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01-03-2020 | Insomnia | Sleep Breathing Physiology and Disorders • Original Article

New-onset insomnia among cancer patients undergoing chemotherapy: prevalence, risk factors, and its correlation with other symptoms

Authors: Huong Thi Xuan Hoang, Alex Molassiotis, Choi Wan Chan, Thi Huong Nguyen, Van Liep Nguyen

Published in: Sleep and Breathing | Issue 1/2020

Abstract

Study objectives

Although insomnia is common among cancer patients, its prevalence remains variable, and its risk factors and correlation with other cancer-related symptoms are not fully explored in the literature. This study aims to determine the prevalence and severity of insomnia as well as risk factors and sleep-related symptom clusters in a sample of cancer patients.

Methods

A cross-sectional survey was conducted collecting data from 213 cancer patients undergoing chemotherapy (age = 53.1 ± 11.3 years, 60% female). Insomnia was measured using the Insomnia Severity Index, a sleep log, and Actigraph, while symptoms were assessed using the Memorial Symptom Assessment Scale and the Hospital Anxiety and Depression Scale. Quality of life was measured with the Functional Assessment of Cancer Therapy—General.

Results

Of the participants, 42.8% reported insomnia, with 31.9% of those with insomnia reporting severe insomnia. Insomnia occurrence and severity were not correlated with the participants’ characteristics, cancer-related or treatment-related factors, only with the participants’ anxiety/depression scores. Principal component analysis showed that insomnia, depression, and anxiety formed a symptom cluster (p < 0.001). There was no difference between sleep parameters measured by Actigraphy in insomnia and non-insomnia participants.

Conclusion

This study demonstrated that the prevalence of insomnia was high and indicated a symptom cluster of insomnia, depression, and anxiety. Therefore, interventions to reduce this symptom cluster may benefit cancer patients who are trying to manage these symptoms.

Romito F, Cormio C, De Padova S, Lorusso V, Berio MA, Fimiani F, Piattelli A, Palazzo S, Abram G, Dudine L, Guglielmi A, Galise I, Romito S, Mattioli V (2014) Patients attitudes towards sleep disturbances during chemotherapy. European Journal of Cancer Care 23(3):385–393. https://doi.org/10.1111/ecc.12106 CrossRefPubMed

Tian J, Chen GL, Zhang HR (2015) Sleep status of cervical cancer patients and predictors of poor sleep quality during adjuvant therapy. Support Care Cancer 23(5):1401–1408. https://doi.org/10.1007/s00520-014-2493-8 CrossRefPubMed

Savard J, Ivers H, Savard MH, Morin CM (2015) Cancer treatments and their side effects are associated with aggravation of insomnia: results of a longitudinal study. Cancer 121(10):1703–1711. https://doi.org/10.1002/cncr.29244 CrossRefPubMed

Palesh OG, Roscoe JA, Mustian KM, Roth T, Savard J, Ancoli-Israel S, Heckler C, Purnell JQ, Janelsins MC, Morrow GR (2010) Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol 28(2):292–298. https://doi.org/10.1200/jco.2009.22.5011 CrossRefPubMed

Davis MP, Khoshknabi D, Walsh D, Lagman R, Platt A (2014) Insomnia in patients with advanced cancer. Am J Hosp Palliat Care 31(4):365–373. https://doi.org/10.1177/1049909113485804 CrossRefPubMed

Shao Y-J, Ji K, Hao J-L, Cheng X-J, Guan B-Q, Liu W-S, Wang K (2016) Nonpain symptom prevalence and intensity of inpatients with moderate to severe cancer pain in China. Am J Hosp Palliat Med 33(5):448–455. https://doi.org/10.1177/1049909114565109 CrossRef

Billiard M, Bentley A (2004) Is insomnia best categorized as a symptom or a disease? Sleep Med 5(Suppl 1):S35–S40CrossRef

Medic G, Wille M, Hemels ME (2017) Short- and long-term health consequences of sleep disruption. Nat Sci Sleep 9:151–161. https://doi.org/10.2147/NSS.S134864 CrossRefPubMedPubMedCentral

Zhang X, Giovannucci EL, Wu K, Gao X, Hu F, Ogino S, Schernhammer ES, Fuchs CS, Redline S, Willett WC, Ma J (2013) Associations of self-reported sleep duration and snoring with colorectal cancer risk in men and women. Sleep 36(5):681–688. https://doi.org/10.5665/sleep.2626 CrossRefPubMedPubMedCentral

10.

Luo J, Sands M, Wactawski-Wende J, Song Y, Margolis KL (2013) Sleep disturbance and incidence of thyroid cancer in postmenopausal women the Women’s Health Initiative. Am J Epidemiol 177(1):42–49. https://doi.org/10.1093/aje/kws193 CrossRefPubMed

11.

