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Personalized goal for insomnia and clinical response in advanced cancer patients

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Abstract

Aim

The aim of this study was to assess the Personalized Insomnia Intensity Goal (PIIG), the achievement of Personalized Goal Response (PGR), and Patient Global Impression (PGI) after a comprehensive symptom management.

Patients and methods

Advanced cancer patients admitted to palliative care units rated pain and symptoms intensity and their PIIG by using the Edmonton Symptom Assessment Score (ESAS) (T0). In patients with significant levels of insomnia, the achievement of target expected (PIIG) was measured (patient goal response, PIGR), as well the patient global impression (PGI), by the minimal clinically important difference (MCID), after a comprehensive symptom management (T7).

Results

Three hundred ninety-seven patients with a level of insomnia of ≥ 3 on ESAS were analyzed in this study. The mean values of PIIG at T0 and T7 were 1.2 (SD 1.5) and 0.9 (SD 1.4), respectively. Most patients (n = 406, 89.8%) indicated a PIIG of ≤ 3 as a target at T0. Such target was significantly lower at T7 (p = < 0.0005). PGI, expressed as MCID, was perceived with a mean decrease in insomnia intensity of − 2.3. In a minority of patients (n = 26; 5.8%) insomnia worsened, with a MCID of 0.50 (SD 2.8). Higher insomnia intensity at T0 and lower insomnia intensity at T7 were independently related to PGI. PIGR was achieved in 87.9% of patients. PIGR was associated with PIIG at T0, and inversely associated to insomnia intensity at T0 and T7, and PIIG at T7.

Conclusion

PGIR and PGI seem to be relevant for evaluating the effects of a comprehensive management of insomnia, suggesting therapeutic decisions according to PIIG. Some factors influencing the individual target and clinical response have been detected.

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Authors and Affiliations

  1. Main Regional Center for Pain Relief & Supportive Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90145, Palermo, Italy

    Sebastiano Mercadante

  2. Pain Relief & Supportive Care, La Maddalena Cancer Center, Palermo, Italy

    Claudio Adile & Patrizia Ferrera

  3. Department of Oncology, Hospital of Teramo, Teramo, Italy

    Federica Aielli

  4. Medical Oncology Unit, IRCCS Neuromed, Pozzilli, Italy

    Lanzetta Gaetano

  5. Medical Oncology Unit, Italian Neuro-Traumatology Institute, Grottaferrata, Italy

    Lanzetta Gaetano

  6. Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece

    Kyriaki Mistakidou

  7. Palliative Care Unit - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy

    Marco Maltoni, Marta Rosati & Romina Rossi

  8. Department of Anesthesioloogy, University of Palermo, Palermo, PA, Italy

    Andrea Cortegiani

  9. Post-Acute Care Services and Palliative Care Program, Hospital Placi, Niterói, Rio de Janeiro, Brazil

    Luiz Guilherme Soares

  10. Palliative Care and Oncologic Pain Service - S. Camillo-Forlanini Hospital, Rome, Italy

    Stefano De Santis

  11. Università di Palermo, Palermo, Italy

    Alessandra Casuccio

Authors
  1. Sebastiano Mercadante
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  2. Claudio Adile
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  3. Federica Aielli
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  4. Lanzetta Gaetano
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  5. Kyriaki Mistakidou
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  6. Marco Maltoni
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  7. Andrea Cortegiani
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  8. Luiz Guilherme Soares
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  9. Stefano De Santis
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  10. Patrizia Ferrera
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  11. Marta Rosati
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  12. Romina Rossi
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  13. Alessandra Casuccio
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Correspondence to Sebastiano Mercadante.

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Mercadante, S., Adile, C., Aielli, F. et al. Personalized goal for insomnia and clinical response in advanced cancer patients. Support Care Cancer 28, 1089–1096 (2020). https://doi.org/10.1007/s00520-019-04912-z

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  • DOI: https://doi.org/10.1007/s00520-019-04912-z

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