Sleep, mood, and quality of life in patients receiving treatment for lung cancer

Is poor sleep quality associated with poor neurocognitive outcome in cancer survivors? A systematic review

PURPOSE

Cancer-related neurocognitive impairment and poor sleep are prevalent in cancer survivors and have a negative impact on their quality of life. This systematic review studies the association between sleep disturbance and neurocognitive functioning, as well as the potential positive effects of sleep interventions on neurocognitive functioning in cancer survivors. In addition, we aimed at determining the potential positive effects of sleep interventions on neurocognitive functioning in this population.

METHODS

Following PRISMA guidelines for reporting systematic reviews and meta-analyses, a comprehensive PubMed, Embase, PsycINFO, and CINAHL search was performed. Inclusion criteria were adult cancer survivors, self-reported or objective measures of neurocognitive functioning and sleep quality, or reports on the association between sleep and neurocognitive functioning.

RESULTS

Of the 4,547 records retrieved, 17 studies were retained for this review. Twelve studies were correlational, and five reported on interventions aimed at improving sleep quality. All studies that included self-reported neurocognitive functioning found that poorer sleep was associated with worse neurocognitive functioning. In four out of eight studies, poorer sleep was associated with objective neurocognitive impairment. Three out of five interventional studies showed neurocognitive functioning improved with improved sleep.

CONCLUSIONS

While poor sleep in cancer survivors is associated with self-reported neurocognitive impairment, the association between poor sleep and objective neurocognitive impairment is less evident.

IMPLICATIONS FOR CANCER SURVIVORS

It is important that care providers are aware of the association between sleep and neurocognitive functioning and that improving sleep quality can be a way to decrease neurocognitive impairment in cancer survivors.

Lifestyle factors on the long-term survival of gastric cancer patients after radical resection: A cohort study

Background

This retrospective cohort study aimed to evaluate the effect of lifestyle factors (e.g., smoking, drinking, physical exercise, and sleep duration) on the long-term survival of gastric cancer (GC) patients after radical resection.

Materials and Methods

GC patients after radical resection were enrolled from January 2016 to December 2017. Their baseline clinical data, lifestyle factors, and prognosis were collected. The primary endpoint was all-cause death. The relationship between the variables and survival was examined using the Cox proportional hazards model.

Results

A total of 309 patients were enrolled and 296 patients were followed up for a median of 54.0 months, with 130 confirmed deaths. Older age (>60 years) (hazard ratio [HR]: 1.307, 95% confidence interval [CI]: 1.056-2.161, P = 0.006), advanced tumor, node, and metastasis stage (P < 0.05), poorly pathological differentiation (HR: 1.765, 95% CI: 1.080-2.884, P = 0.023), history of smoking (P < 0.001), never physical exercise (HR: 2.057, 95% CI: 1.170-3.617, P = 0.012), long sleep duration (≥8 h) (HR: 4.160, 95% CI: 1.501-11.533, P = 0.006), and short sleep duration (<6 h) (HR: 3.417, 95% CI: 1.312-8.900, P = 0.012) were independent indicators of a poor overall survival in GC patients after radical resection.

Conclusion

Smoking cessation, proper sleep duration, and regular physical exercise habits can improve the long-term survival of GC patients after radical resection.

Reliability and validity of the cancer-related dysfunctional beliefs and attitudes about sleep scale in cancer patients

BACKGROUND

Insomnia is a common health problem among cancer patients, which is not only a physical problem but also a psychological problem. Sleep plays an important role in the mental and somatic rehabilitation of cancer patients, and the sleep beliefs and attitudes of cancer patients are key factors in improving their sleep situation and quality of life. The aim of this study was to translate the Cancer-Related Dysfunctional Beliefs and Attitudes about Sleep (C-DBAS-14) scale into Chinese and to validate its reliability and validity in cancer patients.

METHOD

The C-DBAS-14 scale was translated into Chinese using the backward and forward translation procedure. The reliability of the scale was measured by internal consistency, split-half reliability and retest reliability. The validity of the scale was assessed through the content validity indicators, exploratory factor analysis and validation factor analysis.

RESULT

The Cronbach's ɑ coefficient of the Chinese version of the C-DBAS-14 was 0.932 while the McDonald's omega coefficient (ω t) was 0.934. The split-half reliability coefficient was 0.908, and the test-retest reliability was 0.857. The four-factor model was obtained using exploratory factor analysis, explaining 72.7% of the variance, with each item loading greater than 0.4 on the common factor. The results of the confirmatory factor analysis revealed that all indicators of model fit were within an acceptable range, indicating a well-fitting model.

CONCLUSION

The Chinese version of the C-DBAS-14 has good reliability and validity among cancer patients. It can be used to measure the sleep beliefs and attitudes of Chinese cancer patients.

A latent profile analysis of resilience and their relation to differences in sleep quality in patients with lung cancer

PURPOSE

Sleep problems are a significant issue in patients with lung cancer, and resilience is a closely related factor. However, few studies have identified subgroups of resilience and their relationship with sleep quality. This study aimed to investigate whether there are different profiles of resilience in patients with lung cancer, to determine the sociodemographic characteristics of each subgroup, and to determine the relationship between resilience and sleep quality in different subgroups.

METHODS

A total of 303 patients with lung cancer from four tertiary hospitals in China completed the General Sociodemographic sheet, the Connor-Davidson Resilience Scale, and the Pittsburgh Sleep Quality Index. Latent profile analysis was applied to explore the latent profiles of resilience. Multivariate logistic regression was used to analyze the sociodemographic variables in each profile, and ANOVA was used to explore the relationships between resilience profiles and sleep quality.

RESULTS

The following three latent profiles were identified: the "high-resilience group" (30.2%), the "moderate-resilience group" (46.0%), and the "low-resilience group" (23.8%). Gender, place of residence, and average monthly household income significantly influenced the distribution of resilience in patients with lung cancer.

