Association between self-reported sleep disturbance and other symptoms in patients with advanced cancer

ContextSleep disturbance (SD) is a significant source of distress for patients with cancer. Studies of patients with advanced cancer receiving palliative care to identify symptoms associated with the severity of SD are limited.ObjectivesIn this study, we sought to identify the symptoms measured by the Edmonton Symptom Assessment Scale (ESAS) that are associated with SD, as measured by the Pittsburgh Sleep Quality Index (PSQI). Secondary aims of the study were to determine the association between occurrences of SD with occurrences of other symptoms and screening performance of the ESAS-Sleep item against the PSQI.MethodsWe reviewed the completed ESAS and PSQI assessments of 101 patients with advanced cancer who were receiving palliative care and had been admitted to prospective clinical trials previously initiated by us. Patients with a PSQI score of ≥5 were considered to have an SD. The frequency and severity of the ESAS symptoms items, their correlation with each other, the PSQI score, and the screening performance of the ESAS-Sleep item were calculated.ResultsThe median age of patients was 60 years. Most were white non-Hispanic (73%), had lung or breast cancer (41%), and were diagnosed with SD (85%). The PSQI score was correlated with the ESAS items of pain (r = 0.27, P = 0.006), dyspnea (r = 0.25, P < 0.001), well-being (r = 0.35, P < 0.0001), and sleep (r = 0.44, P < 0.0001). Compared with patients without SD, those with SD were more likely to report pain (P = 0.0132), depression (P = 0.019), anxiety (P = 0.01), and a poorer sense of well-being (P = 0.035). An ESAS-Sleep item cutoff score of ≥3 (of 10) resulted in a sensitivity of 74% and a specificity of 73%.ConclusionSD is associated with increased frequency of pain, depression, anxiety, and a worse sense of well-being. These four symptoms should be assessed in all patients with advanced cancer with a complaint of SD. The ideal cutoff point of the ESAS-Sleep item for screening for SD is a score of ≥3. More research is needed to better characterize this frequent and distressing syndrome.     

Sleep disturbance in patients with advanced cancer

Sleep is a complex process, acknowledged to be essential for health and wellbeing. Sleep disturbance is reported to be a significant problem for patients across the cancer care trajectory, including those in the palliative phase of illness. This paper reviews the literature specific to sleep disturbance in patients with advanced cancer. The Human Response to Illness model, which is consistent with the central tenets of palliative care philosophy, provides a valuable framework to examine and organize the current knowledge related to sleep disturbance. The four perspectives of this biopsychosocial nursing model--physiology, pathophysiology, behavioural and experiential, as well as the personal and environmental factors--offer a broad perspective to better understand this multidimensional symptom and create a strong foundation for nursing care and future research directions.     

Mind-body therapies for sleep disturbance among patients with cancer: A systematic review and meta-analysis

ObjectivesTo assess whether mind-body therapies (MBTs) are effective for relieving sleep disturbance among patients with cancer.DesignSystematic review and meta-analysis of randomized controlled trials (RCTs).MethodsSeven English electronic databases were searched from the date of inception to September 2022. All RCTs that included adults (≥18 years) who were treated with mindfulness, yoga, qigong, relaxation, and hypnosis were screened. The outcome was subjective and/or objective sleep disturbance.The revised Cochrane tool (RoB 2.0) was applied to evaluate the risk of bias. The RevMan software was applied to assessed each outcome according different control groups and assessment time points. Subgroup analyses were performed according to different categories of MBTs.ResultsSixty-eight RCTs (6339 participants) were identified. After requesting for missing data from corresponding authors of included RCTs, 56 studies (5051 participants) were included in the meta-analysis. The meta-analysis showed a significant immediate effect of mindfulness, yoga, relaxation, and hypnosis on subjective sleep disturbance, compared with usual care or wait list control, and the effect of mindfulness lasted at least 6 months. For objective sleep outcomes, we observed significant immediate effects of yoga on wake after sleep onset and of mindfulness on sleep onset latency and total sleep time. Compared with active control interventions, MBTs had no significant effect on sleep disturbance.ConclusionsMindfulness, yoga, relaxation, and hypnosis were effective in sleep disturbance severity reduction among patients with cancer at post-intervention, and the effect of mindfulness lasted at least 6 months. Future MBTs studies should apply both objective and subjective sleep measurement tools     

