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. 2024 Mar-Apr;47(2):E108-E122.
doi: 10.1097/NCC.0000000000001185. Epub 2023 Jan 4.

Exploration of the Relationships Between Stress and Distinct Pain and Sleep Disturbance Profiles in Patients Undergoing Chemotherapy

Vita Romanovska  1 , Astrid Block, Steven M Paul, Bruce A Cooper, Marilyn J Hammer, Yvette P Conley, Jon D Levine, Kord M Kober, Christine Miaskowski
Affiliations

Exploration of the Relationships Between Stress and Distinct Pain and Sleep Disturbance Profiles in Patients Undergoing Chemotherapy

Vita Romanovska et al. Cancer Nurs. 2024 Mar-Apr.

Abstract

Background: Unrelieved pain and sleep disturbance are common symptoms in oncology patients. Increased stress may be an underlying cause for both symptoms.

Objectives: The purposes of this study were to identify subgroups of outpatients with distinct pain and sleep disturbance profiles and to evaluate differences among these subgroups in demographic and clinical characteristics. Differences in global stress, cancer-specific stress, and cumulative life stress, as well as resilience and coping, were evaluated.

Methods: Patients (N = 1343) completed self-report questionnaires for demographic and clinical characteristics and stress, resilience, and coping. Latent profile analysis was used to identify subgroups of patients with distinct pain and sleep disturbance profiles. Differences among the subgroups were determined using parametric and nonparametric tests.

Results: Three distinct profiles were identified (ie, No Pain + Moderate Sleep Disturbance (SD) (27.6%), Moderate Pain + Moderate SD (38.6%), Severe Pain + High SD (33.8%)). Compared with the other 2 classes, Severe Pain + High SD class was younger, had fewer years of education, was more likely to be female, more likely to live alone, less likely to be employed, and had a higher level of comorbidity. This class had the highest stress scores and was more likely to report higher rates of adverse childhood experiences.

Conclusion: Over 70% of our sample reported clinically meaningful levels of both symptoms, and 33.8% reported relatively high rates of adverse childhood experiences.

Implication for practice: Clinicians need to perform routine assessments, particularly of adverse childhood experiences, and initiate appropriate referrals.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure.
Figure.
Trajectories of worst pain (WP) and sleep disturbance (SD) for the three latent classes. The numbers on the x-axis indicated the assessments of pain (i.e., rating of worst pain on a 0 to 10 numeric rating scale) and sleep disturbance (i.e., General Sleep Disturbance Scale scores) that were done prior to the administration of chemotherapy (i.e., assessments 1 and 4), in the week following the administration of chemotherapy (i.e., assessments 2 and 5), and two weeks after the administration of chemotherapy (i.e., assessments 3 and 6).
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