CONCLUSION

The resilience patterns of patients with lung cancer varied. It is suggested that health care providers screen out various types of patients with multiple levels of resilience and pay more attention to female, rural, and poor patients. Additionally, individual differences in resilience may provide an actionable means for addressing sleep problems.

A proposed multi-domain, digital model for capturing functional status and health-related quality of life in oncology

Whereas traditional oncology clinical trial endpoints remain key for assessing novel treatments, capturing patients' functional status is increasingly recognized as an important aspect for supporting clinical decisions and assessing outcomes in clinical trials. Existing functional status assessments suffer from various limitations, some of which may be addressed by adopting digital health technologies (DHTs) as a means of collecting both objective and self-reported outcomes. In this mini-review, we propose a device-agnostic multi-domain model for oncology capturing functional status, which includes physical activity data, vital signs, sleep variables, and measures related to health-related quality of life enabled by connected digital tools. By using DHTs for all aspects of data collection, our proposed model allows for high-resolution measurement of objective data as patients navigate their daily lives outside of the hospital setting. This is complemented by electronic questionnaires administered at intervals appropriate for each instrument. Preliminary testing and practical considerations to address before adoption are also discussed. Finally, we highlight multi-institutional pre-competitive collaborations as a means of successfully transitioning the proposed digitally enabled data collection model from feasibility studies to interventional trials and care management.

Sleep dysfunction associated with worse chemotherapy-induced peripheral neurotoxicity functional outcomes

PURPOSE

Sleep problems are commonly reported by cancer survivors; however, knowledge of the impact of chemotherapy-induced peripheral neurotoxicity (CIPN) on sleep quality remains limited. In this study, we explored the impact of CIPN on sleep quality, as well as identified clinical characteristics associated with poor sleep quality.

METHODS

Participants were assessed cross-sectionally post-neurotoxic chemotherapy. CIPN severity was graded using a range of questionnaires that assessed CIPN severity and quality of life, as well as neurological grading scales. Sleep quality was assessed using a self-rated questionnaire (Pittsburgh Sleep Quality Index, PSQI). Participants with poor sleep quality were further grouped according to whether sleep impairment was due to CIPN or other factors.

RESULTS

Among 77 participants who reported CIPN, 75% (n = 58) reported poor sleep quality. Of those, 41% (n = 24) reported CIPN as contributing to sleep impairment, while 59% (n = 34) reported other causes. Participants with CIPN-induced sleep impairments had higher CIPN severity across all outcome measures, as well as greater neuropathic pain (all p < 0.05). Furthermore, participants with CIPN-induced sleep impairments reported worse impact of neuropathy on physical and social functioning, as well as emotional well-being (all p < 0.05).

CONCLUSIONS

Participants with CIPN-induced poor sleep quality reported worse scores across all CIPN severity measures. This emphasises the negative impacts of CIPN symptoms on quality of life of chemotherapy-treated patients and highlights the importance of sleep quality assessment in cancer survivors.

Circadian rhythm disorders in patients with advanced cancer: a scoping review

Circadian rhythms can be demonstrated in several biomarkers and behavioural activities, with rhythmical patterns occurring roughly over a 24-h period. Circadian disorders occur in patients with cancer and may be associated with poor clinical outcomes. This scoping review aimed to identify circadian rhythm research and reporting practices, circadian rhythm patterns, circadian rhythm disorders, and relevant associations of circadian rhythm disorders in patients with advanced cancer. Studies involved adult patients with locally advanced or metastatic cancer and used objective measures of circadian rhythmicity. Two independent authors completed initial screening of title and abstracts, full text reviews, data extraction, and data checking. A total of 98 articles were highlighted in the scoping review, which utilised physical activity measures (actigraphy and polysomnography), biomarkers (cortisol and melatonin), or a combination. Several circadian rhythms are commonly disordered amongst patients with advanced cancer and have significant implications for symptom burden, quality of life, and survival. It remains unclear which patients are most at risk of a circadian rhythm disorder. Significant heterogeneity exists in research and reporting practices. Standardising this approach may address discrepancies in the current literature and allow for research to focus on the most relevant parameters and approaches to improving circadian rhythmicity.

Data-Driven Personalized Care in Lung Cancer: Scoping Review and Clinical Recommendations on Performance Status and Activity Level of Patients With Lung Cancer Using Wearable Devices

PURPOSE

Performance status (PS) is a crucial assessment for research and clinical practice in lung cancer (LC), including its usage for the assessment of the suitability and toxicity of treatment or eligibility for clinical trials of patients with LC. These PS assessments are subjective and lead to substantial discrepancies between observers. To improve the objectivity of PS assessments, Electronic Activity Monitoring devices (EAMs) are increasingly used in oncology, but how these devices are used for PS assessments in LC is an issue that remains unclear. The goal of this study is to address the challenges and opportunities of the use of digital tools to support PS assessments in patients with LC.

METHODS

The literature review followed PRISMA-ScR methodology. Searches were performed in the ScienceDirect, PsycInfo, ACM, IEEE Xplore, and PubMed databases. Furthermore, a panel discussion was performed to address the clinical use cases.

RESULTS

Thirty-two publications were found. Most of the studies used wrist accelerometry-based wearables (59%) and monitored sleep activity (SA; 28%) or physical activity (PA; 72%). Critical findings include positive usefulness of the use of wearables to categorize moderate-to-vigorous/light PA, which was associated with better sleep and health. In addition, steps and time awake immobile were found to be associated with risk of hospitalization and survival. Use cases identified included the health assessment of patients and clinical research.

CONCLUSION

There are positive experiences in the use of EAM to complement PS assessment in LC. However, there is a need for adapting thresholds to the particularities of patients with LC, for example, differentiating moderate-to-vigorous and light. Moreover, developing methodologies combining PS assessments and the use of EAM adapted to clinical and research practice is needed.

Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement

Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel's initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors.

