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Trajectory of insomnia symptoms in older adults with lung cancer: using mixed methods

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Abstract

Context

A knowledge gap exists in our understanding of the illness and insomnia symptom treatment trajectory in adults with inoperable non-small cell lung cancer (NSCLC).

Objectives

Compare valid and reliable sleep-wake measures for insomnia to interpretations of narrative descriptions of sleep to improve our comprehension of sleep-wake disturbances in adults with NSCLC.

Methods

This study employed mixed methods (quantitative and qualitative) in a longitudinal design to study adults (n = 26) from ambulatory thoracic clinics. Valid and reliable surveys (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale), 7-day sleep diary, and actigraphy were obtained with interview narrative interpretations of sleep experiences in the context of lung cancer. Data collection occurred at four-time points: baseline (before chemotherapy), pre-second chemotherapy, pre-third chemotherapy, and 6 months from baseline. Sleep measures were compared to interpretations from interview narratives to understand context of survey measures.

Results

Objective quantitative results were congruent with interview narrative interpretations that reflected participants’ sleep-wake experiences. Objective sleep-wake measures for insomnia over-time described increasing sleep latency and decreasing sleep duration. The interview narratives provided context and insight into participants’ subjective insomnia experiences. While participants’ insomnia symptoms were present, they were resigned to endure insomnia, and the subjective measures reflected a more positive perception of sleep outcomes.

Conclusion

A mixed methods approach provides a deeper understanding of sleep-wake disturbances and the differing quantitative objective and subjective results of sleep measures in the context of the participants’ experience of the trajectory of insomnia symptoms before, during, and after lung cancer treatment.

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Funding

This research was supported by a grant from the Oncology Nursing Society Foundation (REO1) and the National Lung Cancer Partnership Lung Cancer Nursing Research Grant (Dean and Dickerson). This work was conducted at and supported by the VA Western New York Healthcare System, Buffalo, NY.

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Authors and Affiliations

  1. School of Nursing, University at Buffalo, State University of New York, 3435 Main Street, 301 Wende Hall, Buffalo, NY, 14214, USA

    Grace E. Dean & Suzanne S. Dickerson

  2. VA Western New York Health Systems, Buffalo, NY, USA

    Patricia Ziegler & Lynn M. Steinbrenner

  3. Department of Medicine, Thoracic Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

    Hongbin Chen

  4. School of Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA

    Lynn M. Steinbrenner

Authors
  1. Grace E. Dean
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  2. Patricia Ziegler
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  3. Hongbin Chen
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  4. Lynn M. Steinbrenner
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  5. Suzanne S. Dickerson
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Corresponding author

Correspondence to Grace E. Dean.

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Conflict of interest

The authors have no financial relationship with the organization, the Oncology Nursing Society Foundation, which sponsored the research. The authors have full control of all primary data and agree to allow the journal, Supportive Care in Cancer, to review their data upon request.

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Dean, G.E., Ziegler, P., Chen, H. et al. Trajectory of insomnia symptoms in older adults with lung cancer: using mixed methods. Support Care Cancer 27, 2255–2263 (2019). https://doi.org/10.1007/s00520-018-4488-3

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  • DOI: https://doi.org/10.1007/s00520-018-4488-3

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