Global prevalence of sleep disturbances among breast cancer survivors: A systematic review with meta-analysis

Global Prevalence of Mental Health Problems Among Cancer Survivors: A Meta-Analysis From 31 Countries

BACKGROUND

With the improvement of medical treatment, the survival rate of cancer patients continues to rise; however, their psychological issues require further management. Currently, there is uncertainty regarding the prevalence of mental health problems among cancer survivors.

OBJECTIVE

To quantitatively summarize the global prevalence of mental health problems in cancer survivors.

METHODS

We searched CINAHL, PsychlNFO, Embase, Web of Science, and PubMed for studies reporting the prevalence of various mental health problems in cancer survivors who have survived at least 3 months. Subsequently, stratified analyses were conducted based on study design, region, cancer system, and time since diagnosis. Moreover, meta-regression was utilized to investigate sources of heterogeneity. We used Rstudio software 4.3.0, Stata 17.0 software and metaprop package.

RESULTS

A total of 147 studies involving 135,015 cancer survivors from over 30 countries were identified, primarily focusing on six mental health problems. Among 78 studies addressing anxiety, the prevalence was 24.4% (95% CI: 20.2%-28.8%). Among the 96 studies on depression, the prevalence was 23.7% (95% CI: 20.1%-27.4%). In the case of sleep disorders, 42 studies reported a prevalence of 34.1% (95% CI: 27.9%-40.6%). The overall prevalence decreased over time since diagnosis. Most of the analyzed data exhibited significant heterogeneity (I2 > 75%).

CONCLUSION

The analysis indicated that cancer survivors experience a diverse range of mental health problems, which were prevalent among them. The results emphasized the importance of recognizing and treating mental health problems in cancer survivors and served as a reminder for healthcare workers to address mental health problems in this population. The registration number was CRD42023466209.

Care process for breast cancer patients with sleep disturbances: a best practice implementation project

INTRODUCTION

Patients with breast cancer are 50% more likely to experience sleep disturbances during treatment. Sleep disturbances may affect physiological and psychological functions and even induce cancer recurrence. Screening, assessment, and management of sleep disturbances improves sleep quality in breast cancer patients.

OBJECTIVES

This project aimed to establish a care process for breast cancer patients with sleep disturbances in a cancer ward.

METHODS

The project was implemented using the JBI Evidence Implementation Framework, which is grounded in audit and feedback. A baseline audit examined the existing care for sleep disturbances in breast cancer patients undergoing chemotherapy. Eight criteria were applied to evaluate compliance with best practice recommendations. A JBI Getting Research into Practice (GRiP) analysis was conducted, and five barriers to recommended practices were identified. Fourteen improvement strategies were then implemented and a follow-up audit was conducted to measure changes in practice.

RESULTS

The baseline audit showed that the sleep screening rate was 71% (Criterion 1). However, for the remaining criteria (2-8), the compliance rate was 0%. After project implementation, all criteria improved. Thus, 100% of nurses received education on sleep disturbance; the screening rate increased to 90%; 100% of screened patients received comprehensive sleep assessment; and 100% of assessed patients received tailored, multimodal sleep management based on their assessment results.

CONCLUSIONS

This project improved compliance with evidence-based practices in caring for breast cancer patients with sleep disturbances. Process orientation, interdisciplinary collaboration, and leadership contributed to project success. Further studies in digitalized sleep assessment are needed to ensure the efficiency and sustainability of sleep care.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A300.

Sleep quality and risk of obstructive sleep apnea among breast cancer survivors with and without lymphedema

PURPOSE

Breast cancer survivors (BCSs) tend to have sleep disturbances such as obstructive sleep apnea (OSA). However, limited evidence exists on the role of breast cancer-related lymphedema (BCRL) in sleep disturbances and OSA. Therefore, this study aimed to investigate the quality of sleep (QoS) and OSA risk among women with and without BCRL.

METHODS

The quality of life (QoL) was evaluated using the SF-12 and EORTC-QLQ C-30 questionnaires, while their sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The STOP-bang questionnaire (SBQ) was utilized to quantify OSA risk. Sleepiness was assessed using the Epworth Sleepiness Scale (ESS). Also, neck and waist circumference and the excessive volume in the affected limb were measured using a tape measure. The statistical analyses were performed using the SPSS 21.0 software.

RESULTS

Seventy-one women with BCRL and 84 BCS without lymphedema were included. The comparison of PSQI, SBQ, ESS, SF-12, and EORTC QLQ-C30 questionnaires exhibited no significant difference between these two groups. The overnight snoring and average neck circumference were significantly higher in the BCRL group than in the control. The BCRL stage significantly correlated with neck circumference and SBQ total score. Additionally, the mean volume difference indicated a significant correlation with the ESS total score and both physical and mental summary components of the SF-12 questionnaire.