Protocol of a dyadic sleep intervention for adult patients with cancer and their sleep-partner caregivers

Background

Sleep disturbance is common and problematic among both patients with cancer and their sleep partner caregivers. Although 70% of the general adult population sleep in the same bed with a significant other, as do adult cancer patients and their spousal/partner caregivers, and one's sleep affect the partner's sleep, existing psychobehavioral interventions have targeted patients' and caregivers' sleep problems independently.

Methods

We developed a new sleep intervention, My Sleep Our Sleep (MSOS), for both adult patients with cancer and their sleep-partner caregivers together. This protocol is to test the feasibility and acceptability as well as to provide preliminary efficacy of the MSOS intervention, which is a dyadic intervention designed to reduce sleep disturbance and improving sleep quality of both adult cancer patients and their sleep-partner caregivers (dyads). The intervention will be delivered weekly for 4 weeks. Questionnaire and daily sleep logs will be collected at baseline (T1) and one-week after conclusion of the intervention (T2). Satisfaction with the intervention will be assessed weekly for 4 weeks.

Results

We estimate 43 dyads be enrolled (43 patients and 43 sleep-partner caregivers). We expect >75% of eligible and screened dyads will enroll within the enrollment period, >80% of enrolled dyads will complete the intervention, and >80% of participants will report satisfaction across all acceptability measures. We also expect MSOS will reveal a small-to-medium effect on sleep efficiency (primary outcome), overall sleep disturbance, subjective sleep quality, and insomnia severity (secondary outcomes).

Conclusions

Results will inform the feasibility and acceptability of conducting a dyadic sleep intervention, and provide preliminary efficacy data to guide further refinement of the intervention content and procedure for adult patients with cancer and their sleep-partner caregivers.

Trial registration

NCT04712604 Clinicaltrials.gov.

Association between the self-reported duration and quality of sleep and cognitive function among middle-aged and older adults in China

BACKGROUND

The World Alzheimer Report showed that 46.8 million people suffered from dementia in 2015. This study examined how the duration and quality of sleep are associated with cognition among older adults in China.

METHOD

Data were drawn from waves 2011, 2013, and 2015 of the China Health and Retirement Longitudinal Study (CHARLS), including noninstitutionalized adults aged 45 and older (n=10,768). Cognition was measured by interview-based assessments of mental status (TICS-10), episodic memory, and visuospatial abilities. Sleep duration was categorized as long, medium, or short and sleep quality was categorized as good, fair, or poor.

RESULTS

Sleep duration had an inverted U-shape relationship with cognitive scores (P <.001); and sleep quality had a positive linear relationship with cognitive scores (P <.001). Short and long sleep durations were associated with consistently lower cognition scores with increasing age (both P <.001); and fair and poor quality of sleep were associated with consistently lower levels of cognition (both P <.001). Tests of interactions between sleep duration and sleep quality showed that participants reporting long durations of sleep with poor quality of sleep had the lowest overall cognitive scores.

LIMITATIONS

Self-reported methods were used to measure sleep quality and duration and thus our findings underscore the need for more evidence-based research to improve prevention efforts and tailor interventions to reduce cognitive decline among Chinese older adults.

CONCLUSIONS

Suboptimal sleep duration and quality were associated with poor cognition. Cognitive scores were lowest among those who reported long durations of sleep that were of poor quality.

Chronodisruption and Ambulatory Circadian Monitoring in Cancer Patients: Beyond the Body Clock

Purpose of Review

Circadian rhythms impose daily rhythms a remarkable variety of metabolic and physiological functions, such as cell proliferation, inflammation, and DNA damage response. Accumulating epidemiological and genetic evidence indicates that circadian rhythms’ disruption may be linked to cancer. The integration of circadian biology into cancer research may offer new options for increasing cancer treatment effectiveness and would encompass the prevention, diagnosis, and treatment of this disease.

Recent Findings

In recent years, there has been a significant development and use of multi-modal sensors to monitor physical activity, sleep, and circadian rhythms, allowing, for the very first time, scaling accurate sleep monitoring to epidemiological research linking sleep patterns to disease, and wellness applications providing new potential applications.

Summary

This review highlights the role of circadian clock in tumorigenesis, cancer hallmarks and introduces the state-of-the-art in sleep-monitoring technologies, discussing the eventual application of insights in clinical settings and cancer research.

Sleep and quality of life in lung cancer patients and survivors

BACKGROUND

Lung cancer patients and survivors are vulnerable to disturbed sleep and impaired quality of life (QOL) across the continuum of illness. Few studies have sought to identify predictors of QOL using well-validated measures of both sleep quality and QOL in this population.

PURPOSE

The purpose of this study was to examine factors associated with lung cancer that are predictive of QOL in adult lung cancer patients and survivors in the outpatient setting.

METHOD

Cross-sectional data collected exclusively in the outpatient setting from three lung cancer clinics in the Northeastern United States were pooled and analyzed. The pooled sample (N = 103) data included cancer type and stage, body mass index, Pittsburgh Sleep Quality Index, and Functional Assessment of Cancer Treatment-Lung information.

RESULTS

Significant correlations between sleep quality, lung cancer symptom severity, and QOL were observed. Sleep quality and lung cancer symptoms were found to be statistically significant predictors of QOL. No significant differences in QOL were found based on cancer type or recruitment source. Demographic factors and cancer stage were also not predictive of overall QOL.

CONCLUSIONS

Lung cancer symptoms and sleep quality were important determinants of QOL in this pooled sample of lung cancer patients and survivors.

IMPLICATIONS FOR PRACTICE

Patients and survivors of lung cancer require routine screening for sleep disturbance, lung cancer symptoms, and QOL needs. Nurse practitioners can help improve QOL in this population by screening for and treating sleep disturbance and lung cancer symptoms.

