Sleep and gynecological cancer outcomes: opportunities to improve quality of life and survival

Abstract

Sleep is important for immune function, metabolic function and physical repair. Sleep is more commonly disrupted in women compared with men and is disrupted by surgery, chemotherapy, and cancer itself, making gynecological oncology patients at higher risk of insomnia and sleep disruption. Insomnia and sleep disruption are linked to increased pain, poorer quality of life, depression, and anxiety which can all negatively affect patient outcomes. A number of environmental, behavioral, and pharmacological interventions have been investigated to improve patient sleep and aid in the recovery process. It is vital to understand and address patient sleep quality in order to give patients the highest quality care and improve outcomes.

Relationships among Inflammatory Biomarkers and Objectively Assessed Physical Activity and Sleep during and after Chemotherapy for Gynecologic Malignancies

“…IL-6, TNF-α, and IL-1β are proinflammatory cytokines [28]. Prior research has found that TNF-α is essential for the sleep-wake cycle, and both elevations and decrements can disrupt the homeostasis necessary for efficient sleep [11,29]. These results suggest that greater inflammation is associated with less light physical activity, more sedentary behavior, and less efficient sleep.…”

“…Each blood sample was evaluated for the presence of circulating markers of inflammation, which included interleukin 10 (IL-10), interleukin 1β (IL-1β), tumor necrosis factor α (TNFα), interleukin 6 (IL-6), interleukin 1 receptor antagonist (IL-1Ra), tumor necrosis factor receptor 1 (TNFR1), tumor necrosis factor receptor 2 (TNFR2), and c-reactive protein (CRP). These inflammatory biomarkers were selected because previous studies have shown that they are associated with physical activity and sleep, they are relatively stable over time, and they are readily detectable using existing laboratory methodologies [10,11,13]. All blood samples were sent to the Cancer Control and Psychoneuroimmunology Lab at the University of Rochester for analysis.…”

“…Inflammation is a potential mechanism to explain the relationship of cancer and its treatment with well-established 'sickness behaviors' associated with cancer, such as reduced physical activity and changes in sleep patterns [10,11]. Sleep disturbance reportedly affects up to 80% of people with gynecologic cancer during treatment [12], and prior research has found evidence for inflammation-associated sleep disturbance lasting at least one year after treatment for patients with ovarian cancer [13].…”

Pre-Diagnosis Sleep Status and Survival after a Diagnosis of Ovarian Cancer: A Prospective Cohort Study

“…Additionally, when sleep appears abnormal, it should be actively intervened. Previous studies have shown that sleep can be improved before, during, and after cancer treatment through certain interventions, such as cognitive behavioral therapy, a regular sleep schedule, limit caffeine intake, exercise therapy, ambient noise limitation, melatonin and other medications [ 40 ]. Second, our investigation had a prospective design, characterized by high baseline survey participation rate and follow-up retention rate, which could reduce the potential for recall bias and selection bias.…”

Impact of Lifestyle Interventions on Gynecologic Cancers: Beyond Diet and Exercise

“…35 Lack of sleep is also linked to inadequate pain management, depression, and overall QoL scores among women with cancer. Zhao and colleagues 36 provide supporting evidence and strategies for sleep optimization in women with gynecologic cancers. The ACLM website (www.lifestylemedicine.org) provides patient education material to address sleep disruptors and proposes evidence-based strategies to improve sleep hygiene.…”