Supportive Care in Cancer

, Volume 12, Issue 5, pp 355–359 | Cite as

Sleep disorders in advanced cancer patients: prevalence and factors associated

  • Sebastiano Mercadante
  • Davide Girelli
  • Alessandra Casuccio
Short Communication

Abstract

Goals of work

Sleep disorders have been invariably reported in cancer population. However, the prevalence of this problem in advanced cancer patients has never been assessed. The aim of this study was to evaluate the frequency of sleep disturbances in terms of quantity and quality, and possible associated factors.

Patients and methods

A consecutive sample of patients admitted to a pain relief and palliative care unit were surveyed. Patients with severe cognitive problems or who were too ill were excluded. Epidemiological and clinical data, including the performance status, habits, relevant symptoms, and drug use were recorded. Patients were asked to answer a small questionnaire regarding their sleep, and duration and characteristics (nocturnal and diurnal hours slept, falling asleep, awaking, getting back to sleep, early awaking, restoring sleep, nightmares, feeling depressed or anxious). The level of information about the illness was also assessed.

Main results

Among the causes of admission, pain control was the main indication (about 58%). Of 123 patients surveyed, 30% slept less than 5 h. Women significantly slept more hours than men (p=0.042). Anxiety (p=0.045), falling asleep (p=0.003), awaking (p=0.035), early awaking (p=0.001), getting beck to sleep (p=0.021), and nightmares (p=0.034), were significantly associated with less hours slept. This relationship was highly significant for less restoring sleep, fatigue, and drowsiness (p<0.0005). No differences were found for age (p=0.294), primary tumor (p=0.225), level of information (p=0.529), Karnofsky status (p=0.539), depression (p= 0.095), confusion (p=0.074), possible causes of awaking (p= 0.881), use of opioids (p= 0.798), use of hypnotics (p= 0.197), other morbidities (p=0.460), or use of alcohol or coffee (p= 0.141). Patients admitted for pain control and/or those receiving opioids more frequently had drowsiness (p=0.01) Patients with lower Karnofsky scores had more drowsiness and diurnal hours slept (p=0.01). Anxiety created more difficulties in falling asleep, produced a less restoring sleep, and nightmares. Depression was associated with early awaking, nonrestorative sleep, fatigue, and nightmares. Confusion was associated with fatigue and nightmares.

Conclusion

Sleep problems appear to be a significant issue for advanced cancer patients. Attention to sleep disturbance needs to be incorporated into the routine practice in palliative care evaluation.

