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Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapy

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Abstract

Purpose

In a sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer who received at least two cycles of chemotherapy (CTX), the purposes were to evaluate for inter-individual differences in the severity of sleep disturbance and determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of sleep disturbance.

Methods

A total of 1331 patients completed study questionnaires in their homes, at six time points over two cycles of CTX (prior to CTX administration, approximately 1 week after CTX administration, and approximately 2 weeks after CTX administration). Questionnaires included demographic, clinical, and symptom assessments (i.e., General Sleep Disturbance Scale, Lee Fatigue Scale, Center for Epidemiological Studies-Depression Scale, Spielberger State-Trait Anxiety Inventories, Attentional Function Index). Hierarchical linear modeling based on full maximum likelihood estimation was performed.

Results

Characteristics associated with higher initial levels of sleep disturbance included higher body mass index, poorer functional status, higher trait anxiety, higher depressive symptoms, and higher evening fatigue. Characteristics associated with the worse trajectories of sleep disturbance were higher levels of education and higher sleep disturbance at enrollment. Characteristics associated with both higher initial levels and worse trajectories of sleep disturbance were higher morning fatigue and worse attentional function.

Conclusions

A large amount of inter-individual variability exists in sleep disturbance during CTX. The modifiable and non-modifiable characteristics found in this study can be used to identify higher risk patients and provide earlier interventions to reduce sleep disturbance.

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Acknowledgements

This study was funded by the National Cancer Institute (NCI, CA134900). Dr. Miaskowski is supported by a grant from the American Cancer Society and NCI (CA168960). Dr. Sueann Mark was supported by a Graduate Scholarship in Cancer Nursing Practice, GSCNP-15-110-01 from the American Cancer Society.

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Authors and Affiliations

  1. School of Nursing, University of California, San Francisco, San Francisco, CA, USA

    Sueann Mark, Janine Cataldo, Steven M. Paul, Kathryn Lee & Christine Miaskowski

  2. School of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Anand Dhruva, Lee-May Chen, Jon D. Levine & Michelle Melisko

  3. Department of Nursing, Mount Sinai Medical Center, New York, NY, USA

    Marilyn J. Hammer

  4. School of Nursing, Yale University, New Haven, CT, USA

    Fay Wright

  5. School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA

    Yvette P. Conley

  6. Department of Physiological Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA

    Christine Miaskowski

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  1. Sueann Mark
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Correspondence to Christine Miaskowski.

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Mark, S., Cataldo, J., Dhruva, A. et al. Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapy. Support Care Cancer 25, 2485–2494 (2017). https://doi.org/10.1007/s00520-017-3655-2

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  • DOI: https://doi.org/10.1007/s00520-017-3655-2

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