Hostname: page-component-84b7d79bbc-g5fl4 Total loading time: 0 Render date: 2024-07-28T07:14:32.372Z Has data issue: false hasContentIssue false
  • English
  • Français

Insomnia in breast cancer: Independent symptom or symptom cluster?

Published online by Cambridge University Press:  05 December 2016

Philip R. Gehrman Open the ORCID record for Philip R. Gehrman [Opens in a new window] ,
Sheila N. Garland ,
Lea Ann Matura  and
Jun Mao
Philip R. Gehrman*
Affiliation:
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Sheila N. Garland
Affiliation:
Department of Psychology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
Lea Ann Matura
Affiliation:
School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
Jun Mao
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: Philip Gehrman, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 670, Philadelphia, Pennsylvania 19104. E-mail: gehrman@exchange.upenn.edu.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

This study examined insomnia in the context of breast cancer, both as an independent symptom and as a component of a symptom cluster that includes depression, anxiety, fatigue, and pain.

Method:

Women with a history of breast cancer currently taking an aromatase inhibitor and who had completed cancer treatment at least one month prior to enrollment were included (n = 413). Participants completed validated measures of insomnia, fatigue, pain, depression, and anxiety. Factor analysis was utilized to examine the extent to which these symptoms could be represented by common latent factors. Insomnia severity was then separated into a symptom cluster component (I–SC) and an insomnia-unique (I–U) component. The associations between each insomnia component and demographic and clinical factors were examined in multivariate models.

Results:

A single-factor solution provided the best fit to the symptom measures. Some 53.3% of the variance in insomnia severity was captured by this symptom cluster (I–SC), with the remaining 43.7% being unique to insomnia (I–U). Unique patterns of demographic factors (e.g., age and body–mass index), but not clinical factors, were associated with each insomnia measure.

Significance of results:

Approximately 50% of insomnia severity was related to the symptom cluster, with the rest being unique to insomnia. Different sociodemographic risk factors were related to the different insomnia measures. Stronger underlying foundations for the mechanisms of each component could lead to refined diagnoses and targeted interventions for addressing the overall insomnia burden in cancer patients.

