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Sleep quality and lymphedema in breast cancer survivors: a mixed method analysis

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Abstract

Purpose

The purpose of this convergent mixed methods study was to assess the perceptions and characteristics of sleep in breast cancer survivors (BCSs) and elucidate perceptions of sleep among BCS with lymphedema.

Methods

Participants were BCS with and without lymphedema. Both groups completed the Pittsburgh Sleep Quality Index (PSQI), PROMIS® Sleep Disturbance (8a short form), and wore an actigraph on their wrist to capture sleep/wake cycles for 7 days/nights while logging their sleep using a sleep diary. The coefficient of variation of sleep efficiency was calculated from the sleep diary to assess intraindividual variability. In addition, a subsample of BCS with lymphedema participated in a semi-structured qualitative interview. The qualitative data was analyzed separately, and the themes were applied to provide a more nuanced explanation of the quantitative outcomes.

Results

The BCS with lymphedema (n=23) had a significant difference in PSQI (p=0.002), PROMIS® Sleep Disturbance (p=0.084), and sleep efficiency coefficient of variation (p=0.014) compared to BCS without lymphedema (n=23). There were no statistically significant differences between groups in the actigraphy results. BCS with lymphedema perceived that lymphedema management contributed to their sleep disturbance, further exacerbating their mind/body fatigue.

Conclusion

This study provides the foundation for future research to investigate the integration of sleep interventions with lymphedema management for holistic survivorship care for BCS with lymphedema.

Implications for Cancer Survivors

An innovative sleep health intervention designed to consider the unique factors contributing to sleep disturbance in BCS with lymphedema will fill a gap in their post-cancer treatment quality of life.

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Data Availability

The datasets generated and analyzed during the current study are not publicly available due to the fact individual privacy could be compromised but anonymized or deidentified data may be available from the corresponding author on reasonable request.

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Acknowledgements

We would like to acknowledge Kristin Kelly and Delanie Pospichal for contributing to the qualitative data analysis, Eryen Nelson and Allison Glaser for assisting with participant recruitment and screening, Rebecca Ludwig for assisting with recruitment, and Diego Mazzotti for guidance with data and statistical analysis.

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Authors and Affiliations

  1. Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS, USA

    Karen Bock, Wen Liu, Yvonne Colgrove, Irina Smirnova & Catherine Siengsukon

  2. School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA

    Jill Peltzer

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  1. Karen Bock
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  2. Jill Peltzer
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  3. Wen Liu
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  4. Yvonne Colgrove
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  6. Catherine Siengsukon
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Karen Bock. The first draft of the manuscript was written by Karen Bock and all authors commented on previous versions of the manuscript. All authors reviewed and approved the final manuscript.

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Correspondence to Karen Bock.

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Conflict of interest

Karen Bock has received honorarium for educational content development for Lohmann & Rauscher GmbH & Co. KG.

Jill Peltzer has no disclosures or conflicts.

Wen Liu has no disclosures or conflicts.

Yvonne Colgrove has no disclosures or conflicts.

Irina Smirnova has no disclosures or conflicts.

Catherine Siengsukon is the owner and CEO of Sleep Health Education, LLC.

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Bock, K., Peltzer, J., Liu, W. et al. Sleep quality and lymphedema in breast cancer survivors: a mixed method analysis. J Cancer Surviv (2024). https://doi.org/10.1007/s11764-023-01516-9

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