Sleep Quality among Breast and Prostate Cancer Patients: A Comparison between Subjective and Objective Measurements

Breast and prostate cancer patients may experience physical and psychological distress, and a possible decrease in sleep quality. Subjective and objective methods measure different aspects of sleep quality. Our study attempted to determine differences between objective and subjective measurements of sleep quality using bivariate and Pearson's correlation data analysis. Forty breast (n = 20) and prostate (n = 20) cancer patients were recruited in this observational study. Participants were given an actigraphy device (ACT) and asked to continuously wear it for seven consecutive days, for objective data collection. Following this period, they filled out the Pittsburgh Sleep Quality Index Questionnaire (PSQI) to collect subjective data on sleep quality. The correlation results showed that, for breast cancer patients, PSQI sleep duration was moderately correlated with ACT total sleeping time (TST) (r = -0.534, p < 0.05), and PSQI daytime dysfunction was related to ACT efficiency (r = 0.521, p < 0.05). For prostate cancer patients, PSQI sleep disturbances were related to ACT TST (r = 0.626, p < 0.05). Both objective and subjective measurements are important in validating and determining details of sleep quality, with combined results being more insightful, and can also help in personalized care to further improve quality of life among cancer patients.

The Use of Wearables in Clinical Trials During Cancer Treatment: Systematic Review

Background

Interest in the use of wearables in medical care is increasing. Wearables can be used to monitor different variables, such as vital signs and physical activity. A crucial point for using wearables in oncology is if patients already under the burden of severe disease and oncological treatment can accept and adhere to the device. At present, there are no specific recommendations for the use of wearables in oncology, and little research has examined the purpose of using wearables in oncology.

Objective

The purpose of this review is to explore the use of wearables in clinical trials during cancer treatment, with a special focus on adherence.

Methods

PubMed and EMBASE databases were searched prior and up to October 3, 2019, with no limitation in the date of publication. The search strategy was aimed at studies using wearables for monitoring adult patients with cancer during active antineoplastic treatment. Studies were screened independently by 2 reviewers by title and abstract, selected for inclusion and exclusion, and the full-text was assessed for eligibility. Data on study design, type of wearable used, primary outcome, adherence, and device outcome were extracted. Results were presented descriptively.

Results

Our systematic search identified 1269 studies, of which 25 studies met our inclusion criteria. The types of cancer represented in the studies were breast (7/25), gastrointestinal (4/25), lung (4/25), and gynecologic (1/25); 9 studies had multiple types of cancer. Oncologic treatment was primarily chemotherapy (17/25). The study-type distribution was pilot/feasibility study (12/25), observational study (10/25), and randomized controlled trial (3/25). The median sample size was 40 patients (range 7-180). All studies used a wearable with an accelerometer. Adherence varied across studies, from 60%-100% for patients wearing the wearable/evaluable sensor data and 45%-94% for evaluable days, but was differently measured and reported. Of the 25 studies, the most frequent duration for planned monitoring with a wearable was 8-30 days (13/25). Topics for wearable outcomes were physical activity (19/25), circadian rhythm (8/25), sleep (6/25), and skin temperature (1/25). Patient-reported outcomes (PRO) were used in 17 studies; of the 17 PRO studies, only 9 studies reported correlations between the wearable outcome and the PRO.

Conclusions

We found that definitions of outcome measures and adherence varied across studies, and limited consensus among studies existed on which variables to monitor during treatment. Less heterogeneity, better consensus in terms of the use of wearables, and established standards for the definitions of wearable outcomes and adherence would improve comparisons of outcomes from studies using wearables. Adherence, and the definition of such, seems crucial to conclude on data from wearable studies in oncology. Additionally, research using advanced wearable devices and active use of the data are encouraged to further explore the potential of wearables in oncology during treatment. Particularly, randomized clinical studies are warranted to create consensus on when and how to implement in oncological practice.

[Analysis of Influencing Factors of Preoperative Anxiety or Depression in Patients with Lung Cancer Surgery]

BACKGROUND

Preoperative anxiety/depression can bring physical and mental harm to the patients with lung cancer. There is little study on whether hospital waiting time before surgery can increase the psychological burden of patients with lung cancer. The aim of this study was to investigate the preoperative anxiety and depression of patients with lung cancer in our hospital, and to analyze the related influencing factors.

METHODS

A total of 135 lung cancer inpatients in the Department of Thoracic Surgery of Beijing Friendship Hospital were studied. Their general information and anxiety/depression were recorded by general questionnaire, Zung self-rating anxiety scale (SAS) and self-rating depression scale (SDS).

RESULTS

The score of SAS was 36.25 (30.00, 42.50) on the day of admission, and 37.50 (31.25, 43.75) on one day before operation. The score of self-rating depression scale (SDS) was 46.25 (40.00, 52.50) on the day of admission, and 47.50 (41.25, 53.75) on one day before operation. Compared with the Chinese norm, there were 0 patient suffered from anxiety on the day of admission, and one day before operation. There were 2 patients suffered from mild anxiety; 6 patients suffered from mild depression on the day of admission, and this number went up to 8 on the day before operation. Single factor analysis showed that the hospital waiting time before surgery was positively correlated with preoperative anxiety and depression, and the results were statistically significant (P<0.05). The generalized linear model analysis showed that other factors such as knowledge, gender, age and marital status had no significant correlation with preoperative anxiety and depression.

CONCLUSIONS

The occurrence of preoperative anxiety in hospitalized patients with lung cancer is positively correlated to the hospital waiting time before surgery. The longer they stayed in the hospital before operation, the greater their risk of anxiety/depression. So medical staff should actively focus on the psychological condition of the patients with lung cancer, and it is strongly recommended that patients complete preoperative examination and preparation in the outpatient department, in order to reduce the waiting time before operation and reduced the risk of adverse psychological problems such as anxiety and depression.

