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. 2023 Nov-Dec;46(6):417-431.
doi: 10.1097/NCC.0000000000001139. Epub 2022 Dec 1.

Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life

Alejandra Calvo-Schimmel  1 , Steven M Paul, Bruce A Cooper, Joosun Shin, Carolyn Harris, Kate Oppegaard, Marilyn J Hammer, Frances Cartwright, Yvette P Conley, Kord M Kober, Jon D Levine, Christine Miaskowski
Affiliations

Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life

Alejandra Calvo-Schimmel et al. Cancer Nurs. 2023 Nov-Dec.

Abstract

Background: Anxiety and sleep disturbance are frequent symptoms during chemotherapy.

Objectives: Purposes were to identify subgroups of oncology outpatients with distinct joint anxiety and sleep disturbance profiles, as well as evaluate for differences in demographic and clinical characteristics, sleep disturbance characteristics, severity of common symptoms, and quality-of-life outcomes among these subgroups.

Methods: Oncology outpatients (n = 1331) completed self-report measures of anxiety and sleep disturbance 6 times over 2 chemotherapy cycles. Latent profile analysis was done to identify subgroups of patients with distinct joint anxiety and sleep disturbance profiles.

Results: Three profiles were identified (ie, no anxiety and low sleep disturbance (59.7%), moderate anxiety and high sleep disturbance (32.5%), high anxiety and very high sleep disturbance (7.8%)). Compared with the no anxiety and low sleep disturbance class, the other 2 classes were younger; less likely to be married; had a lower annual household income; and had childcare responsibilities. Patients in the 2 worse profiles had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and evening fatigue, as well as lower levels of morning and evening energy, cognitive function, and poorer quality of life.

Conclusions: More than 40% of patients had moderate or high levels of anxiety and high or very high levels of sleep disturbance. Modifiable risk factors associated with these profiles may be used to develop targeted interventions for 1 or both symptoms.

Implications for practice: Clinicians need to assess for the co-occurrence of anxiety and sleep disturbance.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Changes in Spielberger State Anxiety Inventory (STAI-S (ANX), left y-axis) and General Sleep Disturbance Scale (GSDS (SD), right y-axis) scores over two cycles of chemotherapy for subgroups of patients with No Anxiety and Low Sleep Disturbance (panel A), Moderate Anxiety and High Sleep Disturbance (panel B), and High Anxiety and Very High Sleep D (panel C).
Figure 2.
Figure 2.
Differences in Medical Outcomes Study - Short Form-12 physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), mental health (ME), physical component summary (PCS), and mental component summary (MCS) scores among the anxiety and sleep disturbance latent classes. All values are plotted as means ± standard deviations. For the RP, BP, GH, VT, SF, RE, MH, and MCS domains, post hoc contrasts demonstrated that the differences among the classes followed the same pattern (i.e., No Anxiety and Low Sleep Disturbance class > Moderate Anxiety and High Sleep Disturbance class > High Anxiety and Very High Sleep Disturbance class (all, p Moderate Anxiety and High Sleep Disturbance and High Anxiety and Very High Sleep Disturbance classes (both, p
Figure 3.
Figure 3.
Differences in mean Quality of Life Scale – Patient Version physical, psychological, social, and spiritual well-being domains as well as total quality of life (QOL) scores among the anxiety and sleep disturbance latent classes. All values are plotted as means ± standard deviations. For all of the subscales as well as the total scores, post hoc contrasts demonstrated that significant differences among the classes followed the same pattern (i.e., No Anxiety and Low Sleep Disturbance class > Moderate Anxiety and High Sleep Disturbance class > High Anxiety and Very High Sleep Disturbance class (all, p
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