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
Breast Cancer Research and Treatment
Published in: Breast Cancer Research and Treatment 2/2020

01-06-2020 | Insomnia | Review

Evaluation and management of insomnia in women with breast cancer

Authors: Agnes Kwak, Jamie Jacobs, Dana Haggett, Rachel Jimenez, Jeffrey Peppercorn

Published in: Breast Cancer Research and Treatment | Issue 2/2020

Login to get access

Abstract

Purpose

Insomnia is a common issue among patients with breast cancer with a potentially devastating impact on quality of life. It can be caused or exacerbated by multiple disease and treatment-related factors. Despite the prevalence and impact of insomnia, it is rarely addressed systematically in the oncology clinic. We conducted a comprehensive review of insomnia to guide clinical care of patient’s with breast cancer and insomnia.

Methods

This manuscript reviews the prevalence, etiology, emerging science and both non-pharmacologic and pharmacologic options for treatment of insomnia among patients with breast cancer.

Results

Multiple factors contribute to insomnia among patients with breast cancer including endocrine therapy and hotflashes, pain and discomfort from local therapy, and fear of recurrence. If we do identify insomnia, there are treatment options and strategies available to help patients. In particular, there is now a considerable body of evidence supporting the use of psychosocial interventions and behavioral treatments, such as cognitive behavioral therapy for insomnia (CBT-I), yoga, and mind-body programs. It is also important for oncology providers to be educated regarding available pharmacologic therapies and emerging data for cannabis-based therapy.

