Insomnia in breast cancer: a prospective observational study

Abstract

STUDY OBJECTIVES-Insomnia in cancer patients is prevalent, persistent and confers risk for physical and psychological disorder. We must better understand how insomnia develops in cancer patients and explore the main contributors to its chronicity so that insomnia management protocols can be integrated more effectively within cancer care. This study monitors the etiology of insomnia in breast cancer patients and identifies risk factors for its persistence. METHODS-173 females with newly diagnosed, non-metastatic breast cancer were tracked from diagnosis for 12-months. Participants completed monthly sleep assessments using the Insomnia Severity Index (ISI) and 3-monthly health-related quality-of-life assessments using the European Organisation for Research and Treatment of Cancer-Breast (EORTC QLQ-C30-BR23) scale. Clinical data on disease status and treatment regimens were also assessed. RESULTS-Prior to diagnosis, 25% of participants reported sleep disturbance, including 8% with insomnia syndrome (IS). Prevalence increased at cancer diagnosis to 46% (18% IS) and remained stable thereafter at around 50% (21% IS). We also explored sleep status transitions. The most common pattern was to remain a good sleeper (34%-49%) or to persist with insomnia (23%-46%). 77% of good sleepers developed insomnia during the 12-month period and 54% went into insomnia remission. Chemotherapy (odds ratio=0•08, 95% ci 0•02-0•29, p<•001) and pre-diagnosis ISI scores (odds ratio=1•13/unit increase in pre-diagnosis sleep score, 95% ci 1•05-1•21, p=•001) were identified as the main risk factors for persistent insomnia. CONCLUSIONS-These data advance our understanding of insomnia etiology in cancer patients and help identify those who should be prioritised for insomnia management protocols.

Patient-reported Outcomes of Patients With Breast Cancer During the COVID-19 Outbreak in the Epicenter of China: A Cross-sectional Survey Study

“…Over one-fifth of patients with BC presented severe distress symptoms during the COVID-19 outbreak. The scores in our study were significantly higher than patients with BC under normal conditions in previous studies, which showed about only 3.5% patients reported severe anxiety and depression, [17][18][19][20][21] indicating an additional increase of mental stress on the patients with BC by the COVID-19 crisis.…”

“…A 4-point Likert scale is used to rate each item (eg, 0 ¼ none, 4 ¼ very severe), yielding a total score ranging from 0 to 28. The total score is interpreted as follows: absent of insomnia (0-7); subthreshold insomnia (8)(9)(10)(11)(12)(13)(14); moderate insomnia (15)(16)(17)(18)(19)(20)(21); and severe insomnia (22)(23)(24)(25)(26)(27)(28). The IES-R, also a self-reported questionnaire, yields a total score (ranging from 0 to 88).…”

Effects of mindfulness‐based cognitive therapy on breast cancer survivors with insomnia: A randomised controlled trial

“…Sleep disturbance is a widespread public‐health problem that has a negative impact on quality of life for individuals and represents a serious economic burden for society (Dragioti, Bernfort, Larsson, Gerdle, & Levin, 2017). Approximately 23%–46% of breast cancer survivors (BCS) suffer from an “insomnia disorder,” the most common sleep disorder, which is characterised as persistent difficulty initiating or maintaining sleep with a concomitant waking dysfunction (Fleming et al., 2019). Insomnia has been associated with various factors, such as joint pain, hot flushes, anxiety, depression and fear of recurrence in BCS (Desai et al., 2013; Lowery‐Allison et al., 2018).…”

The Relationship between Fatigue and Actigraphy-Derived Sleep and Rest-Activity Patterns in Cancer Survivors

“…The longer time spent awake during the night and the longer time taken to fall asleep observed in fatigued participants, corroborates the higher subjective feeling of insomnia in this study. As a self-report, the ISI was chosen since insomnia is common in cancer survivors reporting having sleep disorders 48 . We found that the majority (83%) of fatigued participants in the present study reported significant sleep disruption (ISI total score > 8), whereas this was reduced to 50% in the non-fatigued group.…”