Sleep Disturbances in Women With Metastatic Breast Cancer

Abstract

We examined sleeping problems in women with metastatic breast cancer in relation to depression, social support, and salivary cortisol. Ninety-seven women with metastatic breast cancer were drawn from a larger study on the effects of group therapy on quality of life and survival. This study is based on the baseline assessments conducted prior to randomization into treatment conditions. Sleep, depression symptoms, and social support were assessed by self-reporting. Cortisol was assessed from saliva samples taken over a 3-day period. Medical status and demographic characteristics were also examined in relation to each sleep variable in multiple regression analysis. Most women (63%) reported one or more types of sleep disturbance and 37% reported using sleeping pills in the previous 30 days. Problems with falling to sleep were significantly related to greater pain and depressive symptoms. Problems of waking during the night were significantly associated with greater depression and less education. Problems in waking/getting up were significantly associated with greater depressive symptoms and less social support. Sleepiness during the day was not significantly related to the variables in the regression model. Fewer hours of sleep were significantly associated with metastases to the bone, higher depressive symptoms, and more social support. Women who reported sleeping 9 or more hours per night, compared to those who reported a moderate amount of sleep (6.5-8.5 hours), had significantly lower 9 p.m. cortisol levels. Use of sleeping pills was more frequent among women reporting greater pain and depressive symptoms. These results suggest that women with metastatic breast cancer who are at higher risk for having sleeping problems are those who are less educated, in pain, depressed, have bony metastases, or lack social support.

Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma

“…Of particular concern is the possibility that there may be profound consequences of disturbed sleep for cancer patients, because sleep may mediate both psychologic health and physical health. 38,41,42 In fact, sleep disturbances have been associated with worse quality of life in cancer patients, including increased depression and higher pain levels, 40,43 and with depression in noncancer patients. 42 Persistent sleep disturbances also may increase a cancer patient's risk for mood disorders, altered metabolic and endocrine function, and compromised immune functioning.…”

“…42 Persistent sleep disturbances also may increase a cancer patient's risk for mood disorders, altered metabolic and endocrine function, and compromised immune functioning. 38,41,43,44 It is noteworthy that sleep disruptions have been associated with adverse physical health outcomes, including increased morbidity and mortality. [45][46][47] Potential changes in metabolic, endocrine, and immune function may have particularly important health consequences for patients with hematologic malignancies.…”

A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer

“…Hann and colleagues (Hann et al, 1999) reported adequate internal consistency for this scale in both healthy controls (alpha=.87) and cancer patients (alpha =.89) and good test-retest reliability in both healthy controls (r= 0.51;p < 0.001) and cancer patients (r = 0.57; p < 0.001). The measure has one sleep-related item ("My sleep was restless") and is similar in this way to other depression scales (e.g., Zung Depression Inventory (Zung, 1965); BDI (Beck, 1978))Pain-In keeping with previous research in our laboratory concerning pain among women with metastatic breast cancer (e.g., Koopman, Nouriani et al, 2002;Spiegel & Bloom, 1983)), current pain was assessed using a single item from the Pain Questionnaire (Spiegel & Bloom, 1983): "Please rate your experience of pain at this moment by selecting a number from 1 "not noticeable" to 10 "excruciating -worst ever".Stressful life events-Stressful life events were measured using a 37-item checklist developed by Horowitz, Schaefer, Hiroto, Wilner and Levin (Horowitz, Schaefer, Hiroto, Wilner, & Levin, 1977). This assessment was conducted only at baseline.…”

“…Koopman and colleagues (Koopman, Nouriani et al, 2002) found that 63% of a sample of metastatic breast cancer patients reported one or more types of sleep disturbance. In a sample of 72 breast cancer patients, Fortner and colleagues (2002) found that 61% had significant sleep deficits.…”

“…Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Disturbed sleep is common among breast cancer patients (Davidson, MacLean, Brundage, & Schulze, 2002;Koopman, Nouriani et al, 2002;Savard & Morin, 2001) and has been found to be associated not only with poor quality of life (Carpenter & Andrykowski, 1998;Fortner, Stepanski, Wang, Kasprowicz, & Durrence, 2002), depressive symptoms (Koopman, Nouriani et al, 2002), and fatigue (Lichstein, Means, Noe, & Aguillard, 1997), but also with increased breast cancer risk (Davis, Mirick, & Stevens, 2001). Rates of sleep disturbance for women with breast cancer are well above those for the general adult population and higher than the above average rates for cancer patients in general.…”