CONCLUSION

The prevalence of sleep disturbances among BCSs with and without BCRL is high. Women with advanced stages of BCRL might be at high risk for OSA. Therefore clinical evaluation of BMI, neck circumference, and, snoring overnight should be emphasized among this population.

Effect of auricular acupressure on sleep quality in breast cancer patients: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND PURPOSE

Sleep disturbance is a very common problem among breast cancer patients, and auricular acupressure is a non-pharmacologic intervention to improve the sleep quality. This study aimed to investigate the effectiveness and safety of auricular acupressure to improve sleep quality in breast cancer patients.

METHODS

Overall, 8 electronic databases in English and Chinese were systematically searched from inception to August 12, 2023 to identify eligible randomized controlled trials (RCTs). The risk of bias was assessed by version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2.0).

RESULTS

A total of 16 studies with 1199 participants were included. The synthesized results showed that compared with the control group, auricular acupressure had a significant effect on improving the effective rate of sleep quality improvement in patients with breast cancer (risk ratio [RR] 1.56, 95 % confidence interval [CI] 1.14 to 2.14; P < 0.001), and that significantly reduced the Pittsburgh Sleep Quality Index (PSQI) global score (mean difference [MD] -3.47, 95 % CI -4.37 to -2.58; P < 0.001). Subgroup analysis of effective rate and PSQI score showed similar significant effects. Additionally, the improvement of sleep quality was better when auricular acupressure was performed by nurses using Vaccaria seeds. Furthermore, the optimal intervention program was performed 1-2 times a day, 3-5 min each time, and lasted for 2-4 weeks.

CONCLUSION

Auricular acupressure may effectively improve the sleep quality of patients with breast cancer. However, more rigorously designed, large-sample, multi-center RCTs are required to further validate the results.

Prevalence of sleep disturbances in endometriosis patients: a systematic review and meta-analysis

Objective

This study systematically analyzes the prevalence of sleep disturbance in patients with endometriosis.

Methods

The PubMed, Web of Science, Embase, Wanfang, China National Knowledge Internet Database (CNKI), China Science and Technology Journal Database were searched from their establishment to January 2024, using the search terms endometriosis and sleep disturbance to collect relevant literature on the prevalence of sleep disturbance in patients with endometriosis. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias. The prevalence of sleep disorders in patients with endometriosis was systematically analyzed using Stata17.0 software.

Results

Sixteen studies with 2573 participants were included. The prevalence of sleep disturbance in patients with endometriosis was 70.8% (95% confidence interval: 60.7%~80.9%). The said prevalence was higher in China than in Iran and the European countries (78.2 vs. 57.6 vs. 64.4, Q=9.27, P=0.010) and increased significantly since 2018 (79.0 vs. 61.3, Q=3.97, P=0.046). This prevalence was significantly higher in the cohort study than that in cross-sectional and case-control studies (84.0 vs. 74.0 vs. 59.5, Q=7.16, P=0.028).

Conclusion

The prevalence of sleep disturbance is high in patients with endometriosis, particularly in China and its prevalence has increased significantly in recent years. Appropriate interventions are recommended to effectively prevent or minimize sleep disturbances in patients with endometriosis.

Global prevalence of poor sleep quality in cancer patients: A systematic review and meta-analysis

OBJECTIVE

Poor sleep quality is common in patients with cancer, but the prevalence rates varied widely across studies. This systematic review and meta-analysis examined the pooled prevalence of poor sleep quality among patients with cancer.

METHODS

Systematic literature searches were independently conducted in the major databases (Web of Science, PubMed, EMBASE and PsycINFO). Studies that reported the prevalence of poor sleep quality in patients with cancer were analyzed using a random effects model. Funnel plots and Egger's tests were used to assess publication bias. Statistical analyses were performed using R software.

RESULTS

A total of 59 epidemiological studies involving 16,223 patients were included. The pooled prevalence of poor sleep quality in patients with cancer was 57.4% [95% confidence interval (CI): 53.3% - 61.6%]. Additionally, three comparative studies with 372 patients and 412 healthy controls were included. Compared to healthy controls, patients with cancer had a significantly higher risk for poor sleep quality [odd ratio (OR) = 3.0; 95%CI: 1.2-7.2; P < 0.05]. Subgroup analyses of the studies revealed that studies from Middle East & North Africa region and low income countries, and on gynecological cancer as well as those with a lower cut-off value of sleep quality (all P < 0.01) reported a higher prevalence of poor sleep quality. Meta-regression analyses showed that higher prevalence of poor sleep quality was associated with higher prevalence of comorbid depression (P < 0.05) and anxiety (P < 0.01), but was associated with a lower education level (P < 0.05) and alcohol use ratio (P < 0.05).

CONCLUSION

Poor sleep quality is common among patients with cancer. Considering the overall high prevalence rate and negative impact of poor sleep quality, appropriate measures to identify and improve poor sleep quality are needed to enhance the clinical outcomes in this group.