors with lymphedema and cancer survivors without lymphedema. These studies found that lymphedema is a significant predictor of insomnia and is a risk factor for insomnia. Two randomized control trials compared sleep among breast cancer survivors with lymphedema after an intervention. Sleep improved with a yoga intervention and was unchanged after adding a night-time compression garment. CONCLUSION In this scoping review, breast and gynecological cancer survivors with lymphedema report increased sleep disturbance compared to survivors without lymphedema. Further research is needed to characterize the specific sleep disturbances in cancer survivors with lymphedema for improved screening and treatment.
Collapse
|
37
|
Hwang Y, Conley S, Jeon S, Redeker NS, Sanft T, Knobf MT. Factors associated with sleep health in young women after breast cancer treatment. Res Nurs Health 2022; 45:680-692. [DOI: 10.1002/nur.22264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/21/2022] [Accepted: 08/25/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Youri Hwang
- School of Nursing Yale University Orange Connecticut USA
| | | | - Sangchoon Jeon
- School of Nursing Yale University Orange Connecticut USA
| | | | - Tara Sanft
- School of Medicine Yale University New Haven Connecticut USA
| | - M. Tish Knobf
- School of Nursing Yale University Orange Connecticut USA
| |
Collapse
|
38
|
Gao Y, Liu M, Yao L, Yang Z, Chen Y, Niu M, Sun Y, Chen J, Hou L, Sun F, Wu S, Zhang Z, Zhang J, Li L, Li J, Zhao Y, Fan J, Ge L, Tian J. Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta-analysis. J Evid Based Med 2022; 15:216-229. [PMID: 35996803 DOI: 10.1111/jebm.12485] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/27/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to examine the most effective delivery format of cognitive behavioral therapy for insomnia (CBT-I) on insomnia in cancer patients. METHODS We searched five databases up to February 2021 for randomized clinical trials that compared CBT-I with inactive or active controls for insomnia in cancer patients. Outcomes were insomnia severity, sleep efficiency, sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Pairwise meta-analyses and frequentist network meta-analyses with the random-effects model were applied for data analyses. RESULTS Sixteen unique trials including 1523 participants met inclusion criteria. Compared with inactive control, CBT-I could significantly reduce insomnia severity (mean differences [MD] = -4.98 points, 95% confidence interval [CI]: -5.82 to -4.14), SOL (MD = -12.29 min, 95%CI: -16.48 to -8.09), and WASO (MD = -16.58 min, 95%CI: -22.00 to -11.15), while increasing sleep efficiency (MD = 7.62%, 95%CI: 5.82% to 9.41%) at postintervention. Compared with active control, CBT-I could significantly reduce insomnia severity (MD = -2.75 points, 95%CI: -4.28 to -1.21), SOL (MD = -13.56 min, 95%CI: -18.93 to -8.18), and WASO (MD = -6.99 min, 95%CI: -11.65 to -2.32) at postintervention. These effects diminished in short-term follow-up and almost disappeared in long-term follow-up. Most of the results were rated as "moderate" to "low" certainty of evidence. Network meta-analysis showed that group CBT-I had an increase in sleep efficiency of 10.61%, an increase in TST of 21.98 min, a reduction in SOL of 14.65 min, and a reduction in WASO of 24.30 min, compared with inactive control at postintervention, with effects sustained at short-term follow-up. CONCLUSIONS CBT-I is effective for the management of insomnia in cancer patients postintervention, with diminished effects in short-term follow-up. Group CBT-I is the preferred choice based on postintervention and short-term effects. The low quality of evidence and limited sample size demonstrate the need for robust evidence from high-quality, large-scale trials providing long-term follow-up data.
