Sleep disturbance and insomnia are prevalent problems for the more than 15 million cancer survivors in the United States. If not addressed, poor-quality sleep can negatively impact physical and psychological recovery from cancer diagnosis and treatment. Cancer survivors are increasingly turning to integrative therapies to improve sleep and optimize their health. The purpose of this article is to review the evidence for the use of nonpharmacological integrative therapies to improve sleep health in cancer patients. Therapies are grouped into the following categories: cognitive-behavioral, meditative (e.g., mindfulness-based interventions, yoga, qigong/tai chi), and body based (e.g., acupuncture, acupressure, massage, reflexology). Cognitive-behavioral therapy for insomnia, mindfulness-based therapies, qigong/tai chi, and acupuncture have the most evidence for improving sleep and insomnia, whereas yoga, acupressure, massage, and reflexology are still being investigated or building their evidence base. Several areas of strength are identified, gaps in the literature are highlighted, and recommendations for improving future research are provided.
Cancer may have greater financial consequences for young adults (YAs), defined as those between 15 to 39, than older adults because of developmental stage. YA cancer survivors (N = 575) reported on out-of-pocket cancer costs and missed work. They were compared to age, sex, and education-matched peers without cancer on income, debts and assets using data from the 2014 Canadian Financial Capability Survey and Canadian Community Health Survey. Almost 60% of YA survivors spent at least $100 per month on out-of-pocket cancer-related expenses, and 49% missed at least one year of work. Groups did not differ in personal or household income. Compared to non-cancer peers in both groups, YA survivors were more likely to have outstanding credit card and line of credit balances. Regardless of current age or time since diagnosis, YA survivors were also more likely to not own assets while their non-cancer peers were more likely to be home owners. YAs face long-term financial impact due to cancer in assets and debts, but not in income.
Introduction Sleep disturbances are a prevalent and enduring problem in women who have completed treatment for breast cancer. Less is known about whether sleep during and after cancer treatment is influenced by pre-treatment sleep quality and menopausal status. The present study aims to examine the trajectory of sleep quality in the 12 months following a cancer diagnosis and assess whether trajectory is influenced by pre-treatment sleep quality and menopausal status. Methods Newly-diagnosed women (N=88) with non-metastatic BCa were recruited before beginning treatment. They completed the Pittsburgh Sleep Quality Index (PSQI) before treatment and 4, 8, and 12 months later. Women with a score ≥5 on the Pittsburgh Sleep Quality Index at treatment onset were classified as poor sleepers. Menopausal status (pre- or post-menopausal) was chart abstracted. A mixed ANOVA assessed the impact of pre-treatment sleep quality and menopausal status on sleep quality trajectory. Results The mean age of the sample was 60 years, 70% were classified as poor sleepers, and 72% were post-menopausal. There was a significant linear time by sleep quality interaction, F(1, 83)= 5.79, p =.02. Good sleepers experienced a greater initial worsening of sleep quality than poor sleepers. At 12 months, poor sleepers had returned to baseline levels whereas scores in good sleepers remained higher than baseline. The 3-way time x sleep quality x menopausal status and the 2-way time by menopausal status interactions were not significant. Conclusion Baseline sleep quality is a more powerful determinant of sleep trajectory during treatment than menopausal status. Early intervention is necessary to treat existing sleep problems and prevent the development of sleep problems in women with a history of good sleep. Support Dr. Garland is supported by a New Investigator Award and seed funding from the Beatrice Hunter Cancer Research Institute (BHCRI).
Introduction Insomnia symptoms are a common problem and are often comorbid with hot flashes, fatigue, anxiety, and depression following a breast cancer diagnosis. The present study examined changes in insomnia severity and comorbid symptoms in the year following diagnosis. Methods This study is part of a larger prospective observational cohort study of 100 women with early stage breast cancer. Insomnia symptoms were measured using the Insomnia Severity Index, fatigue was measured using the Multidimensional Fatigue Symptom Inventory-Short Form, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and hot flashes were assessed using the Hot Flash Related Daily Interference Scale. Assessments were performed shortly after diagnosis, 4, 8, and 12 months. A series of repeated measures within subjects ANOVAs were performed to assess changes in symptoms over time. Results Among 100 women with breast cancer, 45% reported at least mild insomnia symptoms. There were significant quadratic effects of time on insomnia severity, F(3, 297)= 12.776, p ≤ .001, depression (F[3, 297]= 4.409, p = .005), and fatigue (F[3, 297]= 7.995, p ≤ .001). These symptoms initially worsen and then improve throughout the year, but they do not rebound to pre-treatment levels. Interference from hot flashes worsens and endures for longer than other symptoms but does begin to show improvement one year post-diagnosis (F[3, 297]= 12.110, p ≤ .001). The were no time effects for anxiety (F[3, 297] = 1.4, p = .243). Conclusion In general, women treated for breast cancer can expect insomnia and comorbid symptoms to worsen then improve, but not recover, during the first year after a breast cancer diagnosis. Early efforts to educate women and manage symptoms could prevent insomnia and other issues from becoming persistent problems. Support Dr. Garland is supported by a Scotiabank New Investigator Award and seed funding from the Beatrice Hunter Cancer Research Institute (BHCRI).
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