- Volume 16 Issue 15
Background: Insomnia is a common condition in cancer patients. In spite of the high prevalence its associations have not been well studied. Existing data suggests that insomnia is related to depression and pain. However, the impact of ongoing chemotherapy on sleep is not investigated. Aim: To study the relationship between insomnia and chemotherapy after analysing confounding variables. Materials and Methods: Consecutive patients who visited New England Oncology Clinic in Tamworth were recruited. Insomnia was assessed with the Bergen insomnia scale. The Montgomery Asberg Depression rating scale was used to measure depression. Pain was assessed with the Brief Pain inventory. Chronic medical conditions, type of cancer, side effects to chemotherapy, role of steroids and other drugs were studied as confounders. Results: A total of 56 patients participated in the study. Age ranged from 33 to 83 years (mean: 63.6, SD=10.97). There were 29 men and 27 women. 42 patients received at least one form of chemotherapy and 15 were receiving radiotherapy at the time of assessment. Mean insomnia score was significantly higher in those receiving chemotherapy than in those without chemotherapy (8.92 vs 17.2, two tailed p=0.005, 95% CI=2.63-13.71). There was no significant variation in insomnia scores in terms of chronic medical condition, type of cancer, psychiatric history, use of steroids or adverse effects of chemotherapy. However, total insomnia score was correlated with depression rating score (Pearson correlation, r=0.39, p=0.003) and magnitude of pain (r=0.37, p=0.006). On regression analysis only pain was found to be predictive of insomnia. Conclusions: Insomnia in patients with cancer is found to be associated with concurrent chemotherapy and correlated with degree of depression and pain. Identifying factors related to insomnia in cancer population has implications in its management and patient education.
- Akman T, Yavuzsen T, Sevgen Z, et al (2015). Evaluation of sleep disorders in cancer patients based on Pittsburgh Sleep Quality Index. Eur J Cancer Care. Doi:10.1111/ecc.12296 (Epub ahead of print). https://doi.org/10.1111/ecc.12296
- American Psychiatric Association, (1994). Diagnostic and statistical manual of mental disorders. 4th Ed. Text Revision. DSM-IV-TR. Washington DC: APA: 551.
- American Psychiatric Association, (2013). Diagnostic and Statistical Manual of Mental Disorder. V'th Edition. Washington DC.
- Clevenger L, Schrepf A, Degeest K, et al (2013). Sleep disturbance, distress and quality of life in ovarian cancer patients during the first year after diagnosis. Cancer, 119, 3234-41. https://doi.org/10.1002/cncr.28188
- Costa AR, Fontes F, Pareira S, et al (2014). Impact of breast cancer treatments on sleep disturbance-A systematic review. Breast, 23, 697-709. https://doi.org/10.1016/j.breast.2014.09.003
- Dahiya S, Ahluwallia MS, Walla HK,et al (2013). Sleep disturbances in cancer patients: underrecognized and undertreated. Cleve Clin J Med, 80, 722-732. https://doi.org/10.3949/ccjm.80a.12170
- Davidson JR, MacLean AW, Brundage MD, et al (2002). Sleep disturbance in cancer patients. Social Science& Medicine, 54: 1309-21. https://doi.org/10.1016/S0277-9536(01)00043-0
- Davis MP, Khoshknabi D, Walsh D, et al (2014). Insomnia in patients with advanced cancer. Am J Hosp Palliat Care, 31, 365-73. https://doi.org/10.1177/1049909113485804
- Dean GE, Abu Sabbah E, Yingrengreung S, et al (2015). Sleeping with the enemy: sleep and quality of life in patients with lung cancer. Cancer Nurs, 38, 60-70. https://doi.org/10.1097/NCC.0000000000000128
- Foley DJ, Monjan AA, Brown SL, et al (1995). Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep, 18, 425-32.
- Gilsason T, Reynisdottir H, Kristbjarnarson H, et al (1993). Sleep habits and sleep disturbances among the elderly-an epidemiological survey. J Intern Med, 234, 31-39. https://doi.org/10.1111/j.1365-2796.1993.tb00701.x
- Katz DA, McHorney CA, et al (1998). Clinical correlates of insomnia in patients with chronic illness. Archives of Intern Med, 158, 1099-1107. https://doi.org/10.1001/archinte.158.10.1099
- Mictell AJ, Chan M, Bhatti H, et al (2011). Prevalence of depression, anxiety and adjustment disorder in oncological, haematological and palliative care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol, 12160-174.
- Nishiura M, Tamura A, Nagai H, et al (2014). Assessment of sleep disturbance in lung cancer patients: relationship between sleep disturbance and pain, fatigue, quality of life and psychological distress. Palliat Support Care, 13, 1-7.
- Ohayon MM, (1997). Prevalence of DSM-IV diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders. J Psyciatr Res, 31, 333-46. https://doi.org/10.1016/S0022-3956(97)00002-2
- Pallesen S, Bjorvatn B, Nordhus IH, et al (2008). A new scale for measuring insomnia: the Bergen Insomnia Scale. Percept Mot Skills, 107, 691-706.
- Punnoose AR, Golub RM, Burke AE, et al (2012). Insomnia. JAMA, 307, 2563.
- Savard J, Ivers H, Savard MH, et al (2015). Cancer treatments and their side effects are associated with aggravation of insomnia: results of a longitudinal study. Cancer, 121, 1703-11. https://doi.org/10.1002/cncr.29244
- Smith MT, Haythornthwaite JA, et al (2004). How do sleep disturbance and chronic pain interrelate? Insights from the longitudinal and cognitive-behavioural clinical trials literature. Sleep Med Rev, 8, 119-32. https://doi.org/10.1016/S1087-0792(03)00044-3
- Tang NK, Wright KJ, Salkovskis PM, et al (2007). Prevalence and correlates of clinical insomnia co-occurring with chronic back pain. J Sleep Res, 16, 85-95. https://doi.org/10.1111/j.1365-2869.2007.00571.x
- Taylor DJ, Mallory LJ, Lichstein KL, et al (2007). Comorbidity of chronic insomnia with medical problems. Sleep, 30, 213-8.
- Van den Beuken-van Everdingen MHJ, de Rijke JM, et al (2007). Prevalence of pain in patients with cancer: a systematic review of the past 40 years. Annals Oncol, 18, 1437-49. https://doi.org/10.1093/annonc/mdm056
- Walker J, Hansen CH, Martin P, et al (2013). Prevalence of depression in adults with cancer: a systematic review. Annals Oncol, 24, 895-900. https://doi.org/10.1093/annonc/mds575
- Zhao J, Dai YH, Xi QS, et al (2013). A clinical study on insomnia in patients with cancer during chemotherapy containing high-dose of glucocorticoids. Pharmazie, 68, 421-7.
- Association among presence of cancer pain, inadequate pain control, and psychotropic drug use vol.12, pp.6, 2017, https://doi.org/10.1371/journal.pone.0178742
- Physical functioning and psychological morbidity among regional and rural cancer survivors: A report from a regional cancer centre vol.26, pp.3, 2018, https://doi.org/10.1111/ajr.12419