Nurse-Delivered Brief Behavioral Treatment for Insomnia in Lung Cancer Survivors: A Pilot RCT

Objective/Background: Insomnia occurs in 50 to 80% of lung cancer survivors. Cognitive behavioral therapy is the standard treatment for insomnia (CBTI); however, treatment length and lack of psychologists trained in CBTI limits access. Brief Behavioral Treatment for Insomnia (BBTI), a nurse-delivered modified CBTI, is proposed. This feasibility pilot study sought to compare the BBTI intervention to attention control Healthy Eating Program (HEP) for insomnia in lung cancer survivors. Participants: The participants comprised adults, 21 years of age or older with insomnia and stage I/II non-small cell lung cancer, more than 6 weeks from surgery and living in Western NY. Methods: Participants (n = 40) were randomly assigned to an experimental (BBTI) or attention control condition (Healthy Eating Program). Thirty participants completed the study. Results: Participants were 66 years of age (± 7.6; range 53-82), 40% (n = 16) male, 87.5% (n = 35) Caucasian, 50% (n = 20) married, BMI 27.7 (± 5.8), and 12% (n = 5) never smokers. Baseline sleep diary sleep efficiency, ISI and other baseline covariates were balanced between the groups. Sleep efficiency improved ≥85% in BBTI group (p = .02), but not in HEP control group (p = 1.00). Mean ISI for BBTI and attention control were 6.40 ± 4.98 and 14.10 ± 4.48 (p = .001) respectively. In addition, BBTI group mean total FACT-L score improved by 6.66 points from baseline while HEP group score worsened (p = .049). Conclusions: BBTI is a practical, evidence-based, clinically relevant intervention that improved sleep and quality of life in lung cancer survivors with insomnia. Additional research to evaluate efficacy, duration, and implementation strategies are essential.

Further content validation of the 18-item NCCN/FACT Ovarian Symptom Index and its Disease Related Symptom-Physical (DRS-P) subscale for use in advanced ovarian cancer clinical trials

BACKGROUND

This study evaluated pre-defined aspects of content validity of the 18-item NCCN FACT-Ovarian Symptom Index (NFOSI-18) and its Disease-Related Symptoms-Physical (DRS-P) subscale, as clinical trial outcome tools for patients with advanced ovarian cancer.

METHODS

Twenty-one women (mean age 59.5 years) diagnosed with advanced ovarian cancer completed the NFOSI-18 and participated in a cognitive interview to explore: (1) whether 'pain' and 'cramps' are considered redundant; (2) whether 'fatigue' and 'lack of energy' are overlapping concepts; (3) whether patients consider severity when responding to the item "I am bothered by constipation;" and (4) factors considered when responding to the item "I am sleeping well." Interviews were audio-recorded, transcribed, and analyzed qualitatively.

RESULTS

Pain was associated with discomfort, hurt, and life interference; 'cramps' was associated with pain, muscle tightening, and menstrual or digestive issues. Most (81%) considered the items "I have pain" and "I have cramps in my stomach area" to be more different than similar. Participants associated 'fatigue' with intense tiredness and 'lack of energy' with motivation and capability to complete daily activities. Item comparisons revealed a majority (65%) considered the items to be more different than similar. When responding to "I am bothered by constipation," patients indicated constipation severity was related to bother. Finally, patients considered disease, treatment, and other factors when responding to "I am sleeping well."

CONCLUSIONS

Findings support content validity of the NFOSI-18 and its DRS-P as originally constructed. We propose an alternative scoring option that excludes the item "I am sleeping well" from the DRS-P when used as a symptom-focused index for clinical research in a regulatory context.

Evaluation of sleep quality in adolescent patients with osteosarcoma using Pittsburgh Sleep Quality Index

The sleep quality of patients with osteosarcoma (OS) was poorly understood. We aimed to evaluate the prevalence of sleep dysfunction in adolescent patients with OS using the Pittsburgh Sleep Quality Index (PSQI) and to further investigate the psychometric properties of the PSQI in this cohort of patients. Fifty four adolescent patients with OS who underwent chemotherapy treatment in our clinic centre were included. Sleep quality was assessed with the Chinese PSQI. Cronbach's alpha was calculated to evaluate the internal consistency. The confirmatory factor analysis (CFA) was used to determine the fitness of a two-factor structure. Sleep disturbance was observed in 57.4% (31/54) of the patients. Patients with the presence of metastasis or more than 2 cycles of chemotherapy were found to have remarkably higher median global score. The overall Cronbach's alpha was 0.87. The CFA showed an overall comparative fit index of 0.97, a root mean square error of approximation of 0.06 and a standardised root mean square residual of 0.07 respectively. PSQI was a reliable instrument to evaluate the sleep quality of adolescent patients with OS. Over half of the patients may experience sleep disturbance during the treatment. Early psychological interventions were recommended to improve the sleep quality of the patients.

Central regulation of breast cancer growth and metastasis

Cancer is a systemic disease. In order to fully understand it, we must take a holistic view on how cancer interacts with its host. The brain monitors and responds to natural and aberrant signals arriving from the periphery, particularly those of metabolic or immune origin. As has been well described, a hallmark of cancer is marked disruption of metabolic and inflammatory processes. Depending on the salience and timing of these inputs, the brain responds via neural and humoral routes to alter whole-body physiology. These responses have consequences for tumor growth and metastasis, directly influencing patient quality of life and subsequent mortality. Additionally, environmental inputs such as light, diet, and stress, can promote inappropriate neural activity that benefits cancer. Here, I discuss evidence for brain-tumor interactions, with special emphasis on subcortical neuromodulator neural populations, and potential ways of harnessing this cross-talk as a novel approach for cancer treatment.

Sleep Discrepancy in Patients With Comorbid Fibromyalgia and Insomnia: Demographic, Behavioral, and Clinical Correlates

STUDY OBJECTIVES

Individuals with primary insomnia often have poorer self-reported sleep than objectively measured sleep, a phenomenon termed negative sleep discrepancy. Recent studies suggest that this phenomenon might differ depending on comorbidities. This study examined sleep discrepancy, its night-to-night variability, and its correlates in comorbid insomnia and fibromyalgia.

