Sleep disturbance in cancer patients referred to an ambulatory integrative oncology consultation.

Santhosshi Narayanan,Akhila Reddy,Wenli Liu,Gabriel Lopez,Sara Ali,Sriram Yennurajalingam,Eduardo Bruera,Lorenzo Cohen

doi:10.1007/s00520-021-06668-x

Santhosshi Narayanan, Akhila Reddy + Show 6 more

Open Access

https://doi.org/10.1007/s00520-021-06668-x

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Abstract

Sleep disturbance (SD) is highly prevalent in oncology and negatively affects quality of life and mortality. Evidence supports the use of integrative oncology (IO) practices to treat SD, but there is limited published data on the characteristics of SD and factors associated with SD in IO. We determined the prevalence, severity, and factors associated with SD among cancer patients seen in an ambulatory IO consultation. Patients with cancer referred for initial outpatient IO consultation in 2017 were eligible. Patient demographics, clinical characteristics, and patient-reported outcomes (Edmonton Symptom Assessment Scale (ESAS), Measure Yourself Concerns and Wellbeing (MYCaW), PROMIS-10) were retrospectively reviewed. One thousand five hundred twenty patients were included in the analysis. The majority (70%) were women with breast cancer (42%). Nine hundred seventy-one (64%) patients reported significant SD with ESAS Sleep ≥ 4, yet only 11% expressed poor sleep as their primary or secondary concern for the IO consultation. The median SD (IQR) was 5 (3,7). ESAS scores for fatigue (adjusted OR 1.16; CI 1.07-1.26, p < 0.001), pain (adjusted OR 1.07; CI 1.00-1.15, p < 0.05), hot flashes (adjusted OR 1.14; CI 1.07-1.22, p < 0.001), well-being (adjusted OR 1.33; CI 1.22-1.46, p < 0.001), and psychological distress score (anxiety and depression) (adjusted OR 1.16; CI 1.01-1.11, p < 0.01) were independently associated with SD in multivariate analysis. Acupuncture was the most frequent intervention prescribed, 175 (35%). Other modalities included oncology massage (15%), health psychology (5%), and meditation (1%). Although 64% of patients seeking IO consultation reported clinically significant SD, only 11% were seeking integrative approaches for managing SD. ESAS fatigue, hot flashes, well-being, and psychological symptoms were significantly associated with SD.

Highlights

IntroductionSleep disturbance (SD) is common in cancer patients, with a prevalence of 23 to 61% compared to the general population (9–30%). 1–5 Prevalence of SD in cancer can be attributed to emotional distress, physical pain, discomfort, the effects of cancer treatments, and adverse medication effects
Edmonton Symptom Assessment Scale (ESAS) fatigue, hot flashes, well-being, and psychological symptoms were significantly associated with Sleep disturbance (SD)
Sleep disturbance (SD) is common in cancer patients, with a prevalence of 23 to 61% compared to the general population (9–30%). 1–5 Prevalence of SD in cancer can be attributed to emotional distress, physical pain, discomfort, the effects of cancer treatments, and adverse medication effects

Summary

Introduction

Sleep disturbance (SD) is common in cancer patients, with a prevalence of 23 to 61% compared to the general population (9–30%). 1–5 Prevalence of SD in cancer can be attributed to emotional distress, physical pain, discomfort, the effects of cancer treatments, and adverse medication effects. Sleep disturbance (SD) is common in cancer patients, with a prevalence of 23 to 61% compared to the general population (9–30%). 1–5 Prevalence of SD in cancer can be attributed to emotional distress, physical pain, discomfort, the effects of cancer treatments, and adverse medication effects. Improved sleep leads to decreased emotional distress, and attenuates proinflammatory and counter-regulatory cytokines and increases cell-mediated immunity suggesting the significant role of sleep in regulating key cancer biological processes.. Pharmacological management of insomnia is often used in patients with severe sleep disturbances. Sleep medications are associated with adverse effects. Multiple systematic reviews conclude that cognitive behavioral therapy is an effective non-pharmacological intervention for insomnia.. Sleep disturbance (SD) is highly prevalent in oncology and negatively affects quality of life and mortality.

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