Abstract
Background: Cancer patients often describe poor sleep quality and sleep disruption as contributors to poor quality of life (QoL). In a cross-sectional study of post-treatment breast, endometrial, and melanoma cancer patients, we used actigraphy to quantify sleep regularity using the sleep regularity index (SRI), and examined relationships with reported sleep symptoms and QoL.Methods: Participants were recruited post-primary treatment (35 diagnosed with breast cancer, 24 endometrial cancer, and 29 melanoma) and wore an actigraphy device for up to 2 weeks and SRI was calculated. Self-report questionnaires for cancer-related QoL [European Organization for Research and Treatment of Cancer EORTC (QLQ-C30)] were completed. Data were compared using analysis of variance (ANOVA) or Chi-Square tests. Multivariate linear regression analysis was used to determine independent variable predictors for questionnaire-derived data.Results: Age distribution was similar between cohorts. Endometrial and breast cancer cohorts were predominantly female, as expected, and body mass index (BMI) was higher in the endometrial cancer cohort, followed by breast and melanoma. There were no differences between tumor groups in: total sleep time, sleep onset latency, bedtime, and SRI (breast 80.9 ± 8.0, endometrial 80.3 ± 12.2, and melanoma 81.4 ± 7.0) (all p > 0.05). A higher SRI was associated with both better functional and symptom scores, including increased global QoL, better physical functioning, less sleepiness and fatigue, better sleep quality, and associated with less nausea/vomiting, dyspnea, and diarrhea (all p < 0.05).Conclusion: In cancer patients post-treatment, greater sleep regularity is associated with increased global QoL, as well as better physical functioning and fewer cancer related symptoms. Improving sleep regularity may improve QoL for cancer patients.
Highlights
Sleep disturbance is a common symptom associated with cancer and its treatment, with up to 95% of people with cancer (Fortner et al, 2002; Langford et al, 2012) reporting disturbed sleep
We found that greater sleep regularity is associated with higher quality of life (QoL) in melanoma, breast, and endometrial cancer patients
Other predictors were important, including: (1) male sex, which was associated with better QoL, emotional functioning, fewer diarrhea symptoms, and less insomnia severity; (2) shorter sleep onset latency, which was a predictor of less nausea and diarrhea symptoms, and fewer financial difficulties; (3) longer total sleep time, which was a predictor of more diarrhea symptoms and greater appetite loss; and (4) later sleep onset time, which was associated with less sleepiness
Summary
Sleep disturbance is a common symptom associated with cancer and its treatment, with up to 95% of people with cancer (Fortner et al, 2002; Langford et al, 2012) reporting disturbed sleep. For some people with cancer, the negative impact of poor sleep persists post-treatment (AncoliIsrael et al, 2014) and has been associated with poorer cancer outcomes and QoL. In women with a history of breast cancer, perceived poor sleep quality post-treatment is a predictor for a poorer survival outcome (Palesh et al, 2014). Long sleep duration and frequent sleep difficulties are associated with increased breast cancer mortality in women with a history of breast cancer (Palesh et al, 2014; Trudel-Fitzgerald et al, 2017). In a cross-sectional study of post-treatment breast, endometrial, and melanoma cancer patients, we used actigraphy to quantify sleep regularity using the sleep regularity index (SRI), and examined relationships with reported sleep symptoms and QoL
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