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Sleep problems in breast cancer survivors 1–10 years posttreatment

Published online by Cambridge University Press:  16 May 2017

Amy E. Lowery-Allison ,
Steven D. Passik ,
Matthew R. Cribbet ,
Ruth A. Reinsel ,
Barbara O'Sullivan ,
Larry Norton ,
Kenneth L. Kirsh  and
Neil B. Kavey
Amy E. Lowery-Allison*
Affiliation:
Department of Psychiatry and Health Behavior, Georgia Cancer Center at Augusta University, Augusta, Georgia, USA Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
Steven D. Passik
Affiliation:
Millennium Health, San Diego, California, USA
Matthew R. Cribbet
Affiliation:
Department of Psychological Sciences, Texas Tech University, Lubbock, Texas, USA
Ruth A. Reinsel
Affiliation:
Department of Anesthesiology, School of Medicine, Stony Brook University, Stony Brook, New York, USA National Sleep Research Institute, New York, New York, USA
Barbara O'Sullivan
Affiliation:
The Rockefeller University, New York, New York, USA
Larry Norton
Affiliation:
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
Kenneth L. Kirsh
Affiliation:
Millennium Health, San Diego, California, USA
Neil B. Kavey
Affiliation:
National Sleep Research Institute, New York, New York, USA The Rockefeller University, New York, New York, USA New York–Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA
*
Address correspondence and reprint requests to: Amy E. Lowery-Allison, Georgia Cancer Center, 1411 Laney Walker Boulevard, AN-2108, Augusta, Georgia 30912. E-mail: amallison@augusta.edu.
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Abstract

Objective:

Sleep can affect quality of life (QoL) during cancer survivorship, and symptoms related to poor sleep can be exacerbated. We examined the prevalence, severity, and nature of subjective sleep complaints in women surviving stage I–III breast cancer who were 1–10 years posttreatment. We also examined the demographic, medical, physical, and psychosocial correlates of poor sleep in these women in order to identify the subgroups that may be most in need of intervention.

Method:

A total of 200 patients at a comprehensive cancer center who were 1–10 years posttreatment for primary stage I–III breast cancer with no evidence of disease at the time of enrollment completed a battery of questionnaires on demographics, sleep, physical symptoms, mood, cancer-specific fears, and QoL.

Results:

The women had a mean age of 57 years (SD = 10.0), with a mean of 63.3 months (SD = 28.8) of post-cancer treatment. Some 38% of these patients were identified as having poor-quality sleep. Women with poor sleep took longer to fall asleep, had more awakenings, and acquired 2 hours less sleep per night than those with good sleep. They also had a lower QoL, greater severity of pain, more concerns about health and recurrence, and increased vasomotor symptoms (p < 0.05). Daytime sleepiness and depression were found to be not significantly correlated with sleep quality.

Significance of results:

Many breast cancer survivors had severe subjective insomnia, and several breast cancer survivor subgroups were identified as having members who might be most in need of sleep-improvement interventions. Addressing physical symptoms (e.g., vasomotor symptoms and pain) and providing education about the behavioral, social, environmental, and medical factors that affect sleep could result in substantial improvement in the life course of breast cancer survivors.

Keywords

Breast cancerSurvivorSleepVasomotor symptomsQuality of life
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 3 , June 2018 , pp. 325 - 334
Copyright
Copyright © Cambridge University Press 2017 