Conclusion

This manuscript provides an up-to-date and comprehensive review of the prevalence, etiology, and treatment approaches available for insomnia for clinicians treating patients with breast cancer. We also address strategies and goals for cancer care delivery and future research.
Literature
1.
American Psychiatric Association (2013) In: Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association, Washington, DC
2.
Zhou ES, Partridge AH, Syrjala KL, Michaud AL, Recklitis CJ (2017) Evaluation and treatment of insomnia in adult cancer survivorship programs. J Cancer Surviv 11(1):74–79PubMed
3.
Davidson JR, MacLean AW, Brundage MD, Schulze K (2002) Sleep disturbance in cancer patients. Soc Sci Med 54(9):1309–1321PubMed
4.
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):583–590PubMed
5.
Kyle SD, Morgan K, Espie CA (2010) Insomnia and health-related quality of life. Sleep Med Rev 14(1):69–82PubMed
6.
Bolge SC, Doan JF, Kannan H, Baran RW (2009) Association of insomnia with quality of life, work productivity, and activity impairment. Qual Life Res 18(4):415–422PubMed
7.
Sarsour K, Kalsekar A, Swindle R, Foley K, Walsh JK (2011) The association between insomnia severity and healthcare and productivity costs in a health plan sample. Sleep 34(4):443–450PubMedPubMedCentral
8.
Klink ME, Quan SF, Kaltenborn WT, Lebowitz MD (1992) Risk factors associated with complaints of insomnia in a general adult population Influence of previous complaints of insomnia. Arch Intern Med 152(8):1634–1637PubMed
9.
Schieber K, Niecke A, Geiser F, Erim Y, Bergelt C, Buttner-Teleaga A, Maatouk I, Stein B, Teufel M, Wickert M et al (2019) The course of cancer-related insomnia: don't expect it to disappear after cancer treatment. Sleep Med 58:107–113PubMed
10.
Fortner BV, Stepanski EJ, Wang SC, Kasprowicz S, Durrence HH (2002) Sleep and quality of life in breast cancer patients. J Pain Symptom Manag 24(5):471–480
11.
Koopman C, Nouriani B, Erickson V, Anupindi R, Butler LD, Bachmann MH, Sephton SE, Spiegel D (2002) Sleep disturbances in women with metastatic breast cancer. Breast J 8(6):362–370PubMed
12.
Desai K, Mao JJ, Su I, Demichele A, Li Q, Xie SX, Gehrman PR (2013) Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors. Support Care Cancer 21(1):43–51PubMed
13.
Couzi RJ, Helzlsouer KJ, Fetting JH (1995) Prevalence of menopausal symptoms among women with a history of breast cancer and attitudes toward estrogen replacement therapy. J Clin Oncol 13(11):2737–2744PubMed
14.
Savard J, Davidson JR, Ivers H, Quesnel C, Rioux D, Dupere V, Lasnier M, Simard S, Morin CM (2004) The association between nocturnal hot flashes and sleep in breast cancer survivors. J Pain Symptom Manag 27(6):513–522
15.
Cho NY, Kim S, Nowakowski S, Shin C, Suh S (2019) Sleep disturbance in women who undergo surgical menopause compared with women who experience natural menopause. Menopause 26(4):357–364PubMed
16.
Hatcher KM, Royston SE, Mahoney MM (2018) Modulation of circadian rhythms through estrogen receptor signaling. Eur J Neurosci 51:217PubMed
17.
Van Onselen C, Aouizerat BE, Dunn LB, Paul SM, West C, Hamolsky D, Lee K, Melisko M, Neuhaus J, Miaskowski C (2013) Differences in sleep disturbance, fatigue and energy levels between women with and without breast pain prior to breast cancer surgery. Breast 22(3):273–276PubMed
18.
Savard J, Morin CM (2001) Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19(3):895–908PubMed
19.
Palesh OG, Collie K, Batiuchok D, Tilston J, Koopman C, Perlis ML, Butler LD, Carlson R, Spiegel D (2007) A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biol Psychol 75(1):37–44PubMed
20.
Hall DL, Jimenez RB, Perez GK, Rabin J, Quain K, Yeh GY, Park ER, Peppercorn JM (2019) Fear of cancer recurrence: a model examination of physical symptoms, emotional distress, and health behavior change. J Oncol Pract 15(9):e787–e797PubMed
21.
Berrett-Abebe J, Cadet T, Pirl W, Lennes I (2015) Exploring the relationship between fear of cancer recurrence and sleep quality in cancer survivors. J Psychosoc Oncol 33(3):297–309PubMed
22.
Salo P, Sivertsen B, Oksanen T, Sjosten N, Pentti J, Virtanen M, Kivimaki M, Vahtera J (2012) Insomnia symptoms as a predictor of incident treatment for depression: prospective cohort study of 40,791 men and women. Sleep Med 13(3):278–284PubMed
23.
Siefert ML, Hong F, Valcarce B, Berry DL (2014) Patient and clinician communication of self-reported insomnia during ambulatory cancer care clinic visits. Cancer Nurs 37(2):E51–59PubMedPubMedCentral
24.
Engstrom CA, Strohl RA, Rose L, Lewandowski L, Stefanek ME (1999) Sleep alterations in cancer patients. Cancer Nurs 22(2):143–148PubMed
25.
Davidson JR, Feldman-Stewart D, Brennenstuhl S, Ram S (2007) How to provide insomnia interventions to people with cancer: insights from patients. Psychooncology 16(11):1028–1038PubMed
26.
