Disturbance In Cancer Patients Research Articles

Interventions for insomnia in cancer patients and survivors-a comprehensive systematic review and meta-analysis.

Considering the persistent nature and higher prevalence of insomnia in cancer patients and survivors compared with the general population, there is a need for effective management strategies. This systematic review and meta-analysis aimed to comprehensively evaluate the available evidence for the efficacy of pharmacological and nonpharmacological interventions for insomnia in adult cancer patients and survivors. Following the PRISMA guidelines, we analyzed data from 61 randomized controlled trials involving 6528 participants. Interventions included pharmacological, physical, and psychological treatments, with a focus on insomnia severity and secondary sleep and non-sleep outcomes. Frequentist and Bayesian analytical strategies were employed for data synthesis and interpretation. Cognitive-Behavioral Therapy for Insomnia (CBT-I) emerged as the most efficacious intervention for reducing insomnia severity in cancer survivors and further demonstrated significant improvements in fatigue, depressive symptoms, and anxiety. CBT-I showed a large postintervention effect (g = 0.86; 95% confidence interval [CI] = 0.57 to 1.15) and a medium effect at follow-up (g = 0.55; 95% CI = 0.18 to 0.92). Other interventions such as bright white light therapy, sleep medication, melatonin, exercise, mind-body therapies, and mindfulness-based therapies showed benefits, but the evidence for their efficacy was less convincing compared with CBT-I. Brief Behavioral Therapy for Insomnia showed promise as a less burdensome alternative for patients in active cancer treatment. CBT-I is supported as a first-line treatment for insomnia in cancer survivors, with significant benefits observed across sleep and non-sleep outcomes. The findings also highlight the potential of less intensive alternatives. The research contributes valuable insights for clinical practice and underscores the need for further exploration into the complexities of sleep disturbances in cancer patients and survivors.

Self Care for Overcoming Sleep Disorders in Cancer Patients: Literature Review

Cancer can cause pain, weakness, sleep problems, and fatigue, and affect functional limitations that affect daily life. One of the most common and frequently complained symptoms in cancer patients is sleep disturbance. This paper aims to determine the effect of self-care to overcome sleep disorders in cancer patients. The author uses several databases, such as Scopus, SpringerLink, and Sage Journal. Clinical Key Nursing for use in the search for relevant articles. There are a total of 8 articles have been analyzed where several self-care interventions are used to treat sleep disorders in cancer patients, including mindfulness, exercise, yoga, dance, and personal psychotherapy. most of them showed results in a decrease in sleep disturbances in cancer patients, but there was one article that did not show significant results related to sleep disturbances. All the articles found were forms of intervention from self-care. There are three articles related to insomnia, one related to sleep quality, and four others related to sleep disturbance. Based on several journals that have been analyzed, it can be concluded that the provision of self-care interventions can affect the incidence of sleep disorders in cancer patients. A practical and secure method, exemplified by self-care practices, seeks to enhance sleep quality, general comfort, and the patient's overall quality of life.

Invasive or noninvasive? A systematic review and network meta-analysis of acupuncture and acupressure to treat sleep disturbance in cancer patients.

Both acupuncture and acupressure have been suggested beneficial for reducing sleep disturbance in cancer patients. While acupuncture is invasive involving needle insertion, acupressure is noninvasive. Their comparative effectiveness is unclear, hindering clinical recommendations. This study aimed to explore the comparative effectiveness of acupuncture and acupressure on sleep in cancer patients. This is a systematic review and Bayesian network meta-analysis. Eight key English and Chinese databases were searched. Twenty-four randomized controlled trials involving 2002 cancer patients comparing the effects of six treatments (manual acupuncture, electroacupuncture, acupressure, sham, enhanced usual care, and no treatment) on sleep were found. Compared with enhanced supportive care, acupressure demonstrated the largest effect size for reducing self-reported sleep disturbance (standardized mean difference [SMD]=-2.67, 95% CrI: -3.46 to -1.90; GRADE=moderate), followed by acupuncture (SMD=-1.87, 95% CrI: -2.94 to -0.81, GRADE=moderate) and electroacupuncture (SMD=-1.60, 95% CrI: -3 to -0.21; GRADE=low). The surface under the cumulative ranking curve indicates that acupressure is most likely to rank highest. Based on available evidence, acupressure can be recommended as the optimal treatment for reducing sleep disturbance in cancer patients. More rigorous trials are warranted to confirm whether different forms of acupuncture or acupressure have different effects on sleep in cancer patients. Particularly, studies examining acupuncture interventions alone instead of in combination with other therapies are needed.