Collapse
Affiliation(s)
- Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Ming Liu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Zhirong Yang
- Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Yamin Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Mingming Niu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China
| | - Ji Chen
- Mianyang Hospital of Traditional Chinese Medicine, Mianyang, China
| | - Liangying Hou
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shanshan Wu
- National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zeqian Zhang
- The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Junhua Zhang
- Evidence-Based Medicine Center, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lun Li
- Department of Breast Cancer, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiang Li
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhao
- First Clinical Medical College, Lanzhou University, Lanzhou, China
- Departments of Biochemistry and Molecular Biology, Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jingchun Fan
- Epidemiology and Evidence Based-Medicine, School of Public Health, Gansu University of Chinese Medicine, Lanzhou, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| |
Collapse
|
39
|
Shuboni-Mulligan DD, Young D, De La Cruz Minyety J, Briceno N, Celiku O, King AL, Munasinghe J, Wang H, Adegbesan KA, Gilbert MR, Smart DK, Armstrong TS. Histological analysis of sleep and circadian brain circuitry in cranial radiation-induced hypersomnolence (C-RIH) mouse model. Sci Rep 2022; 12:11131. [PMID: 35778467 PMCID: PMC9249744 DOI: 10.1038/s41598-022-15074-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/17/2022] [Indexed: 11/24/2022] Open
Abstract
Disrupted sleep, including daytime hypersomnolence, is a core symptom reported by primary brain tumor patients and often manifests after radiotherapy. The biological mechanisms driving the onset of sleep disturbances after cranial radiation remains unclear but may result from treatment-induced injury to neural circuits controlling sleep behavior, both circadian and homeostatic. Here, we develop a mouse model of cranial radiation-induced hypersomnolence which recapitulates the human experience. Additionally, we used the model to explore the impact of radiation on the brain. We demonstrated that the DNA damage response following radiation varies across the brain, with homeostatic sleep and cognitive regions expressing higher levels of γH2AX, a marker of DNA damage, than the circadian suprachiasmatic nucleus (SCN). These findings were supported by in vitro studies comparing radiation effects in SCN and cortical astrocytes. Moreover, in our mouse model, MRI identified structural effects in cognitive and homeostatic sleep regions two-months post-treatment. While the findings are preliminary, they suggest that homeostatic sleep and cognitive circuits are vulnerable to radiation and these findings may be relevant to optimizing treatment plans for patients.
Collapse
Affiliation(s)
| | - Demarrius Young
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Nicole Briceno
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Orieta Celiku
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Amanda L King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeeva Munasinghe
- Mouse Imaging Facility, National Institute of Neurological Disorder and Stroke, NIH, Bethesda, MD, USA
| | - Herui Wang
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kendra A Adegbesan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - DeeDee K Smart
- Radiation Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
40
|
Zhou ES, Ritterband LM, Bethea TN, Robles YP, Heeren TC, Rosenberg L. Effect of Culturally Tailored, Internet-Delivered Cognitive Behavioral Therapy for Insomnia in Black Women: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:538-549. [PMID: 35442432 PMCID: PMC9021979 DOI: 10.1001/jamapsychiatry.2022.0653] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Black women are at risk for insomnia disorder. Despite interest in addressing sleep health disparities, there is limited research investigating the efficacy of criterion-standard treatment (cognitive behavioral therapy for insomnia [CBT-I]) among this racial minority population. OBJECTIVE To compare the efficacy of a standard version of an internet-delivered CBT-I program, a culturally tailored version, and a sleep education control at improving insomnia symptoms. DESIGN, SETTING, AND PARTICIPANTS In this single-blind, 3-arm randomized clinical trial, participants in a national, longitudinal cohort (Black Women's Health Study [BWHS]) were recruited between October 2019 and