Palesh O, Aldridge-Gerry A, Zeitzer JM, Koopman C, Neri E, Giese-Davis J, Jo B, Kraemer H, Nouriani B, Spiegel D (2014) Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep 37(5):837–842PubMedPubMedCentral
27.
Irwin M, McClintick J, Costlow C, Fortner M, White J, Gillin JC (1996) Partial night sleep deprivation reduces natural killer and cellular immune responses in humans. FASEB J 10(5):643–653PubMed
28.
Sephton SE, Sapolsky RM, Kraemer HC, Spiegel D (2000) Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst 92(12):994–1000PubMed
29.
Kidwell KM, Harte SE, Hayes DF, Storniolo AM, Carpenter J, Flockhart DA, Stearns V, Clauw DJ, Williams DA, Henry NL (2014) Patient-reported symptoms and discontinuation of adjuvant aromatase inhibitor therapy. Cancer 120(16):2403–2411PubMedPubMedCentral
30.
Kakizaki M, Kuriyama S, Sone T, Ohmori-Matsuda K, Hozawa A, Nakaya N, Fukudo S, Tsuji I (2008) Sleep duration and the risk of breast cancer: the Ohsaki Cohort Study. Br J Cancer 99(9):1502–1505PubMedPubMedCentral
31.
McElroy JA, Newcomb PA, Titus-Ernstoff L, Trentham-Dietz A, Hampton JM, Egan KM (2006) Duration of sleep and breast cancer risk in a large population-based case-control study. J Sleep Res 15(3):241–249PubMed
32.
Wu AH, Wang R, Koh WP, Stanczyk FZ, Lee HP, Yu MC (2008) Sleep duration, melatonin and breast cancer among Chinese women in Singapore. Carcinogenesis 29(6):1244–1248PubMedPubMedCentral
33.
Thompson CL, Li L (2012) Association of sleep duration and breast cancer OncotypeDX recurrence score. Breast Cancer Res Treat 134(3):1291–1295PubMedPubMedCentral
34.
Wang Y, Zhu X, Li L, Yi J, He J (2016) What factors affect the insomnia symptom trajectories in women with nonmetastatic breast cancer? J Pain Symptom Manag 52(6):850–858
35.
36.
Savard MH, Savard J, Simard S, Ivers H (2005) Empirical validation of the insomnia severity index in cancer patients. Psycho-Oncology 14(6):429–441PubMed
37.
Beck SL, Schwartz AL, Towsley G, Dudley W, Barsevick A (2004) Psychometric evaluation of the pittsburgh sleep quality index in cancer patients. J Pain Symptom Manag 27(2):140–148
38.
Luyster FS, Choi J, Yeh CH, Imes CC, Johansson AE, Chasens ER (2015) Screening and evaluation tools for sleep disorders in older adults. Appl Nurs Res 28(4):334–340PubMedPubMedCentral
39.
Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL, Morin CM (2012) The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep 35(2):287–302PubMedPubMedCentral
40.
Edinger JD, Hoelscher TJ, Webb MD, Marsh GR, Radtke RA, Erwin CW (1989) Polysomnographic assessment of DIMS: empirical evaluation of its diagnostic value. Sleep 12(4):315–322PubMed
41.
Kupfer DJ, Reynolds CF 3rd (1997) Management of insomnia. N Engl J Med 336(5):341–346PubMed
42.
Vincent N, Lionberg C (2001) Treatment preference and patient satisfaction in chronic insomnia. Sleep 24(4):411–417PubMed
43.
Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD (2016) Clinical guidelines committee of the American College of P: management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med 165(2):125–133PubMed
44.
Morin CM, Culbert JP, Schwartz SM (1994) Nonpharmacological interventions for insomnia: a meta-analysis of treatment efficacy. Am J Psychiatry 151(8):1172–1180PubMed
45.
Matthews EE, Berger AM, Schmiege SJ, Cook PF, McCarthy MS, Moore CM, Aloia MS (2014) Cognitive behavioral therapy for insomnia outcomes in women after primary breast cancer treatment: a randomized, controlled trial. Oncol Nurs Forum 41(3):241–253PubMed
46.
Dirksen SR, Epstein DR (2008) Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. J Adv Nurs 61(6):664–675PubMed
47.
Arnedt JT, Cuddihy L, Swanson LM, Pickett S, Aikens J, Chervin RD (2013) Randomized controlled trial of telephone-delivered cognitive behavioral therapy for chronic insomnia. Sleep 36(3):353–362PubMedPubMedCentral
48.
Dozeman E, Verdonck-de Leeuw IM, Savard J, van Straten A (2017) Guided web-based intervention for insomnia targeting breast cancer patients: feasibility and effect. Internet Interv 9:1–6PubMedPubMedCentral
49.
Atema V, van Leeuwen M, Kieffer JM, Oldenburg HSA, van Beurden M, Gerritsma MA, Kuenen MA, Plaisier PW, Lopes Cardozo AMF, van Riet YEA et al (2019) Efficacy of internet-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors: results of a randomized controlled trial. J Clin Oncol 37(10):809–822PubMed
50.
Savard J, Ivers H, Savard MH, Morin CM (2016) Long-term effects of two formats of cognitive behavioral therapy for insomnia comorbid with breast cancer. Sleep 39(4):813–823PubMedPubMedCentral
51.
Vargas S, Antoni MH, Carver CS, Lechner SC, Wohlgemuth W, Llabre M, Blomberg BB, Gluck S, DerHagopian RP (2014) Sleep quality and fatigue after a stress management intervention for women with early-stage breast cancer in southern Florida. Int J Behav Med 21(6):971–981PubMedPubMedCentral
52.
