Sleep Disturbance after Cancer Diagnosis and Treatment- A Multifaceted Clinical Problem - A Pilot Study

Purpose: Cancer patients may experience simultaneous effects of the disease, as well as side effects from the treatment. These factors may all contribute to sleep disturbances. This study explores sleep disruption among cancer patients who undergo systemic adjuvant or palliative oncological treatment. Methods: Patient-reported data was collected using three questionnaires. The Medical Outcomes Study Sleep Scale, the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire as well as study-specific open-ended questions. The patients responded at the initial onset of treatment alternatively when changing to a new line of treatment as well as three months later. The analysis was performed using “Svenssons’ method” for paired ordered categorical data. Results: Seventy-two (80%) of the ninety patients responded. Of these, 82% (n=59) reported having insufficient sleep at baseline and 86% (n=62) at followup. Health-related quality of life was affected in 92% (n=66) of the patients with a wide variation (Range variation of 0.22). The main causes of sleep disturbance reported at baseline were the disease itself and anxiety. At follow-up the main causes were anxiety and nocturia. The level of anxiety as a self-reported cause of sleeping disturbances in the open-ended questions were similar both before treatment and at follow up due to coping strategies established by the patients. Conclusion: Insufficient sleep is a problem for the cancer patients in this study. The perception of sleep showed a heterogeneous pattern. The cancer treatment does not seem to further worsen the perception of the sleep disturbance. As sleep disturbance is a problem this should be of concern in the clinical care for the cancer patients and an individualized approach should be used.