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Effects of a multidisciplinary quality of life intervention on sleep quality in patients with advanced cancer receiving radiation therapy

Published online by Cambridge University Press:  26 September 2019

Melanie T. Gentry*
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
Pamela J. Atherton
Affiliation:
Cancer Center Statistics Section, Division of Biomedical Statistics and Informatics, Department of Health Sciences, Mayo Clinic, Rochester, MN
Maria Lapid
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
Preetha Sharone Rosen
Affiliation:
Peace Health St John Medical Center, Longview, Washington, WA
Simon Kung
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
Jarrett Richardson
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
Shehzad K. Niazi
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
William V. Bobo
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
Matthew M. Clark
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
Teresa A. Rummans
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL
*
Author for correspondence: Melanie T. Gentry M.D., Department of Psychiatry and Psychology, Mayo Clinic Rochester, 200 1st Street SW, Rochester, MN55905. E-mail: [email protected]

Abstract

Objectives

Sleep disturbances are prevalent in cancer patients, especially those with advanced disease. There are few published intervention studies that address sleep issues in advanced cancer patients during the course of treatment. This study assesses the impact of a multidisciplinary quality of life (QOL) intervention on subjective sleep difficulties in patients with advanced cancer.

Method

This randomized trial investigated the comparative effects of a multidisciplinary QOL intervention (n = 54) vs. standard care (n = 63) on sleep quality in patients with advanced cancer receiving radiation therapy as a secondary endpoint. The intervention group attended six intervention sessions, while the standard care group received informational material only. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), administered at baseline and weeks 4 (post-intervention), 27, and 52.

Results

The intervention group had a statistically significant improvement in the PSQI total score and two components of sleep quality and daytime dysfunction than the control group at week 4. At week 27, although both groups showed improvements in sleep measures from baseline, there were no statistically significant differences between groups in any of the PSQI total and component scores, or ESS. At week 52, the intervention group used less sleep medication than control patients compared to baseline (p = 0.04) and had a lower ESS score (7.6 vs. 9.3, p = 0.03).

Significance of results

A multidisciplinary intervention to improve QOL can also improve sleep quality of advanced cancer patients undergoing radiation therapy. Those patients who completed the intervention also reported the use of less sleep medication.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

This article has been corrected since its original publication. See doi:10.1017/S147895151900083X.

