Abstract

Objective: Insomnia affects around 30% to 60% of cancer patients and is common in most cancers especially in breast cancer. This study aims at evaluating the quality of sleep and determining the predisposing factors of insomnia in breast cancer patients.

Methods: It was a cross sectional study including breast cancer patients consulting at the departments of medical oncology in the university hospitals of Monastir and Sousse in Tunisia. Eligible patients were invited to complete one questionnaire and four scales: the insomnia severity index; the hospital anxiety and depression scale; the brief fatigue inventory and the short form-36 health survey.

Results: Seventy breast cancer patients were included in the study. Forty percent of them had clinically significant insomnia, all of them had mild level of fatigue, 12.9% had depressive symptoms and 21.4% had anxiety symptoms. The alteration of the quality of life was observed in all domains. The physical role functioning was the most affected dimension, whereas social functioning was the least altered dimension.

Insomnia was significantly associated with a longer time since cancer diagnosis (p = 0.01) ; hot flushes (p = 0.015) ; depressive (p < 0.001) and anxiety symptoms (p < 0.001) ; fatigue (p = 0.007) ; poor physical functioning (p < 0.001) ; less ability to function generally (p = 0.015) ; less vitality in daily life (p < 0.001) ; more bodily pain (p = 0.045) ; more mental health issues (p < 0.001) and lower ability to function socially (p = 0.002).

Conclusions: Information concerning the prevalence and predisposing factors of insomnia in breast cancer patients will be of great help in developing future interventions to manage insomnia in this population.

