Abstract
Purpose
Cross-sectional data suggest that many individuals with breast cancer experience significant sleep disturbance across the continuum of care. Understanding the longitudinal trajectory of sleep disturbance may help identify factors associated with its onset, severity, or influence on health-related quality of life (HRQL). Study objectives were to observe sleep quality in breast cancer patients prior to, during, and after completion of adjuvant chemotherapy, evaluate its relationship with HRQL and explore correlates over time.
Methods
Participants were administered patient-reported outcome measures including the Pittsburgh Sleep Quality Index (PSQI) and the Functional Assessment of Cancer Therapy—General (FACT-G), which assesses HRQL. Data were collected prospectively 3–14 days prior to beginning chemotherapy, cycle 4 day 1 of chemotherapy, and 6 months following initiation of chemotherapy.
Results
Participants (n = 80) were primarily women (97.5 %) with stage II (69.0 %) breast cancer. Total FACT-G scores were negatively correlated with global PSQI scores at each time point (rho = −0.46, −0.41, −0.45; all p < 0.001). Poor sleep quality (PSQI ≥ 5) was prevalent at all time points (48.5–65.8 %); however, there were no significant changes within participants over time. Correlates with sleep quality varied across time points. Participants with poor sleep quality reported worse overall HRQL, fatigue, depression, and vasomotor/endocrine symptoms.
Conclusions
These findings suggest that early identification of sleep disturbance and ongoing assessment and treatment of contributing factors over the course of care may minimize symptom burden associated with chemotherapy and prevent chronic insomnia in survivorship.
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References
Palesh OG, Roscoe JA, Mustian KM et al (2010) Prevalence, demographics, and psychological associations of sleep disturbance in patients with cancer: University of Rochester Cancer Center—Community Clinical Oncology Program. J Clin Oncol 28:292–298
Berger AM, Farr LA, Kuhn BR, Fischer P, Agrawal S (2007) Values of sleep/wake, activity/rest, circadian rhythms, and fatigue prior to adjuvant breast cancer chemotherapy. J Pain Symptom Manag 33:398–409
Liu L, Fiorentino L, Natarajan L et al (2009) Pre-treatment symptom cluster in breast cancer patients is associated with worse sleep, fatigue, and depression during chemotherapy. Psycho-Oncology 18:187–194
Savard J, Liu L, Natarajan L et al (2009) Breast cancer patients have progressively impaired sleep–wake activity rhythms during chemotherapy. Sleep 32:1155–1160
Knobf MT, Sun Y (2005) A longitudinal study of symptoms and self-care activities in women treated with primary radiotherapy for breast cancer. Cancer Nurs 28:210–218
Bardwell WA, Profant J, Casden DR et al (2008) The relative importance of specific risk factors for insomnia in women treated for early-stage breast cancer. Psycho-Oncology 17:9–18
Janz NK, Mujahid M, Chung LK et al (2007) Symptom experience and quality of life of women following breast cancer treatment. J Women’s Health 16:1348–1361
Otte JL, Carpenter JS, Russell KM, Bigatti S, Champion VL (2010) Prevalence, severity, and correlates of sleep–wake disturbances in long-term breast cancer survivors. J Pain Symptom Manag 39:535–547
Fortner BV, Stepanski EJ, Wang SC, Kasprowicz S, Durrence HH (2002) Sleep and quality of life in breast cancer patients. J Pain Symptom Manag 24:471–480
Miller AH, Ancoli-Israel S, Bower JE, Capuron L, Irwin MR (2008) Neuroendocrine–immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol 26:971–982
Sephton SE, Sapolsky RM, Kraemer HC, Spiegel D (2000) Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst 92:994–1000
Savard J, Morin CM (2001) Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19:895–908
Byar KL, Berger AM, Bakken SL, Cetak MA (2006) Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life. Oncol Nurs Forum 33:E18–E26
Berger AM, Kuhn BR, Farr LA et al (2009) Behavioral therapy intervention trial to improve sleep quality in cancer-related fatigue. Psycho-Oncology 18:634–646
Buysee DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psych Res 28:193–213
Carpenter JS, Andrykowski MA (1998) Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res 45:5–13
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 Manag 27:140–148
Cella D, Tulsky D, Gray G et al (1993) The Functional Assessment of Cancer Therapy Scale: development and validation of the general measure. J Clin Oncol 11:570–579
Cella D (1997) FACIT manual. Center on Outcomes, Research and Education, Evanston Northwestern Healthcare, and Northwestern University
Victorson D, Barocas J, Song J, Cella D (2008) Reliability across studies from the Functional Assessment of Cancer Therapy-General (FACT-G) and its subscales: a reliability generalization. Qual Life Res 17:1137–1146
Fallowfield LJ, Leaity SK, Howell A, Benson S, Cella D (1999) Assessment of quality of life in women undergoing hormonal therapy for breast cancer: validation of an endocrine symptom subscale for the FACT-B. Breast Cancer Res Treat 55:189–199
Yellen S, Cella D, Webster K, Blendowski C, Kaplan E (1997) Measuring fatigue and other anemia-related symptoms in the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage 13:63–74
Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370
Cohen J (1969) Statistical power analysis for the behavioral sciences. Academic, New York
Zubrod CG, Sscheiderman M, Frei E et al (1960) Cancer—appraisal of methods for the study of chemotherapy of cancer in man: thiophosphamide. J Chronic Dis 11:7–33
Savard J, Davidson JR, Ivers H et al (2004) The association between nocturnal hot flashes and sleep in breast cancer survivors. J Pain Symptom Manag 27:513–522
Berger AM, Marunda HAT, Agrawal S (2009) Influence of menopausal status on sleep and hot flashes throughout breast cancer adjuvant chemotherapy. J Obstet Gynecol Neonatal Nurs 38:353–366
Conflict of interest
This study was supported in part by an unrestricted educational grant from Ortho Biotech, LLC. There are no other relevant disclosures. The authors of this manuscript have no financial relationship with the organization that sponsored this research, have full control of all primary data, and agree to allow the journal to review data if requested.
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Sanford, S.D., Wagner, L.I., Beaumont, J.L. et al. Longitudinal prospective assessment of sleep quality: before, during, and after adjuvant chemotherapy for breast cancer. Support Care Cancer 21, 959–967 (2013). https://doi.org/10.1007/s00520-012-1612-7
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DOI: https://doi.org/10.1007/s00520-012-1612-7