Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Supportive Care in Cancer
Published in: Supportive Care in Cancer 5/2021

01-05-2021 | Breast Cancer | Original Article

Patient characteristics associated with sleep disturbance in breast cancer survivors

Authors: Chelsea G. Ratcliff, Stephanie G. Zepeda, Martica H. Hall, Emily A. Tullos, Shaelyn Fowler, Alejandro Chaoul, Amy Spelman, Banu Arun, Lorenzo Cohen

Published in: Supportive Care in Cancer | Issue 5/2021

Login to get access

Abstract

Background

Disturbed sleep is common among breast cancer survivors. Identifying patients at risk for disturbed sleep and its sequelae will aid in improving screening and intervention strategies to improve sleep and cancer-related quality of life (QOL).

Methods

Women with stages I–III breast cancer undergoing neoadjuvant or adjuvant chemotherapy (N = 415) reported subjectively assessed sleep quality (PSQI) and actigraphy-assessed wake after sleep onset (AAS-WASO), total sleep time (AAS-TST), and sleep efficiency (AAS-SE), sociodemographic, and clinical characteristics and completed questionnaires assessing physical and mental health QOL at study entry and 3, 6, 12, and 15 months later.

Results

Being from a racially/ethnically underserved population was associated with poorer sleep in all indices (p’s < .04). Lower income was associated with poorer subjective sleep and greater AAS-WASO (p’s < .02). BMI was associated with lower AAS-SE (p < .001). Baseline subjective sleep complaints were positively associated with depression, fatigue, and health-related QOL and cancer-related symptoms across follow-up (p’s < 0.05). Baseline AAS-WASO was positively associated with anxiety and negatively associated with physical health-related QOL at the 3-month follow-up (p’s < .001). Baseline AAS-WASO and AAS-SE were associated with mental health-related QOL at the 6-month follow-up (p’s < .05).

