Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer

Rades, Dirk; Narvaez, Carlos A; Schild, Steven E.; Tvilsted, Soeren; Kjær, Troels W.

doi:10.21873/invivo.12498

Cited by 12 publications

(17 citation statements)

References 21 publications

(37 reference statements)

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“…Similar to our study, no significant associations were found between sleep disorders and age or previous chemotherapy. Associations between sleep disorders and physical and emotional problems were also found in two previous studies investigating pre-radiotherapy sleep disorders in breast cancer patients (17,18). Moreover, in one of these studies, a trend was observed for an association between sleep disorders and a higher Charlson comorbidity index (17).…”

Section: Discussionsupporting

confidence: 70%

Sleep Disorders Prior to Adjuvant Radiation Therapy for Gynecological Malignancies

et al. 2021

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Background/Aim: Many patients with gynecological malignancies receive postoperative radiotherapy, which can lead to fear and sleep disorders. We aimed to identify the prevalence of and risk factors for sleep disorders. Patients and Methods: Sixty-two patients assigned to radiotherapy for gynecological malignancies were retrospectively evaluated. Seventeen characteristics were analyzed for associations with pre-radiotherapy sleep disorders including age, Karnofsky performance score, Charlson comorbidity index, history of additional malignancy, family history of gynecological cancer, distress score, emotional, physical or practical problems, tumor site/stage; chemotherapy, treatment volume, brachytherapy, and the COVID-19 pandemic. Results: The prevalence of preradiotherapy sleep disorders was 46.8%. Sleep disorders were significantly associated with Charlson comorbidity index ≥3 (p=0.012), greater number of physical problems (p<0.0001), and advanced primary tumor stage (p=0.005). A trend was found for greater number of emotional problems (p=0.075). Conclusion: Pre-radiotherapy sleep disorders are common in patients with gynecological malignancies, particularly in those with specific risk factors. Patients should be offered early psychological support. After breast cancer, gynecological malignancies represent the second most common group of female cancers (1). Many of

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Section: Discussionsupporting

confidence: 70%

Sleep Disorders Prior to Adjuvant Radiation Therapy for Gynecological Malignancies

et al. 2021

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“…In a study of 48 patients scheduled for radiotherapy of prostate cancer, higher distress scores and greater numbers of physical problems were significantly associated with pre-radiotherapy sleep disturbances (21). Moreover, higher distress scores and greater numbers of emotional or physical problems were previously shown in patients irradiated for lung cancer and breast cancer (23,24). Younger age did not prove to be a significant risk factor for pre-treatment sleep disturbances in patients with pelvic malignancies (19)(20)(21) but was significantly associated with the occurrence of preradiotherapy sleep disturbances in previous studies investigating patients irradiated for breast cancer (24) or head-and-neck cancers (25).…”

Section: Discussionmentioning

confidence: 87%

Evaluation of Sleep Disturbances in Patients With Bladder Cancer Scheduled for Local or Loco-regional Radiochemotherapy

et al. 2022

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Background/Aim: Organ-sparing treatment is increasingly used for bladder cancer, particularly for patients with significant comorbidities or advanced age. The upcoming treatment can cause distress and sleep disturbances. This study investigated pre-radiotherapy sleep disturbances in these patients. Patients and Methods: Twenty-two patients with bladder cancer scheduled for local or loco-regional radiotherapy were retrospectively evaluated. Sixteen characteristics were analyzed for sleep disturbances including age, sex, performance score, comorbidities, previous malignancy, distress score, emotional problems, physical problems, treatment situation, treatment intent, current primary tumor and nodal stage, distant metastasis, treatment volume, concurrent chemotherapy, and Coronavirus Disease 2019 pandemic. Results: Eleven patients (50.0%) reported sleep disturbances that were significantly associated with distress scores ≥5 (p=0.035). Trends were found for age ≤75 years (p=0.183), ≥2 emotional problems (p=0.183), ≥5 physical problems (p=0.064), and distant metastasis (p=0.090). Conclusion: Half of the patients reported pre-radiotherapy sleep disturbances. Risk factors facilitate identification of patients requiring psychological support.When compared to other solid malignancies, cancers of the urinary bladder are comparably rare (1). Radical cystectomy is considered the standard approach in many institutions but can be associated with major complications including perioperative death (2-4). Therefore, bladder-sparing treatment approaches including radio-chemotherapy or radiotherapy and transurethral resection have become more popular, particularly for patients with significant comorbidities, worse performance status or advanced age (5-8). However, also multimodal bladder-sparing treatment can be quite burdensome for the patients, which may cause significant emotional distress associated with sleep disturbances. Moreover, to be scheduled for radiation therapy may aggravate the distress due to the fear of radiation exposure and high-tech machines. This idea is supported by a study performed in patients with breast or prostate cancer treated with local or loco-regional radiotherapy (9). In that study, the more pronounce sleep disturbances were reported by the patients before or during the initial phase of their course of radiotherapy. However, to our knowledge, no data have been reported so far regarding pre-treatment sleep disturbances in patients with bladder cancer assigned to a multimodal bladdersparing treatment approach. The present study aimed to provide data for this group of patients by evaluating the prevalence of sleep disturbances prior to a radio-chemotherapy course and potential risk factors for such sleep disturbances. These data will likely contribute to the identification of patients who need psycho-oncological support before the start of their radiochemotherapy treatment. Patients and MethodsTwenty-two patients with bladder cancer scheduled for local or loco-regional radiochemotherapy were retrospecti...

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“…Patients included in this study had completed a questionnaire regarding distress (National Comprehensive Cancer Network Distress Thermometer) at the time of the pre-radiotherapy consent discussion with the patients (11). Of these patients who were previously evaluated for sleep disorders (12), 163 presented before and 175 patients during the COVID-19 pandemic.…”

Section: Methodsmentioning

confidence: 99%

Emotional Problems Prior to Adjuvant Radiation Therapy for Breast Cancer

Rades

Narvaez

Dziggel

et al. 2021

In Vivo

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Background/Aim: Being scheduled for radiotherapy can cause emotional distress. This study aimed to identify risk factors in 338 patients assigned to radiotherapy for breast cancer. Patients and Methods: Nineteen potential risk factors including the COVID-19 pandemic were investigated for associations with the six emotional problems included in the National Comprehensive Cancer Network Distress Thermometer. Results: Worry and fears were significantly associated with age ≤60 years; sadness with age and Karnofsky performance score (KPS) <90; depression with KPS and Charlson Comorbidity Index ≥3; loss of interest with KPS. Trends were found for associations between sadness and additional breast cancer/DCIS, Charlson Index and chemotherapy; between depression and additional breast cancer/DCIS, treatment volume and nodal stage N1-3; between nervousness and additional breast cancer/DCIS, mastectomy and triplenegativity; between loss of interest and Charlson Index, family history of breast cancer/DCIS, invasive cancer, chemotherapy, and treatment volume. The COVID-19 pandemic did not increase emotional problems. Conclusion: Several risk factors for emotional problems were identified. Patients with such factors should receive psychological support well before radiotherapy.Breast cancer is the most common site of new cancers in women in many countries including Denmark and Germany (1-5). Most patients with primary breast cancer receive adjuvant radiotherapy as an integral part of breast-conserving treatment. Radiotherapy may also be indicated after mastectomy if specific risk factors exist (6). The vast majority of patients assigned to adjuvant irradiation receive external beam radiotherapy (EBRT) of the whole breast with or without a boost to the tumor bed (6). Depending on the nodal stage, the treatment volume of radiotherapy may include the locoregional lymph nodes in addition to the breast.Being scheduled for radiotherapy and the radiation treatment itself can be associated with emotional distress. Breast cancer patients were reported to have higher prevalence and distress levels than patients with several other malignancies (7,8). According to previous studies, 30-50% of women with breast cancer report moderate to severe distress and decline in quality of life during their course of radiation treatment (2). Moreover, higher levels of distress prior to surgery or chemotherapy for breast cancer were associated with increased adverse events during and following treatment (2). For patients receiving radiotherapy, it is important to avoid interruption of the treatment due to adverse events in order to achieve optimal results. Very few studies investigated emotional distress before a course of radiotherapy. Browall et al. found that better emotional functioning predicted better quality of live in patients with breast cancer receiving adjuvant radiotherapy (9). Mose et al. reported that 48% of patients with early-stage breast cancer were afraid of adjuvant radiotherapy after breast-conserving surgery (BCS) (10). In their stu...

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Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer

Cited by 12 publications

References 21 publications

Sleep Disorders Prior to Adjuvant Radiation Therapy for Gynecological Malignancies

Sleep Disorders Prior to Adjuvant Radiation Therapy for Gynecological Malignancies

Evaluation of Sleep Disturbances in Patients With Bladder Cancer Scheduled for Local or Loco-regional Radiochemotherapy

Emotional Problems Prior to Adjuvant Radiation Therapy for Breast Cancer

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