Analysis of preoperative sleep quality and related influencing factors in cancer patients.

The sleep disturbance in cancer patients is more prevalent, and it significantly affects these patients' recovery after the operation. However, the clinical characteristics regarding sleep quality are scarce. This study aimed to evaluate the quality of preoperative sleep quality and its risk factors in different cancer patients requiring elective surgery. Cancer patients who were scheduled for elective surgery were selected. The demographic data, basic preoperative diseases, and factors related to the preoperative hospital environment were also recorded. Self-made questionnaires (such as gender, age, and personal history), and the Anxiety Self-Assessment Scale were used to assess the patient's underlying condition. The modified Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the preoperative sleep status. A total of 297 patients completed the investigation. The incidence of preoperative sleep disturbance in cancer patients was 47.8%. Multiple logistic regression showed that patients with PSQI ≥ 7 were associated with females (odds ratios [95% confidence intervals]): 1.815 [1.031-3.193], p = 0.039), and the ward space was confined (3.127 [1.016-9.625], p = 0.047), which increased the possibility of sleep disturbance in cancer patients. Meanwhile, increased anxiety levels (1.323 [1.261-1.439], p < 0.001) significantly increased the likelihood of sleep disorders in cancer patients. 47.8% of sleep disturbance in cancer patients before surgery. Female patients, preoperative anxiety, and confined ward environment were independent risk factors of subjective sleep disturbance.

TRPV1 in dorsal root ganglion contributed to bone cancer pain.

Tumor growth in situ or bone metastases in cancer patients all can induce bone cancer pain. It is frequently occurred in patients with breast, prostate, and lung cancer. Because of the lack of effective treatment, bone cancer pain causes depression, anxiety, fatigue, and sleep disturbances in cancer patients, disrupts the daily quality of life, and results in huge economic and psychological burden. Over the past years, transient receptor potential channels (TRPs), especially TRP vanilloid 1 (TRPV1) in dorsal root ganglion (DRG), have been considered to be involved in bone cancer pain. The characteristic of TRPV1 had been well studied. The mechanisms under TRPV1 regulation in DRG with bone cancer pain are complex, including inflammatory mediators, endogenous formaldehyde, and other mechanisms. In the present review, we summarize the role and potential mechanism of TRPV1 in DRG in bone cancer pain. As the primary sensory neurons, targeting the TRPV1 channel in DRG, might have fewer side effects than in central. We hope systematically understand of TRPV1 modulation in DRG will bring more effective strategy.

Electrolytes disturbances in cancer patients.

Hypernatremia, hyperphosphatemia, hypocalcaemia, hyperkalaemia and hypermagnesemia are electrolytes disturbances that can arise in cancer patients in relation to unique causes that are related to the cancer itself or its treatment and can lead to delay or interruption of cancer therapy. This article summarizes these main causes, the proposed pathophysiology and the recommended management for these disturbances. There have been many cancer drugs approved in the field of oncology over the past several years and a subset of these drugs have been associated with electrolytes disturbances. This includes, for example, immune checkpoint inhibitor related hyperkalemia, fibroblast growth factor 23 inhibitor associated hyperphosphatemia and epidermal growth factor receptor inhibitor associated hypomagnesemia and hypocalcaemia. This article provides an updated review of certain electrolytes disturbance in cancer patients and allows clinicians to have a greater awareness and knowledge of these electrolyte abnormalities in efforts to early recognition and timely management.

The Role of Vascular-Immune Interactions in Modulating Chemotherapy Induced Neuropathic Pain.