References

REFERENCES

Berger, AM (2009) Update on the state of the science: Sleep-wake disturbances in adult patients with cancer. Oncology Nursing Forum 36(4), E165177.CrossRefGoogle ScholarPubMed
Berger, AM, Parker, KP, Young-McCaughan, S, et al. (2005) Sleep wake disturbances in people with cancer and their caregivers: State of the science. Oncology Nursing Forum 32(6), E98E126.CrossRefGoogle ScholarPubMed
Beszterczey, A and Lipowski, ZJ (1977) Insomnia in cancer patients. Canadian Medical Association Journal 116(4), 355.Google ScholarPubMed
Bretscher, M, Rummans, T, Sloan, J, et al. (1999) Quality of life in hospice patients. A pilot study. Psychosomatics 40(4), 309313.CrossRefGoogle ScholarPubMed
Buysse, DJ, Reynolds, CF III, Monk, TH, et al. (1989) The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research 28(2), 193213.CrossRefGoogle ScholarPubMed
Carlson, LE and Garland, SN (2005) Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. International Journal of Behavioral Medicine 12(4), 278285.CrossRefGoogle ScholarPubMed
Cella, DF, Tulsky, DS, Gray, G, et al. (1993) The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. Journal of Clinical Oncology 11(3), 570579.CrossRefGoogle ScholarPubMed
Cheville, AL, Kollasch, J, Vandenberg, J, et al. (2013) A home-based exercise program to improve function, fatigue, and sleep quality in patients with Stage IV lung and colorectal cancer: A randomized controlled trial. Journal of Pain & Symptom Management 45(5), 811821.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(4), 747771.CrossRefGoogle ScholarPubMed
Clark, MM, Rummans, TA, Atherton, PJ, et al. (2013) Randomized controlled trial of maintaining quality of life during radiotherapy for advanced cancer. Cancer 119(4), 880887.CrossRefGoogle ScholarPubMed
Cohen, L, Warneke, C, Fouladi, RT, et al. (2004) Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer 100(10), 22532260.CrossRefGoogle Scholar
Dalton, JA, Keefe, FJ, Carlson, J, et al. (2004) Tailoring cognitive-behavioral treatment for cancer pain. Pain Management Nursing 5(1), 318.CrossRefGoogle ScholarPubMed
Davidson, JR, MacLean, AW, Brundage, MD, et al. (2002) Sleep disturbance in cancer patients. Social Science & Medicine 54(9), 13091321.CrossRefGoogle ScholarPubMed
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 & Symptom Management 41(5), 819827.CrossRefGoogle ScholarPubMed
de Moor, C, Sterner, J, Hall, M, et al. (2002) A pilot study of the effects of expressive writing on psychological and behavioral adjustment in patients enrolled in a Phase II trial of vaccine therapy for metastatic renal cell carcinoma. Health Psychology 21(6), 615619.CrossRefGoogle Scholar
Dhruva, A, Paul, SM, Cooper, BA, et al. (2012) A longitudinal study of measures of objective and subjective sleep disturbance in patients with breast cancer before, during, and after radiation therapy. Journal of Pain and Symptom Management 44(2), 215228.CrossRefGoogle ScholarPubMed
Garland, SN, Carlson, LE, Stephens, AJ, et al. (2014a) 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), 449457.CrossRefGoogle Scholar
Garland, SN, Johnson, JA, Savard, J, et al. (2014b) Sleeping well with cancer: A systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatric Disease and Treatment 10, 11131124.Google Scholar
Garrett, K, Dhruva, A, Koetters, T, et al. (2011) Differences in sleep disturbance and fatigue between patients with breast and prostate cancer at the initiation of radiation therapy. Journal of Pain & Symptom Management 42(2), 239250.CrossRefGoogle Scholar
Gibbins, J, McCoubrie, R, Kendrick, AH, et al. (2009) Sleep-wake disturbances in patients with advanced cancer and their family carers. Journal of Pain & Symptom Management 38(6), 860870.CrossRefGoogle ScholarPubMed
Grutsch, JF, Wood, PA, Du-Quiton, J, et al. (2011) Validation of actigraphy to assess circadian organization and sleep quality in patients with advanced lung cancer. Journal of Circadian Rhythms 9, 4.CrossRefGoogle ScholarPubMed
Hickok, JT, Morrow, GR, Roscoe, JA, et al. (2005) Occurrence, severity, and longitudinal course of twelve common symptoms in 1129 consecutive patients during radiotherapy for cancer. Journal of Pain & Symptom Management 30(5), 433442.CrossRefGoogle ScholarPubMed
Johns, MW (1991) A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 14(6), 540545.CrossRefGoogle ScholarPubMed
Kwekkeboom, KL, Abbott-Anderson, K, Cherwin, C, et al. (2012) Pilot randomized controlled trial of a patient-controlled cognitive-behavioral intervention for the pain, fatigue, and sleep disturbance symptom cluster in cancer. Journal of Pain & Symptom Management 44(6), 810822.CrossRefGoogle ScholarPubMed
Lehrer, S, Green, S, Ramanathan, L, et al. (2013) Obesity and deranged sleep are independently associated with increased cancer mortality in 50 US states and the District of Columbia. Sleep Breath 17(3), 11171118.CrossRefGoogle ScholarPubMed
Locke, DEC, Decker, PA, Sloan, JA, et al. (2007) Validation of Single-Item Linear Analog Scale assessment of quality of life in neuro-oncology patients. Journal of Pain and Symptom Management 34(6), 628638.CrossRefGoogle ScholarPubMed
