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Jeon MS, Allcroft P, Brown LR, Currow D, Kochovska S, Krishnan A, Webster A, Campbell R. Assessment and Management of Sleep Disturbance in Palliative Care Settings. J Palliat Med 2024; 27:905-911. [PMID: 38466992 DOI: 10.1089/jpm.2023.0537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Background: Sleep disturbances, including insomnia, sleep-disordered breathing, and circadian rhythm disorders with potential consequences including excessive daytime somnolence and worsening fatigue, are prevalent yet largely under-measured and therefore under-managed problems in people receiving palliative care. This has the potential to negatively affect the person's functioning and quality of life. Objectives: We aimed to review the current practice of assessment and management of sleep disturbances in people with life-limiting illnesses in Australian and New Zealand palliative care settings, and to define areas for improvement in assessment and management of sleep disturbances and further research. Design: A cross-sectional, online survey was conducted with palliative care health professionals (PCHPs) to explore current approaches to routine assessment of sleep disturbances and PCHPs' awareness of, and perceived access to, evidence-based resources for assessing and managing sleep disturbances in their local settings. Results: Fifty-four PCHPs responded to the survey, including allied health professionals (44%), palliative care nurses (26%), and physicians (19%). Over 70% of PCHPs endorsed routine verbal screening of sleep symptoms, and >90% recommended management with basic behavioral strategies. However, none of PCHPs used validated patient-reported outcome measures for sleep, and <10% of PCHPs demonstrated awareness or use of sleep-specific interventions (including medications). Only 40% reported they had access to sleep specialist services for patients. Conclusion: Our findings provide a useful snapshot of current approaches to managing sleep disturbances in palliative care. Gaps in current practice are highlighted, including the lack of structured, clinical assessment, referral pathways, and PCHPs' perceived lack of access to targeted interventions for sleep disturbances.
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Affiliation(s)
- Megan S Jeon
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Allcroft
- Southern Adelaide Palliative Services, Southern Adelaide Local Health Network and Flinders University, South Australia, Australia
| | - Linda Ruth Brown
- The Palliative Care Clinical Studies Collaborative (PaCCSC) and Cancer Symptom Trials (CST), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Anu Krishnan
- Western Australia Country Health Service and Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Andrew Webster
- Faculty of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Rachel Campbell
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
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Malhotra A, Fransen HP, Quaresma M, Raijmakers N, Versluis MAJ, Rachet B, van Maaren MC, Leyrat C. Associations between treatments, comorbidities and multidimensional aspects of quality of life among patients with advanced cancer in the Netherlands-a 2017-2020 multicentre cross-sectional study. Qual Life Res 2023; 32:3123-3133. [PMID: 37389733 PMCID: PMC10522740 DOI: 10.1007/s11136-023-03460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To investigate associations between quality of life (QoL) and 1) immunotherapy and other cancer treatments received three months before QoL measurements, and 2) the comorbidities at the time of completion or in the year prior to QoL measurements, among patients with advanced cancer. METHODS A cross-sectional study is conducted on patients with advanced cancer in the Netherlands. The data come from the baseline wave of the 2017-2020 eQuiPe study. Participants were surveyed via questionnaires (including EORTC QLQ-C30). Using multivariable linear and logistic regression models, we explored statistical associations between QoL components and immunotherapy and other cancer treatments as well as pre-existing comorbidities while adjusting for age, sex, socio-economic status. RESULTS Of 1088 participants with median age 67 years, 51% were men. Immunotherapy was not associated with global QoL but was associated with reduced appetite loss (odds ratio (OR) = 0.6, 95%CI = [0.3,0.9]). Reduced global QoL was associated with chemotherapy (adjusted mean difference (β) = - 4.7, 95% CI [- 8.5,- 0.8]), back pain (β = - 7.4, 95% CI [- 11.0,- 3.8]), depression (β = - 13.8, 95% CI [- 21.5,- 6.2]), thyroid diseases (β = - 8.9, 95% CI [- 14.0,- 3.8]) and diabetes (β = - 4.5, 95% CI [- 8.9,- 0.5]). Chemotherapy was associated with lower physical (OR = 2.4, 95% CI [1.5,3.9]) and role (OR = 1.8, 95% CI [1.2,2.7]) functioning, and higher pain (OR = 1.9, 95% CI [1.3,2.9]) and fatigue (OR = 1.6, 95% CI [1.1,2.4]). CONCLUSION Our study identified associations between specific cancer treatments, lower QoL and more symptoms. Monitoring symptoms may improve QoL of patients with advanced cancer. Producing more evidence from real life data would help physicians in better identifying patients who require additional supportive care.
