Sleep–wake disturbances in cancer patients: narrative review of literature focusing on improving quality of life outcomes

Abstract

PurposeEvidence suggests a high prevalence of sleep–wake disturbances in patients with cancer, occurring at diagnosis, during treatment, and continuing to survivorship. Yet associations between sleep–wake disturbances and the impact on quality of life outcomes is less clear. The purpose of this narrative review of the literature is to evaluate sleep–wake disturbances in patients with cancer, to describe the influence of poor sleep on quality of life as an outcome, and to evaluate the evidence to recommend future interventions.Framework and methodsThis review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. Four databases (CINAHL, MEDLINE, PsycINFO, and Embase) were searched using terms “cancer OR neoplasm”, “sleep, sleep disturbance, sleep disorders or insomnia”, and “quality of life”; the search included all years, English language, and peer-reviewed articles on research studies. Studies included measurements of sleep and quality of life in cancer patients at a minimum of two time points and demonstrated relationships between sleep and quality of life. Data were collected on date, patient demographics, cancer type and treatment, timeframe, design, measurement, variables, and results.ResultsThis narrative review demonstrates that sleep–wake disturbance is a major problem/symptom in patients with cancer. Of the 18 studies included, measurement of sleep-related variables included objective and subjective measures; however, direct measurement of the associations between sleep and quality of life was not common. Cognitive behavioral therapy for insomnia and mind–body interventions demonstrated feasibility when implemented into cancer care settings. In addition, the majority of interventions exhibited moderate effectiveness in improving sleep–wake disturbance and quality of life outcomes.ConclusionThe studies predominantly reported that poor sleep negatively impacts quality of life. The intervention studies included nonpharmacologic interventions such as cognitive behavioral treatment and mind–body and exercise interventions with moderate-to-high levels of evidence for improvement in sleep measures and quality of life.

Using a personalized measure (Patient Generated Index (PGI)) to identify what matters to people with cancer

“…Other studies that have used the PGI in cancer samples also found this wide range of areas [9,19]. Our findings are concordant with the literature on the importance of fatigue, sleep, and pain to QOL, as the most recent systematic reviews endorsed their importance [48][49][50][51][52][53].…”

Relationship between fatigue, sleep quality and inflammatory cytokines during external beam radiation therapy for prostate cancer: A prospective study

“…Additionally, sleep disturbance in cancer patients have also independently been shown to negatively impact QOL [29]. In our cohort, we did not see an association with increasing sleep disturbance across EBRT treatment weeks.…”

Melatonin-Induced Oncostasis, Mechanisms and Clinical Relevance

“…However, they generally remained underdiagnosed and poorly treated [170][171][172][173]. In a cross-sectional survey study on nearly 1,000 cancer patients to examine the prevalence of sleep problems, sleep disturbance was most prevalent among the lung and breast cancer patients.…”