Skip to main content

Advertisement

SpringerLink
Log in

Patient characteristics associated with sleep disturbance in breast cancer survivors

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Background

Disturbed sleep is common among breast cancer survivors. Identifying patients at risk for disturbed sleep and its sequelae will aid in improving screening and intervention strategies to improve sleep and cancer-related quality of life (QOL).

Methods

Women with stages I–III breast cancer undergoing neoadjuvant or adjuvant chemotherapy (N = 415) reported subjectively assessed sleep quality (PSQI) and actigraphy-assessed wake after sleep onset (AAS-WASO), total sleep time (AAS-TST), and sleep efficiency (AAS-SE), sociodemographic, and clinical characteristics and completed questionnaires assessing physical and mental health QOL at study entry and 3, 6, 12, and 15 months later.

Results

Being from a racially/ethnically underserved population was associated with poorer sleep in all indices (p’s < .04). Lower income was associated with poorer subjective sleep and greater AAS-WASO (p’s < .02). BMI was associated with lower AAS-SE (p < .001). Baseline subjective sleep complaints were positively associated with depression, fatigue, and health-related QOL and cancer-related symptoms across follow-up (p’s < 0.05). Baseline AAS-WASO was positively associated with anxiety and negatively associated with physical health-related QOL at the 3-month follow-up (p’s < .001). Baseline AAS-WASO and AAS-SE were associated with mental health-related QOL at the 6-month follow-up (p’s < .05).

Conclusions

In keeping with previous health disparity research, racially/ethnically underserved populations, lower household income, and higher BMI were associated with increased risk for disturbed sleep. Sleep disturbance may have long-term effects on multiple aspects of QOL for women undergoing treatment for breast cancer. Results may inform strategies to identify patients at greatest risk for disturbed sleep and its sequelae.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lowery-Allison AE, Passik SD, Cribbet MR et al (2018) Sleep problems in breast cancer survivors 1-10 years posttreatment. Palliat Support Care 16(3):325–334. https://doi.org/10.1017/S1478951517000311

    Article  PubMed  Google Scholar 

  2. Vin-Raviv N, Akinyemiju T, Galea S, Bovbjerg D (2018) Sleep disorder diagnoses and clinical outcomes among hospitalized breast cancer patients: a nationwide inpatient sample study. Support Care Cancer 26(6):1833–1840

    Article  Google Scholar 

  3. Bardwell WA, Profant J, Casden DR, Dimsdale JE, Ancoli-Israel S, Natarajan L et al (2008) The relative importance of specific risk factors for insomnia in women treated for early-stage breast cancer. Psycho-oncology 17(1):9–18

    Article  Google Scholar 

  4. Ohayon MM (2002) Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 6(2):97–111

    Article  Google Scholar 

  5. Ancoli-Israel S, Liu L, Marler MR, Parker BA, Jones V, Sadler GR et al (2006) Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer 14(3):201–209

    Article  Google Scholar 

  6. Liu L, Rissling M, Natarajan L, Fiorentino L, Mills PJ, Dimsdale JE et al (2012) The longitudinal relationship between fatigue and sleep in breast cancer patients undergoing chemotherapy. Sleep 35(2):237–245

    Article  Google Scholar 

  7. Colagiuri B, Christensen S, Jensen AB, Price MA, Butow PN, Zachariae R (2011) Prevalence and predictors of sleep difficulty in a national cohort of women with primary breast cancer three to four months postsurgery. J Pain Symptom Manag 42(5):710–720

    Article  Google Scholar 

  8. Ratcliff CG, Lam CY, Arun B, Valero V, Cohen L (2014) Ecological momentary assessment of sleep, symptoms, and mood during chemotherapy for breast cancer. Psycho-Oncology 23(11):1220–1228

    Article  Google Scholar 

  9. Liu L, Fiorentino L, Rissling M, Natarajan L, Parker BA, Dimsdale JE et al (2013) Decreased health-related quality of life in women with breast cancer is associated with poor sleep. Behav Sleep Med 11(3):189–206

    Article  Google Scholar 

  10. Koopman C, Nouriani B, Erickson V, Anupindi R, Butler LD, Bachmann MH et al (2002) Sleep disturbances in women with metastatic breast cancer. Breast J 8(6):362–370

    Article  Google Scholar 

  11. Wright CE, Schnur JB, Montgomery GH, Bovbjerg DH (2010) Psychological factors associated with poor sleep prior to breast surgery: an exploratory study. Behav Med 36(3):85–91