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Affiliation(s)
- Ananya Malhotra
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Heidi P Fransen
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Manuela Quaresma
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Natasja Raijmakers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Moyke A J Versluis
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Graduate School of Social & Behavioral Sciences, Universiteit Van Tilburg, Warandelaan 2, 5037 AB, Tilburg, Nederland
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Marissa C van Maaren
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Clémence Leyrat
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Price SN, Hamann HA, Halaby L, Trejo JI, Corella F, Weihs KL. Poor Subjective Sleep Quality Among Patients with Cancer and Comorbid Depression: An Opportunity to Inform Screening and Intervention. Behav Sleep Med 2023; 21:45-60. [PMID: 35098834 DOI: 10.1080/15402002.2022.2033243] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Sleep disturbances are under-identified and under-treated in oncology settings, especially for underserved populations and those with psychiatric comorbidities. This study examined the prevalence and correlates of poor subjective sleep quality as well as clinical sleep recommendations among a socioeconomically and ethnically diverse population of patients with cancer referred for depression management. METHODS Participants were 140 adults with cancer who screened positive for depression through routine, practice-based assessment with the Patient Health Questionnaire (PHQ-9 ≥ 8) and were referred to a study of collaborative care for depression. Demographics, clinical characteristics, subjective sleep quality, and sleep recommendations received were self-reported by patients prior to intervention. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), general health status was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10, and depressive symptoms were measured using the PHQ-9. RESULTS Of 138 patients with complete data, 123 (89.1%) reported poor sleep quality, and 87 (63%) met the threshold for possible insomnia. The strongest correlates of poor subjective sleep were female gender (β = 0.19, p = .02), greater depressive symptom severity (β = 0.28, p = .001), and worse physical health (β = -0.19, p = .04). Of 118 patients reporting problems with sleep since their cancer diagnosis, 95 discussed the issue with a medical provider; medications were recommended most often (37; 38.9%); only 9 (9.5%) received recommendations for cognitive-behavioral therapy for insomnia (CBT-I) or other CBT. CONCLUSIONS Patients with cancer seeking treatment for depression report very high rates of poor subjective sleep quality and insomnia, underscoring the importance of providing and referring to guideline-concordant sleep interventions in oncology supportive care contexts.
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Affiliation(s)
- Sarah N Price
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Heidi A Hamann
- Department of Psychology, University of Arizona, Tucson, Arizona, USA.,Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA.,Departments of Family and Community Medicine and Psychiatry, University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Laila Halaby
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Juanita I Trejo
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, USA
| | - Fernanda Corella
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Karen L Weihs
- Department of Family and Community Medicine, University of Arizona, Tucson, Arizona, USA.,Departments of Family and Community Medicine and Psychiatry, University of Arizona Cancer Center, Tucson, Arizona, USA.,Department of Psychiatry, University of Arizona, Tucson, Arizona, USA
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Effect of Conventional Nursing Combined with Bedtime Oculomotor Training on Sleep Quality and Body Immunity of Advanced Lung Cancer Patients. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4357915. [PMID: 35310178 PMCID: PMC8930206 DOI: 10.1155/2022/4357915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
Abstract
Objective. The aim of this study is to explore the effect of conventional nursing combined with bedtime oculomotor training on sleep quality and body immune of advanced lung cancer patients. Methods. By means of a retrospective study, 120 advanced lung cancer patients admitted to our hospital from January 2019 to January 2020 were selected as the research subject and divided into the intervention group (PSQI (Pittsburgh Sleep Quality Index) score≥10 points, n = 60) and the control group (PSQI score<10 points, n = 60). Conventional nursing was performed to the control group, and an eye movement exercise before sleep was added additionally in the intervention group, 30 min each time, once a day, and 5 times a week for 3 months, so as to compare their sleep quality, body immunity indexes, negative emotion scores, adverse reaction rate (ARR), quality of life, and satisfaction with nursing. Results. After nursing, the intervention group obtained a significantly lower PSQI score (5.54 ± 1.23 VS 7.98 ± 1.65,
), better body immunity indexes (
), lower negative emotion scores (
), lower ARR (
), better quality of life (
), and higher satisfaction with nursing (
) than the control group. Conclusion. Combining conventional nursing with the eye movement exercise before sleep can alleviate negative emotions, improve the sleep quality, promote body immunity, and reduce the ARR, which is more satisfying to patients and should be applied and promoted in practice.
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Effect of Eye Movement Training on Sleep Quality of Patients with Advanced Lung Cancer Based on Pittsburgh Sleep Quality Index. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9811980. [PMID: 34956583 PMCID: PMC8702321 DOI: 10.1155/2021/9811980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022]
Abstract
Objective To explore the effect of eye movement training on sleep quality of patients with advanced lung cancer based on the Pittsburgh Sleep Quality Index (PSQI). Methods 120 advanced lung cancer patients admitted to our hospital from January 2019 to January 2020 were selected as the research object and divided into group A (PSQI scores ≥ 10 points, n = 60) and group B (PSQI < 10 points, n = 60). Routine nursing was performed to both groups, and patients in group A received the eye movement training additionally, so as to compare their PSQI scores, negative emotion scores, adverse reaction rate (ARR), Cancer Coping Modes Questionnaire (CCMQ) scores, and pain scores. Results After training, group A obtained significantly better sleep quality (P < 0.05), lower negative emotion scores (P < 0.001), lower ARR (P < 0.05), better CCMQ scores (P < 0.05), and lower pain scores (P < 0.001) than group B. Conclusion Eye movement training should be promoted in practice because it can reduce negative emotions, alleviate pain sensation, improve sleep quality and body condition, and lower the ARR for advanced lung cancer patients.
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