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Sleepless from the Get Go: Sleep Problems Prior to Initiating Cancer Treatment

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Abstract

Purpose

Cancer patients are likely to experience sleep problems. Understanding their perception of sleep problems is important as subjective symptom experience is associated with treatment-seeking behavior. We explored the prevalence of sleep problems and its correlates in a large sample of cancer patients at an important but understudied stage of their cancer journey: prior to initiating treatment.

Methods

Cancer patients (5702) (67.5% female; 76.9% White; 23.0% Hispanic), following diagnosis and prior to initiating cancer treatment, completed an electronic screening instrument. Patients across eight different cancer diagnoses (breast, gastrointestinal, gynecological, head and neck, hematological, lung, prostate, urinary) rated their sleep problems on a five-point scale, with those reporting “severe” or “very severe” sleep problems classified as having high sleep problems.

Results

Overall, 12.5% of patients reported high sleep problems. Across diagnoses, the proportion of patients reporting high sleep problems ranged from 4.3 to 13.8%, with prostate cancer patients least likely and gastrointestinal cancer patients most likely to report high sleep problems. Older age, having a partner, higher education, and higher household income were associated with a lower likelihood of experiencing sleep problems. Being female, Black, Hispanic, and reporting anxiety or depression was associated with an increased likelihood of sleep problems.

Conclusions

A sizeable proportion of cancer patients experience significant problems with their sleep before any treatment has occurred. This clinical issue cannot be ignored as treatment is likely to worsen existing sleep problems. Oncology providers should routinely screen for sleep-related problems. Identifying and treating patients for sleep problems during a vulnerable period early in their cancer trajectory should be an essential component of clinical care.

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Funding

This research was supported by internal funding at the City of Hope Comprehensive Cancer Center.

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Authors and Affiliations

  1. Perini Family Survivors’ Center, Dana-Farber Cancer Institute, Boston, MA, USA

    Eric S. Zhou & Christopher J. Recklitis

  2. Pediatrics, Harvard Medical School, Boston, MA, USA

    Eric S. Zhou & Christopher J. Recklitis

  3. Supportive Care Medicine, City of Hope National Medical Center, Duarte, CA, USA

    Karen Clark, Richard Obenchain & Matthew Loscalzo

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  1. Eric S. Zhou
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  2. Karen Clark
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Correspondence to Eric S. Zhou.

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Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare that they have no conflict of interest.

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Zhou, E.S., Clark, K., Recklitis, C.J. et al. Sleepless from the Get Go: Sleep Problems Prior to Initiating Cancer Treatment. Int.J. Behav. Med. 25, 502–516 (2018). https://doi.org/10.1007/s12529-018-9715-2

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