June 2020. BWHS participants with elevated insomnia symptoms were enrolled and randomized in the current study. INTERVENTIONS Participants were randomized to receive (1) an automated internet-delivered treatment called Sleep Healthy Using the Internet (SHUTi); (2) a stakeholder-informed, tailored version of SHUTi for Black women (SHUTi-BWHS); or (3) patient education (PE) about sleep. MAIN OUTCOMES AND MEASURES The primary outcome was insomnia severity (Insomnia Severity Index [ISI]). Index score ranged from 0 to 28 points, with those scoring less than 8 points considered to not have clinically significant insomnia symptoms and a score of 15 points or higher suggesting insomnia disorder. An ISI score reduction of more than 7 points was considered a clinically significant improvement in insomnia symptoms. The SHUTi-BWHS program was hypothesized to be more effective at significantly decreasing insomnia severity compared with the SHUTi program and PE. RESULTS A total of 333 Black women were included in this trial, and their mean (SD) age was 59.5 (8.0) years. Those randomized to receive either SHUTi or SHUTi-BWHS reported significantly greater reductions in ISI score at 6-month follow-up (SHUTi: -10.0 points; 95% CI, -11.2 to -8.7; SHUTi-BWHS: -9.3 points; 95% CI, -10.4 to -8.2) than those randomized to receive PE (-3.6 points; 95% CI, -4.5 to -2.1) (P < .001). Significantly more participants randomized to SHUTi-BWHS completed the intervention compared with those randomized to SHUTi (86 of 110 [78.2%] vs 70 of 108 [64.8%]; P = .008). Participants who completed either intervention showed greater reductions in insomnia severity compared with noncompleters (-10.4 points [95% CI, -11.4 to -9.4] vs -6.2 points [95% CI, -8.6 to -3.7]). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, both the SHUTi and SHUTi-BWHS programs decreased insomnia severity and improved sleep outcomes more than PE. The culturally tailored SHUTi-BWHS program was more effective at engaging participants with the program, as a greater proportion completed the full intervention. Program completion was associated with greater improvements in sleep. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03613519.
Collapse
Affiliation(s)
- Eric S. Zhou
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts,Perini Family Survivors’ Center, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lee M. Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Charlottesville
| | - Traci N. Bethea
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC
| | - Yvonne P. Robles
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| | | | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, Massachusetts
| |
Collapse
|
41
|
Yi K, Lee J, Yeo S, Kim K, Chung S. Assessing the Sleep-wake Pattern in Cancer Patients for Predicting a Short Sleep Onset Latency. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2022; 20:364-372. [PMID: 35466107 PMCID: PMC9048007 DOI: 10.9758/cpn.2022.20.2.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/26/2021] [Accepted: 05/11/2021] [Indexed: 12/14/2022]
Abstract
Objective We investigated the sleep parameters and clinical factors related to short sleep onset latency (SL) in cancer patients. Methods We retrospectively reviewed the medical records of 235 cancer patients. Patient Health Questionnaire-9, State and Trait Anxiety Inventory (State subcategory), Insomnia Severity Index (ISI), Cancer-related Dysfunctional Beliefs about Sleep, and Fear of Progression scale scores and sleep related parameters including sleeping pill ingestion time, bedtime, sleep onset time, and wake-up time were collected. We also calculated the duration from sleeping pill ingestion to bedtime, sleep onset time, and wake-up time; duration from wake-up time to bedtime and sleep onset time; and time spent in bed over a 24 hours period. Results Among patients not taking sleeping pills (n = 145), early wake-up time (adjusted odds ratio [OR] 0.39, 95% confidence interval [CI] 0.19−0.78), early sleep onset time (OR 0.50, 95% CI 0.27−0.93), and low ISI score (OR 0.82, 95% CI 0.71−0.93) were identified as expecting variables for SL ≤ 30 minutes. Longer duration from wake-up time to bedtime (OR 2.49, 95% CI 1.48−4.18) predicted SL ≤ 30 minutes. Among those taking sleeping pills (n = 90), early sleep onset time (OR 0.54, 95% CI 0.39−0.76) and short duration from pill ingestion to sleep onset time (OR 0.05, 95% CI 0.02−0.16) predicted SL ≤ 30 minutes. Conclusion Cancer patients who fell asleep quickly spent less time in bed during the day. Thus, before cancer patients with insomnia are prescribed sleeping pills, their sleep parameters should be examined to improve their SL.
