Advertisement

Supportive Care in Cancer

, Volume 22, Issue 11, pp 3061–3069 | Cite as

Insomnia in adult survivors of childhood cancer: a report from project REACH

  • Eric S. Zhou
  • Christopher J. RecklitisEmail author
Original Article

Abstract

Purpose

Insomnia is a common problem affecting cancer survivors even years after completion of therapy. Childhood cancer survivors may be at particular risk due to vulnerability to the effects of treatment and medical late effects which impact normal sleep development. Using an indicator of clinically significant insomnia (sleep efficiency), we examined a group of adult survivors of childhood cancer to (1) describe clinical insomnia rates, (2) identify physical and psychological correlates of insomnia, and (3) investigate the frequency with which sleep issues were evaluated during a cancer survivorship medical visit.

Methods

A total of 122 adult survivors of childhood cancer completed standard measures of sleep, psychological distress, and health-related quality of life. Medical records of the 75 survivors with a survivorship medical visit on the day of self-report measure completion were reviewed for documentation of sleep-related issues.

Results

Twenty-eight percent of participants endorsed sleep efficiency below 85 %, indicating clinically significant insomnia. Insomnia was associated with poor physical health and anxiety but not with demographic or cancer treatment variables. Medical providers failed to document sleep in visit notes for 67 % of patients with self-reported insomnia.

Conclusions

A significant proportion of adult survivors of childhood cancer report insomnia, which is associated with physical and psychological health. Few survivors with insomnia discuss this issue with oncology providers during survivorship care. There is a clear need to screen for insomnia in this population. Patients and providers should take greater responsibility for discussing sleep issues and seeking out proper treatment referrals when it is identified.

Keywords

Insomnia Sleep disorder Childhood cancer Cancer survivorship Quality of life 

Notes

Conflict of interest

Eric S. Zhou and Christopher J. Recklitis declare that they have no conflicts of interest and no disclosures to declare.

