Hostname: page-component-745bb68f8f-d8cs5 Total loading time: 0 Render date: 2025-02-11T05:54:17.276Z Has data issue: false hasContentIssue false
  • English
  • Français

Sleep–wake difficulties in community-dwelling cancer patients receiving palliative care: subjective and objective assessment

Published online by Cambridge University Press:  21 September 2017

Marie Solange Bernatchez ,
Josée Savard ,
Marie-Hélène Savard ,
Michèle Aubin  and
Hans Ivers
Marie Solange Bernatchez
Affiliation:
School of Psychology, Université Laval, Quebec, Quebec, Canada CHU de Québec–Université Laval Research Center, Quebec, Quebec, Canada Laval University Cancer Research Center, Quebec, Quebec, Canada
Josée Savard*
Affiliation:
School of Psychology, Université Laval, Quebec, Quebec, Canada CHU de Québec–Université Laval Research Center, Quebec, Quebec, Canada Laval University Cancer Research Center, Quebec, Quebec, Canada
Marie-Hélène Savard
Affiliation:
CHU de Québec–Université Laval Research Center, Quebec, Quebec, Canada Laval University Cancer Research Center, Quebec, Quebec, Canada
Michèle Aubin
Affiliation:
Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
Hans Ivers
Affiliation:
School of Psychology, Université Laval, Quebec, Quebec, Canada CHU de Québec–Université Laval Research Center, Quebec, Quebec, Canada Laval University Cancer Research Center, Quebec, Quebec, Canada
*
Address correspondence and reprint requests to: Josée Savard, Centre de Recherche du CHU de Québec–Université Laval, L'Hôtel-Dieu de Québec, 11 Côte du Palais, Québec, Québec, Canada, G1R 2J6. E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Prevalence rates of sleep difficulties in advanced cancer patients have varied widely across studies (12 to 96%), and none of these employed a diagnostic interview to distinguish different types of sleep–wake disorders. Moreover, very limited information is available on subjective and objective sleep parameters in this population. Our study was conducted in palliative cancer patients and aimed to assess rates of sleep–wake disorders and subsyndromal symptoms and to document subjective and objective sleep–wake parameters across various types of sleep–wake difficulties.

Method:

The sample was composed of 51 community-dwelling cancer patients receiving palliative care and having an Eastern Cooperative Oncology Group score of 2 or 3. Relevant sections of the Duke Interview for Sleep Disorders were administered over the phone. An actigraphic recording and a daily sleep diary were completed for 7 consecutive days.

Results:

Overall, 68.6% of the sample had at least one type of sleep–wake difficulty (disorder or symptoms): 31.4% had insomnia and 29.4% had hypersomnolence as their main sleep–wake problem. Participants with insomnia as their main sleep difficulty had greater disruptions of subjective sleep parameters, while objectively-assessed sleep was more disrupted in patients with hypersomnolence comorbid with another sleep–wake difficulty.

Significance of the Results:

The high rates of sleep–wake difficulties found in this study indicate a need to screen more systematically for sleep–wake disorders, including insomnia and hypersomnolence, in both palliative care research and clinical practice, and to develop effective nonpharmacological interventions specifically adapted to this population.

Keywords

InsomniaHypersomnolencePalliative careActigraphySleep diary
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 6 , December 2018 , pp. 756 - 766
Copyright
Copyright © Cambridge University Press 2017 

