Insomnia in cancer patients.

Abstract

e18657 Background: As new treatments extend patient survival, the quality of their lives (QoL) grows in importance. QoL may differentiate alternative treatments, and QoL assessment has become a standard component of treatment evaluations. Sleep is a key component of QoL. Insomnia can worsen pain, fatigue, depression and cognitive impairments in cancer patients. Inappropriate treatments for insomnia can further worsen these and interact with chemotherapy medications. Recognizing this, in 2019 the American Society of Clinical Oncology identified Insomnia as a key patient-reported outcome performance measure (PRO-PM) for the National Quality Forum to consider. Methods: Through review of the scientific literature the project identified specific cancers and their treatments where treating Insomnia can have a significant impact on patient QoL. PubMed, Pharmapendium, and Science Direct databases were used. Search terms included “insomnia demographics, epidemiology of insomnia in cancer, insomnia in tumor types, cancer insomnia, insomnia associated hormonal treatment, insomnia in patients awaiting cancer diagnosis; insomnia in cancer care-givers, insomnia in cancer survivors, cancers treated with corticosteriods”. Original research articles in English that used human subjects between January 1, 1993 and January 31, 2020 were included. Results: Insomnia is associated with specific tumor types: brain tumors, breast cancer, gastrointestinal cancer, leukemia, lymphoma, multiple myelomaand terminal cancer. Autoimmune causes of insomnia in paraneoplastic syndromes. Insomnia is prevalent in oncology patients being evaluated, awaiting diagnosis and treatment. Age and gender are demographic factors associated with oncology insomnia. Insomnia is associated with specific antineoplastic agents. Corticosteroid use is associated with insomnia, before, during and after cancer treatment. Insomnia in cancer survivors starts during their treatment and may persist for years. Conclusions: Specific demographics, cancers and treatments are associated with insomnia. Insomnia often occurs in patients undergoing evaluations for cancer. Insomnia is often not recognized and not treated in oncology patients. Insomnia that is not addressed during cancer treatment often persists in cancer survivors. There is the need to investigate whether treating insomnia early in cancer patients during their course of treatment can reduce symptoms such as fatigue and improve their QOL.