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Journal of Cancer Survivorship

Published in:

01-02-2017

Evaluation and treatment of insomnia in adult cancer survivorship programs

Authors: Eric S. Zhou, Ann H. Partridge, Karen L. Syrjala, Alexis L. Michaud, Christopher J. Recklitis

Published in: Journal of Cancer Survivorship | Issue 1/2017

Abstract

Purpose

Insomnia is commonly experienced by cancer survivors. Chronic insomnia is associated with significant physical and psychosocial consequences if not properly treated. Both the National Cancer Institute (NCI) and the National Comprehensive Cancer Network (NCCN) recommend the evaluation of sleep disturbances and evidence-based treatment of insomnia during routine survivorship care. To better understand current clinical practices, we conducted a survey of major cancer centers across the United States (US).

Methods

Adult survivorship programs at the 25 US cancer centers that are both NCI-designated comprehensive cancer centers and NCCN member institutions were surveyed about the evaluation and treatment of insomnia in their hospital.

Results

All institutions responded to the survey. Thirteen centers (56 %) reported screening <25 % of survivors for sleep disorders, and few clinicians providing survivorship care were well-prepared to conduct a proper sleep evaluation. Insomnia was most commonly treated with sleep hygiene, or pharmacotherapy, rather than cognitive-behavioral therapy. No program reported that >50 % of their survivors were receiving optimal insomnia-related care. A variety of methods to improve insomnia care were endorsed by respondents.

Conclusions

There is a clear need to improve the evaluation and treatment of insomnia for cancer survivors at institutions across the country. Cancer centers deemed a number of modalities relevant for improving provider confidence in addressing sleep challenges.

Implications for cancer survivors

To improve the quality of insomnia care for survivors, systematic interventions to increase standardized screening for sleep disorders, providing additional sleep medicine training for survivorship clinicians, and optimizing the role of sleep medicine specialists in the oncology setting should be considered.

Costa AR, Fontes F, Pereira S, Goncalves M, Azevedo A, Lunet N. Impact of breast cancer treatments on sleep disturbances—a systematic review. Breast. 2014;23(6):697–709. doi:10.1016/j.breast.2014.09.003.CrossRefPubMed

Palesh O, Peppone L, Innominato PF, Janelsins M, Jeong M, Sprod L, et al. Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer. Nat Sci Sleep. 2012;4:151–62. doi:10.2147/NSS.S18895.CrossRefPubMedPubMedCentral

Fleming L, Gillespie S, Espie CA. The development and impact of insomnia on cancer survivors: a qualitative analysis. Psychooncology. 2010;19(9):991–6. doi:10.1002/pon.1652.CrossRefPubMed

Savard J, Hervouet S, Ivers H. Prostate cancer treatments and their side effects are associated with increased insomnia. Psychooncology. 2013;22(6):1381–8. doi:10.1002/pon.3150.CrossRefPubMed

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fifth edition. 5th ed. Washington, DC: American Psychiatric Association; 2013.CrossRef

Davidson JR, MacLean AW, Brundage MD, Schulze K. Sleep disturbance in cancer patients. Soc Sci Med. 2002;54(9):1309–21.CrossRefPubMed

Savard J, Simard S, Hervouet S, Ivers H, Lacombe L, Fradet Y. Insomnia in men treated with radical prostatectomy for prostate cancer. Psychooncology. 2005;14(2):147–56. doi:10.1002/pon.830.CrossRefPubMed

Sanford SD, Wagner LI, Beaumont JL, Butt Z, Sweet JJ, Cella D. Longitudinal prospective assessment of sleep quality: before, during, and after adjuvant chemotherapy for breast cancer. Support Care Cancer. 2013;21(4):959–67. doi:10.1007/s00520-012-1612-7.CrossRefPubMed

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

10.

Savard J, Ivers H, Villa J, Caplette-Gingras A, Morin CM. Natural course of insomnia comorbid with cancer: an 18-month longitudinal study. J Clin Oncol. 2011;29(26):3580–6. doi:10.1200/JCO.2010.33.2247.CrossRefPubMed

11.

