The impact of insomnia on patient satisfaction with quality of life in advanced cancer: A longitudinal analysis

Abstract

20501 Background: Insomnia is one of the most common and disabling symptoms experienced by cancer patients. We prospectively quantified the relationship between insomnia and patient satisfaction with quality of life (QoL) in advanced cancer. Methods: 295 cancer patients treated at Cancer Treatment Centers of America between 10/03 and 10/05 for a period of 3 months and who completed 2 QoL questionnaires at both baseline and 3 months. Insomnia was measured using the EORTC QLQ-C30 insomnia subscale. Scores ranged from 0 - 100, higher scores indicating more insomnia. Patient satisfaction with QoL was measured using Ferrans & Powers Quality of Life Index (QLI). Scores ranged from 0 - 30, higher scores indicating better QoL. The mean insomnia scores were compared using paired-samples t test across the 2 time periods. Results: Of 295 patients, 140 were males and 155 females. 73 had breast cancer, 65 lung, 39 prostate, 33 colorectal, 12 pancreas and 73 had other cancers. 150 were newly diagnosed and 145 had received prior treatment elsewhere. The mean insomnia scores at baseline and 3 months were 41.2 (more insomnia) and 32.9 (less insomnia) respectively (p=0.001). Similarly, the mean QLI health scores at baseline and 3 months were 17 (low QoL) and 18.3 (better QoL) respectively (p=0.002). At baseline, after controlling for age, gender, prior treatment history, and tumor stage at diagnosis, every 10-unit increase in insomnia was significantly associated with 0.86 (p < 0.001), 0.21 (p = 0.01), 0.48 (p < 0.001), 0.27 (p < 0.007) and 0.53 (p < 0.001) unit decrease in QLI health, social, psychological, family and overall QoL respectively. At 3 months, every 10-unit increase in insomnia was significantly associated with 0.87 (p < 0.001), 0.35 (p = 0.001), 0.51 (p < 0.001), 0.34 (p = 0.003) and 0.59 (p < 0.001) unit decrease in QLI health, social, psychological, family and overall QoL. Conclusions: We found that insomnia is a strong correlate of QoL independent of age, gender, prior treatment history and tumor stage at diagnosis during the first 3 months of treatment. Despite receiving aggressive cancer therapy, patients treated at our integrative cancer center reported statistically significant improvements in insomnia and overall QoL. No significant financial relationships to disclose.