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References

REFERENCES

Bardwell, W.A., Profant, J., Casden, D.R., et al. (2008). The relative importance of specific risk factors for insomnia in women treated for early-stage breast cancer. Psycho-Oncology, 17(1), 9–18. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575103/pdf/nihms-73982.pdf.CrossRefGoogle ScholarPubMed
Bastien, C.H., Vallieres, A. & Morin, C.M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297–307.CrossRefGoogle ScholarPubMed
Beck, S.L., Berger, A.M., Barsevick, A.M., et al. (2010). Sleep quality after initial chemotherapy for breast cancer. Supportive Care in Cancer, 18(6), 679–689. Epub ahead of print Jun 13, 2009. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2874643/.Google Scholar
Berger, A.M., Kuhn, B.R., Farr, L.A., et al. (2009 a). One-year outcomes of a behavioral therapy intervention trial on sleep quality and cancer-related fatigue. Journal of Clinical Oncology, 27(35), 6033–6040.Google Scholar
Berger, A.M., Treat Marunda, H.A. & Agrawal, S. (2009 b). Influence of menopausal status on sleep and hot flashes throughout breast cancer adjuvant chemotherapy. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 38(3), 353–366.Google Scholar
Berger, A.M., Visovsky, C., Hertzog, M., et al. (2012). Usual and worst symptom severity and interference with function in breast cancer survivors. The Journal of Supportive Oncology, 10(3), 112–118. Epub ahead of print Jan 24.CrossRefGoogle ScholarPubMed
Budhrani, P.H., Lengacher, C.A., Kip, K., et al. (2015). An integrative review of subjective and objective measures of sleep disturbances in breast cancer survivors. Clinical Journal of Oncology Nursing, 19(2), 185–191.CrossRefGoogle ScholarPubMed
Buscemi, N., Vandermeer, B., Friesen, C., et al. (2005). Manifestations and Management of Chronic Insomnia in Adults. Rockville, MD: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Available from https://www.ncbi.nlm.nih.gov/books/NBK11906/.Google ScholarPubMed
Buysse, D.J., Reynolds, C.F. 3rd, Monk, T.H., et al. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213.Google Scholar
Carney, C.E., Harris, A.L., Moss, T.G., et al. (2010). Distinguishing rumination from worry in clinical insomnia. Behaviour Research and Therapy, 48(6), 540–546. Epub ahead of print Mar 11. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2871974/.CrossRefGoogle ScholarPubMed
Carpenter, J.S. & Andrykowski, M.A. (1998). Psychometric evaluation of the Pittsburgh Sleep Quality Index. Journal of Psychosomatic Research, 45(1), 5–13.Google Scholar
Carpenter, J.S., Johnson, D., Wagner, L., et al. (2002). Hot flashes and related outcomes in breast cancer survivors and matched comparison women. Oncology Nursing Forum, 29(3), E16–E25.Google Scholar
Carpenter, J.S., Elam, J.L., Ridner, S.H., et al. (2004). Sleep, fatigue, and depressive symptoms in breast cancer survivors and matched healthy women experiencing hot flashes. Oncology Nursing Forum, 31(3), 591–598.Google Scholar
Colagiuri, B., Christensen, S., Jensen, A.B., et al. (2011). Prevalence and predictors of sleep difficulty in a national cohort of women with primary breast cancer three to four months postsurgery. Journal of Pain and Symptom Management, 42(5), 710–720. Epub ahead of print May 26.CrossRefGoogle Scholar
Colten, H.R. & Altevogt, B.M., eds. (2007). Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington, DC: National Academies Press.Google Scholar
Davidson, J.R., MacLean, A.W., Brundage, M.D., et al. (2002). Sleep disturbance in cancer patients. Social Science & Medicine, 54(9), 1309–1321.Google Scholar
Dugan, W., McDonald, M.V., Passik, S.D., et al. (1998). Use of the Zung Self-Rating Depression Scale in cancer patients: Feasibility as a screening tool. Psycho-Oncology, 7(6), 483–493.Google Scholar
Dupont, A., Bower, J.E., Stanton, A.L., et al. (2014). Cancer-related intrusive thoughts predict behavioral symptoms following breast cancer treatment. Health Psychology, 33(2), 155–163. Epub ahead of print Feb 4, 2013. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796187/.Google Scholar
Ellis, J.G., Perlis, M.L., Bastien, C.H., et al. (2014). The natural history of insomnia: Acute insomnia and first-onset depression. Sleep, 37(1), 97–106. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3902876/.Google Scholar
Enderlin, C.A., Coleman, E.A., Cole, C., et al. (2010). Sleep across chemotherapy treatment: A growing concern for women older than 50 with breast cancer. Oncology Nursing Forum, 37(4), 461–463.Google Scholar