Fang H-F, Miao N-F, Chen C-D, Sithole T, Chung M-H (2015) Risk of cancer in patients with insomnia, parasomnia, and obstructive sleep apnea: a nationwide nested case-control study. J Cancer 6(11):1140–1147. https://doi.org/10.7150/jca.12490 CrossRefPubMedPubMedCentral

12.

Cheung V, Yuen VM, Wong GTC, Choi SW (2019) The effect of sleep deprivation and disruption on DNA damage and health of doctors. Anaesthesia 74:434–440. https://doi.org/10.1111/anae.14533 CrossRefPubMed

13.

Davidson JR, MacLean AW, Brundage MD, Schulze K (2002) Sleep disturbance in cancer patients. Soc Sci Med 54(9):1309–1321CrossRef

14.

Vargas S, Wohlgemuth WK, Antoni MH, Lechner SC, Holley HA, Carver CS (2010) Sleep dysfunction and psychosocial adaptation among women undergoing treatment for non-metastatic breast cancer. Psycho-Oncology 19(6):669–673. https://doi.org/10.1002/pon.1603 CrossRefPubMedPubMedCentral

15.

Phillips KM, Jim HS, Donovan KA, Pinder-Schenck MC, Jacobsen PB (2012) Characteristics and correlates of sleep disturbances in cancer patients. Support Care Cancer 20(2):357–365. https://doi.org/10.1007/s00520-011-1106-z CrossRefPubMed

16.

Collins KP, Geller DA, Antoni M, Donnell DM, Tsung A, Marsh JW, Burke L, Penedo F, Terhorst L, Kamarck TW, Greene A, Buysse DJ, Steel JL (2017) Sleep duration is associated with survival in advanced cancer patients. Sleep Med 32:208–212. https://doi.org/10.1016/j.sleep.2016.06.041 CrossRefPubMedPubMedCentral

17.

Dahiya S, Ahluwalia MS, Walia HK (2013) Sleep disturbances in cancer patients: underrecognized and undertreated. Cleve Clin J Med 80(11):722–732. https://doi.org/10.3949/ccjm.80a.12170 CrossRefPubMed

18.

Savard J, Morin CM (2001) Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19(3):895–908CrossRef

19.

O’Donnell JF (2004) Insomnia in cancer patients. Clin Cornerstone 6(1):S6–S14. https://doi.org/10.1016/S1098-3597(05)80002-X CrossRefPubMed

20.

Raghava R, Induru DW (2014) Cancer-related insomnia. Am J Hosp Palliat Med 3(7):777–785

21.

Lowery AE (2015) Sleep and cancer. In: Psycho-oncology. Oxford University Press, Oxford, pp 231–238. https://doi.org/10.1093/med/9780199363315.003.0030

22.

Otte JL, Carpenter JS, Manchanda S, Rand KL, Skaar TC, Weaver M, Chernyak Y, Zhong X, Igega C, Landis CA (2015) Systematic review of sleep disorders in cancer patients: can the prevalence of sleep disorders be ascertained? Cancer Med 4(2):183–200. https://doi.org/10.1002/cam4.356 CrossRefPubMed

23.

Dodd MJ, Miaskowski C, Paul SM (2001) Symptom clusters and their effect on the functional status of patients with cancer. Oncol Nurs Forum 28(3):465–470PubMed

24.

Molassiotis A, Wengström Y, Kearney N (2010) Symptom cluster patterns during the first year after diagnosis with cancer. J Pain Symptom Manag 39(5):847–858. https://doi.org/10.1016/j.jpainsymman.2009.09.012 CrossRef

25.

Okuyama T, Akechi T, Kugaya A, Okamura H, Imoto S, Nakano T, Mikami I, Hosaka T, Uchitomi Y (2000) Factors correlated with fatigue in disease-free breast cancer patients: application of the Cancer Fatigue Scale. Support Care Cancer 8(3):215–222CrossRef

26.

Chen ML, Tseng HC (2006) Symptom clusters in cancer patients. Support Care Cancer 14(8):825–830. https://doi.org/10.1007/s00520-006-0019-8 CrossRefPubMed

27.

Ivanova MO, Ionova TI, Kalyadina SA, Uspenskaya OS, Kishtovich AV, Guo H, Mendoza TR, Novik A, Cleeland CS, Wang XS (2005) Cancer-related symptom assessment in Russia: validation and utility of the Russian M. D. Anderson Symptom Inventory. J Pain Symptom Manag 30(5):443–453. https://doi.org/10.1016/j.jpainsymman.2005.04.015 CrossRef

28.