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):449–457PubMed
53.
Lengacher CA, Johnson-Mallard V, Post-White J, Moscoso MS, Jacobsen PB, Klein TW, Widen RH, Fitzgerald SG, Shelton MM, Barta M et al (2009) Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psycho-Oncology 18(12):1261–1272PubMed
54.
Nakamura Y, Lipschitz DL, Kuhn R, Kinney AY, Donaldson GW (2013) Investigating efficacy of two brief mind-body intervention programs for managing sleep disturbance in cancer survivors: a pilot randomized controlled trial. J Cancer Surviv 7(2):165–182PubMedPubMedCentral
55.
Payne JK, Held J, Thorpe J, Shaw H (2008) Effect of exercise on biomarkers, fatigue, sleep disturbances, and depressive symptoms in older women with breast cancer receiving hormonal therapy. Oncol Nurs Forum 35(4):635–642PubMed
56.
Rogers LQ, Fogleman A, Trammell R, Hopkins-Price P, Vicari S, Rao K, Edson B, Verhulst S, Courneya KS, Hoelzer K (2013) Effects of a physical activity behavior change intervention on inflammation and related health outcomes in breast cancer survivors: pilot randomized trial. Integr Cancer Ther 12(4):323–335PubMed
57.
Mustian KM, Sprod LK, Janelsins M, Peppone LJ, Palesh OG, Chandwani K, Reddy PS, Melnik MK, Heckler C, Morrow GR (2013) Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. J Clin Oncol 31(26):3233–3241PubMedPubMedCentral
58.
Huang MI, Nir Y, Chen B, Schnyer R, Manber R (2006) A randomized controlled pilot study of acupuncture for postmenopausal hot flashes: effect on nocturnal hot flashes and sleep quality. Fertil Steril 86(3):700–710PubMed
59.
Guo J, Wang LP, Liu CZ, Zhang J, Wang GL, Yi JH, Cheng JL (2013) Efficacy of acupuncture for primary insomnia: a randomized controlled clinical trial. Evid Based Complement Alternat Med 2013:163850PubMedPubMedCentral
60.
Koffel E, Bramoweth AD, Ulmer CS (2018) Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review. J Gen Intern Med 33(6):955–962PubMedPubMedCentral
61.
62.
Morin CM, Koetter U, Bastien C, Ware JC, Wooten V (2005) Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep 28(11):1465–1471PubMed
63.
Chen WY, Giobbie-Hurder A, Gantman K, Savoie J, Scheib R, Parker LM, Schernhammer ES (2014) A randomized, placebo-controlled trial of melatonin on breast cancer survivors: impact on sleep, mood, and hot flashes. Breast Cancer Res Treat 145(2):381–388PubMedPubMedCentral
64.
Holbrook AM, Crowther R, Lotter A, Cheng C, King D (2000) Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ 162(2):225–233PubMedPubMedCentral
65.
66.
Huedo-Medina TB, Kirsch I, Middlemass J, Klonizakis M, Siriwardena AN (2012) Effectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the food and drug administration. BMJ 345:e8343PubMedPubMedCentral
67.
Yi XY, Ni SF, Ghadami MR, Meng HQ, Chen MY, Kuang L, Zhang YQ, Zhang L, Zhou XY (2018) Trazodone for the treatment of insomnia: a meta-analysis of randomized placebo-controlled trials. Sleep Med 45:25–32PubMed
68.
Belendiuk KA, Babson KA, Vandrey R, Bonn-Miller MO (2015) Cannabis species and cannabinoid concentration preference among sleep-disturbed medicinal cannabis users. Addict Behav 50:178–181PubMed
69.
Kuhathasan N, Dufort A, MacKillop J, Gottschalk R, Minuzzi L, Frey BN (2019) The use of cannabinoids for sleep: A critical review on clinical trials. Exp Clin Psychopharmacol 27(4):383–401PubMed
70.
Babson KA, Sottile J, Morabito D (2017) Cannabis, cannabinoids, and sleep: a review of the literature. Curr Psychiatry Rep 19(4):23PubMed
Metadata
Title
Evaluation and management of insomnia in women with breast cancer
Authors
Agnes Kwak
Jamie Jacobs
Dana Haggett
Rachel Jimenez
Jeffrey Peppercorn
Publication date
01-06-2020
Publisher
Springer US
Published in
Breast Cancer Research and Treatment / Issue 2/2020
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI
https://doi.org/10.1007/s10549-020-05635-0

Other articles of this Issue 2/2020

Breast Cancer Research and Treatment 2/2020 Go to the issue

Clinical trial

Axillary lymph node dissection is not obligatory in breast cancer patients with biopsy-proven axillary lymph node metastasis

Preclinical study

Lymphovascular invasion in breast cancer is associated with gene expression signatures of cell proliferation but not lymphangiogenesis or immune response

Epidemiology

Prediction of contralateral breast cancer: external validation of risk calculators in 20 international cohorts

Clinical trial

FDG uptake reflects breast cancer immunological features: the PD-L1 expression and degree of TILs in primary breast cancer

Preclinical study

Suppression of breast cancer metastasis and extension of survival by a new antiestrogen in a preclinical model driven by mutant estrogen receptors

Review

Mechanistic basis for PI3K inhibitor antitumor activity and adverse reactions in advanced breast cancer
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