Espeland, M.A., Bush, T.L., Mebane-Sims, I., et al. (1995). Rationale, design, and conduct of the PEPI Trial: Postmenopausal Estrogen/Progestin Interventions. Controlled Clinical Trials, 16(Suppl. 4), 3S–19S.Google Scholar
Espie, C.A., Fleming, L., Cassidy, J., et al. (2008). Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. Journal of Clinical Oncology, 26(28), 4651–4658. Epub ahead of print Jun 30.CrossRefGoogle ScholarPubMed
Ferrell, B.R., Dow, K.H. & Grant, M. (1995). Measurement of the quality of life in cancer survivors. Quality of Life Research, 4(6), 523–531.Google Scholar
Forsythe, L.P., Helzlsouer, K.J., MacDonald, R., et al. (2012). Daytime sleepiness and sleep duration in long-term cancer survivors and non-cancer controls: Results from a registry-based survey study. Supportive Care in Cancer, 20(10), 2425–2432. Epub ahead of print Jan 5.Google Scholar
Greendale, G.A., Reboussin, B.A., Hogan, P., et al. (1998). Symptom relief and side effects of postmenopausal hormones: Results from the Postmenopausal Estrogen/Progestin Interventions Trial. Obstetrics and Gynecology, 92(6), 982–988.Google Scholar
Hall, D.L., Mishel, M.H. & Germino, B.B. (2014). Living with cancer-related uncertainty: Associations with fatigue, insomnia, and affect in younger breast cancer survivors. Supportive Care in Cancer, 22(9), 2489–2495. Epub ahead of print Apr 12.Google Scholar
Harris, P.F., Remington, P.L., Trentham-Dietz, A., et al. (2002). Prevalence and treatment of menopausal symptoms among breast cancer survivors. Journal of Pain and Symptom Management, 23(6), 501–509.Google Scholar
Irwin, M.R., Olmstead, R.E., Ganz, P.A., et al. (2013). Sleep disturbance, inflammation and depression risk in cancer survivors. Brain, Behavior, and Immunity, 30(Suppl.), S58–S67. Epub ahead of print May 24, 2012. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435451/.Google Scholar
Jim, H.S., Jacobsen, P.B., Phillips, K.M., et al. (2013). Lagged relationships among sleep disturbance, fatigue, and depressed mood during chemotherapy. Health Psychology, 32(7), 768–774. Epub ahead of print Feb 25. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3700563/.Google Scholar
Johns, M.W. (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep, 14(6), 540–545.Google Scholar
Kotronoulas, G., Wengstrom, Y. & Kearney, N. (2012). A critical review of women's sleep–wake patterns in the context of neo-/adjuvant chemotherapy for early-stage breast cancer. Breast, 21(2), 128–141. Epub ahead of print Dec 20, 2011.Google Scholar
Lee, E., Cho, H.J., Olmstead, R., et al. (2013). Persistent sleep disturbance: A risk factor for recurrent depression in community-dwelling older adults. Sleep, 36(11), 1685–1691. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792386/.Google Scholar
Le Guen, Y., Gagnadoux, F., Hureaux, J., et al. (2007). Sleep disturbances and impaired daytime functioning in outpatients with newly diagnosed lung cancer. Lung Cancer, 58(1), 139–143. Epub ahead of print Jul 5.Google Scholar
Lehrer, S., Green, S. & Rosenzweig, K.E. (2013). Coffee consumption associated with increased mortality of women with breast cancer. Journal of Caffeine Research, 3(1), 38–40. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3643262/.Google Scholar
Lindley, C., Vasa, S., Sawyer, W.T., et al. (1998). Quality of life and preferences for treatment following systemic adjuvant therapy for early-stage breast cancer. Journal of Clinical Oncology, 16(4), 1380–1387.Google Scholar
Lu, W., Cantor, J.B., Aurora, R.N., et al. (2015). The relationship between self-reported sleep disturbance and polysomnography in individuals with traumatic brain injury. Brain Injury, 29(11), 1342–1350. Epub ahead of print Jul 23.Google Scholar
Miaskowski, C., Dodd, M. & Lee, K. (2004). Symptom clusters: The new frontier in symptom management research. Journal of the National Cancer Institute, Monographs, 2004(32), 17–21. Available from https://academic.oup.com/jncimono/article/2004/32/17/1021847/Symptom-Clusters-The-New-Frontier-in-Symptom.Google Scholar
Miaskowski, C., Cooper, B., Paul, S.M., et al. (2012). Identification of patient subgroups and risk factors for persistent breast pain following breast cancer surgery. Journal of Pain, 13(12), 1172–1187. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511823/.Google Scholar
Mourits, M.J., Bockermann, I., de Vries, E.G., et al. (2002). Tamoxifen effects on subjective and psychosexual well-being, in a randomised breast cancer study comparing high-dose and standard-dose chemotherapy. British Journal of Cancer, 86(10), 1546–1550. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746594/.Google Scholar
