Sleep During Oncological Treatment – A Systematic Review and Meta-Analysis of Associations With Treatment Response, Time to Progression and Survival

Abstract

IntroductionDisrupted sleep and sleep-wake activity are frequently observed in cancer patients undergoing oncological treatment. These disruptions are often associated with aggravated symptom burden and diminished health-related quality of life that in turn may compromise treatment adherence and, thus, effectiveness. In addition, disrupted sleep has been linked to carcinogenic processes, which ultimately could result in worse prognostic outcomes.AimsOur aim was to systematically review and conduct a meta-analysis of studies examining the associations between sleep and sleep-wake activity and prognostic outcomes in cancer patients undergoing oncological treatment.MethodsA comprehensive systematic search of English language papers was undertaken in June 2020 using PubMed, The Cochrane Library, and CINAHL. Two reviewers independently screened 4,879 abstracts. A total of 26 papers were included in the narrative review. Thirteen papers reporting hazard ratios reflecting associations between a dichotomized predictor variable (sleep) and prognostic outcomes were subjected to meta-analysis.ResultsNineteen of the 26 eligible studies on a total of 7,092 cancer patients reported associations between poorer sleep and poorer response to treatment, shorter time to progression, and/or reduced overall survival, but were highly heterogeneous with respect to the sleep and outcome parameters investigated. Meta-analysis revealed statistically significant associations between poor self-reported sleep and reduced overall survival (HR = 1.33 [95% CI 1.09–1.62], k = 11), and shorter time to progression (HR = 1.40 [95% CI 1.23–1.59], k = 3) and between poor objectively assessed sleep and reduced overall survival (HR = 1.74 [95% CI 1.05–2.88], k = 4).ConclusionThe current findings indicate that disturbed sleep during treatment may be a relevant behavioral marker of poor cancer prognosis. The limited number of studies, the common use of single item sleep measures, and potential publication bias highlight the need for further high quality and longitudinal studies.

Psychological and behavioral symptoms in patients with melanoma: A systematic review and meta‐analysis

“…Timely identification of clinically significant symptoms of anxiety and depression has the potential to improve overall quality of life, prognosis, and other treatment outcomes. 23,24,26,73 While there currently is no agreed-upon universal screening tool, one of the most used screening tools for depression and anxiety, the HADS, 45 was included in several studies, and our review provides pooled mean HADS depression and anxiety scores at different time points for comparison. Unfortunately, few studies had examined fatigue, cognitive problems, and sleep, preventing us from evaluating the possible factors associated with higher rates of these symptoms.…”

“…Our findings highlight vulnerable periods for these patients and the need to screen for distress, that is, anxiety and/or depression, as the “6th vital sign” 72 before, during, and after treatment and for providing relevant interventions for patients in need. Timely identification of clinically significant symptoms of anxiety and depression has the potential to improve overall quality of life, prognosis, and other treatment outcomes 23,24,26,73 . While there currently is no agreed‐upon universal screening tool, one of the most used screening tools for depression and anxiety, the HADS, 45 was included in several studies, and our review provides pooled mean HADS depression and anxiety scores at different time points for comparison.…”

“…[18][19][20] While the etiology of these symptoms, that is, whether they are due to the cancer or its treatment, is not always clear, these symptoms are associated with lower quality of life, poor daily functioning, slower recovery, and increased morbidity. [21][22][23][24][25][26] A systematic review of 44 studies published in 2009 indicated that approximately one third of patients with melanoma report high levels of psychological distress requiring clinical intervention. 27 A more recent systematic review of 18 studies showed that patients with uveal melanoma experienced impaired physical functioning and well-being after treatment.…”

An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research

“…Given the high level of physical and psychological symptoms in these patients, health care providers should be aware of the prognostic consequences of sleep disturbances. A recent review indicated that disturbed sleep during oncological treatment might be a relevant behavioral marker of poor cancer prognosis [ 78 ]. In detail, disturbances in sleep and sleep–wake activity immediately prior to or during treatment were associated with reduced overall survival, poorer response to treatment, and shorter time to progression [ 78 ].…”

“…A recent review indicated that disturbed sleep during oncological treatment might be a relevant behavioral marker of poor cancer prognosis [ 78 ]. In detail, disturbances in sleep and sleep–wake activity immediately prior to or during treatment were associated with reduced overall survival, poorer response to treatment, and shorter time to progression [ 78 ]. Moreover, sleep disorder prevalence data might be helpful for future development of interventions in the treatment of sleep disturbances.…”