Matthews, EE, Berger, AM, Schmiege, SJ, et al. (2014) Cognitive behavioral therapy for insomnia outcomes in women after primary breast cancer treatment: A randomized, controlled trial. Oncology Nursing Forum 41(3), 241253.CrossRefGoogle ScholarPubMed
Mercadante, S, Adile, C, Ferrera, P, et al. (2017) Sleep disturbances in advanced cancer patients admitted to a supportive/palliative care unit. Supportive Care in Cancer 25(4), 13011306.CrossRefGoogle ScholarPubMed
Miaskowski, C, Paul, SM, Cooper, BA, et al. (2011) Predictors of the trajectories of self-reported sleep disturbance in men with prostate cancer during and following radiation therapy. Sleep 34(2), 171179.CrossRefGoogle ScholarPubMed
Mishel, MH, Belyea, M, Germino, BB, et al. (2002) Helping patients with localized prostate carcinoma manage uncertainty and treatment side effects: Nurse-delivered psychoeducational intervention over the telephone. Cancer 94(6), 18541866.CrossRefGoogle ScholarPubMed
Mormont, MC and Waterhouse, J (2002) Contribution of the rest-activity circadian rhythm to quality of life in cancer patients. Chronobiology International 19(1), 313323.CrossRefGoogle ScholarPubMed
Mystakidou, K, Parpa, E, Tsilika, E, et al. (2007a) Depression, hopelessness, and sleep in cancer patients’ desire for death. International Journal of Psychiatry in Medicine 37(2), 201211.CrossRefGoogle Scholar
Mystakidou, K, Parpa, E, Tsilika, E, et al. (2007b) The relationship of subjective sleep quality, pain, and quality of life in advanced cancer patients. Sleep 30(6), 737742.CrossRefGoogle Scholar
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(1), 4653.CrossRefGoogle Scholar
Nezu, AM, Nezu, CM, Felgoise, SH, et al. (2003) Project Genesis: Assessing the efficacy of problem-solving therapy for distressed adult cancer patients. Journal of Consulting and Clinical Psychology 71(6), 10361048.CrossRefGoogle ScholarPubMed
Nishiura, M, Tamura, A, Nagai, H, et al. (2015) Assessment of sleep disturbance in lung cancer patients: Relationship between sleep disturbance and pain, fatigue, quality of life, and psychological distress. Palliative and Supportive Care 13(3), 575581.CrossRefGoogle ScholarPubMed
Owen, DC, Parker, KP and McGuire, DB (1999) Comparison of subjective sleep quality in patients with cancer and healthy subjects. Oncology Nursing Forum 26(10), 16491651.Google ScholarPubMed
Page, MS, Berger, AM and Johnson, LB (2006) Putting evidence into practice: Evidence-based interventions for sleep-wake disturbances. Clinical Journal of Oncology Nursing 10(6), 753767.CrossRefGoogle ScholarPubMed
Palesh, OG, Roscoe, JA, Mustian, KM, 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(2), 292298.CrossRefGoogle ScholarPubMed
Palesh, O, Aldridge-Gerry, A, Zeitzer, JM, et al. (2014) Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep 37(5), 837842.CrossRefGoogle ScholarPubMed
Parker, KP, Bliwise, DL, Ribeiro, M, et al. (2008) Sleep/Wake patterns of individuals with advanced cancer measured by ambulatory polysomnography. Journal of Clinical Oncology 26(15), 24642472.CrossRefGoogle ScholarPubMed
Pocock, SJ and Simon, R (1975) Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics 31(1), 103115.CrossRefGoogle ScholarPubMed
Reimer, MA and Flemons, WW (2003) Quality of life in sleep disorders. Sleep Medicine Reviews 7(4), 335349.CrossRefGoogle ScholarPubMed
Sateia, MJ and Pigeon, WR (2004) Identification and management of insomnia. Medical Clinics of North America 88(3), 567596, vii.CrossRefGoogle ScholarPubMed
Savard, J, Simard, S, Giguere, I, et al. (2006) Randomized clinical trial on cognitive therapy for depression in women with metastatic breast cancer: Psychological and immunological effects. Palliative & Supportive Care 4(3), 219237.CrossRefGoogle ScholarPubMed
Sephton, S and Spiegel, D (2003) Circadian disruption in cancer: A neuroendocrine-immune pathway from stress to disease? Brain, Behavior, & Immunity 17(5), 321328.CrossRefGoogle ScholarPubMed
Sloan, JA, Zhao, X, Novotny, PJ, et al. (2012) Relationship between deficits in overall quality of life and non-small-cell lung cancer survival. Journal of Clinical Oncology 30(13), 14981504.CrossRefGoogle ScholarPubMed
Stepanski, EJ, Walker, MS, Schwartzberg, LS, et al. (2009) The relation of trouble sleeping, depressed mood, pain, and fatigue in patients with cancer. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine 5(2), 132136.Google ScholarPubMed
Vena, C, Parker, K, Allen, R, et al. (2006) Sleep-wake disturbances and quality of life in patients with advanced lung cancer. Oncology Nursing Forum 33(4), 761769.CrossRefGoogle ScholarPubMed
Yennurajalingam, S, Chisholm, G, Palla, SL, et al. (2015) Self-reported sleep disturbance in patients with advanced cancer: Frequency, intensity, and factors associated with response to outpatient supportive care consultation — a preliminary report. Palliative & Supportive Care 13(2), 135143.CrossRefGoogle ScholarPubMed