Keywords

Sleep Palliative care Epidemiology 

References

  1. 1.
    Affleck G, Urrows S, Tennen H, et al (1996) Sequential daily relations of sleep, pain intensity, and attention to pain among women with fibromialgia. Pain 68:363–368CrossRefPubMedGoogle Scholar
  2. 2.
    Ancoli-Israel S, Moore PJ, Jones V (2001) The relationship between fatigue and sleep in cancer patients: a review. Eur J Cancer Care 10:245–255CrossRefGoogle Scholar
  3. 3.
    Anderson K, Getto G, Mendoza T, Palmer S, Wang XS, ReyesGibby C, Cleeland C (2003) Fatigue and sleep disturbance in patients with cancer, patients with clinical depression, and community-dwelling adults. J Pain Symptom Manage 25:307–318CrossRefPubMedGoogle Scholar
  4. 4.
    Beck SL, Schwartz AL, Towsley G, Dudley W, Barsevick A (2004) Psychometric evaluation of the Pittsburgh sleep quality index in cancer patients. J Pain Symptom Manage 27:140–148CrossRefGoogle Scholar
  5. 5.
    Carpenter JS, Andrykowski MA (1998) Psychometric evaluation of the Pittsburgh Sleep quality index. J Psychosom Res 45:5–13Google Scholar
  6. 6.
    Davidson JR, MacLean AW, Brudage MD, Schulze K (2002) Sleep disturbances in cancer patients. Soc Sci Med 54:1309–1321CrossRefPubMedGoogle Scholar
  7. 7.
    Ford DE, Kamerow DB (1989) Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 262:1479–1484CrossRefPubMedGoogle Scholar
  8. 8.
    Fortner B, Stepanski EJ, Wang SC, Kasprowicz S, Durrence HH (2002) Sleep and quality of life in breast cancer patients. J Pain Symptom Manage 24:471–480CrossRefPubMedGoogle Scholar
  9. 9.
    Ginsburg ML, Quirt C, Ginsburg AD et al (1995) Psychiatric illness and psychosocial concerns of patients with newly diagnosed lung cancer. Can Med Assoc J 152:701–709Google Scholar
  10. 10.
    Greenberg DB, Gray JL, Mannix CM, Eisenthal S, Carey M (1993) Treatment-related fatigue and serum interleukin-1 levels in patients during external beam irradiation for prostate cancer. J Pain Symptom Manage 8:196–200PubMedGoogle Scholar
  11. 11.
    Haponik EF, Frye AW, Richards B, et al (1996) Sleep history is neglected diagnostic information. Challenges for primary care physicians. J Gen Intern Med 11:759–761PubMedGoogle Scholar
  12. 12.
    Koopman C, Nouriani B, Erickson V, et al (2002) Sleep disturbances in women with metastatic breast cancer. Breast J 8:362–370CrossRefPubMedGoogle Scholar
  13. 13.
    Malone M, Harris AL, Luscombe DK (1994) Assessment of the impact of cancer on work, recreation, home, management and sleep using a general health status measure. J R Soc Med 87:386–389PubMedGoogle Scholar
  14. 14.
    McCorcke R, Quintin-Benoliel J (1983) Symptom distress, current concerns and mood disturbances after diagnosis of life-threatening disease. Soc Sci Med 17:431–438CrossRefPubMedGoogle Scholar
  15. 15.
    Mercadante S. Casuccio A, Fulfaro F (2000) The course of symptom frequency and intensity in advanced cancer patients followed at home. J Pain Symptom Manage 20:246–252CrossRefPubMedGoogle Scholar
  16. 16.
    Miaskowski C, Lee KA (1999) Pain. Fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis. A pilot study. J Pain Symptom Manage 17:320–332PubMedGoogle Scholar
  17. 17.
    Moore P, Dimsdale JE (2002) Opioids, sleep, and cancer-related fatigue. Med Hypothese 58:77–82CrossRefGoogle Scholar
  18. 18.
    Morin CM, Gibson DG, Wade J (1998) Self-reported sleep and mood disturbance in chronic pain patients. Clin J Pain 14:311–314CrossRefPubMedGoogle Scholar
  19. 19.
    Ng K, von Gunten CF (1998) Symptoms and attitudes of 100 consecutive patients admitted to an acute hospice/palliative care unit. J Pain Symptom Manage 16:307–316CrossRefPubMedGoogle Scholar
  20. 20.
    Portenoy RK, Miransky J, Thaler HT et al (1992) Pain in ambulatori patients with lung or colon cancer. Cancer 14:1616–1624Google Scholar
  21. 21.
    Portenoy RK, Thaler HT, Korblith AB, et al (1994) Symptom prevalence, characteristics, and distress in a cancer population. Qual Life Res 3:183–189PubMedGoogle Scholar
  22. 22.
    Sanna P, Bruera E (2002) Insomnia and sleep disturbances. Eur J Palliat Care 9:8–12Google Scholar
  23. 23.
    Sarna L (1993) Correlates of symptom di stress in women with lung cancer. Cancer Practice 1:21–18PubMedGoogle Scholar
  24. 24.
    Savard J, Morin CM (2001) Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19:895–908PubMedGoogle Scholar
  25. 25.
    Thomas C (1987) Insomnia among individual with cancer (abstract). Onc Nurs Soc 13:63Google Scholar
  26. 26.
    Van der Pompe G, Antoni MH, Heijnen CJ (1996) Elevated basal cortisol levels and attenuated ACTH and cortisol responses to a behavioral challenge in women with metastatic breast cancer. Psychoneuroendocrinology 21:361–374CrossRefPubMedGoogle Scholar
  27. 27.
    Van’t Spijker A, Trijsburg RW, Duivenvoorden HJ (1997) Psychological sequelae of cancer diagnosis: a meta-analytical review of 58 studies after 1980. Psychosom Med 59:280–293PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Sebastiano Mercadante
    • 1
  • Davide Girelli
    • 1
  • Alessandra Casuccio
    • 2
  1. 1.Pain Relief and Palliative Care UnitLa Maddalena Cancer CenterPalermoItaly
  2. 2.Epidemiological Methodology, Facoltà di FarmaciaUniversità di Palermo PalermoItaly

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