Morin CM, Belanger L, LeBlanc M, Ivers H, Savard J, Espie CA, et al. The natural history of insomnia: a population-based 3-year longitudinal study. Arch Intern Med. 2009;169(5):447–53. doi:10.1001/archinternmed.2008.610.CrossRefPubMed

12.

Berger AM, Mitchell SA. Modifying cancer-related fatigue by optimizing sleep quality. J Natl Compr Cancer Netw. 2008;6(1):3–13.

13.

Byar KL, Berger AM, Bakken SL, Cetak MA, editors. Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life. Oncol Nurs Forum; 2006.

14.

Ho S-Y, Rohan KJ, Parent J, Tager FA, McKinley PS. A longitudinal study of depression, fatigue, and sleep disturbances as a symptom cluster in women with breast cancer. J Pain Symptom Manag. 2015;49(4):707–15.CrossRef

15.

Palesh O, Aldrige-Gerry A, Zeitzer JM, Koopman C, Neri E, Giese-Davis J, et al. Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep. 2014;37(5):837–42.PubMedPubMedCentral

16.

Jim HS, Jacobsen PB, Phillips KM, Wenham RM, Roberts W, Small BJ. Lagged relationships among sleep disturbance, fatigue, and depressed mood during chemotherapy. Health Psychol. 2013;32(7):768.CrossRefPubMedPubMedCentral

17.

Lockefeer J, De Vries J. What is the relationship between trait anxiety and depressive symptoms, fatigue, and low sleep quality following breast cancer surgery? Psychooncology. 2013;22(5):1127–33.CrossRefPubMed

18.

Clanton NR, Klosky JL, Li C, Jain N, Srivastava DK, Mulrooney D, et al. Fatigue, vitality, sleep, and neurocognitive functioning in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer. 2011;117(11):2559–68. doi:10.1002/cncr.25797.CrossRefPubMedPubMedCentral

19.

National Cancer Institute. Follow-up care after cancer treatment. National Cancer Institute. 2013. http://www.cancer.gov/cancertopics/factsheet/Therapy/followup. Accessed November 2013.

20.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: survivorship. 2015.

21.

Savard J, Simard S, Ivers H, Morin CM. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: sleep and psychological effects. J Clin Oncol. 2005;23(25):6083–96. doi:10.1200/JCO.2005.09.548.CrossRefPubMed

22.

Espie CA, Fleming L, Cassidy J, Samuel L, Taylor LM, White CA, et al. Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. J Clin Oncol. 2008;26(28):4651–8. doi:10.1200/JCO.2007.13.9006.CrossRefPubMed

23.

Epstein DR, Dirksen SR. Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors. Oncol Nurs Forum. 2007;34(5):E51–9.CrossRefPubMed

24.

Ritterband LM, Bailey ET, Thorndike FP, Lord HR, Farrell-Carnahan L, Baum LD. Initial evaluation of an internet intervention to improve the sleep of cancer survivors with insomnia. Psychooncology. 2012;21(7):695–705. doi:10.1002/pon.1969.CrossRefPubMed

25.

Zhou ES, Partridge AH, Recklitis CJ. A pilot trial of brief group cognitive-behavioral treatment for insomnia in an adult cancer survivorship program. Psychooncology. 2016. doi:10.1002/pon.4096.

26.

Garland SN, Johnson JA, Savard J, Gehrman P, Perlis M, Carlson L, et al. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat. 2014;10:1113–24. doi:10.2147/NDT.S47790.PubMedPubMedCentral

27.

Qaseem A, Barry MJ, Kansagara D. Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;164(5):350–9.CrossRefPubMed

28.

Zhou ES, Recklitis CJ. Insomnia in adult survivors of childhood cancer: a report from project REACH. Support Care Cancer. 2014;22(11):3061–9. doi:10.1007/s00520-014-2316-y.CrossRefPubMed

29.