METHODS

Sleep diaries and actigraphy data were obtained from 223 adults with fibromyalgia and insomnia (age = 51.53 [standard deviation = 11.90] years; 93% women) for 14 days. Sleep discrepancy was calculated by subtracting diary from actigraphy estimates of sleep onset latency (SOL-D), wake after sleep onset (WASO-D), and total sleep time (TST-D) for each night. Night-to-night variability in sleep discrepancy was calculated by taking the within-individual standard deviations over 14 days. Participants completed measures of mood, pain, fatigue, sleep/pain medications, nap duration, and caffeine consumption.

RESULTS

Average sleep discrepancies across 14 days were small for all sleep parameters (< 10 minutes). There was no consistent positive or negative discrepancy. However, sleep discrepancy for any single night was large, with average absolute discrepancies greater than 30 minutes for all sleep parameters. Greater morning pain was associated with larger previous-night WASO-D, although diary and actigraphy estimates of WASO remained fairly concordant. Taking prescribed pain medications, primarily opioids, was associated with greater night-to-night variability in WASO-D and TST-D.

CONCLUSIONS

Unlike patients with primary insomnia, patients with comorbid fibromyalgia do not exhibit consistent negative sleep discrepancy; however, there are both substantial positive and negative discrepancies in all sleep parameters at the daily level. Future research is needed to investigate the clinical significance and implications of high night-to-night variability of sleep discrepancy, and the role of prescribed opioid medications in sleep perception.

Nonpharmacologic Interventions for Improving Sleep Disturbances in Patients With Lung Cancer: A Systematic Review and Meta-analysis

CONTEXT

Lung cancer patients experience higher levels of sleep disturbances compared to other cancer patients, and this leads to greater distress, poorer function, and lower quality of life. Nonpharmacologic interventions have demonstrated improvements in the context of breast cancer, but their efficacy in the lung cancer population is unclear.

OBJECTIVES

The aim of this review was to determine the effects of any nonpharmacologic intervention on sleep quality of lung cancer patients.

METHODS

Intervention studies of any design that reported primary or secondary outcomes on sleep quality were included. Databases searched were Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and PsycINFO. Risk of bias was assessed regarding randomization, allocation concealment, blinding, incomplete outcome data, selective reporting, and other biases.

RESULTS

Twenty-two studies were identified with a total of 1272 participants. Pittsburgh Sleep Quality Index was the most common instrument used. Statistically significant results were observed for all intervention categories examined in the short-term follow-up period: exercise and rehabilitation programs (standardized mean difference [SMD]: -0.43, 95% CI: -0.68, -0.19, P = 0.0005); information, psychoeducation, and symptom screening interventions (SMD: -0.87, 95% CI: -1.21, -0.54, P < 0.00001); and mind-body interventions (SMD: -0.88, 95% CI: -1.59, -0.16, P = 0.02). However, effectiveness was lower and nonsignificant when evaluated over one month after completion.

CONCLUSION

Limitations include the high heterogeneity of interventions and outcome measures, in addition to small sample sizes and high risk of bias within studies. Because they do not allow for a clear interpretation of the results, it is recommended that every patient should be assessed individually to guide a possible referral.

Sleep was associated with depression and anxiety status during pregnancy: a prospective longitudinal study

The purpose of this study was to reveal the cross-sectional and longitudinal association of sleep with depression and anxiety among Chinese pregnant women. Pregnant women were recruited in Zhoushan Pregnant Women Cohort at Zhoushan Maternal and Child Care Hospital from 2011 to 2015. Self-rating depression scales (SDS) and self-rating anxiety scales (SAS) were used for evaluating depression and anxiety status at each trimester; corresponding sleep quality and duration were reported by pregnant women. Ordinary or multilevel linear and logistic regression model were used to estimate the cross-sectional or longitudinal association of sleep with depression and anxiety. The prevalence rates were 35.64, 24.23, and 26.24% for depression and 22.57, 17.41, and 21.04% for anxiety at 1st (T1), 2nd (T2), and 3rd trimester (T3), respectively. Controlling for potential confounders, it revealed significant cross-sectional and longitudinal associations of sleep with depression and anxiety status. In cross-sectional analysis, women who slept less than 8 h/day had higher risk of depression (T1: OR (95%CI) = 1.75 (1.39, 2.20); T2: 1.52 (1.26, 2.05); T3: 1.60 (1.18, 2.05)) and anxiety (T1: 2.00 (1.57, 2.55); T2: 1.86 (1.37, 2.54); T3: 1.33 (0.99, 1.79)). In the longitudinal analysis, multilevel model revealed that women with subjective "fair" or "bad" sleep quality had elevated risk of depression (OR ranging from 1.54 to 3.71) and anxiety (2.38 to 7.53) during pregnancy. Prenatal depression and anxiety status were prevalent in pregnant women. Sleep quality was associated with depression and anxiety status in both cross-sectional and longitudinal analyses, implying that improving sleep quality should benefit for mental health of pregnant women.

Sleep duration is associated with survival in advanced cancer patients

OBJECTIVE

Sleep problems have been linked to increased risk of mortality in the general population. Limited evidence suggests similar relationships among people diagnosed with cancer. The aims of the present study were to investigate the type and rates of sleep problems in advanced cancer patients and examine whether sleep problems are associated with survival.

METHODS

A prospective study of 292 patients with advanced cancers affecting the hepatobiliary and pancreatic systems were administered a battery of questionnaires measuring sociodemographic information, sleep, and depression. Descriptive statistics, ANOVA, Chi-square, Kaplan-Meier survival, and Cox regression analyses were performed to test the aims.

RESULTS

The majority of patients were male (64%) and the mean age was 62 years (SD = 11). Fifty-nine percent of patients reported poor sleep quality; 43% reported sleeping ≤6 h and 2% ≥10 h; 40% reported sleep latency of 30 min or greater; average sleep efficiency was 80%. Of the 292 patients, 58% reported clinically levels of depression and depressive symptoms were related to shorter sleep duration (p = 0.02). After adjusting for factors known to contribute to survival, a curvilinear relationship was observed between sleep duration and mortality: short and long sleep duration were associated with increased mortality [linear term: hazard ratio (HR) = 0.485, 95% confidence interval (CI) = 0.275-0.857; quadratic term: HR = 1.064, 95% CI = 1.015-1.115].