Chemotherapy causes sensory disturbances in cancer patients that results in neuropathies and pain. As cancer survivorships has dramatically increased over the past 10 years, pain management of these patients is becoming clinically more important. Current analgesic strategies are mainly ineffective and long-term use is associated with severe side effects. The issue being that common analgesic strategies are based on ubiquitous pain mediator pathways, so when applied to clinically diverse neuropathic pain and neurological conditions, are unsuccessful. This is principally due to the lack of understanding of the driving forces that lead to chemotherapy induced neuropathies. It is well documented that chemotherapy causes sensory neurodegeneration through axonal atrophy and intraepidermal fibre degeneration causing alterations in pain perception. Despite the neuropathological alterations associated with chemotherapy-induced neuropathic pain being extensively researched, underlying causes remain elusive. Resent evidence from patient and rodent studies have indicated a prominent inflammatory cell component in the peripheral sensory nervous system in effected areas post chemotherapeutic treatment. This is accompanied by modulation of auxiliary cells of the dorsal root ganglia sensory neurons such as activation of satellite glia and capillary dysfunction. The presence of a neuroinflammatory component was supported by transcriptomic analysis of dorsal root ganglia taken from mice treated with common chemotherapy agents. With key inflammatory mediators identified, having potent immunoregulatory effects that directly influences nociception. We aim to evaluate the current understanding of these immune-neuronal interactions across different cancer therapy drug classes. In the belief this may lead to better pain management approaches for cancer survivors.

Reducing Sleep Disturbance by Using Slow Deep Breathing and Dhikr in Cancer Patients During Chemotherapy

This study aims to investigate the effects of slow deep breathing (SDP) and dhikr on sleep disturbance in cancer patients during chemotherapy. This study used a Quasi-experiment design. A total of 44 cancer patients experiencing chemotherapy who met the inclusion criteria were divided into 2 groups of 22 patients. The treatment group practiced SDB and dhikr, while the control group practiced normal breathing. This intervention was performed for 30 minutes and repeated for 3 cycles of chemotherapy. Furthermore, sleep disturbance is measured by the Pittsburgh Sleep Quality Index sheet. The data is analyzed using the Paired t-test, independent t-test, and Chi-square test with a significance limit of p &lt;0.05. The result after 3 treatment cycles, sleep disturbances decreased in the treatment group from 7.64 ± 2.19 to 6.73 ± 1.78 or decreased by 0.91 ± 1.54, but in the control group, there was an increase from 5.00 ± 1 .90 to 5.18 ± 1.99 or an increase of 0.18 ± 0.85. The analysis results of SDP and dhikr effect on sleep disturbance in cancer patients during chemotherapy is significant (p=0.010). This study concludes SDB, and Dhikr can reduce sleep disturbance in cancer patients during chemotherapy.

Research Trends of Non-Pharmacological Interventions for Sleep-Wake Disturbances in Cancer Patients

Research Trends of Non-Pharmacological Interventions for Sleep-Wake Disturbances in Cancer Patients

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

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.

Mind-Body Therapies for Cancer Patients Living with Depression, Anxiety or Insomnia (MIRACLE): A Systematic Review with Individual Participant Data Network Meta-Analysis.

Depression, anxiety, and insomnia are common in cancer patients. Mind-body therapies (MBTs) are promising forms of treatment for cancer patients living with depression, anxiety, and insomnia. The objective of this study is to assess the effectiveness and acceptability of MBTs in cancer patients living with depression, anxiety, or insomnia. EMBase, PubMed, Cinahl, PsychINFO, IndMED, CSI-NISCAIR, CNKI, Clinicaltrial.gov, ChiCTR, and CTRI will be searched until October 2020 for relevant studies. Randomized controlled studies in which MBTs were tested in a cancer population will be selected. The authors of the selected studies will be contacted to obtain individual participant data. The participants who reached a defined clinical threshold for depression, anxiety, or insomnia will be selected for the three sub-studies on depression, anxiety, and insomnia, respectively. Pairwise and network meta-analyses will be used to assess the changes in depression, anxiety, sleep quality, and completion rate. We will assess the effect of the treatment dose (number and frequency of interventions) on effectiveness. The results of this study will inform clinical decision-making for the treatment of psychological disturbances in cancer patients. If MBTs are found effective, they will potentially be recommended as treatments for cancer patients with psychological symptoms.