Hoffman AJ, Given BA, von Eye A, Gift AG, Given CW (2007) Relationships among pain, fatigue, insomnia, and gender in persons with lung cancer. Oncol Nurs Forum 34(4):785–792. https://doi.org/10.1188/07.onf.785-792 CrossRefPubMed

29.

Savard J, Simard S, Hervouet S, Ivers H, Lacombe L, Fradet Y (2005) Insomnia in men treated with radical prostatectomy for prostate cancer. Psycho-Oncology 14(2):147–156. https://doi.org/10.1002/pon.830 CrossRefPubMed

30.

Gehrman PR, Garland SN, Matura LA, Mao J (2016) Insomnia in breast cancer: independent symptom or symptom cluster? Palliat Support Care:1–7

31.

Ho SY, Rohan KJ, Parent J, Tager FA, McKinley PS (2015) A longitudinal study of depression, fatigue, and sleep disturbances as a symptom cluster in women with breast cancer. J Pain Symptom Manag 49(4):707–715. https://doi.org/10.1016/j.jpainsymman.2014.09.009 CrossRef

32.

Morin CM, Belleville G, Bélanger L, Ivers H (2011) The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 34(5):601–608. https://doi.org/10.1093/sleep/34.5.601 CrossRefPubMedPubMedCentral

33.

Long NH, Thanasilp S, Thato R (2016) A causal model for fatigue in lung cancer patients receiving chemotherapy. Eur J Oncol Nurs 21:242–247. https://doi.org/10.1016/j.ejon.2015.10.010 CrossRefPubMed

34.

Ancoli-Israel S, Martin JL, Blackwell T, Buenaver L, Liu L, Meltzer LJ, Sadeh A, Spira AP, Taylor DJ (2015) The SBSM guide to actigraphy monitoring: clinical and research applications. Behav Sleep Med 13(Suppl 1):S4–s38. https://doi.org/10.1080/15402002.2015.1046356 CrossRefPubMed

35.

Lee PH, Suen LK (2017) The convergent validity of Actiwatch 2 and ActiGraph Link accelerometers in measuring total sleeping period, wake after sleep onset, and sleep efficiency in free-living condition. Sleep Breath 21:1522–1709

36.

Cella DF, Tulsky DS, Gray G, et al. The Functional Assessment of Cancer Therapy Scale: development and validation of the general measure. J Clin Oncol 1993:11:570–579. http://www.facit.org/FACITOrg/Questionnaires

37.

Neubauer DN, Pandi-Perumal SR, Spence DW, Buttoo K, Monti JM (2018) Pharmacotherapy of insomnia. J Cent Nerv Syst Dis 10:1179573518770672. https://doi.org/10.1177/1179573518770672 CrossRefPubMedPubMedCentral

38.

Buysse DJ (2013) Insomnia. JAMA 309(7):706–716. https://doi.org/10.1001/jama.2013.193 CrossRefPubMedPubMedCentral

39.

Morris BA, Thorndike FP, Ritterband LM, Glozier N, Dunn J, Chambers SK (2015) Sleep disturbance in cancer patients and caregivers who contact telephone-based help services. Support Care Cancer 23(4):1113–1120. https://doi.org/10.1007/s00520-014-2458-y CrossRefPubMed

40.

Savard J, Hervouet S, Ivers H (2013) Prostate cancer treatments and their side effects are associated with increased insomnia. Psycho-Oncology 22(6):1381–1388. https://doi.org/10.1002/pon.3150 CrossRefPubMed

41.

Ohayon MM, Roth T (2001) What are the contributing factors for insomnia in the general population? J Psychosom Res 51(6):745–755. https://doi.org/10.1016/S0022-3999(01)00285-9 CrossRefPubMed

42.

Akman T, Yavuzsen T, Sevgen Z, Ellidokuz H, Yilmaz AU (2015) Evaluation of sleep disorders in cancer patients based on Pittsburgh Sleep Quality Index. Eur J Cancer Care 24(4):553–559. https://doi.org/10.1111/ecc.12296 CrossRef

43.

Miaskowski C, Lee K, Dunn L, Dodd M, Aouizerat BE, West C, Paul SM, Cooper B, Wara W, Swift P (2011) Sleep-wake circadian activity rhythm parameters and fatigue in oncology patients prior to the initiation of radiation therapy. Cancer Nurs 34(4):255–268. https://doi.org/10.1097/NCC.0b013e3181f65d9b CrossRefPubMedPubMedCentral

44.

Savard J, Simard S, Blanchet J, Ivers H, Morin CM (2001) Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep 24(5):583–590CrossRef

45.