Keywords

InsomniaBreast cancerSymptomsFatiguePain
Type
Original Articles
Information
Palliative & Supportive Care , Volume 15 , Issue 3 , June 2017 , pp. 369 - 375
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Bastien, C.H., Vallieres, A. & Morin, C.M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297–307.CrossRefGoogle ScholarPubMed
Benca, R. (2001). Consequences of insomnia and its therapies. The Journal of Clinical Psychiatry, 62(Suppl. 10), 33–38.Google ScholarPubMed
Brown, J.C., Mao, J.J., Stricker, C., et al. (2014). Aromatase inhibitor associated musculoskeletal symptoms are associated with reduced physical activity among breast cancer survivors. The Breast Journal, 20(1), 22–28. Epub ahead of print Oct 25, 2013. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046274/.CrossRefGoogle ScholarPubMed
Carroll, B.T., Kathol, R.G., Noyes, R. Jr., et al. (1993). Screening for depression and anxiety in cancer patients using the Hospital Anxiety and Depression Scale. General Hospital Psychiatry, 15(2), 69–74.CrossRefGoogle ScholarPubMed
Chen, M.L. & Tseng, H.C. (2006). Symptom clusters in cancer patients. Supportive Care in Cancer, 14(8), 825–830. Epub ahead of print Feb 21.CrossRefGoogle ScholarPubMed
Cleeland, C.S. & Ryan, K.M. (1994). Pain assessment: Global use of the Brief Pain Inventory. Annals of the Academy of Medicine, Singapore, 23(2), 129–138. Available from http://www.health.utah.gov/prescription/pdf/guidelines/BPIglobaluseof.pdf.Google ScholarPubMed
Cleeland, C.S., Mendoza, T.R., Wang, X.S., et al. (2000). Assessing symptom distress in cancer patients: The MDAnderson Symptom Inventory. Cancer, 89(7), 1634–1646. Available from http://onlinelibrary.wiley.com/doi/10.1002/1097-0142(20001001)89:7%3C1634::AID-CNCR29%3E3.0.CO;2-V/full.3.0.CO;2-V>CrossRefGoogle Scholar
Desai, K., Mao, J.J., Su, I., et al. (2013). Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors. Supportive Care in Cancer, 21(1), 43–51. Epub ahead of print May 15, 2012. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3600410/.CrossRefGoogle ScholarPubMed
Dodd, M.J., Miaskowski, C. & Paul, S.M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. Oncology Nursing Forum, 28(3), 465–470.Google ScholarPubMed
Enderlin, C.A., Coleman, E.A., Cole, C., et al. (2010). Sleep across chemotherapy treatment: A growing concern for women older than 50 with breast cancer. Oncology Nursing Forum, 37(4), 461–463. Available from https://onf.ons.org/sites/default/files/4270U45WKWML0566_first.pdf.CrossRefGoogle ScholarPubMed
Fleming, L., Randell, K., Harvey, C.J., et al. (2014). Does cognitive behaviour therapy for insomnia reduce clinical levels of fatigue, anxiety and depression in cancer patients? Psycho-Oncology, 23(6), 679–684.CrossRefGoogle ScholarPubMed
Garland, S.N., Carlson, L.E., Stephens, A.J., et al. (2014). Mindfulness-based stress reduction compared with cognitive behavioral therapy for the treatment of insomnia comorbid with cancer: A randomized, partially blinded, noninferiority trial. Journal of Clinical Oncology, 32(5), 449–457. Epub ahead of print Jan 6. Available from http://ascopubs.org/doi/pdf/10.1200/JCO.2012.47.7265.CrossRefGoogle Scholar
Heckler, C.E., Garland, S.N., Peoples, A.R., et al. (2015). Cognitive behavioral therapy for insomnia, but not armodafinil, improves fatigue in cancer survivors with insomnia: A randomized placebo-controlled trial. Supportive Care in Cancer, 24(5), 2059–2066. Epub ahead of print Nov 5.CrossRefGoogle Scholar
Hoffman, A.J., Given, B.A., von Eye, A., et al. (2007). Relationships among pain, fatigue, insomnia, and gender in persons with lung cancer. Oncology Nursing Forum, 34(4), 785–792.CrossRefGoogle ScholarPubMed
Kenne Sarenmalm, E., Browall, M. Gaston-Johansson, F. (2014). Symptom burden clusters: A challenge for targeted symptom management. A longitudinal study examining symptom burden clusters in breast cancer. Journal of Pain and Symptom Management, 47(4), 731–741. Epub ahead of print Aug 3, 2013. Available from http://www.jpsmjournal.com/article/S0885-3924(13)00327-8/pdf.CrossRefGoogle ScholarPubMed
Kim, H.J., McGuire, D.B., Tulman, L., et al. (2005). Symptom clusters: Concept analysis and clinical implications for cancer nursing. Cancer Nursing, 28(4), 270–282; quiz 283–284.CrossRefGoogle ScholarPubMed
Mendoza, T.R., Wang, X.S., Cleland, C.S., et al. (1999). The rapid assessment of fatigue severity in cancer patients: Use of the Brief Fatigue Inventory. Cancer, 85(5), 1186–1196. Available from http://onlinelibrary.wiley.com/doi/10.1002/(SICI)1097-0142(19990301)85:5%3C1186::AID-CNCR24%3E3.0.CO;2-N/full,3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Miller, A.H., Ancoli-Israel, S., Bower, J.E. Bower, et al. (2008). Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. Journal of Clinical Oncology, 26(6), 971–982. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770012/,CrossRefGoogle ScholarPubMed
Osborne, R.H., Elsworth, G.R., Sprangers, M.A., et al. (2004). The value of the Hospital Anxiety and Depression Scale (HADS) for comparing women with early-onset breast cancer with population-based reference women. Quality of Life Research, 13(1), 191–206.CrossRefGoogle ScholarPubMed
Sanford, S.D., Beaumont, J.L., Butt, Z., et al. (2014). Prospective longitudinal evaluation of a symptom cluster in breast cancer. Journal of Pain and Symptom Management, 47(4), 721–730. Epub ahead of print Jul 20, 2013. Available from http://www.jpsmjournal.com/article/S0885-3924(13)00325-4/pdf.CrossRefGoogle ScholarPubMed
Savard, J. & Morin, C.M. (2001). Insomnia in the context of cancer: A review of a neglected problem. Journal of Clinical Oncology, 19(3), 895–908. Available from http://ascopubs.org/doi/full/10.1200/jco.2001.19.3.895.CrossRefGoogle Scholar
Savard, J., Ivers, H., Villa, J., et al. (2011). Natural course of insomnia comorbid with cancer: An 18-month longitudinal study. Journal of Clinical Oncology, 29(26), 3580–3586. Epub ahead of print Aug 8. Available from http://ascopubs.org/doi/full/10.1200/JCO.2010.33.2247.CrossRefGoogle ScholarPubMed
Savard, M.H., Savard, J., Simard, S., et al. (2005). Empirical validation of the Insomnia Severity Index in cancer patients. Psycho-Oncology, 14(6), 429–441.CrossRefGoogle ScholarPubMed
Smith, M.T. & Haythornthwaite, J.A. (2004). How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Medicine Reviews. 8(2), 119–132.CrossRefGoogle ScholarPubMed
Trudel-Fitzgerald, C., Savard, J. & Ivers, H. (2013). Which symptoms come first? Exploration of temporal relationships between cancer-related symptoms over an 18-month period. Annals of Behavioral Medicine, 45(3), 329–337.CrossRefGoogle ScholarPubMed
van Nes, J.G., Fontein, D.B., Hille, E.T., et al. (2012). Quality of life in relation to tamoxifen or exemestane treatment in postmenopausal breast cancer patients: A Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial side study. Breast Cancer Research and Treatment, 134(1), 267–276. Epub ahead of print Mar 28. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3397233/.CrossRefGoogle ScholarPubMed
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.CrossRefGoogle ScholarPubMed