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A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer

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Abstract

Purpose

This study aims to provide recommendations on the optimal strategies and interventions for the prevention, screening, assessment, and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) in adult cancer populations.

Methods

A systematic search of the published health literature was conducted to identify randomized controlled trials, clinical practice guidelines, systematic reviews, and other guidance documents. The Sleep Disturbance Expert Panel [comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers, and guideline methodologists] reviewed, discussed, and approved the final version of the guideline. Health care professionals across Canada were asked to provide feedback through an external review process.

Results

Three clinical practice guidelines and 12 randomized controlled trials were identified as the evidence base. Overall, despite the paucity of evidence, the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using standardized screening tools on a routine basis. While prevention of sleep disturbance is the desired objective, cognitive behavioral therapies are effective in improving sleep outcomes. As part of the external review with 16 health care providers, 81 % indicated that they agreed with the recommendations as written.

Conclusions

Sleep difficulty is a prevalent problem in cancer populations that needs greater recognition by health professionals. Prevention, screening, assessment, and treatment strategies supported by the best available evidence are critical. Recommendations and care path algorithms for practice are offered.

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Acknowledgments

The authors wish to thank Petrus de Villiers, PharmD, for the thoughtful review of the pharmacologic treatment section, the external reviewers for their insightful feedback, as well as Lavannya Bahirathan and Sandra Costa for their assistance in the preparation of the systematic review and manuscript, respectively.

Conflict of interest

Production of this guideline has been made possible through a financial contribution from Health Canada through the Canadian Partnership Against Cancer. The sponsors of the study had no role in the study design, data collection, analysis, interpretation, or writing of the report. Unrelated to the project reported here, C.S. has previously acted in a consultant/advisory role for Valeant Pharmaceuticals and received funding from both Valeant Pharmaceuticals and Pfizer Pharmaceuticals. No other relevant financial conflict of interest was reported for the other authors. D.H. has full control of all primary data, and the journal may review the data if requested.

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Authors and Affiliations

  1. University Health Network (Princess Margaret Hospital), 610 University Avenue PMH, Room 15-617, Toronto, ON, Canada

    Doris Howell

  2. Division Nursing and Psychosocial Research, Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada

    Doris Howell

  3. Canadian Partnership Against Cancer, Toronto, ON, Canada

    Thomas K. Oliver

  4. Toronto, ON, Canada

    Sue Keller-Olaman

  5. Department of Psychology, Queen’s University, Kingston, ON, Canada

    Judith Davidson

  6. Department of Oncology, Queen’s University, Kingston, ON, Canada

    Judith Davidson

  7. Kingston Family Health Team, Kingston, ON, Canada

    Judith Davidson

  8. Department of Psychosocial Resources, Tom Baker Cancer Centre, Calgary, AB, Canada

    Sheila Garland

  9. Department of Psychology, University of Calgary, Calgary, AB, Canada

    Sheila Garland

  10. Centre for Sleep and Human Performance in Calgary, Calgary, AB, Canada

    Charles Samuels

  11. Department of Psychology, Université Laval, Quebec City, QC, Canada

    Josée Savard

  12. Department of Psychology and Psychosocial Oncology Program, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada

    Cheryl Harris

  13. Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada

    Michèle Aubin

  14. Faculty of Nursing, University of Alberta, Edmonton, AB, Canada

    Karin Olson

  15. Department of Oncology, Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON, Canada

    Jonathan Sussman

  16. Department of Pediatrics, University of Toronto, Toronto, ON, Canada

    James MacFarlane

  17. Department of Psychiatry, University of Toronto, Toronto, ON, Canada

    James MacFarlane

  18. MedSleep (Network of Clinics), Toronto, ON, Canada

    James MacFarlane

  19. Department of Nursing, Cape Breton University, Sydney, NS, Australia

    Claudette Taylor

Authors
  1. Doris Howell
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  2. Thomas K. Oliver
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  3. Sue Keller-Olaman
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  4. Judith Davidson
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  5. Sheila Garland
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  6. Charles Samuels
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  7. Josée Savard
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  8. Cheryl Harris
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  9. Michèle Aubin
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  10. Karin Olson
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  11. Jonathan Sussman
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  12. James MacFarlane
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  13. Claudette Taylor
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as the Sleep Disturbance Expert Panel on behalf of the Cancer Journey Advisory Group of the Canadian Partnership Against Cancer

Corresponding author

Correspondence to Doris Howell.

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Howell, D., Oliver, T.K., Keller-Olaman, S. et al. A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer. Support Care Cancer 21, 2695–2706 (2013). https://doi.org/10.1007/s00520-013-1823-6

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  • DOI: https://doi.org/10.1007/s00520-013-1823-6

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