    Article  Google Scholar 

  12. Kung P-Y, Chou K-R, Lin K-C, Hsu H-W, Chung M-H (2015) Sleep disturbances in patients with major depressive disorder: incongruence between sleep log and actigraphy. Arch Psychiatr Nurs 29(1):39–42

    Article  Google Scholar 

  13. Beck SL, Berger AM, Barsevick AM, Wong B, Stewart KA, Dudley WN (2010) Sleep quality after initial chemotherapy for breast cancer. Support Care Cancer 18(6):679–689

    Article  Google Scholar 

  14. Dhruva A, Paul SM, Cooper BA, Lee K, West C, Aouizerat BE et al (2012) A longitudinal study of measures of objective and subjective sleep disturbance in patients with breast cancer before, during, and after radiation therapy. J Pain Symptom Manag 44(2):215–228

    Article  Google Scholar 

  15. Enderlin CA, Coleman EA, Cole C, Richards KC, Kennedy RL, Goodwin JA et al (2011) Subjective sleep quality, objective sleep characteristics, insomnia symptom severity, and daytime sleepiness in women aged 50 and older with nonmetastatic breast cancer. Oncol Nurs Forum

  16. Budhrani PH, Lengacher CA, Kip K, Tofthagen C, Jim H (2014) Minority breast cancer survivors: the association between race/ethnicity, objective sleep disturbances, and physical and psychological symptoms. Nurs Res Pract 858403

  17. Durrence HH, Lichstein KL (2006) The sleep of African Americans: a comparative review. Behav Sleep Med 4(1):29–44

    Article  Google Scholar 

  18. Aldridge-Gerry A, Zeitzer JM, Palesh OG, Jo B, Nouriani B, Neri E et al (2013) Psychosocial correlates of sleep quality and architecture in women with metastatic breast cancer. Sleep Med 14(11):1178–1186

    Article  Google Scholar 

  19. Savard J, Simard S, Blanchet J, Ivers H, Morin CM (2001) Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep 24(5):583–590

    Article  CAS  Google Scholar 

  20. Rissling MB, Liu L, Natarajan L, He F, Ancoli-Israel S (2011) Relationship of menopausal status and climacteric symptoms to sleep in women undergoing chemotherapy. Support Care Cancer 19(8):1107–1115

    Article  Google Scholar 

  21. Champion VL, Wagner LI, Monahan PO, Daggy J, Smith L, Cohee A et al (2014) Comparison of younger and older breast cancer survivors and age-matched controls on specific and overall quality of life domains. Cancer 120(15):2237–2246

    Article  Google Scholar 

  22. Tworoger SS, Davis S, Vitiello MV, Lentz MJ, McTiernan A (2005) Factors associated with objective (actigraphic) and subjective sleep quality in young adult women. J Psychosom Res 59(1):11–19

    Article  Google Scholar 

  23. Wirth MD, Hébert JR, Hand GA, Youngstedt SD, Hurley TG, Shook RP et al (2015) Association between actigraphic sleep metrics and body composition. Ann Epidemiol 25(10):773–778

    Article  Google Scholar 

  24. Chaoul A, Milbury K, Spelman A, Basen-Engquist K, Hall MH, Wei Q et al (2018) Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy. Cancer 124(1):36–45

    Article  Google Scholar 

  25. Hall MH (2010) Behavioral medicine and sleep: concepts, measures, and methods. In: Handbook of Behavioral Medicine. Springer, Berlin, pp 749–765

    Chapter  Google Scholar 

  26. Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213

    Article  CAS  Google Scholar 

  27. Blackwell T, Redline S, Ancoli-Israel S, Schneider JL, Surovec S, Johnson NL, Cauley JA, Stone KL, Study of Osteoporotic Fractures Research Group (2008) Comparison of sleep parameters from actigraphy and polysomnography in older women: the SOF study. Sleep 31(2):283–291. https://doi.org/10.1093/sleep/31.2.283

    Article  PubMed  PubMed Central  Google Scholar 

  28. Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401

    Article  Google Scholar 

  29. Spielberger CD (1970) STAI manual for the state-trait anxiety inventory. Self-evaluation questionnaire, pp 1–24

    Google Scholar 

  30. Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK et al (1999) The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 85(5):1186–1196

    Article  CAS  Google Scholar 

  31. Ware JE, Kosinski M, Dewey JE, Gandek B (2000) SF-36 health survey: manual and interpretation guide: Quality Metric Inc.

