Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Aug;25(8):2485-2494.
doi: 10.1007/s00520-017-3655-2. Epub 2017 Mar 9.

Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapy

Sueann Mark  1 , Janine Cataldo  1 , Anand Dhruva  2 , Steven M Paul  1 , Lee-May Chen  2 , Marilyn J Hammer  3 , Jon D Levine  2 , Fay Wright  4 , Michelle Melisko  2 , Kathryn Lee  1 , Yvette P Conley  5 , Christine Miaskowski  6   7
Affiliations

Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapy

Sueann Mark et al. Support Care Cancer. 2017 Aug.

Abstract

Purpose: In a sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer who received at least two cycles of chemotherapy (CTX), the purposes were to evaluate for inter-individual differences in the severity of sleep disturbance and determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of sleep disturbance.

Methods: A total of 1331 patients completed study questionnaires in their homes, at six time points over two cycles of CTX (prior to CTX administration, approximately 1 week after CTX administration, and approximately 2 weeks after CTX administration). Questionnaires included demographic, clinical, and symptom assessments (i.e., General Sleep Disturbance Scale, Lee Fatigue Scale, Center for Epidemiological Studies-Depression Scale, Spielberger State-Trait Anxiety Inventories, Attentional Function Index). Hierarchical linear modeling based on full maximum likelihood estimation was performed.

Results: Characteristics associated with higher initial levels of sleep disturbance included higher body mass index, poorer functional status, higher trait anxiety, higher depressive symptoms, and higher evening fatigue. Characteristics associated with the worse trajectories of sleep disturbance were higher levels of education and higher sleep disturbance at enrollment. Characteristics associated with both higher initial levels and worse trajectories of sleep disturbance were higher morning fatigue and worse attentional function.

Conclusions: A large amount of inter-individual variability exists in sleep disturbance during CTX. The modifiable and non-modifiable characteristics found in this study can be used to identify higher risk patients and provide earlier interventions to reduce sleep disturbance.

Keywords: Cancer; Chemotherapy; Depression, anxiety; Fatigue; Hierarchical linear modeling; Sleep disturbance.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A – Piecewise model of mean sleep disturbance scores for six assessment points over two cycles of chemotherapy (CTX). Figure 1B - Spaghetti plots of individual sleep disturbance trajectories for a random sample of 50 patients over two cycles of CTX. Abbreviation: GSTOT = General Sleep Disturbance Scale total score.
Figure 2
Figure 2
A–E- Influence of enrollment scores for body mass index (A), Karnofsky Performance Status (KPS) score (B), trait anxiety (C), depressive symptoms (D), and evening fatigue (E), on inter-individual differences in the intercept for sleep disturbance.
Figure 3
Figure 3
A–D Influence of enrollment scores for level of education (A) and sleep disturbance (GSDS score) (B), on the slope parameters for sleep disturbance and influence of enrollment scores for morning fatigue (C) and attentional function (D) on inter-individual differences in the intercept and slope parameters for sleep disturbance.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Liu L, Ancoli-Israel S. Sleep disturbances in cancer. Psychiatr Ann. 2008;38(9):627–634. - PMC - PubMed
    1. Savard J, Morin CM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001;19(3):895–908. - PubMed
    1. Vena C, Parker K, Cunningham M, Clark J, McMillan S. Sleep-wake disturbances in people with cancer part I: an overview of sleep, sleep regulation, and effects of disease and treatment. Oncol Nurs Forum. 2004;31(4):735–746. doi: 10.1188/04.ONF.735-746. - DOI - PubMed
    1. Knobf MT, Cooley ME, Duffy S, et al. The 2014–2018 Oncology Nursing Society Research Agenda. Oncol Nurs Forum. 2015;42(5):450–465. doi: 10.1188/15.ONF.450-465. - DOI - PubMed
    1. Enderlin CA, Coleman EA, Cole C, Richards KC, Hutchins LF, Sherman AC. Sleep across chemotherapy treatment: a growing concern for women older than 50 with breast cancer. Oncol Nurs Forum. 2010;37(4):461–A463. 4270U45WKWML0566. - PubMed