Otte, J.L., Carpenter, J.S., Russell, K.M., et al. (2010). Prevalence, severity, and correlates of sleep–wake disturbances in long-term breast cancer survivors. Journal of Pain and Symptom Management, 39(3), 535–547. Epub ahead of print Jan 18. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843803/.Google Scholar
Paice, J.A. & Cohen, F.L. (1997). Validity of a verbally administered numeric rating scale to measure cancer pain intensity. Cancer Nursing, 20(2), 88–93.Google Scholar
Palesh, O.G., Roscoe, J.A., Mustian, K.M., et al. (2010). Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center–Community Clinical Oncology Program. Journal of Clinical Oncology, 28(2), 292–298. Epub ahead of print Nov 23, 2009. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815717/.Google Scholar
Palesh, O., Aldridge-Gerry, A., Ulusakarya, A., et al. (2013). Sleep disruption in breast cancer patients and survivors. Journal of the National Comprehensive Cancer Network, 11(12), 1523–1530.Google Scholar
Palesh, O., Aldridge-Gerry, A., Zeitzer, J.M., et al. (2014). Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep, 37(5), 837–842. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3985107/.Google Scholar
Reinsel, R.A., Starr, T.D., O'Sullivan, B., et al. (2015). Polysomnographic study of sleep in survivors of breast cancer. Journal of Clinical Sleep Medicine, 11(12), 1361–1370. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4661327/.CrossRefGoogle ScholarPubMed
Rumble, M.E., Keefe, F.J., Edinger, J.D., et al. (2010). Contribution of cancer symptoms, dysfunctional sleep related thoughts, and sleep inhibitory behaviors to the insomnia process in breast cancer survivors: A daily process analysis. Sleep, 33(11), 1501–1509. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954700/.Google Scholar
Savard, J. & Morin, C.M. (2001). Insomnia in the context of cancer: A review of a neglected problem. Journal of Clinical Oncology, 19(3), 895–908.Google Scholar
Savard, J., Simard, S., Blanchet, J., et al. (2001). Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep, 24(5), 583–590.Google Scholar
Savard, J., Laroche, L., Simard, S., et al. (2003). Chronic insomnia and immune functioning. Psychosomatic Medicine, 65(2), 211–221.Google Scholar
Savard, J., Davidson, J.R., Ivers, H., et al. (2004). The association between nocturnal hot flashes and sleep in breast cancer survivors. Journal of Pain and Symptom Management, 27(6), 513–522.Google Scholar
Savard, J., Simard, S., Ivers, H., et al. (2005). Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects. Journal of Clinical Oncology, 23(25), 6083–6096.Google Scholar
Savard, J., Ivers, H., Villa, J., et al. (2011). Natural course of insomnia comorbid with cancer: An 18-month longitudinal study. Journal of Clinical Oncology, 29(26), 3580–3586. Epub ahead of print Aug 8.Google Scholar
Setthawatcharawanich, S., Limapichat, K., Sathirapanya, P., et al. (2014). Excessive daytime sleepiness and nighttime sleep quality in Thai patients with Parkinson's disease. Journal of the Medical Association of Thailand, 97(10), 1022–1027.Google Scholar
Spiegel, K., Sheridan, J.F. & Van Cauter, E. (2002). Effect of sleep deprivation on response to immunization. The Journal of the American Medical Association, 288(12), 1471–1472.Google Scholar
Syrjala, K.L., Jensen, M.P., Mendoza, M.E., et al. (2014). Psychological and behavioral approaches to cancer pain management. Journal of Clinical Oncology, 32(16), 1703–1711.CrossRefGoogle ScholarPubMed
Vanaparthy, R., Mota, P., Khan, R., et al. (2015). A longitudinal assessment of sleep variables during exacerbations of chronic obstructive pulmonary disease. Chronic Respiratory Disease, 12(4), 299–304. Epub ahead of print May 31.CrossRefGoogle ScholarPubMed
Van Onselen, C., Paul, S.M., Lee, K., et al. (2013). Trajectories of sleep disturbance and daytime sleepiness in women before and after surgery for breast cancer. Journal of Pain and Symptom Management, 45(2), 244–260. Epub ahead of print Aug 24, 2012. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3561473/.Google Scholar
Vickberg, S.M. (2003). The Concerns About Recurrence Scale (CARS): A systematic measure of women's fears about the possibility of breast cancer recurrence. Annals of Behavioral Medicine, 25(1), 16–24.Google Scholar
Vitiello, M.V., McCurry, S.M., Shortreed, S.M., et al. (2014). Short-term improvement in insomnia symptoms predicts long-term improvements in sleep, pain, and fatigue in older adults with comorbid osteoarthritis and insomnia. Pain, 155(8), 1547–1554. Epub ahead of print May 1. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104256/.Google Scholar