Hostname: page-component-7479d7b7d-fwgfc Total loading time: 0 Render date: 2024-07-10T08:26:14.502Z Has data issue: false hasContentIssue false
  • English
  • Français

Self-reported sleep disturbance in patients with advanced cancer: Frequency, intensity, and factors associated with response to outpatient supportive care consultation — A preliminary report

Published online by Cambridge University Press:  04 November 2013

Sriram Yennurajalingam ,
Gary Chisholm ,
Shana L. Palla ,
Holly Holmes ,
James M. Reuben  and
Eduardo Bruera
Sriram Yennurajalingam*
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Gary Chisholm
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Shana L. Palla
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Holly Holmes
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
James M. Reuben
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
Eduardo Bruera
Affiliation:
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
*
Address correspondence and reprint requests to: Sriram Yennurajalingam, Department of Palliative Care and Rehabilitation Medicine, Unit 1414, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas77030. E-mail: syennu@mdanderson.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Self-reported sleep disturbance (SD) is a distressing symptom in patients with advanced cancer. There are limited data on the treatment of SD and predictors to response of SD to outpatient supportive care clinic (OPC) consultation. The aims of our study was to determine the frequency, intensity, and correlates of SD as assessed with the Edmonton Symptom Assessment System (ESAS) sleep item at the time of initial consultation and identify the predictors of improvement in SD at follow-up.

Methods:

We reviewed the records of consecutive patients with advanced cancer presenting to the OPC. ESAS scores were obtained at the initial and subsequent visits between January 2008 and February 2010. All patients underwent screening for SD (0–10 scale: 0 = best sleep, presence of SD defined as ≥3) and interdisciplinary assessment and treatment, including drug review, counseling, sleep hygiene review, and drug therapy. A response was defined as a 1-point improvement at the follow-up visit on the Edmonton Symptom Assessment Scale (ESAS) sleep item score. Baseline patient characteristics, medication use, and ESAS scores were analyzed to determine their association with response.

Results:

The median age was 58 years, and 53% of patients were men. The most common cancer type was head and neck or lung (36%). Of the 442 patients, 330 had baseline SD (score ≥3/10, 75%). Median and mean (standard deviation) baseline SD scores were 5 and 5.1 (2.9). The multivariable regression model found the intensity of baseline ESAS sleep item scores to be associated with baseline sedative use, baseline ESAS pain scores, baseline ESAS fatigue scores, baseline ESAS feeling of well-being scores, and sedative use (R2 = 0.22). Sleep disturbance response at first follow-up was seen in 196 of 330 patients (59%). Moderate to high SD score and anxiety at initial visit with odds ratios (OR) of 2.53 (p = 0.0007) and 1.59 (p = 0.048), respectively, were associated with a response.

Significance of results:

Both the frequency and severity of SD were high. Response to supportive care consultation was substantial. The severity of SD and anxiety at the initial visit predicted a response at first follow-up. Further research is needed.

Keywords

Sleep disordersPalliative careAdvanced cancerPredictors of response
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 2 , April 2015 , pp. 135 - 143
Copyright
Copyright © Cambridge University Press 2013 

