Longitudinal Analysis of Sleep Disturbance in Breast Cancer Survivors

Comparing the experiences of cancer survivors living with sleep disturbances between differing levels of psychological distress: a qualitative study

BACKGROUND

Psychological distress often co-occurs with sleep disturbances; but the specific mechanisms linking the two remain unclear. A qualitative study explored perceptions and factors associated with sleep disturbances in cancer survivors between patients with varying levels of psychological distress.

METHODS

Thirty-three Cantonese speaking mixed type cancer survivors were recruited from a community cancer care program. Participants that scored > 5 on the Pittsburgh Sleep Quality Index and had non-clinical or borderline to clinical levels of psychological distress underwent semi-structured interviews. Interviews were analyzed using grounded theory.

RESULTS

Common triggers of sleep disturbances included unresolved treatment side-effects, intrusive thoughts about cancer and fear of cancer recurrence or progression, poor sleep hygiene and a lack of routine. Those with higher levels of distress exhibited more worry about recovery after cancer. Further, they engaged in thought suppression and experienced meta-worry about negative emotions and worry of poor sleep impacting recovery and cancer progression. They commonly exhibited high sleep reactivity and were observed to have limited social support. In contrast, those with low distress adopted better adaptive mechanisms, including a changed commitment to prioritizing health and positive reappraisal of their recovery progress. Self-distraction was used to cope with sleep disturbances and they had fewer expectations of good sleep quality.

CONCLUSIONS

Findings provided insights into the suitability of interventions for patients with sleep disturbances. Interventions targeting maladaptive emotion-focused coping may be more effective in addressing sleep disturbances in cancer survivors with higher distress. Interventions adopting a stepped-care approach may be advantageous in managing sleep disturbances by catering for varying levels of distress.

Current evidence supporting associations of DNA methylation measurements with survivorship burdens in cancer survivors: A scoping review

INTRODUCTION

Identifying reliable biomarkers that reflect cancer survivorship symptoms remains a challenge for researchers. DNA methylation (DNAm) measurements reflecting epigenetic changes caused by anti-cancer therapy may provide needed insights. Given lack of consensus describing utilization of DNAm data to predict survivorship issues, a review evaluating the current landscape is warranted.

OBJECTIVE

Provide an overview of current studies examining associations of DNAm with survivorship burdens in cancer survivors.

METHODS

A literature review was conducted including studies if they focused on cohorts of cancer survivors, utilized peripheral blood cell DNAm data, and evaluated the associations of DNAm and survivorship issues.

RESULTS

A total of 22 studies were identified, with majority focused on breast (n = 7) or childhood cancer (n = 9) survivors, and half studies included less than 100 patients (n = 11). Survivorship issues evaluated included those related to neurocognition (n = 5), psychiatric health (n = 3), general wellness (n = 9), chronic conditions (n = 5), and treatment specific toxicities (n = 4). Studies evaluated epigenetic age metrics (n = 10) and DNAm levels at individual CpG sites or regions (n = 12) for their associations with survivorship issues in cancer survivors along with relevant confounding factors. Significant associations of measured DNAm in the peripheral blood samples of cancer survivors and survivorship issues were identified.

DISCUSSION/CONCLUSION

Studies utilizing epigenetic age metrics and differential methylation analysis demonstrated significant associations of DNAm measurements with survivorship burdens. Associations were observed encompassing diverse survivorship outcomes and timeframes relative to anti-cancer therapy initiation. These findings underscore the potential of these measurements as useful biomarkers in survivorship care and research.

Does use of health behaviours to cope with stress predict sleep impairment in trauma-exposed community adults?

Individuals who have been exposed to trauma experience high levels of sleep impairment. Given the well-established negative effects of stress on sleep, the ways in which trauma-exposed individuals cope with stress is likely to be associated with their sleep. This study examined how the use of health behaviours (i.e., exercise, comfort eating, and maintaining a self-care routine) to cope relate to sleep impairment in a community sample of trauma-exposed adults (N = 84, mean age = 35.1, 83% female). We also tested whether use of health behaviours to cope moderates the relationship between psychological distress and sleep impairment. Results demonstrate that exercise and maintaining a self-care routine to cope are associated with less sleep impairment, while comfort eating to cope is associated with greater sleep impairment. Further, comfort eating to cope moderated the relationship between distress and sleep impairment. Findings suggest that the use of health behaviours to cope is differentially associated with sleep impairment, which has important clinical and research implications for the health of trauma-exposed adults.

A qualitative study of sleep in young breast cancer survivors: "No longer able to sleep through the night"