    Google Scholar 

  32. Cleeland CS, Ryan KM (1994) Pain assessment: global use of the Brief Pain Inventory. Annal Acad Med 23(2):129–138

    CAS  Google Scholar 

  33. Natale V, Plazzi G, Martoni M (2009) Actigraphy in the assessment of insomnia: a quantitative approach. Sleep 32(6):767–771. https://doi.org/10.1093/sleep/32.6.767

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hale L, Do DP (2007) Racial differences in self-reports of sleep duration in a population-based study. Sleep 30(9):1096–1103

    Article  Google Scholar 

  35. Redline S, Kirchner HL, Quan SF, Gottlieb DJ, Kapur V, Newman A (2004) The effects of age, sex, ethnicity, and sleep-disordered breathing on sleep architecture. Arch Intern Med 164(4):406–418

    Article  Google Scholar 

  36. Jehan S, Myers AK, Zizi F, Pandi-Perumal SR, Jean-Louis G, Singh N et al (2018) Sleep health disparity: the putative role of race, ethnicity and socioeconomic status. Sleep Med Disorders Int J 2(5):127

    Google Scholar 

  37. Ellison GT, Smart A, Tutton R, Outram SM, Ashcroft R, Martin P (2007) Racial categories in medicine: a failure of evidence-based practice? PLoS Med 4(9):e287

    Article  Google Scholar 

  38. Krueger PM, Reither EN (2015) Mind the gap: race/ethnic and socioeconomic disparities in obesity. Current diabetes reports 15(11):95

    Article  Google Scholar 

  39. Vena C, Parker KP, Allen R, Bliwise DL, Jain S, Kimble L (2006) Sleep-wake disturbances and quality of life in patients with advanced lung cancer. Oncology Nursing Forum, Oncology Nursing Society

    Book  Google Scholar 

  40. Palesh O, Aldridge-Gerry A, Zeitzer JM et al (2014) Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep 37(5):837–842. Published 2014 May 1. https://doi.org/10.5665/sleep.3642

    Article  PubMed  PubMed Central  Google Scholar 

  41. Yennurajalingam S, Tayjasanant S, Balachandran D, Padhye NS, Williams JL, Liu DD et al (2016) Association between daytime activity, fatigue, sleep, anxiety, depression, and symptom burden in advanced cancer patients: a preliminary report. J Palliat Med 19(8):849–856

    Article  Google Scholar 

  42. Guzman GG (2017) Household income: 2016: US Department of Commerce, Economics and Statistics Administration.

    Google Scholar 

  43. Garland SN, Carlson LE, Stephens AJ, Antle MC, Samuels C, Campbell TS (2014) Mindfulness-based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: a randomized, partially blinded, noninferiority trial. J Clin Oncol 32(5):449–457

    Article  Google Scholar 

Download references

Funding

This work was supported by the National Institutes of Health/National Cancer Institute (NCI) under award numbers R01CA105023 (PI: LC), P30CA016672, an NCI cancer prevention fellowship for CGR (R25T CA057730; PI: Chang), the National Cancer Institute Cancer Center Support (A016672), and the Richard E. Haynes Distinguished Professorship for Clinical Cancer Prevention at the University of Texas MD Anderson Cancer Center (LC).

Author information

Authors and Affiliations

  1. Department of Psychology, Sam Houston State University, Huntsville, TX, USA

    Chelsea G. Ratcliff, Emily A. Tullos & Shaelyn Fowler

  2. Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA

    Chelsea G. Ratcliff

  3. Departmnet of Psychology, Our Lady of the Lake University, The Woodlands, TX, USA

    Stephanie G. Zepeda

  4. Department of Psychology, The University of Pittsburgh, Pittsburgh, PA, USA

    Martica H. Hall

  5. Mind, Body, Spirit Institute, The Jung Center, Houston, TX, USA

    Alejandro Chaoul

  6. Office of Protocol Research, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Amy Spelman

  7. Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Banu Arun

  8. Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA

    Lorenzo Cohen

Authors
  1. Chelsea G. Ratcliff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephanie G. Zepeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martica H. Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emily A. Tullos
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shaelyn Fowler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alejandro Chaoul
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Amy Spelman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Banu Arun
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Lorenzo Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chelsea G. Ratcliff.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Chelsea G. Ratcliff is a Co-first authors

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ratcliff, C.G., Zepeda, S.G., Hall, M.H. et al. Patient characteristics associated with sleep disturbance in breast cancer survivors. Support Care Cancer 29, 2601–2611 (2021). https://doi.org/10.1007/s00520-020-05777-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-020-05777-3

Keywords

Search

Navigation