Characteristics of Cancer-Related Fatigue and Concomitant Sleep Disturbance in Cancer Patients

ContextCancer patients often experience cancer-related fatigue (CRF) and sleep disturbances due to cancer and cancer treatment, and symptoms can persist long after treatment. Despite these common occurrences, few studies simultaneously characterize CRF and sleep architecture among cancer patients. ObjectivesThe objective was to characterize CRF and the sleep architecture of patients seen in a CRF clinic and sleep clinic at the University of Texas MD Anderson Cancer Center. MethodsCRF Clinic medical records were retrospectively reviewed from September 1, 2006, to September 30, 2010, for self-reported performance status, fatigue, pain, sleep disturbance, depression, anxiety, and sleepiness (n = 219). Polysomnography results were recorded for those referred for additional sleep consultation (n = 39). ResultsNotably, patients often reported fatigue, sleep disturbance, excessive daytime sleepiness, and a majority of patients referred for a sleep consultation were diagnosed with obstructive sleep apnea (n = 33). ConclusionThe results highlight the promise of an interdisciplinary collaboration between dedicated a CRF clinic and sleep clinic to conduct effective assessments to identify treatable CRF and sleep disorders.

Evaluation and Management of Sleep and Circadian Rhythm Disturbance in Cancer.

Sleep and circadian rhythm disturbance are among the most commonly experienced symptoms in patients with cancer. These disturbances occur throughout the spectrum of cancer care from diagnosis, treatment, and long into survivorship. The pathogenesis of these symptoms and disturbances is based on common inflammatory pathways related to cancer and its' treatments. The evaluation of sleep and circadian disorders requires an understanding of how these symptoms cluster with other cancer-related symptoms and potentiate each other. A thorough evaluation of these symptoms and disorders utilizing validated diagnostic tools, directed review of clinical information, and diagnostic testing is recommended. Treatment of sleep and circadian disturbance in cancer patients should be based on the findings of a detailed evaluation, including specific treatment of primary sleep and circadian disorders, and utilize integrative and personalised management of cancer-related symptoms through multiple pharmacologic and non-pharmacologic modalities. Recognition, evaluation, and treatment of sleep and circadian rhythm disturbance in cancer may lead to improved symptom management, quality of life, and outcomes.

Assessment of the relationship between psychological locus of control and immune status in breast cancer patients: Thesis Abstract

Thesis Abstract Several recent studies confirm the immune disturbances in cancer patients in comparison with the healthy individual. Other studies confirmed the effective role of psychological status on the immune system. In breast cancer patient, depression associated with decreased inflammatory and immune function. Several studies suggested relationship between locus of control and depression as an external locus of control individuals have more symptoms of depression. Therefore, it is proposed that there is a direct relation between immune status and locus of control in breast cancer patients. Patients and participators responded to three questionnaires (God health locus of control, multidimensional health locus of control, and Rotter internalexternal locus of control). The first analysis was the calculation of the numbers and phenotype of CD4+ T, Treg and NK cells by flow-cytometry, measure gene expression of pro-inflammatory cytokines with real time PCR. Results show significant direct co- relation between IHLC and CD4+ T cells, IHLC and NK cells.

Evaluation of Subjective Sleep Disturbances in Cancer Patients: A Cross-Sectional Study in a Radiotherapy Department.

