Sleep Behavior and Sleep Regulation from Infancy through Adolescence: Normative Aspects

Symptom clusters in children and adolescents receiving cisplatin, doxorubicin, or ifosfamide

PURPOSE/OBJECTIVES

To examine the influence of the proposed symptom cluster of fatigue, nausea and vomiting, and sleep disturbances on clinical outcomes defined as behavior changes, depression, and performance status in children and adolescents before and after receiving cisplatin, doxorubicin, or ifosfamide chemotherapy.

DESIGN

A prospective, descriptive, within-group, before-and-after-chemotherapy design was used.

SETTING

Two major childhood cancer treatment hospitals in the United States.

SAMPLE

67 patients aged 7-18 years who were receiving chemotherapy courses of cisplatin, doxorubicin, or ifosfamide.

METHODS

Fatigue, depression, behavior, and performance assessments were completed on the first day of cisplatin, doxorubicin, or ifosfamide therapy and one week later. Patients wore a wrist actigraph on the nondominant hand during the course of therapy and for 48 hours after discharge from the hospital. Nausea and vomiting were measured every 24 hours during the course of therapy and for 48 hours after discharge. A linear mixed model was used to evaluate the influence of the symptom cluster. Regression analysis was used to examine the associations between performance status and the symptom cluster. Principal component analysis with varimax rotation was used to produce the correlation of sleep symptoms.

MAIN RESEARCH VARIABLES

Fatigue, nausea and vomiting, sleep disturbances, behavior, depression, and performance.

FINDINGS

Adolescents with the cluster of increased fatigue and sleep disturbances experienced more depressive symptoms and behavior changes. Children with higher levels of fatigue had increased depressive symptoms. The more fatigue parents perceived in their children or adolescents, the more behavior and emotional difficulties were reported.

CONCLUSIONS

Fatigue, sleep disturbance, and nausea and vomiting, when clustered, impacted depressive symptoms and behavior changes in adolescents after chemotherapy. In children, fatigue alone impacted depressive symptoms and behavior changes.

IMPLICATIONS FOR NURSING

Symptom clusters can have a significant impact on children's and adolescents' quality of life during cancer treatment. Early recognition and intervention for these symptoms are an important nursing role.

Sleep in children with cancer

PURPOSE OF REVIEW

Advances in cancer treatment have improved the 5-year survival rate for childhood cancers to over 78%, resulting in a large population of pediatric cancer survivors. There is increasing recognition that sleep intersects with cancer through the circadian control of the cell cycle and that sleep problems are one of the 'effects' of cancer, its treatments, or both. Recognition of these intersections will facilitate new areas of treatment and the use of proven clinical interventions for sleep problems in cancer survivors.

RECENT FINDINGS

Discoveries in circadian biology have revealed that the biologic clocks, which control sleep/wake rhythms, are present in all cells and exert considerable control over the cell cycle. This has opened new opportunities for improving efficacy, decreasing toxicity, or both of cancer therapy through circadian timing of chemotherapy. Excessive daytime sleepiness has emerged as one of the most common, but often unrecognized, sleep symptoms in cancer survivors.

SUMMARY

Sleep complaints are especially common in survivors of childhood cancer who have sustained an injury to the hypothalamus or brainstem, have evidence of endocrine dysfunction, are obese, or have been treated with cranial radiation. If recognized and treated appropriately, sleep problems can be successfully managed.