CONCLUSIONS

Consistent with findings in the general population, a curvilinear relationship between sleep duration and mortality was observed in advanced cancer patients. The high prevalence of sleep problems and link with mortality warrants routine screening and development of evidence-based treatments for sleep problems in the oncology setting.

Actigraphic and Sleep Diary Measures in Veterans With Traumatic Brain Injury: Discrepancy in Selected Sleep Parameters

OBJECTIVE

To examine the discrepancy between sleep diary and actigraphic measures of sleep in Veterans with moderate-severe post-acute traumatic brain injury (TBI) and to explore whether these discrepancies vary according to participant characteristics.

SETTING

VA Medical Center in the Rocky Mountain United States.

PARTICIPANTS

Nineteen males with moderate-severe post-acute TBI and insomnia symptoms as measured by the Insomnia Severity Index.

DESIGN

Descriptive, cross-sectional.

MAIN MEASURES

Sleep diary, wrist actigraphy, Ohio State University TBI-Identification Method, Insomnia Severity Index, and Hospital Anxiety and Depression Scale.

RESULTS

There was poor agreement between actigraphic and sleep diary measurements of (1) total sleep time, (2) wake after sleep onset, and (3) sleep onset latency. On average, actigraphy measured greater duration of all 3 sleep parameters. Discrepancies were not found to be associated with specific TBI characteristics or mood-related symptoms.

CONCLUSION

When measuring sleep-related outcomes among Veterans with moderate-severe post-acute TBI, notable mismatches were found between actigraphic and self-reported sleep diary data. Knowledge regarding measure-related limitations is important for both clinical and research practices among those with moderate-severe post-acute TBI.

Symptom burden in lung cancer: management updates

Lung cancer is recognized to carry a high symptom burden with associated lowered quality of life as compared with other cancers. Research has shown that symptom severity can be a prognostic indicator of poorer clinical outcomes and survival post treatment. The purpose of this paper is to review current literature relative to symptom burden associated with diagnosis, medical and/or surgical intervention, assessment and management updates, and emerging initiatives that promote positive outcomes based on updated evidence. Discussion relative to interdisciplinary coordination of supportive services and palliative care initiation is provided.

Association between Daytime Activity, Fatigue, Sleep, Anxiety, Depression, and Symptom Burden in Advanced Cancer Patients: A Preliminary Report

BACKGROUND

There is limited research in advanced cancer patients (ACP) regarding association between objectively measured daytime activity and sleep (as measured by actigraphy), patient characteristics, and cancer symptoms (fatigue, sleep, anxiety, depression, cachexia, and symptom distress scores [SDSs]).

OBJECTIVES

Our aim of the study was to determine the association between mean daytime activity (MDTA) and the following items: fatigue (FACIT-F), SDSs (Edmonton Symptom Assessment Scale [ESAS]), sleep quality (Pittsburg Sleep Quality Index [PSQI]), objective sleep variables (OSV) (sleep onset, sleep efficacy, wake after sleep onset, total sleep time), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), body composition scores, and overall survival (OS). We also examined the association between sleep [PSQI and OSV scores] and FACIT-F, HADS, and ESAS.

METHODS

Secondary analysis of a recent clinical trial of cancer-related fatigue in advanced cancer (NCT00424099). Association between MDTA and OSV (measured by actigraphy) during the first week of the study and patient characteristics, symptoms (FACIT-F, ESAS, HADS, and PSQI), and OS were analyzed.

RESULTS

Seventy-nine eligible patients were evaluable. The median age was 57 years. Median MDTA was 248.43 counts/minute. Multivariate analysis shows that low MDTA was significantly associated with age, gender, Functional Assessment of Cancer Therapy (FACT)-Functional Well-Being (FWB), ESAS dyspnea, HADS-anxiety, and total sleep time. MDTA was not associated with FACIT-F (p = 0.997) and OS (p = 0.18). Sleep quality (PSQI) was significantly associated with FACIT-F, HADS, ESAS anxiety, and depression, but none of these variables was associated with OSV.

CONCLUSION

In ACP, lower MDTA was significantly associated with age, gender, FACT-FWB, ESAS dyspnea, HADS-anxiety, and total sleep time. Both sleep quality and cancer-related fatigue scores were strongly associated with depression and anxiety. More research is needed.

The effects of footbath on sleep among the older adults in nursing home: A quasi-experimental study

OBJECTIVES

To examine the long-term effects of foot-bathing therapy, using different water temperatures, on the sleep quality of older adults living in nursing homes.

DESIGN

A quasi-experimental study design with non-equivalent control group.

SETTINGS

Thirty participants were recruited from a nursing home in Gyeong-gi Province, South Korea.

INTERVENTIONS

The participants were randomly assigned to experimental, placebo, and control groups. The foot-bathing therapy was performed for 30min daily for four weeks. Water at 40°C was used for the experimental group, while water at 36.5°C was used for the placebo group. The control group did not receive any intervention.

MAIN OUTCOME MEASURES

The participants' sleep patterns (total sleep amount, sleep efficiency, and sleep latency) and sleep-disturbed behaviors were compared based on group, using actigraphy and a sleep disorder inventory.

RESULTS

The total amount of sleep and sleep efficiency were significantly different for the experimental group, especially those with poor sleep quality. There were no differences in sleep latency or sleep-disturbed behaviors among the groups. The long-term effect of the therapy decreased in the third week of the therapy.