Sleep disturbance is common among women with breast cancer and is associated with greater symptom distress and poorer outcomes. Yet, for the unique subgroup of young women with breast cancer (YWBC), there is limited information on sleep. To address the gap in our understanding of sleep health in YWBC, we explored their perspective on sleep quality, sleep changes over time, contributing factors, and any strategies used to promote sleep. As part of an explanatory sequential mixed method study, we recruited a sub-sample of 35 YWBC (≤ 50 years of age at the time of diagnosis) from the larger quantitative study phase. These participants were within the first 5 years since diagnosis and completed primary and systemic adjuvant therapy. We conducted virtual semi-structured interviews, transcribed them verbatim, and analyzed data with an interpretive description approach. YWBC experience difficulty falling asleep, waking up at night, and not feeling refreshed in the morning. They attributed interrupted sleep to vasomotor symptoms, anxiety/worry, ruminating thoughts, everyday life stressors, and discomfort. The sleep disturbance was most severe during and immediately after treatment but persisted across the 5 years of survivorship. The participants reported trying pharmacologic and non-pharmacologic strategies to improve the quantity and quality of their sleep. Future research would benefit from longitudinal designs to capture temporal changes in sleep and develop interventions to improve sleep health. Clinically, assessment of sleep health is indicated for YWBC related to the prevalence of disturbed sleep. IMPLICATIONS FOR CANCER SURVIVORS: Early access to sleep assessment and management, ideally before cancer treatment, would be beneficial for young breast cancer survivors. In addition, cancer treatment plans should include physical and psychological symptoms, especially those reported by women in this study: vasomotor symptoms, anxiety and worry, discomfort, and pain.

Early change in fatigue, insomnia, and cognitive impairment and symptom severity 3 years post-treatment in breast cancer survivors

PURPOSE

Breast cancer is the most common form of cancer among Canadian women. Survivorship challenges include fatigue, sleep disturbance, and cognitive impairment. This study examined (1) symptom trajectory from diagnosis to 3 years; (2) whether symptom change in the first 4 months was associated with prolonged difficulties after 3 years; and (3) which factors were associated with deterioration in symptoms during the first 4 months.

METHODS

This prospective observational cohort study examined 53 women (Mage = 58.6, 96.2% White, 67.9% stage I) with newly diagnosed breast cancer over 3 years. Women completed assessments before starting treatment, 4 months, and 3 years after diagnosis. Three-way repeated-measures ANOVAs evaluated symptom trajectories. A repeated-measures mediation analysis was performed to determine if change from pre-treatment to 4 months accounted for change from pre-treatment to 3 years. A series of between-subjects ANOVAs were used to determine what variables significantly differed by deterioration status.

RESULTS

Perceived cognitive impairment and fatigue increased linearly from diagnosis to 3 years. Change in fatigue in the first 4 months fully accounted for its change over 3 years. Insomnia severity and sleep quality deteriorated from diagnosis to 4 months, but returned to pre-treatment levels at 3 years. Those whose fatigue and cognitive ability deteriorated during the first 4 months were younger.

CONCLUSION

Efforts to identify those who are at risk of experiencing fatigue, sleep disturbance, and cognitive impairment; monitor patients early after receiving a diagnosis; and provide targeted interventions may prevent long-term deterioration and improve well-being.

Chinese Medicines Treatment for Sleep Disturbance in Breast Cancer Survivors: A Network Meta-Analysis

BACKGROUND

Sleep disturbance and insomnia are common adverse events in patients with breast cancer (BC). Traditional Chinese Medicine (TCM) treatment for sleep disturbance includes acupuncture, acupressure, auricular acupressure/auricular acupuncture, and Qigong. However, the specific efficacy of these TCM treatment remains unclear.

MATERIALS AND METHODS

This systematic review and network meta-analysis (NMA) investigated the effects of various TCM treatment on improving sleep quality in BC survivors.

METHODS

Only randomized controlled trials (RCTs) reporting the results of TCM treatments were included. The main NMA included 12 RCTs involving 1011 participants. The risk of bias was assessed using the RoB 2 tool for randomized controlled trials. The certainty of evidence of the NMA was assessed in accordance with GRADE (the Grading of Recommendations, Assessment, Development, and Evaluations).

RESULTS

Acupressure, acupuncture, auricular acupuncture/auricular acupressure, and qigong were identified as optimal TCM treatment (P < .05) for enhancing sleep quality in BC survivors.

CONCLUSION

Our results provide some evidence that TCM treatment, particularly acupressure, can be beneficial in improving sleep quality in BC survivors. However, larger-scale clinical trials with robust methodological designs are required to validate and extend our findings.

Impact of the CALM intervention on breast cancer patients during the COVID-19 pandemic

OBJECTIVE

The COVID-19 outbreak has adversely affected breast cancer patients both physically and mentally. Managing Cancer and Living Meaningfully (CALM) is a psychological intervention that is easy to implement. It also decreases the possibility of virus transmission because it can be administered online. Therefore, this study investigated the effects of CALM on the sleep quality, memory, psychological distress, and quality of life (QoL) of breast cancer patients during the ongoing COVID-19 pandemic.

METHODS

Sixty breast cancer patients were recruited and randomly assigned to a CALM group and a Care as Usual (CAU) group. They filled in questionnaires before and after the CALM intervention and CAU. These included the Sleep Quality Scale (SQS), Prospective Memory Scale (PM), Retrospective Memory Scale (RM), Psychological Distress Thermometer (DT), and Quality of life (QoL) Scale.

RESULTS

The scores of all the aforementioned scales after the CALM intervention (ACM) were significantly lower compared to the said scores before the CALM intervention (BCM) and after Care as Usual (ACU) (t = 12.369/8.013, t = 8.632/4.583, t = 7.500/6.900, t = 12.479/9.780, t = 12.224/6.729 respectively, P < 0.05) There was a linear correlation between the QoL, DT, and SQS scores.

CONCLUSION

CALM is an effective psychotherapy for breast cancer patients, especially during the COVID-19 pandemic, for improving the QoL because it relieves psychological distress and enhances sleep quality.