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Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors

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Abstract

Purpose

Insomnia is increasingly recognized as a major symptom outcome in breast cancer; however, little is known about its prevalence and risk factors among women receiving aromatase inhibitors (AIs), a standard treatment to increase disease-free survival among breast cancer patients.

Methods

A cross-sectional survey study was conducted among postmenopausal women with stage 0–III breast cancer receiving adjuvant AI therapy at an outpatient breast oncology clinic of a large university hospital. The insomnia severity index (ISI) was used as the primary outcome. Multivariate logistic regression analyses were performed to evaluate risk factors.

Results

Among 413 participants, 130 (31.5 %) had subthreshold insomnia on the ISI, and 77 (18.64 %) exceeded the threshold for clinically significant insomnia. In a multivariate logistic regression model, clinically significant insomnia was independently associated with severe joint pain (adjusted odds ratio (AOR) 4.84, 95 % confidence interval (CI) 1.71–13.69, P = 0.003), mild/moderate hot flashes (AOR 2.28, 95 % CI 1.13–4.60, P = 0.02), severe hot flashes (AOR 2.29, 95 % CI 1.23–6.81, P = 0.015), anxiety (AOR 1.99, 95 % CI 1.08–3.65, P = 0.027), and depression (AOR 3.57, 95 % CI 1.48–8.52, P = 0.004). Age (>65 vs. <55 years; AOR 2.31; 95 % CI 1.11–4.81; P = 0.026) and time since breast cancer diagnosis (<2 vs. 2–5 years; AOR 1.94; 95 % CI 1.02–3.69; P = 0.045) were also found to be significant risk factors. Clinical insomnia was more common among those who used medication for treating insomnia and pain.

Conclusions

Insomnia complaints exceed 50 % among AI users. Clinically significant insomnia is highly associated with joint pain, hot flashes, anxiety and depression, age, and time since diagnosis.

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Acknowledgments

We would like to thank all the breast cancer survivors, physicians, nurse practitioners, and staff for their support. We would like to thank all the work study students for their dedication to the data collection and management process. Funding support was received from the Penn Clinical Pharmacogenomic Epidemiology Pilot Grant National Institutes of Health (NIH) 5P20RR020741, Penn Institute of Aging Pilot Grant, and NIH AT004695. Dr. Mao is supported by the American Cancer Society CCCDA-08-107-01 and NIH K23 AT004112.

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Authors and Affiliations

  1. Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street, 2 Gates Building, Philadelphia, PA, 19104, USA

    Krupali Desai, Jun J. Mao & Qing Li

  2. Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Jun J. Mao, Angela DeMichele & Sharon X. Xie

  3. Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Jun J. Mao & Angela DeMichele

  4. Department of Psychiatry and Penn Sleep Center, University of Pennsylvania Health System, Philadelphia, PA, 19104, USA

    Philip R. Gehrman

  5. Division of Reproductive Endocrinology, Department of Reproductive Medicine, University of California at San Diego School of Medicine, La Jolla, CA, 92093, USA

    Irene Su

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  1. Krupali Desai
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Correspondence to Krupali Desai.

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Desai, K., Mao, J.J., Su, I. et al. Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors. Support Care Cancer 21, 43–51 (2013). https://doi.org/10.1007/s00520-012-1490-z

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