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

Ancoli-Israel, S. (2009). Recognition and treatment of sleep disturbances in cancer. Journal of Clinical Oncology, 27, 5864–5866.CrossRefGoogle ScholarPubMed
Berger, A.M., Parker, K.P., Young-McCaughan, S., et al. (2005). Sleep/wake disturbances in people with cancer and their caregivers: State of the science. Oncology Nursing Forum, 32, E98–E126.Google Scholar
Berger, A.M., Kuhn, B.R., Farr, L.A., et al. (2009). Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Psycho-Oncology, 18, 634–646.Google Scholar
Bruera, E., Kuehn, N., Miller, M.J., et al. (1991). The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care, 7, 6–9.Google Scholar
Breitbart, W., Rosenfeld, B., Roth, A., et al. (1997). The Memorial Delirium Assessment Scale. Journal of Pain and Symptom Management, 13(3), 128–137.CrossRefGoogle ScholarPubMed
Buysse, D.J., Reynolds, C.F. III, Monk, T.H., et al. (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.Google Scholar
Carvajal, A., Centeno, C., Watson, R., et al. (2011). A comprehensive study of psychometric properties of the Edmonton Symptom Assessment System (ESAS) in Spanish advanced cancer patients. European Journal of Cancer, 47, 1863–1872.CrossRefGoogle ScholarPubMed
Clark, J., Cunningham, M., McMillan, S., et al. (2004). Sleep–wake disturbances in people with cancer, part II: Evaluating the evidence for clinical decision making. Oncology Nursing Forum, 31, 747–771.Google Scholar
Dalal, S., Palla, S., Hui, D., et al. (2011). Association between a name change from palliative to supportive care and the timing of patient referrals at a comprehensive cancer center. The Oncologist, 16, 105–111.CrossRefGoogle Scholar
Davidson, J.R., MacLean, A.W., Brundage, M.D., et al. (2002). Sleep disturbance in cancer patients. Social Science & Medicine, 54, 1309–1321.Google Scholar
Delgado-Guay, M., Yennurajalingam, S., Parsons, H., et al. (2011). Association between self-reported sleep disturbance and other symptoms in patients with advanced cancer. Journal of Pain and Symptom Management, 41, 819–827.Google Scholar
Elsayem, A. & Bruera, E. (2008). The MD Anderson symptom control and palliative care handbook, 3rd ed.Houston: University of Texas Health Science Center.Google Scholar
Espie, C.A., Fleming, L., Cassidy, J., et al. (2008). Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. Journal of Clinical Oncology, 26, 4651–4658.Google Scholar
Follwell, M., Burman, D., Le, L.W., et al. (2009). Phase II study of an outpatient palliative care intervention in patients with metastatic cancer. Journal of Clinical Oncology, 27, 206–213.Google Scholar
Gibbins, J., McCoubrie, R., Kendrick, A.H., et al. (2009). Sleep–wake disturbances in patients with advanced cancer and their family carers. Journal of Pain and Symptom Management, 38, 860–870.CrossRefGoogle ScholarPubMed
Hugel, H., Ellershaw, J.E., Cook, L., et al. (2004). The prevalence, key causes and management of insomnia in palliative care patients. Journal of Pain and Symptom Management, 27, 316–321.CrossRefGoogle ScholarPubMed
Joly, F., Vardy, J., Pintilie, M., et al. (2007). Quality of life and/or symptom control in randomized clinical trials for patients with advanced cancer. Annals of Oncology, 18, 1935–1942.Google Scholar
Koopman, C., Nouriani, B., Erickson, V., et al. (2002). Sleep disturbances in women with metastatic breast cancer. The Breast Journal, 8, 362–370.Google Scholar
Lamberg, L. (2000). Sleep disorders, often unrecognized, complicate many physical illnesses. The Journal of the American Medical Association, 284, 2173–2175.Google Scholar
Lianqi, L. & Ancoli-Israel, S. (2008). Sleep disturbances in cancer. Psychiatric Annals, 38(9), 627–634.Google Scholar
McMillan, S.C., Tofthagen, C. & Morgan, M.A. (2008). Relationships among pain, sleep disturbances, and depressive symptoms in outpatients from a comprehensive cancer center. Oncology Nursing Forum, 35, 603–611.Google Scholar
Mercadante, S., Girelli, D., Casuccio, A. (2004). Sleep disorders in advanced cancer patients: Prevalence and factors associated. Supportive Care in Cancer, 12, 355–359.CrossRefGoogle ScholarPubMed
Mystakidou, K., Parpa, E., Tsilika, E., et al. (2007). Sleep quality in advanced cancer patients. Journal of Psychosomatic Research, 62, 527–533.CrossRefGoogle ScholarPubMed
Mystakidou, K., Parpa, E., Tsilika, E., et al. (2009). How is sleep quality affected by the psychological and symptom distress of advanced cancer patients? Palliative Medicine, 23, 46–53.CrossRefGoogle Scholar
National Consensus Project for Quality Palliative Care (NCP) (2009). Clinical practice guidelines for quality palliative care. Accessed May 24, 2013 from http://www.guideline.gov/content.aspx?id=14423.Google Scholar
Osoba, D., Rodrigues, G., Myles, J., et al. (1998). Interpreting the significance of changes in health-related quality-of-life scores. Journal of Clinical Oncology, 16, 139–144.CrossRefGoogle ScholarPubMed
Palesh, O.G., Collie, K., Batiuchok, D., et al. (2007). A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biological Psychology, 75, 37–44.Google Scholar
Palesh, O.G., Roscoe, J.A., Mustian, K.M., et al. (2010). Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center–Community Clinical Oncology Program. Journal of Clinical Oncology, 28, 292–298.Google Scholar
Parker, K.P., Bliwise, D.L., Ribeiro, M., et al. (2008). Sleep/wake patterns of individuals with advanced cancer measured by ambulatory polysomnography. Journal of Clinical Oncology, 26, 2464–2472.Google Scholar
Redwine, L., Hauger, R.L., Gillin, J.C., et al. (2000) Effects of sleep and sleep deprivation on interleukin-6, growth hormone, cortisol, and melatonin levels in humans. Journal of Clinical Endocrinology and Metabolism, 85, 3597–3603.Google ScholarPubMed
Sela, R.A., Watanabe, S. & Nekolaichuk, C.L. (2005) Sleep disturbances in palliative cancer patients attending a pain and symptom control clinic. Palliative & Supportive Care, 3, 23–31.CrossRefGoogle ScholarPubMed
Sharma, N., Hansen, C.H., O'Connor, M., et al. (2011) Sleep problems in cancer patients: Prevalence and association with distress and pain. Psycho-Oncology, 21(9), 1003–1009. doi: 10.1002/pon.2004 [Epub July 1, 2011].Google Scholar