Perlis ML, Giles DE, Buysse DJ, Tu X, Kupfer DJ (1997) Self-reported sleep disturbance as a prodromal symptom in recurrent depression. J Affect Disord 42(2–3):209–212CrossRef

46.

Berk M (2009) Sleep and depression—theory and practice. Aust Fam Physician 38(5):302–304PubMed

47.

Mercadante S, Girelli D, Casuccio A (2004) Sleep disorders in advanced cancer patients: prevalence and factors associated. Support Care Cancer 12(5):355–359. https://doi.org/10.1007/s00520-004-0623-4 CrossRefPubMed

48.

Trudel-Fitzgerald C, Savard J, Ivers H (2014) Longitudinal changes in clusters of cancer patients over an 18-month period. Health Psychol 33(9):1012–1022. https://doi.org/10.1037/a0033497 CrossRefPubMed

49.

Clevenger L, Schrepf A, Degeest K, Bender D, Goodheart M, Ahmed A, Dahmoush L, Penedo F, Lucci J III, Thaker PH, Mendez L, Sood AK, Slavich GM, Lutgendorf SK (2013) Sleep disturbance, distress, and quality of life in ovarian cancer patients during the first year after diagnosis. Cancer 119(17):3234–3241. https://doi.org/10.1002/cncr.28188 CrossRefPubMedPubMedCentral

50.

The National Institutes of Mental Health (2018) Depression. https://www.nimh.nih.gov/health/topics/depression/index.shtml. Accessed 29/5 2018

51.

Walsh D, Rybicki L (2006) Symptom clustering in advanced cancer. Support Care Cancer 14(8):831–836. https://doi.org/10.1007/s00520-005-0899-z CrossRefPubMed

52.

Redeker NS, Lev EL, Ruggiero J (2000) Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Sch Inq Nurs Pract 14(4):275–298PubMed

53.

Alvaro PK, Roberts RM, Harris JK (2013) A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep 36(7):1059–1068CrossRef

54.

Ruivo Marques D, Clemente V, Allen Gomes A, de Azevedo MHP (2018) Profiling insomnia using subjective measures: where are we and where are we going. Sleep Med 42:103–104. https://doi.org/10.1016/j.sleep.2017.12.006 CrossRefPubMed

55.

Zorick F (1994) Insomnia. In: Kryger MH, Roth T, WC D (eds) Principles and practice of sleep medicine. W.B Saunders Co, Philadelphia, pp 483–485

56.

Landry GJ, Best JR, Liu-Ambrose T (2015) Measuring sleep quality in older adults: a comparison using subjective and objective methods. Front Aging Neurosci 7:166. https://doi.org/10.3389/fnagi.2015.00166 CrossRefPubMedPubMedCentral

57.

Grandner MA, Kripke DF, Yoon I-Y, Youngstedt SD (2006) Criterion validity of the Pittsburgh Sleep Quality Index: investigation in a non-clinical sample. Sleep Biol Rhythms 4(2):129–139. https://doi.org/10.1111/j.1479-8425.2006.00207.x CrossRefPubMedPubMedCentral

58.

Silberfarb PM, Hauri PJ, Oxman TE, Lash S (1985) Insomnia in cancer patients. Soc Sci Med 20(8):849–850CrossRef

59.

Kay DB, Karim HT, Soehner AM, Hasler BP, James JA, Germain A, Hall MH, Franzen PL, Price JC, Nofzinger EA, Buysse DJ (2017) Subjective-objective sleep discrepancy is associated with alterations in regional glucose metabolism in patients with insomnia and good sleeper controls. Sleep 40(11). https://doi.org/10.1093/sleep/zsx155

60.

Manconi M, Ferri R, Sagrada C, Punjabi NM, Tettamanzi E, Zucconi M, Oldani A, Castronovo V, Ferini-Strambi L (2010) Measuring the error in sleep estimation in normal subjects and in patients with insomnia. J Sleep Res 19(3):478–486. https://doi.org/10.1111/j.1365-2869.2009.00801.x CrossRefPubMed

61.

American Academy of Seep Medicine (2014) International Classification of Sleep Disorders. 3rd edn. Darien IL, USA

Title: New-onset insomnia among cancer patients undergoing chemotherapy: prevalence, risk factors, and its correlation with other symptoms
Authors: Huong Thi Xuan Hoang
Alex Molassiotis
Choi Wan Chan
Thi Huong Nguyen
Van Liep Nguyen
Publication date: 01-03-2020
Publisher: Springer International Publishing
Keywords: Insomnia
Affective Disorder
Affective Disorder
Anxiety
Cytostatic Therapy
Published in: Sleep and Breathing / Issue 1/2020
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-019-01839-x

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Abstract

Study objectives

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Results

Conclusion

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