Background: The factors associated with sleep disturbances in cancer patients remains unclear. This study aimed to explore the prevalence of sleep disorders and predictors associated with sleep disturbance in cancer patients from a radiotherapy department.Methods: Patients with cancers were recruited before the start of radiotherapy from our institution between January 2019 and February 2020. Pittsburgh Sleep Quality Index (PSQI) scale was used to assess sleep quality. Descriptive statistics, Chi-square test, and multivariate logistic regression analysis were used to conduct statistical analysis.Results: A total of 330 eligible patients were included. Of them, 38.3% (n = 127) had the globe PSQI score >7, indicating that they suffered from sleep disorders. Patients with lung cancer (45.2%) were more likely to suffer from sleep disturbance, followed by cervical cancer (43.8%), nasopharyngeal carcinoma (41.7%), esophageal cancer (41.5%), breast cancer (37.7%), and colorectal cancer (30%). With regard to the PSQI components, the mean sleep duration was 8 h, 20.3% (n = 67) of them reported poor subjective sleep quality, 6.1% (n = 20) needed medication to improve sleep, and 53.6% (n = 177) suffered daytime dysfunction. Multivariate logistic regression models showed body mass index (BMI) ≥ 20 kg/m2 [odds ratio (OR) 0.599, 95% confidence interval (CI) 0.329–0.948, P = 0.031] and the receipt of surgery (OR 0.507, 95% CI 0.258–0.996, P = 0.048) were the significant favorable predictors for sleep disturbance, while age, gender, marital status, education level, comorbidity, metastasis status, diagnostic status, and cancer type were not significantly associated with sleep disturbance.Conclusions: Approximately 40% of the cancer patients suffer from sleep disturbance before the start of radiotherapy. Patients with BMI ≥ 20 kg/m2 and receiving surgery are less likely to develop sleep disturbance in comparison with others.

Taste and smell disturbances in cancer patients: a scoping review of available treatments.

Taste and smell disturbances in patients affected by cancer are very common, but often under-recognized symptoms. If not addressed properly, they may impact nutritional status, food enjoyment, and quality of life. Treatment tools available for clinicians to manage chemosensory alterations are limited and are often based on personal clinical experiences. The aim of this study was to assess current oncological and palliative care literature through a scoping review, in order to identify available treatments for taste and smell alterations in cancer patients. Medline, Embase, CINAHL, ProQuest Dissertations and Theses, and Google Scholar were searched from inception until January 2020, with subject headings relevant to the domains of chemosensory alterations, palliative, and cancer care. A total of 10,718 English and French language publications were reviewed, yielding 43 articles on the researched topic. The heterogeneity of selected articles led to difficulties in interpretation and analysis of the available evidence. Included publications differed in study design, population sample, anticancer treatments, and measures of assessment for taste and smell disturbances. A broad variety of treatment options were described including zinc and polaprezinc, radio-protectors, vitamins and supplements, anti-xerostomia agents, active swallowing exercises, nutritional interventions, delta-9-tetrahydrocannabinol, and photobiomodulation. This scoping review identifies the current state of knowledge regarding chemosensory alterations within supportive cancer care. Despite not reaching firm conclusions, this article offers therapeutic venues to further explore in larger and more methodologically sound studies.

