Association of Nutrition Impact Symptoms With Sleep Disturbance Among Patients With Advanced Cancer Referred to Palliative Care: A Secondary Analysis of a Multicenter Survey

Abstract

Objectives

We investigated the associations of nutrition impact symptoms (NISs) with sleep disturbance among advanced cancer patients receiving palliative care.

Methods

A secondary analysis of a self-administered survey was performed. Participants evaluated 3 components of sleep disturbance (ie, difficulty falling asleep, difficulty staying asleep, and early awakening) and 19 NISs using numerical rating scales (0-10). They also used several screening tools, including the Hospital Anxiety and Depression Scale (HADS). Finally, 2 groups were analyzed by multivariate logistic regression analysis using a cutoff score of 4 for each of the 3 components (< 4, lower score group; ≥ 4, higher score group).

Results

Ultimately, 184 patients were included. For all 3 components, higher score groups had significantly greater numbers of NISs with a score ≥ 4 and higher anxiety and depression than lower score groups. In the logistic regression model using HADS-Anxiety for difficulty falling asleep, significantly higher adjusted odds ratios (ORs) were observed in the 4-6 NISs (with a score ≥ 4) group than in the no NISs (with a score ≥ 4) group (7.15 [95% confidence interval (CI), 1.24-41.06]). Using HADS-Depression for difficulty falling asleep and difficulty staying asleep, significantly higher adjusted ORs were observed in the 4-6 NISs group than in the no NISs group (7.43 [95% CI, 1.29-42.74]; 4.47 [95% CI, 1.02-19.69, respectively]).

Conclusions

Having 4 or more NISs with a score ≥ 4 was significantly associated with sleep disturbance. Cachexia-related symptom management is essential to improve patients’ sleep status.