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

Akechi, T., Okuyama, T., Akizuki, N., et al. (2007). Associated and predictive factors of sleep disturbance in advanced cancer patients. Psycho-Oncology, 16(10), 888–894.Google Scholar
Alliance des Maisons de Soins Palliatifs du Québec (2013). Projet de loi n°52: Loi concernant les soins de fin de vie. Séance du 1 octobre 2013. Available from http://www.assnat.qc.ca/fr/travaux-parlementaires/projets-loi/projet-loi-52-40-1.html.Google Scholar
Alt-Epping, B. & Nauck, F. (2015). Palliative Care in Oncology. Berlin: Springer Verlag.Google Scholar
Beck, A. T. & Steer, R. A. (1991). Manual for the Beck Scale for Suicide Ideation. San Antonio, TX: The Psychological Corporation.Google Scholar
Beck, A. T., Kovacs, M. & Weissman, A. (1979). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47(2), 343–352.Google Scholar
Bernatchez, M. S., Collin, J., Gagnon, P., et al. (2015). La gestion des symptômes en soins palliatifs au-delà de la médication. Cahiers Francophones de Soins Palliatifs, 15(2), 33–52.Google Scholar
Bourdeanu, L., Loseth, D. B. & Funk, M. (2005). Management of opioid-induced sedation in patients with cancer. Clinical Journal of Oncology Nursing, 9(6), 705–711.Google Scholar
Bruera, E. & Paice, J. A. (2015). Cancer pain management: Safe and effective use of opioids. American Society of Clinical Oncology Educational Book, e593–599. Available from http://meetinglibrary.asco.org/record/105301/edbook#fulltext.Google Scholar
Carney, C. E., Edinger, J. D., Olsen, M. K., et al. (2008). Inter-rater reliability for insomnia diagnoses derived from the Duke Structured Interview for Sleep Disorders. Sleep, 31(Suppl. 1), A250.Google Scholar
Chang, W. P. & Lin, C. C. (2014). Correlation between rest–activity rhythm and survival in cancer patients experiencing pain. Chronobiology International, 31(8), 926–934.Google Scholar
Davis, M. P. & Bruera, E. (2014). Fighting insomnia and battling lethargy: The yin and yang of palliative care. Paper presented at the 20th International Congress on Palliative Care, Montreal, Quebec, Canada.Google Scholar
Dean, G. E., Abu Sabbah, E., Yingrengreung, S., et al. (2015). Sleeping with the enemy: Sleep and quality of life in patients with lung cancer. Cancer Nursing, 38(1), 60–70.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(5), 819–827.Google Scholar
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975). “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198.Google Scholar
George, G. C., Iwuanyanwu, E. C., Anderson, K. O., et al. (2016). Sleep quality and its association with fatigue, symptom burden, and mood in patients with advanced cancer in a clinic for early-phase oncology clinical trials. Cancer, 122(21), 3401–3409.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(6), 860–870.Google Scholar
Grutsch, J. F., Wood, P. A., 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). Available from https://www.jcircadianrhythms.com/articles/10.1186/1740-3391-9-4/print/.Google Scholar
Hearson, B. & Sawatzky, J. A. (2008). Sleep disturbance in patients with advanced cancer. International Journal of Palliative Nursing, 14(1), 30–37.Google Scholar
Innominato, P. F., Focan, C., Gorlia, T., et al. (2009). Circadian rhythm in rest and activity: A biological correlate of quality of life and a predictor of survival in patients with metastatic colorectal cancer. Cancer Research, 69(11), 4700–4707.Google Scholar
Johnson, J. A., Rash, J. A., Campbell, T. S., et al. (2016). A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for insomnia (CBT–I) in cancer survivors. Sleep Medicine Reviews, 27, 20–28.Google Scholar
Koopman, C., Nouriani, B., Erickson, V., et al. (2002). Sleep disturbances in women with metastatic breast cancer. The Breast Journal, 8(6), 362–370.Google Scholar
Kotlinska-Lemieszek, A., Paulsen, O., Kaasa, S., et al. (2014). Polypharmacy in patients with advanced cancer and pain: A European cross-sectional study of 2282 patients. Journal of Pain and Symptom Management, 48(6), 1145–1159.Google Scholar
Kryger, M. H., Roth, T. & Dement, W. C. (2011). Principles and Practice of Sleep Medicine, 5th ed. St. Louis: Elsevier Saunders.Google Scholar
Kuriya, M., Yennurajalingam, S., de la Cruz, M. G., et al. (2015). Frequency and factors associated with falls in patients with advanced cancer presenting to an outpatient supportive care clinic. Palliative & Supportive Care, 13(2), 223–227.Google Scholar
Lévi, F., Dugué, P. A., Innominato, P., et al. (2014). Wrist actimetry circadian rhythm as a robust predictor of colorectal cancer patients survival. Chronobiology International, 31(8), 891–900.Google Scholar
Ma, C. L., Chang, W. P. & Lin, C. C. (2014). Rest/activity rhythm is related to the coexistence of pain and sleep disturbance among advanced cancer patients with pain. Supportive Care in Cancer, 22(1), 87–94.Google Scholar
Mercadante, S., Aielli, F., Adile, C., et al. (2015). Sleep disturbances in patients with advanced cancer in different palliative care settings. Journal of Pain and Symptom Management, 50(6), 786–792.Google Scholar
Morin, C. M. (1993). Insomnia: Psychological Assessment and Management. New York: The Guilford Press.Google Scholar
Mystakidou, K., Parpa, E., Tsilika, E., et al. (2007). The relationship of subjective sleep quality, pain, and quality of life in advanced cancer patients. Sleep, 30(6), 737–742.Google 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), 46–53.Google Scholar
Mystakidou, K., Clark, A. J., Fischer, J., et al. (2010). Treatment of chronic pain by long-acting opioids and the effects on sleep. Pain Practice, 11(3), 282–289.Google Scholar
Norusis, M. (2000). Statistical Package for the Social Sciences, Version 13 for Windows. Chicago: SPSS Inc.Google Scholar
Oken, M. M., Creech, R. H., Tormey, D. C., et al. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology, 5(6), 649–655.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(15), 2464–2472.Google Scholar
Qaseem, A., Kansagara, D., Forciea, M. A., et al. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125–133.Google Scholar
Renom-Guiteras, A., Planas, J., Farriols, C., et al. (2014). Insomnia among patients with advanced disease during admission in a palliative care unit: A prospective observational study on its frequency and association with psychological, physical and environmental factors. BMC Palliative Care, 13(1), 40. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135052/.Google Scholar
Rohde, P., Lewinsohn, P. M. & Seeley, J. R. (1997). Comparability of telephone and face-to-face interviews in assessing axis I and II disorders. The American Journal of Psychiatry, 154(11), 1593–1598.Google Scholar
Sanna, P. & Bruera, E. (2002). Insomnia and sleep disturbances. European Journal of Palliative Care, 9(1), 8–12.Google Scholar
Senior, A. C., Kunik, M. E., Rhoades, H. M., et al. (2007). Utility of telephone assessments in an older adult population. Psychology and Aging, 22(2), 392–397.Google Scholar
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), 761–769.Google Scholar
Yennurajalingam, S., Tayjasanant, S., Balachandran, D., et al. (2016). Association between daytime activity, fatigue, sleep, anxiety, depression, and symptom burden in advanced cancer patients: A preliminary report. Journal of Palliative Medicine, 19(8), 849–856.Google Scholar