Collapse
Affiliation(s)
| | - 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
| | - Kyumin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
42
|
Berisha A, Shutkind K, Borniger JC. Sleep Disruption and Cancer: Chicken or the Egg? Front Neurosci 2022; 16:856235. [PMID: 35663547 PMCID: PMC9160986 DOI: 10.3389/fnins.2022.856235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep is a nearly ubiquitous phenomenon across the phylogenetic tree, highlighting its essential role in ensuring fitness across evolutionary time. Consequently, chronic disruption of the duration, timing, or structure of sleep can cause widespread problems in multiple physiological systems, including those that regulate energy balance, immune function, and cognitive capacity, among others. Many, if not all these systems, become altered throughout the course of cancer initiation, growth, metastatic spread, treatment, and recurrence. Recent work has demonstrated how changes in sleep influence the development of chronic diseases, including cancer, in both humans and animal models. A common finding is that for some cancers (e.g., breast), chronic disruption of sleep/wake states prior to disease onset is associated with an increased risk for cancer development. Additionally, sleep disruption after cancer initiation is often associated with worse outcomes. Recently, evidence suggesting that cancer itself can affect neuronal circuits controlling sleep and wakefulness has accumulated. Patients with cancer often report difficulty falling asleep, difficulty staying asleep, and severe fatigue, during and even years after treatment. In addition to the psychological stress associated with cancer, cancer itself may alter sleep homeostasis through changes to host physiology and via currently undefined mechanisms. Moreover, cancer treatments (e.g., chemotherapy, radiation, hormonal, and surgical) may further worsen sleep problems through complex biological processes yet to be fully understood. This results in a "chicken or the egg" phenomenon, where it is unclear whether sleep disruption promotes cancer or cancer reciprocally disrupts sleep. This review will discuss existing evidence for both hypotheses and present a framework through which the interactions between sleep and cancer can be dissociated and causally investigated.
Collapse
Affiliation(s)
- Adrian Berisha
- Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, United States
| | - Kyle Shutkind
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | | |
Collapse
|
43
|
Strøm L, Danielsen JT, Amidi A, Cardenas Egusquiza AL, Wu LM, Zachariae R. Sleep During Oncological Treatment - A Systematic Review and Meta-Analysis of Associations With Treatment Response, Time to Progression and Survival. Front Neurosci 2022; 16:817837. [PMID: 35516799 PMCID: PMC9063131 DOI: 10.3389/fnins.2022.817837] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/02/2022] [Indexed: 01/20/2023] Open
Abstract
Introduction Disrupted sleep and sleep-wake activity are frequently observed in cancer patients undergoing oncological treatment. These disruptions are often associated with aggravated symptom burden and diminished health-related quality of life that in turn may compromise treatment adherence and, thus, effectiveness. In addition, disrupted sleep has been linked to carcinogenic processes, which ultimately could result in worse prognostic outcomes. Aims Our aim was to systematically review and conduct a meta-analysis of studies examining the associations between sleep and sleep-wake activity and prognostic outcomes in cancer patients undergoing oncological treatment. Methods A comprehensive systematic search of English language papers was undertaken in June 2020 using PubMed, The Cochrane Library, and CINAHL. Two reviewers independently screened 4,879 abstracts. A total of 26 papers were included in the narrative review. Thirteen papers reporting hazard ratios reflecting associations between a dichotomized predictor variable (sleep) and prognostic outcomes were subjected to meta-analysis. Results Nineteen of the 26 eligible studies on a total of 7,092 cancer patients reported associations between poorer sleep and poorer response to treatment, shorter time to progression, and/or reduced overall survival, but were highly heterogeneous with respect to the sleep and outcome parameters investigated. Meta-analysis revealed statistically significant associations between poor self-reported sleep and reduced overall survival (HR = 1.33 [95% CI 1.09-1.62], k = 11), and shorter time to progression (HR = 1.40 [95% CI 1.23-1.59], k = 3) and between poor objectively assessed sleep and reduced overall survival (HR = 1.74 [95% CI 1.05-2.88], k = 4). Conclusion The current findings indicate that disturbed sleep during treatment may be a relevant behavioral marker of poor cancer prognosis. The limited number of studies, the common use of single item sleep measures, and potential publication bias highlight the need for further high quality and longitudinal studies.
