Immunotherapy and Chemotherapy Versus Sleep Disturbances for NSCLC Patients

Abstract

Introduction: Cancer patients are known to experience sleep disturbances that differ between disease stages and treatments. Regarding lung cancer patients and immunotherapy, information on their sleep disturbances has been recently acquired, but no comparison has been made between different treatment modalities. Patients and Methods: We recruited 98 non-small cell lung cancer patients; 49 had programmed death-ligand 1 expression of ≥50% and received immunotherapy as first-line treatment and 49 had programmed death-ligand 1 expression in the range from 0–49 and received chemotherapy as first-line treatment. All patients were stage IV, but with no bone metastasis. Sleep disturbances were recorded through polysomnography and sleep questionnaires. Results: For immunotherapy patients with PD-L1 expression ≥ 50%, the disease response was rapid and the sleep disturbances decreased rapidly. On the other hand, for chemotherapy patients, the sleep disturbances remained for all those patients that had partial response and stable disease. It was noticed that chemotherapy drugs induce severe adverse effects. Discussion: In our study, it was observed that patients with complete response had reduced sleep disturbances in the case of immunotherapy patients. However, sleep disturbances continued for several patients in the chemotherapy group due to the adverse effects of chemotherapy drugs. In conclusion: Immunotherapy drugs on their own do not induce sleep disturbances and, through treatment response, alleviate sleep disturbances in lung cancer patients.

The Impact of Immunotherapy on Sleep and Circadian Rhythms in Patients with Cancer

“…These symptoms improved quickly in patients with a PDL-1 expression greater than 80% during the first 4 months of treatment due to the rapid response of the tumor to immunotherapy. There was no difference in symptom control seen between patients who received nivolumab or pembrolizumab (85).…”

“…In contrast, in patients on standard chemotherapy, those with both partial response and stable disease continued to have sleep disturbances. They concluded that although ICIs did not induce sleep disturbance, treatment response may improve sleep disturbances ( 84 ). Another study by the same group showed that upon diagnosis, lung cancer patients had sleep disturbances including early morning awakenings, late sleep onset, prolonged nocturnal waking periods, daytime sleepiness, and unrefreshed sleep.…”

Validation of Shortened Forms of Metacognition Questionnaire-Insomnia and Its Feasibility in the Discrepancy-Cognitive Arousal Model of Insomnia Among Patients With Cancer

“…1 In this population, insomnia has been associated with psychiatric illness-partic-ularly anxiety and depressive disorders, 2 physical symptoms of pain or gastrointestinal symptoms, 3 or anticancer modalities such as chemotherapy, radiotherapy, and hormone therapy. 4 Additionally, multiple studies have suggested that poor sleep and disruption of the circadian rhythm can play a role in tumorigenesis and cancer progression that reinforces the reciprocal causative approach. 5 Based on the two-level model of arousal by Ong et al, 6 an individual's primary and secondary arousal influence their sleep disturbance.…”

“…Insomnia is a common condition among patients with cancer, with nearly half of patients with a recent cancer diagnosis suffering from insomnia symptoms [ 1 ]. In this population, insomnia has been associated with psychiatric illness—particularly anxiety and depressive disorders [ 2 ], physical symptoms of pain or gastrointestinal symptoms [ 3 ], or anticancer modalities such as chemotherapy, radiotherapy, and hormone therapy [ 4 ]. Additionally, multiple studies have suggested that poor sleep and disruption of the circadian rhythm can play a role in tumorigenesis and cancer progression that reinforces the reciprocal causative approach [ 5 ].…”