Insomnia is underrecognized in patients with cancer. By identifying clinical correlations and predisposing factors of insomnia, interventions may be initiated to treat insomnia.
Methods:
Consecutive patients referred to palliative medicine services were screened with a single question. Patients answering affirmatively completed the Insomnia Severity Index (ISI). Patients were screened for depression, fatigue, and pain. Spearman correlation was performed for associations.
Results:
Of 715 consecutive patients, 102 had sleep problems and 64 had clinical insomnia by the ISI criteria. Insomnia correlated with depression (r = .32), pain (r = .29), and tiredness (r = .40) but not with age or precipitating factors.
Discussion:
Insomnia severity moderately correlates with depression, pain, and tiredness. We found no association of insomnia severity with age or medications.
Conclusion:
Insomnia, pain, depression, and tiredness are a symptom cluster.
O'DonnellJF.Insomnia in cancer patients. Clin Cornerstone. 2004;(6 suppl 1D):S6–S14.
2.
TheobaldDE.Cancer pain, fatigue, distress, and insomnia in cancer patients. Clin Cornerstone. 2004;(6 suppl 1D): S15–S21.
3.
DavidsonJRMacLeanAWBrundageMDSchulzeK. Sleep disturbance in cancer patients. Soc Sci Med. 2002;54(9):1309–1321.
4.
SelaRAWatanabeSNekolaichukCL. Sleep disturbances in palliative cancer patients attending a pain and symptom control clinic. Palliat Support Care. 2005;3(1):23–31.
5.
SavardJMorinCM. Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol. 2001;19(3):895–908.
6.
TroxelWMKupferDJReynoldsCF 3rd. Insomnia and objectively measured sleep disturbances predict treatment outcome in depressed patients treated with psychotherapy or psychotherapy-pharmacotherapy combinations. J Clin Psychiatry. 2012;73(4):478–485.
7.
DegnerLFSloanJA. Symptom distress in newly diagnosed ambulatory cancer patients and as a predictor of survival in lung cancer. J Pain Symptom Manage. 1995;10(6):423–431.
8.
SavardJHervouetSIversH. Prostate cancer treatments and their side effects are associated with increased insomnia [Published online August 8, 2012]. Psychooncology. 2012.
9.
McMillanSCSmallBJ. Symptom distress and quality of life in patients with cancer newly admitted to hospice home care. Oncol Nurs Forum. 2002;29(10):1421–1428.
10.
WatanabeSMNekolaichukCLBeaumontC. The Edmonton symptom assessment system, a proposed tool for distress screening in cancer patients: development and refinement. Psychooncology. 2012;21(9):977–985.
11.
SavardJIversHVillaJCaplette-GingrasAMorinCM. Natural course of insomnia comorbid with cancer: an 18-month longitudinal study. J Clin Oncol. 2011;29(26):3580–3586.
12.
PriceMAZachariaeRButowPN. Prevalence and predictors of insomnia in women with invasive ovarian cancer: anxiety a major factor. Eur J Cancer. 2009;45(18):3262–3270.
13.
LisCGGuptaDGrutschJF. The relationship between insomnia and patient satisfaction with quality of life in cancer. Support Care Cancer. 2008;16(3):261–266.
14.
SavardMHSavardJSimardSIversH. Empirical validation of the insomnia severity index in cancer patients. Psychooncology. 2005;14(6):429–441.
15.
RothTRoehrsTPiesR. Insomnia: pathophysiology and implications for treatment. Sleep Med Rev. 2007;11(1):71–79.
16.
SavardJSimardSBlanchetJIversHMorinCM. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep. 2001;24(5):583–590.
17.
RothTFranklinMBramleyTJ. The state of insomnia and emerging trends. Am J Manag Care. 2007;13(suppl 5):S117–S120.
18.
RothT. Introduction--Advances in our understanding of insomnia and its management. Sleep Med. 2007;8(suppl 3):25–26.
19.
MaloneMHarrisALLuscombeDK. Assessment of the impact of cancer on work, recreation, home management and sleep using a general health status measure. J R Soc Med. 1994;87(7):386–389.
20.
KayeJKayeKMadowL. Sleep patterns in patients with cancer and patients with cardiac disease. J Psychol. 1983;114(1st half):107–113.
21.
OhayonMMRothT. Place of chronic insomnia in the course of depressive and anxiety disorders. J Psychiatr Res. 2003;37(1):9–15.
22.
PerlisMLGilesDEBuysseDJTuXKupferDJ. Self-reported sleep disturbance as a prodromal symptom in recurrent depression. J Affect Disord. 1997;42(2-3):209–212.
23.
FavaGAGrandiSCanestrariRMolnarG. Prodromal symptoms in primary major depressive disorder. J Affect Disord. 1990;19(2):149–152.
24.
TangNKGoodchildCEHesterJSalkovskisPM. Pain-related insomnia versus primary insomnia: a comparison study of sleep pattern, psychological characteristics, and cognitive-behavioral processes. Clin J Pain. 2012;28(5):428–436.
25.
HaackMScott-SutherlandJSantangeloGSimpsonNSSethnaNMullingtonJM. Pain sensitivity and modulation in primary insomnia. Eur J Pain. 2012;16(4):522–533.
26.
HaackMScott-SutherlandJSantangeloGSimpsonNSSethnaNMullingtonJM. Pain sensitivity and modulation in primary insomnia[Published online August 23, 2011]. Eur J Pain. 2011.
27.
DorrepaalKLAaronsonNKvan DamFS. Pain experience and pain management among hospitalized cancer patients. A clinical study. Cancer. 1989;63(3):593–598.
28.
StrangP. Emotional and social aspects of cancer pain. Acta Oncol. 1992;31(3):323–326.
29.
SarnaL. Fluctuations in physical function: adults with non-small cell lung cancer. J Adv Nurs. 1993;18(5):714–724.
30.
AbeY. Fatigue as a core symptom of insomnia. Innov Clin Neurosci. 2012;9(2):10–11.
31.
HugelHEllershawJECookLSkinnerJIrvineC. The prevalence, key causes and management of insomnia in palliative care patients. J Pain Symptom Manage. 2004;27(4):316–321.
32.
MercadanteSGirelliDCasuccioA. Sleep disorders in advanced cancer patients: prevalence and factors associated. Support Care Cancer. 2004;12(5):355–359.
33.
DonovanKAJacobsenPB. Fatigue, depression, and insomnia: evidence for a symptom cluster in cancer. Semin Oncol Nurs. 2007;23(2):127–135.
34.
SpencerPZ. Gender, age, and the risk of insomnia. CNS Spectr. 2008;13(12 suppl 17):7–9.
35.
FrommeEKEilersKMMoriMHsiehYCBeerTM. How accurate is clinician reporting of chemotherapy adverse effects? A comparison with patient-reported symptoms from the Quality-of-Life Questionnaire C30. J Clin Oncol. 2004;22(17):3485–3490.
36.
SchnadigIDFrommeEKLoprinziCL. Patient-physician disagreement regarding performance status is associated with worse survivorship in patients with advanced cancer. Cancer. 2008;113(8):2205–2214.