Collapse
Affiliation(s)
- Louise Strøm
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Josefine T. Danielsen
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Ali Amidi
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Ana Lucia Cardenas Egusquiza
- Department of Psychology and Behavioral Sciences, Center for Autobiographical Memory Research, Aarhus University, Aarhus, Denmark
| | - Lisa Maria Wu
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - Robert Zachariae
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
44
|
Brauning A, Rae M, Zhu G, Fulton E, Admasu TD, Stolzing A, Sharma A. Aging of the Immune System: Focus on Natural Killer Cells Phenotype and Functions. Cells 2022; 11:cells11061017. [PMID: 35326467 PMCID: PMC8947539 DOI: 10.3390/cells11061017] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023] Open
Abstract
Aging is the greatest risk factor for nearly all major chronic diseases, including cardiovascular diseases, cancer, Alzheimer’s and other neurodegenerative diseases of aging. Age-related impairment of immune function (immunosenescence) is one important cause of age-related morbidity and mortality, which may extend beyond its role in infectious disease. One aspect of immunosenescence that has received less attention is age-related natural killer (NK) cell dysfunction, characterized by reduced cytokine secretion and decreased target cell cytotoxicity, accompanied by and despite an increase in NK cell numbers with age. Moreover, recent studies have revealed that NK cells are the central actors in the immunosurveillance of senescent cells, whose age-related accumulation is itself a probable contributor to the chronic sterile low-grade inflammation developed with aging (“inflammaging”). NK cell dysfunction is therefore implicated in the increasing burden of infection, malignancy, inflammatory disorders, and senescent cells with age. This review will focus on recent advances and open questions in understanding the interplay between systemic inflammation, senescence burden, and NK cell dysfunction in the context of aging. Understanding the factors driving and enforcing NK cell aging may potentially lead to therapies countering age-related diseases and underlying drivers of the biological aging process itself.
Collapse
Affiliation(s)
- Ashley Brauning
- SENS Research Foundation, Mountain View, CA 94041, USA; (A.B.); (M.R.); (G.Z.); (E.F.); (T.D.A.)
| | - Michael Rae
- SENS Research Foundation, Mountain View, CA 94041, USA; (A.B.); (M.R.); (G.Z.); (E.F.); (T.D.A.)
| | - Gina Zhu
- SENS Research Foundation, Mountain View, CA 94041, USA; (A.B.); (M.R.); (G.Z.); (E.F.); (T.D.A.)
| | - Elena Fulton
- SENS Research Foundation, Mountain View, CA 94041, USA; (A.B.); (M.R.); (G.Z.); (E.F.); (T.D.A.)
| | - Tesfahun Dessale Admasu
- SENS Research Foundation, Mountain View, CA 94041, USA; (A.B.); (M.R.); (G.Z.); (E.F.); (T.D.A.)
| | - Alexandra Stolzing
- SENS Research Foundation, Mountain View, CA 94041, USA; (A.B.); (M.R.); (G.Z.); (E.F.); (T.D.A.)
- Centre for Biological Engineering, Wolfson School of Electrical, Material and Manufacturing Engineering, Loughborough University, Loughborough LE11 3TU, UK
- Correspondence: (A.S.); (A.S.)
| | - Amit Sharma
- SENS Research Foundation, Mountain View, CA 94041, USA; (A.B.); (M.R.); (G.Z.); (E.F.); (T.D.A.)