ES15.03 Managing Sleep Difficulties and Cancer

This paper discusses evidence-based interventions for managing sleep difficulties in people with cancer. Insomnia is a common sleep problem in people with cancer. Insomnia refers to the difficulty of falling asleep, staying asleep and early morning awakenings. It causes distress or impairment in important areas of functioning, such as relationships and employment. It is estimated that between 30-60% of cancer survivors experience significant sleep disturbances that can persist for up to five years post treatment. Aside from greatly impacting on quality of life, poor sleep is associated with anxiety, depression, concentration and memory difficulties, higher rates of pain, increased use of sedatives and poorer work performance [1-3]. People with lung cancer are at an increased risk of experiencing sleep difficulties because of their generally older age, compromised respiratory function, increased disease burden and the impact of treatments [4]. Sleep difficulties also have economic and social impacts on the broader community, due to increased health system costs, productivity losses and wellbeing costs [5]. Cognitive Behaviour Therapy (CBT) is considered to be the first-line treatment for insomnia [6]. CBT targets dysfunctional attitudes, beliefs and habits that interfere with sleep. CBT for insomnia commences with a comprehensive assessment about the nature and duration of sleep complaints, the impact on daytime functioning, compensatory behaviours, the person's beliefs about sleep and any other biopsychosocial factors that might be impacting on sleep. Common screening tools used to assess the impact of sleep difficulties include the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS) and the Pittsburgh Insomnia Rating Scale (PIRS). These tools are self-reporting and easy to administer. CBT for insomnia is a multi-component intervention and includes psychoeducation, sleep hygiene, stimulus control, sleep restriction, relaxation, cognitive strategies and relapse prevention strategies. It is usually delivered between four to eight session modules. CBT is effective in improving sleep disturbance, fatigue, pain and quality of life. The effects of CBT are durable, with benefits lasting up to three years post-treatment [7, 8]. CBT is suitable for most adults with insomnia, however, it works best with people who are motivated and have the cognitive capacity to learn and adopt CBT strategies. CBT can be effectively provided in group settings, individually, via telephone, video or online methods. Over three quarters of patients achieve remission or significant reduction of sleep disturbance after CBT treatment [9]. CBT has been found to be more effective than mindfulness, massage, exercise and acupuncture intervention. CBT has been found to be as effective as pharmacological intervention in the short-term and more beneficial than medication in the longer term. CBT is also more cost-effective than pharmacological or non-treatment of sleep difficulties [10]. Despite the benefits of CBT, access for people with cancer is limited due to lack specialist availability, cost and awareness of the benefit of CBT. To improve access to evidence-based interventions for people with cancer, stepped-care approaches (where face-to-face CBT is reserved for the most complex cases while less burdensome and less costly self-managed interventions are available for less complex cases) could help translate evidence into clinical practice. Sleep difficulties are highly prevalent in people with cancer, however, access to evidenced-based interventions are limited. Embedding evidence based-screening and CBT into routine care is essential to improving quality of life and care for people with cancer. Savard, J., Simard, S., Blanchet, J., Ivers, H. & Morin, C.M. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep 24, 583-590 (2001). Davidson, J.R., MacLean, A.W., Brundage, M.D. & Schulze, K. Sleep disturbance in cancer patients. Social science & medicine (1982) 54, 1309-1321 (2002). Howell, Doris, et al. "A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer.” Supportive Care in Cancer21.10 (2013): 2695-2706. Halle, Ingrid Helene, et al. "Trajectory of sleep disturbances in patients undergoing lung cancer surgery: a prospective study.” Interactive cardiovascular and thoracic surgery 25.2 (2017): 285-291. Deloitte Access Economics. Re-awakening Australia: the economic cost of sleep disorders in Australia C, Australia: Deloitte Access Economics, 2011.. Re-awakening Australia: the economic cost of sleep disorders in Australia, 2010.Canberra, Australia; 2011. Morin CM, Benca R. Chronic insomnia. Lancet (London, England). 2012;379(9821):1129-41 Arico D, Raggi A, Ferri R. Cognitive Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Review of the Literature. Frontiers in psychology. 2016;7:1162. Blom, K., Jernelöv, S., Rück, C., Lindefors, N., & Kaldo, V. (2016). Three-Year follow-up of insomnia and hypnotics after controlled internet treatment for insomnia. Sleep, 39(6), 1, 1267-1274. https://doi.org/10.5665/sleep.5850 Fiorentino L, McQuaid JR, Liu L, Natarajan L, He F, Cornejo M, et al. Individual cognitive behavioral therapy for insomnia in breast cancer survivors: a randomized controlled crossover pilot study. Nature and science of sleep. 2009;2010:1-8. Reynolds S, R. M. The Cost of Insomnia and the Benefit of Increased Access to Evidence-Based Treatment. Sleep Medicine Clinics,. 2017;12(1):39-46.

MON-331 Hypomagnesemia: A Preventable Electrolyte Disturbance from Epidermal Growth Factor Receptor Inhibitors