Keywords: Breast; Cancer; Insomnia; Oncology; Quality of Life

References

1. Desai K., et al. “Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors”. Support Care Cancer 21.1 (2013): 43‑51.
2. Fiorentino L and Ancoli-Israel S. “Insomnia and its Treatment in Women with Breast Cancer”. Sleep Medicine Reviews 10.6 (2006): 419‑429.
3. Rosch PJ. Insomnia, psychological assessment and management, Charles M. Morin, Guilford Press, New York,. No. of pages: 238. Price: $26.95. Stress Medicine 10.1 (1993): 69‑70. 
4. Bastien C., et al. “Validation of the Insomnia Severity Index (ISI) as an outcome measure for insomnia research”. Sleep Medicine 2 (2001): 297‑307. 
5. Savard M-H., et al. “Empirical validation of the Insomnia Severity Index in cancer patients”. Psycho‐Oncology 14.6 (2004): 429‑441. 
6. Savard J., et al. “Cancer treatments and their side effects are associated with aggravation of insomnia: Results of a longitudinal study”. Cancer 121.10 (2015): 1703‑1711. 
7. Bjelland I., et al. “The validity of the Hospital Anxiety and Depression Scale: An updated literature review”. Journal of Psychosomatic Research 52.2 (2002): 69‑77. 
8. Hyun Kim S., et al. “Fatigue and Depression in Disease-Free Breast Cancer Survivors: Prevalence, Correlates, and Association with Quality of Life”. Journal of Pain Symptom Management 35 (2008): 644‑655. 
9. Mendoza TR., et al. “The rapid assessment of fatigue severity in cancer patients”. Cancer 85.5 (1999): 1186‑1196. 
10. Goodwin JS., et al. “Effect of Depression on Diagnosis, Treatment, and Survival of Older Women with Breast Cancer”. Journal of the American Geriatrics Society 52.1 (2004): 106‑111. 
11. Watson M., et al. “Influence of psychological response on survival in breast cancer: a population-based cohort study”. The Lancet 354.9187 (1999): 1331‑1336. 
12. Miaskowski C., et al. “Symptom Clusters: The New Frontier in Symptom Management Research”. 32 (2004): 17. 
13. Fortner BV., et al. “Sleep and Quality of Life in Breast Cancer Patients”. Journal of Pain and Symptom Management 24.5 (2002): 471‑480. 
14. Malone M., et al. “Assessment of the impact of cancer on work, recreation, home management and sleep using a general health status measure”. Journal of the Royal Society of Medicine 87.7 (1994): 386‑389. 
15. Taylor TR., et al. “Understanding sleep disturbances in African-American breast cancer survivors: a pilot study”. Psychooncology 21.8 (2012): 896‑902. 
16. Bardwell WA., et al. “The relative importance of specific risk factors for insomnia in women treated for early-stage breast cancer”. Psychooncology 17.1 (2008): 9‑18. 
17. Couzi RJ., et al. “Prevalence of menopausal symptoms among women with a history of breast cancer and attitudes toward estrogen replacement therapy”. Journal of Clinical Oncology 13.11 (1995): 2737‑2744. 
18. Savard J., et al. “The association between nocturnal hot flashes and sleep in breast cancer survivors”. Journal of Pain Symptom Management 27 (2004): 513‑522. 
19. M Taylor L., et al. “Attentional Bias in People with Acute Versus Persistent Insomnia Secondary to Cancer”. Behavioral Sleep Medicine (2003): 200‑212. 
20. Savard J., et al. “Breast cancer patients have progressively impaired sleep-wake activity rhythms during chemotherapy”. Sleep 32.9 (2009): 1155‑1160. 
21. Van Onselen C., et al. “Trajectories of Sleep Disturbance and Daytime Sleepiness in Women Before and After Surgery for Breast Cancer”. Journal of Pain Symptom Management 45.2 (2013): 244‑260. 
22. Donovan KA and Jacobsen PB. “Fatigue, Depression, and Insomnia: Evidence for a Symptom Cluster in Cancer”. Seminars in Oncology Nursing 23.2 (2007): 127‑135. 
23. Trudel-Fitzgerald C., et al. “Which Symptoms Come First? Exploration of Temporal Relationships Between Cancer-Related Symptoms over an 18-Month Period”. Annals Behaviour Medicne 45.3 (2013): 329‑337. 
24. Wang M-L., et al. “Experiences and insomnia-associated factors in Chinese breast cancer survivors: a qualitative study”. Journal of Clinical Nursing 25.13‑14 (2016): 1923‑1930. 
25. Lovato N., et al. “Evaluation of a Brief Treatment Program of Cognitive Behavior Therapy for Insomnia in Older Adults”. Sleep 37.1 (2014): 117‑126. 
26. Anaclet C., et al. “The GABAergic parafacial zone is a medullary slow wave sleep-promoting center”. Nature Neuroscience 17.9 (2014): 1217‑1224. 
27. Liu L., et al. “Fatigue and sleep quality are associated with changes in inflammatory markers in breast cancer patients undergoing chemotherapy”. Brain, Behavior, and Immunity 26.5 (2012): 706‑713. 
28. Ryan JL., et al. “Mechanisms of Cancer-Related Fatigue”. The Oncologist 12.1 (2007): 22‑34. 
29. Roscoe JA., et al. “Cancer-Related Fatigue and Sleep Disorders”. The Oncologist 12.1 (2007): 35‑42. 
30. Ancoli-Israel S., et al. “Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer”. The Multinational Association for Supportive Care in Cancer Risk 14.3 (2006): 201‑209. 
31. Levkovich I., et al. “Cancer-related fatigue and depression in breast cancer patients postchemotherapy: Different associations with optimism and stress appraisals”. Palliat Support Care 13.5 (2015): 1141‑1151. 
32. Mahowald ML and Mahowald MW. “Nighttime sleep and daytime functioning (sleepiness and fatigue) in less well-defined chronic rheumatic diseases with particular reference to the ‘alpha-delta NREM sleep anomaly”. Sleep Medicine 1.3 (2000): 195‑207. 
33. Holbrook AM., et al. “Meta-analysis of benzodiazepine use in the treatment of insomnia”. Canadian Medical Association Journal 25 162.2 (2000): 225‑233. 
34. Walsh JK., et al. “Subjective hypnotic efficacy of trazodone and zolpidem in DSMIII–R primary insomnia”. Human Psychopharmacology: Clinical and Experimental 13.3 (1998): 191‑198. 
35. Aricò D., et al. “Cognitive Behavioral Therapy for Insomnia in Breast Cancer Survivors: A Review of the Literature”. Frontiers in Psychology 7 (2016): 1162. 
36. Savard J., et al. “Randomized Study on the Efficacy of Cognitive-Behavioral Therapy for Insomnia Secondary to Breast Cancer, Part II: Immunologic Effects”. Journal of Clinical Oncology 23.25 (2005): 6097‑6106. 
37. Jacobs GD., et al. “Cognitive Behavior Therapy and Pharmacotherapy for Insomnia: A Randomized Controlled Trial and Direct Comparison”. Archives of Internal Medicine 164.17 (2004): 1888‑1896. 
38. McClusky HY., et al. “Efficacy of behavioral versus triazolam treatment in persistent sleep- onset insomnia”. American Journal of Psychiatry 148.1 (1991): 121-126. 
39. Carlson LE., et al. “Mindfulness-Based Stress Reduction in Relation to Quality of Life, Mood, Symptoms of Stress, and Immune Parameters in Breast and Prostate Cancer Outpatients”. Psychosomatic Medicine 65.5 (2003): 571‑581. 
40. Cannici J., et al. “Treatment of insomnia in cancer patients using muscle relaxation training”. Journal of Behavior Therapy and Experimental Psychiatry 14.3 (1983): 251‑256. 

Citation

Citation: Krir Mohamed Wassim., et al. “Insomnia in Patients with Breast Cancer: Prevalence and Associated Factors". Acta Scientific Cancer Biology 4.12 (2020): 20-27.

Copyright

Copyright: © 2020 Krir Mohamed Wassim., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.