References

  1. 1.
    Spielman AJ (1986) Assessment of insomnia. Clin Psychol Rev 6(1):11–25CrossRefGoogle Scholar
  2. 2.
    Hinds PS, Hockenberry MJ, Gattuso JS et al (2007) Dexamethasone alters sleep and fatigue in pediatric patients with acute lymphoblastic leukemia. Cancer 110(10):2321–2330PubMedCrossRefGoogle Scholar
  3. 3.
    Walker AJ, Johnson KP, Miaskowski C et al (2010) Sleep quality and sleep hygiene behaviors of adolescents during chemotherapy. J Clin Sleep Med 6(5):439–444PubMedPubMedCentralGoogle Scholar
  4. 4.
    Dogan O, Ertekin S, Dogan S (2005) Sleep quality in hospitalized patients. J Clin Nurs 14(1):107–113PubMedCrossRefGoogle Scholar
  5. 5.
    Hinds PS, Hockenberry M, Rai SN et al (2007) Nocturnal awakenings, sleep environment interruptions, and fatigue in hospitalized children with cancer. Oncol Nurs Forum 34(2):393–402PubMedCrossRefGoogle Scholar
  6. 6.
    Savard J, Simard S, Blanchet J et al (2001) Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep 24(5):583–590PubMedGoogle Scholar
  7. 7.
    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(7):386–389PubMedPubMedCentralGoogle Scholar
  8. 8.
    Kaye J, Kaye K, Madow L (1983) Sleep patterns in patients with cancer and patients with cardiac disease. J Psychol 114(1st Half):107–113PubMedCrossRefGoogle Scholar
  9. 9.
    Savard J, Morin CM (2001) Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19(3):895–908PubMedGoogle Scholar
  10. 10.
    Mulrooney DA, Ness KK, Neglia JP et al (2008) Fatigue and sleep disturbance in adult survivors of childhood cancer: a report from the childhood cancer survivor study (CCSS). Sleep 31(2):271–281PubMedPubMedCentralGoogle Scholar
  11. 11.
    Savard J, Ivers H, Villa J et al (2011) Natural course of insomnia comorbid with cancer: an 18-month longitudinal study. J Clin Oncol 29(26):3580–3586PubMedCrossRefGoogle Scholar
  12. 12.
    Kaleyias J, Manley P, Kothare SV (2012) Sleep disorders in children with cancer. Semin Pediatr Neurol 19(1):25–34PubMedCrossRefGoogle Scholar
  13. 13.
    Clanton NR, Klosky JL, Li C et al (2011) Fatigue, vitality, sleep, and neurocognitive functioning in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer 117(11):2559–2568PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Finnegan L, Campbell RT, Ferrans CE et al (2009) Symptom cluster experience profiles in adult survivors of childhood cancers. J Pain Symptom Manag 38(2):258–269CrossRefGoogle Scholar
  15. 15.
    Rosen G, Brand SR (2011) Sleep in children with cancer: case review of 70 children evaluated in a comprehensive pediatric sleep center. Support Care Cancer 19(7):985–994PubMedCrossRefGoogle Scholar
  16. 16.
    Stuber ML, Meeske KA, Krull KR et al (2010) Prevalence and predictors of posttraumatic stress disorder in adult survivors of childhood cancer. Pediatrics 125(5):e1124–e1134PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Compas BE, Connor-Smith JK, Saltzman H et al (2001) Coping with stress during childhood and adolescence: problems, progress, and potential in theory and research. Psychol Bull 127(1):87–127PubMedCrossRefGoogle Scholar
  18. 18.
    Meeske KA, Siegel SE, Globe DR et al (2005) Prevalence and correlates of fatigue in long-term survivors of childhood leukemia. J Clin Oncol 23(24):5501–5510PubMedCrossRefGoogle Scholar
  19. 19.
    Campos MP, Hassan BJ, Riechelmann R et al (2011) Cancer-related fatigue: a practical review. Ann Oncol 22(6):1273–1279PubMedCrossRefGoogle Scholar
  20. 20.
    Liu X, Zhou H (2002) Sleep duration, insomnia and behavioral problems among Chinese adolescents. Psychiatry Res 111(1):75–85PubMedCrossRefGoogle Scholar
  21. 21.
    Van Litsenburg RR, Huisman J, Hoogerbrugge PM et al (2011) Impaired sleep affects quality of life in children during maintenance treatment for acute lymphoblastic leukemia: an exploratory study. Health Qual Life Out 9:25CrossRefGoogle Scholar
  22. 22.
    Alvaro PK, Roberts RM, Harris JK (2013) A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep 36(7):1059–1068PubMedPubMedCentralGoogle Scholar
  23. 23.
    Trudel-Fitzgerald C, Savard J, Ivers H. Which symptoms come first? Exploration of temporal relationships between cancer-related symptoms over an 18-month period. Annals of Behavioral Medicine, 2013: 1-9.Google Scholar
  24. 24.
    Institute NC. Follow-up care after cancer treatment. 2013 [cited 2013 November]; Available from: http://www.cancer.gov/cancertopics/factsheet/Therapy/followup
  25. 25.
    Johnson EO (1999) Sleep in America: 1999. Results from the National Sleep Foundations, WashingtonGoogle Scholar
  26. 26.
    Morin CM, Leblanc M, Belanger L et al (2011) Prevalence of insomnia and its treatment in Canada. Can J Psychiatry 56(9):540–548PubMedGoogle Scholar
  27. 27.
    Brinkman TM, Zhang N, Recklitis CJ et al (2013) Suicide ideation and associated mortality in adult survivors of childhood cancer. Cancer. doi: 10.1002/cncr.28385 PubMedGoogle Scholar
  28. 28.
    Hoffman AJ, Given BA, Von Eye A, et al. (2007) Relationships among pain, fatigue, insomnia, and gender in persons with lung cancer. in Oncology nursing forum. . Onc Nurs SocietyGoogle Scholar
  29. 29.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th Edition, Text Revision (DSM-IV-TR). 4th ed, Washington, DC: American Psychiatric AssociationGoogle Scholar
  30. 30.
    Buysse DJ, Reynolds CF 3rd, Monk TH et al (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213PubMedCrossRefGoogle Scholar
  31. 31.
    Bastien CH, Vallieres A, Morin CM (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2(4):297–307PubMedCrossRefGoogle Scholar
  32. 32.
    Spielman AJ, Saskin P, Thorpy MJ (1987) Treatment of chronic insomnia by restriction of time in bed. Sleep 10(1):45–56PubMedGoogle Scholar
  33. 33.
    Palesh O, Aldrige-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):837–842PubMedGoogle Scholar
  34. 34.
    Bober SL, Zhou ES, Chen B et al (2013) Sexual function in childhood cancer survivors: a report from Project REACH. J Sex Med 10(8):2084–2093PubMedCrossRefGoogle Scholar
  35. 35.
    Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233PubMedCrossRefGoogle Scholar
  36. 36.
    Derogatis LR (2001) BSI 18, Brief Symptom Inventory 18: Administration, Scoring and Procedure Manual. NCS Pearson, Incorporated, MinneapolisGoogle Scholar
  37. 37.
    Nolan VG, Gapstur R, Gross CR et al (2013) Sleep disturbances in adult survivors of childhood brain tumors. Qual Life Res 22(4):781–789PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Lineberger MD, Carney CE, Edinger JD et al (2006) Defining insomnia: quantitative criteria for insomnia severity and frequency. Sleep 29(4):479–485PubMedGoogle Scholar
  39. 39.
    Morin CM, Leblanc M, Daley M et al (2006) Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med 7(2):123–130PubMedCrossRefGoogle Scholar
  40. 40.
    Meerlo P, Sgoifo A, Suchecki D (2008) Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems and stress responsivity. Sleep Med Rev 12(3):197–210PubMedCrossRefGoogle Scholar
  41. 41.
    Smith MT, Haythornthwaite JA (2004) How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev 8(2):119–132PubMedCrossRefGoogle Scholar
  42. 42.
    Howell D, Oliver TK, Keller-Olaman S et al (2013) A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer. Support Care Cancer 21(10):2695–2706PubMedCrossRefGoogle Scholar
  43. 43.
    Teodorescu MC, Avidan AY, Teodorescu M et al (2007) Sleep medicine content of major medical textbooks continues to be underrepresented. Sleep Med 8(3):271–276PubMedCrossRefGoogle Scholar
  44. 44.
    Association AP (2013) Diagnostic and statistical manual of mental disorders. Vol. 5. American Psychiatric Publishing, ArlingtonGoogle Scholar
  45. 45.
    Mandrell BN, Wise M, Schoumacher RA et al (2012) Excessive daytime sleepiness and sleep-disordered breathing disturbances in survivors of childhood central nervous system tumors. Pediatr Blood Cancer 58(5):746–751PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Landier W, Bhatia S, Eshelman DA et al (2004) Development of risk-based guidelines for pediatric cancer survivors: the Children’s Oncology Group Long-Term Follow-Up Guidelines from the Children’s Oncology Group Late Effects Committee and Nursing Discipline. J Clin Oncol 22(24):4979–4990PubMedCrossRefGoogle Scholar
  47. 47.
    Pigeon WR, Crabtree VM, Scherer MR (2007) The future of behavioral sleep medicine. J Clin Sleep Med 3(1):73–79PubMedGoogle Scholar
  48. 48.
    Miller AB (2006) Childhood cancer control: is progress being made? Int J Cancer 118(11):2651PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Dana-Farber Cancer InstituteBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA

Personalised recommendations