Chemotherapy is a part of the treatment regimen for many different types of cancers and plays a foundational role in treating cancers. With an advent of epidermal growth factor (EGFR) inhibitor and its promising results, it has been widely incorporated in cancer treatment regimen. However, this monoclonal antibody has potential adverse drug reactions especially renal tubular toxicity. Since magnesium is one of the electrolytes that is highly regulated by renal tubular cells, hypomagnesemia is a common electrolyte disturbance in cancer patients. However, the cause of hypomagnesemia may be overlooked. Adequate magnesium supplement in a timely manner can prevent the consequences of hypomagnesemia. We report a case of an elderly man with newly diagnosed squamous cell carcinoma of the tongue with persistent hypomagnesemia after initiation of cetuximab. Magnesium supplement prevented severe hypomagnesemia and maintained serum magnesium. A 77-year-old Caucasian man with stage 3 chronic kidney disease was diagnosed with p16+ poorly differentiated invasive squamous cell carcinoma (cT2-3N2Mx) with basaloid features on the base of the tongue and received cetuximab. He developed acute kidney injury with an elevated serum creatinine up to 2 mg/dL from the baseline serum creatinine of 1.5 to 1.7 mg/dL. He had poor oral intake due to oropharyngeal lesions requiring nutritional supplementation via gastrostomy tube and intermittent intravenous 0.9% sodium chloride infusion. Since starting cetuximab, he had intermittent diarrhea and muscle weakness. Magnesium oxide 400 mg oral daily was an since initiation of cetuximab when serum magnesium a to decrease to 1.7 mg/dL. Throughout in timely months of cetuximab therapy, he had persistent borderline hypomagnesemia with a serum magnesium of 1.4 to 2.2 mg/dL despite receiving an increased magnesium oxide of 400 mg twice a day. Fractional excretion of magnesium (FEMg) was 12.2%. After completion of cetuximab therapy, his serum magnesium became normalized and serum creatinine trended down to 1.6 mg/dL. N/A Our patient started having hypomagnesemia since he received cetuximab therapy. Although there are several potential causes of hypomagnesemia including poor oral intake and diarrhea, high FEMg indicates renal magnesium wasting. Muscle weakness can a by persistent hypomagnesemia. Cetuximab, an EGFR inhibitor, causes impaired distal tubular magnesium reabsorption by inhibiting EGFR receptor at the basolateral membrane of the distal renal tubular epithelial cells which lead to inadequate activation of magnesium channel TRPM6, and subsequently renal magnesium loss. With an increase in the prevalence of malignancy, new chemotherapy agents have been incorporated widely in the cancer treatment, especially EFGR inhibitors. Magnesium plays an important role in maintaining normal cell function and hypomagnesemia results in neuromuscular, cardiovascular and metabolic manifestations. Therefore, proactive magnesium supplement can mitigate these serious consequences of hypomagnesemia until the chemotherapy is completed and hypomagnesemia is normalized.

Are sleep continuity disturbance and fatigue prodromal symptoms of cancer development?

Sleep continuity disturbance (also known as insomnia) and fatigue are common complaints of individuals diagnosed with cancer. Traditionally, many have believed that sleep continuity disturbance and fatigue are caused, in large measure, by the impact of the cancer diagnosis and treatment. Recent prospective research suggests however, that sleep continuity disturbance and fatigue may actually precede a cancer diagnosis. We suggest that sleep continuity disturbance and fatigue may in fact represent prodromal symptoms of cancer. We review the current perspectives of this sequence of events and present a revised schematic that accounts for the role of biological, behavioural, and cognitive factors that contribute to the development and maintenance of sleep continuity disturbances in cancer patients. Monitoring emergent and unexplained patient-reported fatigue, sleepiness, and insomnia may serve as early warning signs of new onset cancer, providing opportunity for early detection and early intervention.

Assessment of Cancer-Related Dysfunctional Beliefs about Sleep for Evaluating Sleep Disturbance in Cancer Patients

Dysfunctional beliefs about sleep may be associated with chronic sleep disturbance in patients afflicted with cancer over the trajectory of their battle with cancer. The objective of this study was exploration of the utility of assessing the sleep disturbances suffered by cancer patients possibly emanating from two cancer-related informationally valid but nonetheless dysfunctional beliefs: “My immune system will have serious problems if I don’t go to sleep at a certain time (question 1)” and “If I don’t sleep well at night, my cancer can recur or metastasize (question 2).” The scores for these beliefs were significantly correlated with insomnia severity [measured using the Insomnia Severity Index (p < 0.01)] and fear of disease progression [measured using the Fear of Progression Questionnaire (p < 0.01)]. The question 2 score also correlated with younger age (p = 0.01) and high depression scores assessed using the Patient Health Questionnaire-9 (p = 0.04). We believe the scores for these two cancer-related dysfunctional beliefs can be used to help evaluate sleep disturbances in cancer patients. Key words: Insomnia, Cancer, Sleep, Sleep-related cognition