Conclusions

In keeping with previous health disparity research, racially/ethnically underserved populations, lower household income, and higher BMI were associated with increased risk for disturbed sleep. Sleep disturbance may have long-term effects on multiple aspects of QOL for women undergoing treatment for breast cancer. Results may inform strategies to identify patients at greatest risk for disturbed sleep and its sequelae.
Literature
1.
2.
Vin-Raviv N, Akinyemiju T, Galea S, Bovbjerg D (2018) Sleep disorder diagnoses and clinical outcomes among hospitalized breast cancer patients: a nationwide inpatient sample study. Support Care Cancer 26(6):1833–1840CrossRef
3.
Bardwell WA, Profant J, Casden DR, Dimsdale JE, Ancoli-Israel S, Natarajan L et al (2008) The relative importance of specific risk factors for insomnia in women treated for early-stage breast cancer. Psycho-oncology 17(1):9–18CrossRef
4.
Ohayon MM (2002) Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 6(2):97–111CrossRef
5.
Ancoli-Israel S, Liu L, Marler MR, Parker BA, Jones V, Sadler GR et al (2006) Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer 14(3):201–209CrossRef
6.
Liu L, Rissling M, Natarajan L, Fiorentino L, Mills PJ, Dimsdale JE et al (2012) The longitudinal relationship between fatigue and sleep in breast cancer patients undergoing chemotherapy. Sleep 35(2):237–245CrossRef
7.
Colagiuri B, Christensen S, Jensen AB, Price MA, Butow PN, Zachariae R (2011) Prevalence and predictors of sleep difficulty in a national cohort of women with primary breast cancer three to four months postsurgery. J Pain Symptom Manag 42(5):710–720CrossRef
8.
Ratcliff CG, Lam CY, Arun B, Valero V, Cohen L (2014) Ecological momentary assessment of sleep, symptoms, and mood during chemotherapy for breast cancer. Psycho-Oncology 23(11):1220–1228CrossRef
9.
Liu L, Fiorentino L, Rissling M, Natarajan L, Parker BA, Dimsdale JE et al (2013) Decreased health-related quality of life in women with breast cancer is associated with poor sleep. Behav Sleep Med 11(3):189–206CrossRef
10.
Koopman C, Nouriani B, Erickson V, Anupindi R, Butler LD, Bachmann MH et al (2002) Sleep disturbances in women with metastatic breast cancer. Breast J 8(6):362–370CrossRef
11.
Wright CE, Schnur JB, Montgomery GH, Bovbjerg DH (2010) Psychological factors associated with poor sleep prior to breast surgery: an exploratory study. Behav Med 36(3):85–91CrossRef
12.
Kung P-Y, Chou K-R, Lin K-C, Hsu H-W, Chung M-H (2015) Sleep disturbances in patients with major depressive disorder: incongruence between sleep log and actigraphy. Arch Psychiatr Nurs 29(1):39–42CrossRef
13.
Beck SL, Berger AM, Barsevick AM, Wong B, Stewart KA, Dudley WN (2010) Sleep quality after initial chemotherapy for breast cancer. Support Care Cancer 18(6):679–689CrossRef
14.
Dhruva A, Paul SM, Cooper BA, Lee K, West C, Aouizerat BE et al (2012) A longitudinal study of measures of objective and subjective sleep disturbance in patients with breast cancer before, during, and after radiation therapy. J Pain Symptom Manag 44(2):215–228CrossRef
15.
Enderlin CA, Coleman EA, Cole C, Richards KC, Kennedy RL, Goodwin JA et al (2011) Subjective sleep quality, objective sleep characteristics, insomnia symptom severity, and daytime sleepiness in women aged 50 and older with nonmetastatic breast cancer. Oncol Nurs Forum
16.
Budhrani PH, Lengacher CA, Kip K, Tofthagen C, Jim H (2014) Minority breast cancer survivors: the association between race/ethnicity, objective sleep disturbances, and physical and psychological symptoms. Nurs Res Pract 858403
17.
Durrence HH, Lichstein KL (2006) The sleep of African Americans: a comparative review. Behav Sleep Med 4(1):29–44CrossRef
18.
Aldridge-Gerry A, Zeitzer JM, Palesh OG, Jo B, Nouriani B, Neri E et al (2013) Psychosocial correlates of sleep quality and architecture in women with metastatic breast cancer. Sleep Med 14(11):1178–1186CrossRef
19.
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
20.
Rissling MB, Liu L, Natarajan L, He F, Ancoli-Israel S (2011) Relationship of menopausal status and climacteric symptoms to sleep in women undergoing chemotherapy. Support Care Cancer 19(8):1107–1115CrossRef
21.
Champion VL, Wagner LI, Monahan PO, Daggy J, Smith L, Cohee A et al (2014) Comparison of younger and older breast cancer survivors and age-matched controls on specific and overall quality of life domains. Cancer 120(15):2237–2246CrossRef
22.
Tworoger SS, Davis S, Vitiello MV, Lentz MJ, McTiernan A (2005) Factors associated with objective (actigraphic) and subjective sleep quality in young adult women. J Psychosom Res 59(1):11–19CrossRef
23.
Wirth MD, Hébert JR, Hand GA, Youngstedt SD, Hurley TG, Shook RP et al (2015) Association between actigraphic sleep metrics and body composition. Ann Epidemiol 25(10):773–778CrossRef
24.
Chaoul A, Milbury K, Spelman A, Basen-Engquist K, Hall MH, Wei Q et al (2018) Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy. Cancer 124(1):36–45CrossRef
25.
Hall MH (2010) Behavioral medicine and sleep: concepts, measures, and methods. In: Handbook of Behavioral Medicine. Springer, Berlin, pp 749–765CrossRef
26.
Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213CrossRef
27.
28.
Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401CrossRef
29.
Spielberger CD (1970) STAI manual for the state-trait anxiety inventory. Self-evaluation questionnaire, pp 1–24
30.
Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK et al (1999) The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 85(5):1186–1196CrossRef
31.
Ware JE, Kosinski M, Dewey JE, Gandek B (2000) SF-36 health survey: manual and interpretation guide: Quality Metric Inc.
32.
Cleeland CS, Ryan KM (1994) Pain assessment: global use of the Brief Pain Inventory. Annal Acad Med 23(2):129–138
33.
34.
Hale L, Do DP (2007) Racial differences in self-reports of sleep duration in a population-based study. Sleep 30(9):1096–1103CrossRef
35.
Redline S, Kirchner HL, Quan SF, Gottlieb DJ, Kapur V, Newman A (2004) The effects of age, sex, ethnicity, and sleep-disordered breathing on sleep architecture. Arch Intern Med 164(4):406–418CrossRef
36.
Jehan S, Myers AK, Zizi F, Pandi-Perumal SR, Jean-Louis G, Singh N et al (2018) Sleep health disparity: the putative role of race, ethnicity and socioeconomic status. Sleep Med Disorders Int J 2(5):127
37.
Ellison GT, Smart A, Tutton R, Outram SM, Ashcroft R, Martin P (2007) Racial categories in medicine: a failure of evidence-based practice? PLoS Med 4(9):e287CrossRef
38.
Krueger PM, Reither EN (2015) Mind the gap: race/ethnic and socioeconomic disparities in obesity. Current diabetes reports 15(11):95CrossRef
39.
Vena C, Parker KP, Allen R, Bliwise DL, Jain S, Kimble L (2006) Sleep-wake disturbances and quality of life in patients with advanced lung cancer. Oncology Nursing Forum, Oncology Nursing SocietyCrossRef
40.
41.
Yennurajalingam S, Tayjasanant S, Balachandran D, Padhye NS, Williams JL, Liu DD et al (2016) Association between daytime activity, fatigue, sleep, anxiety, depression, and symptom burden in advanced cancer patients: a preliminary report. J Palliat Med 19(8):849–856CrossRef
42.
Guzman GG (2017) Household income: 2016: US Department of Commerce, Economics and Statistics Administration.
43.
Garland SN, Carlson LE, Stephens AJ, Antle MC, Samuels C, Campbell TS (2014) Mindfulness-based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: a randomized, partially blinded, noninferiority trial. J Clin Oncol 32(5):449–457CrossRef
Metadata
Title
Patient characteristics associated with sleep disturbance in breast cancer survivors
Authors
Chelsea G. Ratcliff
Stephanie G. Zepeda
Martica H. Hall
Emily A. Tullos
Shaelyn Fowler
Alejandro Chaoul
Amy Spelman
Banu Arun
Lorenzo Cohen
Publication date
01-05-2021
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 5/2021
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-020-05777-3

Other articles of this Issue 5/2021

Supportive Care in Cancer 5/2021 Go to the issue

Original Article

‘I don’t talk about my distress to others; I feel that I have to suffer my problems...’ Voices of Indian women with breast cancer: a qualitative interview study

Original Article

Development and evaluation of a sustainable video health education program for newly diagnosed breast cancer patients in Malaysia

Original Article

FIBCD1 ameliorates weight loss in chemotherapy-induced murine mucositis

Original Article

Acute toxicity and tolerability of anthracycline-based chemotherapy regimens in older versus younger patients with breast cancer: real-world data

Original Article

Perceptions of time spent pursuing cancer care among patients, caregivers, and oncology professionals

Original Article

Men’s sexual help-seeking and care needs after radical prostatectomy or other non-hormonal, active prostate cancer treatments
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits