Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer

Abstract

Sleep problems are highly prevalent in cancer patients undergoing chemotherapy. This article reviews existing evidence on etiology, associated symptoms, and management of sleep problems associated with chemotherapy treatment during cancer. It also discusses limitations and methodological issues of current research. The existing literature suggests that subjectively and objectively measured sleep problems are the highest during the chemotherapy phase of cancer treatments. A possibly involved mechanism reviewed here includes the rise in the circulating proinflammatory cytokines and the associated disruption in circadian rhythm in the development and maintenance of sleep dysregulation in cancer patients during chemotherapy. Various approaches to the management of sleep problems during chemotherapy are discussed with behavioral intervention showing promise. Exercise, including yoga, also appear to be effective and safe at least for subclinical levels of sleep problems in cancer patients. Numerous challenges are associated with conducting research on sleep in cancer patients during chemotherapy treatments and they are discussed in this review. Dedicated intervention trials, methodologically sound and sufficiently powered, are needed to test current and novel treatments of sleep problems in cancer patients receiving chemotherapy. Optimal management of sleep problems in patients with cancer receiving treatment may improve not only the well-being of patients, but also their prognosis given the emerging experimental and clinical evidence suggesting that sleep disruption might adversely impact treatment and recovery from cancer.

Sleep Disorders and Sleep Quality in Moroccan Adult Patients with Cancer during Treatment

“…Regarding clinical characteristics we found that head and neck, Gastrointestinal, and urologic cancer were the types of cancer most associated with insomnia. The strongest associated factors were lowest SES (OR= 3.849 (1,684-5,159)), Head and neck cancer (OR=3.129 (1,985-5,129)), urologic cancer (OR= 2.919 (1,985-5,295)), Surgery (OR= 3.201 (1,157)), and Chemotherapy (OR= 3.154 (2,818)). …”

Symptom self-management strategies reported by adolescents and young adults with cancer receiving chemotherapy

“…Existing evidence shows that AYAs with cancer have insufficient sleep and physical activity [33][34][35]. Self-management related to promoting sleep and physical activity is an important area for intervention development.…”

Short Sleep Duration and Its Correlates among Cancer Survivors in Korea: the Korea National Health and Nutrition Examination Surveys

“…Though the prevalence ranges vary depending on the study characteristics, cancer survivors have consistently reported higher rates of sleep problems compared than the general population (Savard and Morin, 2001;Schultz et al, 2005;Bardwell et al, 2008;Mulrooney et al, 2008;Savard et al, 2011;Zhou and Recklitis, 2014), which parallel with our findings. Notwithstanding the limits of knowledge on the exact mechanism across the cancer trajectory, cancer-related sleep problems covering difficulties initiating or maintaining sleep, dissatisfaction with sleep quality, and/or short sleep duration appear to begin with cancer diagnosis, inducing emotional challenges (i.e., anxiety and distress), and are easily exacerbated during cancer treatments such as chemotherapy, which continue through cancer survivorship (Palesh et al, 2012;Garland et al, 2014). Biologically, these negative consequences are assumed to underlie the inflammatory mechanism: a negative feedback loop where substantial increases in proinflammatory cytokine activity induced by cancer treatments can lead to sleep problems, which in turn may feedback to alter immune profiles, activating chronic inflammatory processes among cancer survivors, and finally progress to long-term sleep disturbance throughout the survivorship (Lee et al, 2004;Miller et al, 2008;Irwin et al, 2013).…”