- Correspondence: (A.S.); (A.S.)
| |
Collapse
|
45
|
Oberoi D, Kwok C, Li Y, Railton C, Horsman S, Reynolds K, Joy AA, King KM, Lupichuk SM, Speca M, Culos-Reed N, Carlson LE, Giese-Davis J. Documenting patients’ and providers’ preferences when proposing a randomized controlled trial: a qualitative exploration. BMC Med Res Methodol 2022; 22:64. [PMID: 35249528 PMCID: PMC8898414 DOI: 10.1186/s12874-022-01549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background With advances in cancer diagnosis and treatment, women with early-stage breast cancer (ESBC) are living longer, increasing the number of patients receiving post-treatment follow-up care. Best-practice survivorship models recommend transitioning ESBC patients from oncology-provider (OP) care to community-based care. While developing materials for a future randomized controlled trial (RCT) to test the feasibility of a nurse-led Telephone Survivorship Clinic (TSC) for a smooth transition of ESBC survivors to follow-up care, we explored patients’ and OPs’ reactions to several of our proposed methods. Methods We used a qualitative study design with thematic analysis and a two-pronged approach. We interviewed OPs, seeking feedback on ways to recruit their ESBC patients for the trial, and ESBC patients, seeking input on a questionnaire package assessing outcomes and processes in the trial. Results OPs identified facilitators and barriers and offered suggestions for study design and recruitment process improvement. Facilitators included the novelty and utility of the study and simplicity of methods; barriers included lack of coordination between treating and discharging clinicians, time constraints, language barriers, motivation, and using a paper-based referral letter. OPs suggested using a combination of electronic and paper referral letters and supporting clinicians to help with recruitment. Patient advisors reported satisfaction with the content and length of the assessment package. However, they questioned the relevance of some questions (childhood trauma) while adding questions about trust in physicians and proximity to primary-care providers. Conclusions OPs and patient advisors rated our methods for the proposed trial highly for their simplicity and relevance then suggested changes. These findings document processes that could be effective for cancer-patient recruitment in survivorship clinical trials. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01549-1.
Collapse
|
46
|
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: 20] [Impact Index Per Article: 10.0] [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.
Collapse
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
| |
Collapse
|
47
|
Almaida-Pagan PF, Torrente M, Campos M, Provencio M, Madrid JA, Franco F, Morilla BR, Cantos B, Sousa PA, Madrid MJM, Pimentao J, Rol MÁ. Chronodisruption and Ambulatory Circadian Monitoring in Cancer Patients: Beyond the Body Clock. Curr Oncol Rep 2022; 24:135-149. [PMID: 35061192 PMCID: PMC8857092 DOI: 10.1007/s11912-021-01158-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 02/01/2023]
Abstract
Purpose of Review Circadian rhythms impose daily rhythms a remarkable variety of metabolic and physiological functions, such as cell proliferation, inflammation, and DNA damage response. Accumulating epidemiological and genetic evidence indicates that circadian rhythms’ disruption may be linked to cancer. The integration of circadian biology into cancer research may offer new options for increasing cancer treatment effectiveness and would encompass the prevention, diagnosis, and treatment of this disease. Recent Findings In recent years, there has been a significant development and use of multi-modal sensors to monitor physical activity, sleep, and circadian rhythms, allowing, for the very first time, scaling accurate sleep monitoring to epidemiological research linking sleep patterns to disease, and wellness applications providing new potential applications. Summary This review highlights the role of circadian clock in tumorigenesis, cancer hallmarks and introduces the state-of-the-art in sleep-monitoring technologies, discussing the eventual application of insights in clinical settings and cancer research.
Collapse
Affiliation(s)
- Pedro F Almaida-Pagan
- Kronohealth SL, Murcia, Spain
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Torrente
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.
- Medical Oncology Department, Puerta de Hierro-Majadahonda University Hospital, Calle Manuel de Falla, 1, 28222, Madrid, Spain.
- Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain.
| | - Manuel Campos
- Kronohealth SL, Murcia, Spain
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mariano Provencio
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Juan Antonio Madrid
- Kronohealth SL, Murcia, Spain
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fabio Franco
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Beatriz Rodríguez Morilla
- Kronohealth SL, Murcia, Spain
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Blanca Cantos
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Pedro A Sousa
- Department of Electrical Engineering, Faculty of Science and Technology, Universidade Nova de Lisboa, Lisbon, Portugal
| | - María José Martínez Madrid
- Kronohealth SL, Murcia, Spain
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Joao Pimentao
- Department of Electrical Engineering, Faculty of Science and Technology, Universidade Nova de Lisboa, Lisbon, Portugal
| | - María Ángeles Rol
- Kronohealth SL, Murcia, Spain
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
48
|
Endeshaw D, Biresaw H, Asefa T, Yesuf NN, Yohannes S. Sleep Quality and Associated Factors Among Adult Cancer Patients Under Treatment at Oncology Units in Amhara Region, Ethiopia. Nat Sci Sleep 2022; 14:1049-1062. [PMID: 35673619 PMCID: PMC9167589 DOI: 10.2147/nss.s356597] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/19/2022] [Indexed: 12/05/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Destaw Endeshaw
- Department of Adult Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Henok Biresaw
- Department of Adult Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tseganesh Asefa
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nurhusien Nuru Yesuf
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Senay Yohannes
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
49
|
Gabra RH, Hashem DF. Sleep disorders and their relationship to other psychiatric disorders in women with breast cancer: a case-control study. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00090-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Breast cancer is the most frequent cancer among women, impacting 2.1 million women each year. The aim of the study is to determine prevalence of sleep disorders among patients with breast cancer, its correlation with different psychological symptoms and the ability of such symptoms to predict sleep disorders among those patients. The current study is a case-control study compromised of 153 participants, 93 breast cancer patients versus 60 cross-matched healthy control persons recruited from the outpatient clinic of Oncology Department—Assiut University Hospital. Arabic versions of Beck’s Depression Inventory, symptom checklist, and Sleep Disorder Scale were used to evaluate depression, obsession, sensitivity, anxiety, hostility, phobic anxiety, paranoia ideation, psychoticism, and sleep disorders, respectively. The correlation of this data with clinical and social variables of these patients and the effect of such variables on each other were also determined.
Results
A statistically higher prevalence of sleep disorders and depression was reported among breast cancer patients compared to the control group. Also, patients with breast cancer scored statistically higher mean scores in somatization, obsession, sensitivity, anxiety, and phobic anxiety than those of the control group.
Conclusions
Prevalence of sleep disorders, depression, obsession, sensitivity, anxiety, hostility, phobic anxiety, paranoia ideation, and psychoticism among breast cancer patients poses a challenge to the treatment of such patients. Misdiagnosis and mismanagement lead to poor treatment outcomes of both cancer disease and psychiatric disorders.
Collapse
|
50
|
Borniger JC. Cancer as a tool for preclinical psychoneuroimmunology. Brain Behav Immun Health 2021; 18:100351. [PMID: 34988496 PMCID: PMC8710415 DOI: 10.1016/j.bbih.2021.100351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/03/2021] [Accepted: 09/17/2021] [Indexed: 12/20/2022] Open
Abstract
Cancer represents a novel homeostatic challenge to the host system. How the brain senses and responds to changes in peripheral physiology elicited by tumor growth is a largely untapped area of research. This is especially relevant given the widespread prevalence of systemic problems that people with various types of cancer experience. These include disruptions in sleep/wake cycles, cognitive function, depression, and changes in appetite/food intake, among others. Critically, many of these problems are evident prior to diagnosis, indicating that their etiology is potentially distinct from the effects of cancer treatment or the stress of a cancer diagnosis. Psychoneuroimmunology (PNI) is well equipped to tackle these types of problems, as it uses approaches from multiple disciplines to understand how specific stimuli (endogenous and environmental) are transduced into neural, endocrine, and immune signals that ultimately regulate health and behavior. In this article, I first provide a brief historical perspective of cancer and PNI, introduce the idea of cancer as a systemic homeostatic challenge, and provide examples from preclinical literature supporting this hypothesis. Given the rise of advanced tools in neuroscience (e.g., calcium imaging), we can now monitor and manipulate genetically defined neural circuits over the extended time scales necessary to disentangle distal communication between peripheral tumors and the brain.
Collapse
|