CONCLUSIONS

Daily, 30-min foot-bathing therapy sessions with water at 40°C were effective in improving sleep quality for older adults. The therapy was more effective for participants with poor sleep quality at baseline assessment than those with relatively good sleep quality. The long-term effects of foot-bathing therapy decreased three weeks after initiation; therefore, it might be desirable to deliver the therapy for two weeks, pause it for a week, and then resume it.

Psychosocial resources and sleep disturbance before chemotherapy for gynecologic cancer

Personal psychosocial resources (e.g., positive affect, social support, perceived mastery, meaning in life) are associated with better sleep in noncancer populations, but there have been few studies in cancer patients. The present study examined psychosocial resources and sleep in gynecological cancer patients. Before chemotherapy, 72 participants completed self-report measures of sleep and psychosocial resources; 63 also completed actigraphic monitoring. Subjective sleep was associated with positive affect, social support, perceived mastery, and meaning in life; objective sleep was associated with social support. Future studies should examine whether interventions to enhance psychosocial resources result in improved sleep in this population.

Actigraphy and Sleep Diary Measurements in Breast Cancer Survivors: Discrepancy in Selected Sleep Parameters

This analysis examined the discrepancy between sleep diary and actigraphy measurements in breast cancer survivors (BCS) with insomnia. BCS from communities in Western U.S. provided demographic/medical information, insomnia, mood, and fatigue data at baseline. Averaged over 5 weeks, actigraphy measured 55.75 minutes (SD = 112.42) less total sleep time (TST), and 85.19 minutes (SD = 81.36) more wake after sleep onset (WASO) than diaries. Some women showed agreement between measures; others were more variable. There were no significant relationships between TST and WASO discrepancy and participant characteristics. There may be sleep differences in BCS that results in greater perceived TST and less WASO reported in diaries. Measurements discrepancy is a significant concern needing further evaluation of medical populations with insomnia.

Incorporating measures of sleep quality into cancer studies

INTRODUCTION/BACKGROUND

Sleep disturbance may influence the development of cancer and responses to treatment. It is also closely tied to recovery and quality of life in cancer patients, survivors, and caregivers, and recent studies have begun to show beneficial effects of sleep-promoting interventions. Despite the importance of sleep to cancer and its treatment and the availability of numerous tools for measuring sleep quality and quantity, sleep measurements are underutilized in cancer studies.

METHODS

This review, written for cancer researchers interested in incorporating sleep measures into their studies, is designed to raise awareness about the importance of sleep and suggests strategies for including sleep evaluation in cancer studies.

CONCLUSIONS

Inclusion of readily available sleep measures may ultimately improve cancer care by facilitating studies that lead to a greater understanding of how sleep and sleep disturbance influence all aspects of cancer care and the patient experience.

Occupational electromagnetic field exposures associated with sleep quality: a cross-sectional study

BACKGROUND

Exposure to electromagnetic field (EMF) emitted by mobile phone and other machineries concerns half the world's population and raises the problem of their impact on human health. The present study aims to explore the effects of electromagnetic field exposures on sleep quality and sleep duration among workers from electric power plant.

METHODS

A cross-sectional study was conducted in an electric power plant of Zhejiang Province, China. A total of 854 participants were included in the final analysis. The detailed information of participants was obtained by trained investigators using a structured questionnaire, which including socio-demographic characteristics, lifestyle variables, sleep variables and electromagnetic exposures. Physical examination and venous blood collection were also carried out for every study subject.

RESULTS

After grouping daily occupational electromagnetic exposure into three categories, subjects with long daily exposure time had a significantly higher risk of poor sleep quality in comparison to those with short daily exposure time. The adjusted odds ratios were 1.68 (95%CI: 1.18, 2.39) and 1.57 (95%CI: 1.10, 2.24) across tertiles. Additionally, among the subjects with long-term occupational exposure, the longer daily occupational exposure time apparently increased the risk of poor sleep quality (OR (95%CI): 2.12 (1.23∼3.66) in the second tertile; 1.83 (1.07∼3.15) in the third tertile). There was no significant association of long-term occupational exposure duration, monthly electric fee or years of mobile-phone use with sleep quality or sleep duration.

CONCLUSIONS

The findings showed that daily occupational EMF exposure was positively associated with poor sleep quality. It implies EMF exposure may damage human sleep quality rather than sleep duration.

Measuring quality of sleep and autonomic nervous function in healthy Japanese women

The purpose of this study was to determine the relationship between quality of sleep and autonomic nervous functioning in healthy adult Japanese women using three measures, namely, the Pittsburgh Sleep Quality Index (PSQI) for subjective assessment of sleep quality, actigraphy for objective assessment of sleep, and heart rate variability using high frequency and low frequency domains. Participants were 31 healthy women in their 20s to 40s who met the selection criteria, including having normal monthly menstrual periods. Participants were categorized as good or poor sleepers according to their PSQI score. Median correlation coefficients of activity count and high frequency were -0.62 (range -0.43 to -0.84) for good sleepers and -0.45 (range 0.003 to -0.64) for poor sleepers. Good sleepers showed a significantly higher correlation of activity count and high frequency (Z=-2.11, P<0.05). Median correlation coefficients of activity count and low frequency/high frequency were 0.54 (range 0.29-0.73) for good sleepers and 0.41 (range 0.11-0.63) for poor sleepers. The PSQI, actigraphy data, and heart rate variability results showed positive correlations between sleep time as measured by PSQI and duration of inactivity as measured by actigraphy (r=0.446, P<0.05) and sleep time as measured by actigraphy (r=0.377, P<0.05), and a negative correlation between sleep time as measured by PSQI and the correlation coefficients of activity count and high frequency (r=-0.460, P<0.01). These results support the finding that sleep-wake rhythms can be monitored efficiently with actigraphy, providing accurate data that can support the diagnosis of sleeping disorders. Furthermore, actigraphy data were associated with heart rate variability and PSQI findings, but only in subjects who were poor sleepers. Actigraphy is an accurate, efficient, rapid, and inexpensive test for determining objective and subjective sleeping problems, and can also be used in clinical tests for sleep assessment.