Stepanski EJ, Wyatt JK. Use of sleep hygiene in the treatment of insomnia. Sleep Med Rev. 2003;7(3):215–25.CrossRefPubMed

30.

Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev. 2015;22:23–36. doi:10.1016/j.smrv.2014.10.001.CrossRefPubMed

31.

Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331(7526):1169. doi:10.1136/bmj.38623.768588.47.CrossRefPubMedPubMedCentral

32.

Kupfer DJ, Reynolds 3rd CF. Management of insomnia. N Engl J Med. 1997;336(5):341–6. doi:10.1056/NEJM199701303360506.CrossRefPubMed

33.

Zhou ES, Manley PE, Marcus KJ, Recklitis CJ. Medical and psychosocial correlates of insomnia symptoms in adult survivors of pediatric brain tumors. J Pediatr Psychol. 2015. doi:10.1093/jpepsy/jsv071.PubMed

34.

Mindell JA, Bartle A, Wahab NA, Ahn Y, Ramamurthy MB, Huong HT, et al. Sleep education in medical school curriculum: a glimpse across countries. Sleep Med. 2011;12(9):928–31. doi:10.1016/j.sleep.2011.07.001.CrossRefPubMed

35.

Rosen RC, Rosekind M, Rosevear C, Cole WE, Dement WC. Physician education in sleep and sleep disorders: a national survey of U.S. medical schools. Sleep. 1993;16(3):249–54.PubMed

36.

Zozula R, Rosen RC, Jahn EG, Engel SH. Recognition of sleep disorders in a community-based setting following an educational intervention. Sleep Med. 2005;6(1):55–61. doi:10.1016/j.sleep.2004.09.004.CrossRefPubMed

37.

Martinez-Garcia MA, Soler-Cataluna JJ, Roman-Sanchez P, Amoros C, Quiles L, Chiner-Vives E, et al. Efficacy of a training program on sleep apnea-hypopnea syndrome aimed at primary care physicians. Arch Bronconeumol. 2008;44(1):15–21.PubMed

38.

Valerio TD, Heaton K. The effects of an online educational program on nurse practitioners’ knowledge of obstructive sleep apnea in adults. J Am Assoc Nurse Pract. 2014;26(11):603–11.PubMed

39.

Savard J, Ivers H, Savard M-H, Villa J, Morin C, editors. Is a video-based cognitive-behavioral therapy as efficacious as a professionally administered treatment for insomnia comorbid with cancer? Preliminary results of a randomized controlled trial. Psychooncology; 2013: Wiley-Blackwell 111 River St, Hoboken 07030–5774, NJ USA.

40.

Savard J, Villa J, Simard S, Ivers H, Morin CM. Feasibility of a self-help treatment for insomnia comorbid with cancer. Psychooncology. 2011;20(9):1013–9. doi:10.1002/pon.1818.PubMed

41.

Zhou ES, Vrooman LM, Manley PE, Crabtree VM, Recklitis CJ. Adapted delivery of cognitive-behavioral treatment for insomnia in adolescent and young adult cancer survivors: a pilot study. Behav Sleep Med. 2016;1-14.

42.

Dahiya S, Ahluwalia MS, Walia HK. Sleep disturbances in cancer patients: underrecognized and undertreated. Cleve Clin J Med. 2013;80(11):722–32. doi:10.3949/ccjm.80a.12170.CrossRefPubMed

43.

Savard J, Savard M-H. Insomnia and cancer: prevalence, nature, and nonpharmacologic treatment. Sleep Med Clin. 2013;8(3):373–87.CrossRef

Title: Evaluation and treatment of insomnia in adult cancer survivorship programs
Authors: Eric S. Zhou
Ann H. Partridge
Karen L. Syrjala
Alexis L. Michaud
Christopher J. Recklitis
Publication date: 01-02-2017
Publisher: Springer US
Published in: Journal of Cancer Survivorship / Issue 1/2017
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-016-0564-1

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Abstract

Purpose

Methods

Results

Conclusions

Implications for cancer survivors

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