The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritis

The objective of this article is to assess the contribution of disease activity, pain, and psychological factors to self-reported sleep disturbance in patients with rheumatoid arthritis (RA), and to evaluate whether depression mediates the effects of pain on sleep disturbance. The sample included 106 patients with confirmed RA who participated in an assessment of their disease activity, pain, psychological functioning, and sleep disturbance during a baseline evaluation prior to participating in a prospective study to help them manage their RA. Self-measures included the Rapid Assessment of Disease Activity in Rheumatology, the SF-36 Pain Scale, the Helplessness and Internality Subscales of the Arthritis Helplessness Index, the Active and Passive Pain Coping Scales of the Pain Management Inventory, the Center for Epidemiological Studies Depression Scale, and the Pittsburgh Sleep Quality Index. Hierarchical multiple regression analysis confirmed that higher income, pain, internality, and depression contributed independently to higher sleep disturbance. A mediational analysis demonstrated that depression acted as a significant mechanism through which pain contributed to sleep disturbance. Cross-sectional findings indicate that pain and depression play significant roles in self-reported sleep disturbance among patients with RA. The data suggest the importance of interventions that target pain and depression to improve sleep in this medical condition.     

Sleep disturbance in family caregivers of patients with advanced cancer

Sleep is a complex process known to be essential for health, well-being, and optimal physical and psychological functioning. Therefore, sleep disturbance may lead to serious consequences. Advanced cancer patients are known to experience a complex constellation of symptoms requiring round-the-clock care. This reality, coupled with the current demographic, social, economic and health policy trends which are shifting palliative care from the hospital to the community setting, will see family members increasingly assuming responsibility for the provision of this care at home. Despite the positive aspects of caregiving, studies report that families experience stress and exhaustion. Given that patient and family constitute the unit of care in palliative care, this area warrants our attention. This article reviews the literature related to family caregivers' disturbed sleep while caring for someone with advanced cancer. What is known and directions for future research will be addressed.     

针刺结合放松训练对中晚期癌症患者疼痛、焦虑及睡眠质量的影响

目的探讨针刺结合放松训练对癌症患者疼痛、焦虑及睡眠质量的影响。 方法将71例伴有不同程度疼痛症状的中晚期癌症患者分为观察组与对照组,实施不同的疼痛干预方案。观察组32例,在止痛药物治疗和心理护理的基础上给予针刺结合放松训练;对照组39例,行止痛药物治疗和心理护理。2组均于疼痛干预前、后应用疼痛自评问卷、焦虑自评量表（SAS）、匹兹堡睡眠质量指数量表（PSQI）、癌症治疗功能评定量表（FACT-G）分别评价癌症患者的疼痛程度、焦虑程度、睡眠质量和生活质量。 结果观察组疼痛缓解的总有效率为90.63%,明显优于对照组(84.62%)（P<0.05）,说明在止痛药物治疗和心理护理的基础上行针刺结合放松训练更有助于癌症疼痛的缓解;此外,观察组的各项睡眠指标（即睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物）也明显优于对照组（P<0.01）,观察组的焦虑程度明显低于对照组（P<0.01）;而2组生活质量比较,差异无统计学意义（P&rt;0.05）。 结论针刺结合放松训练辅助治疗有助于癌症疼痛的缓解,能更有效地减轻癌症疼痛患者的焦虑程度,改善其睡眠质量,可在临床上推广应用。但短期的疼痛干预对改善中晚期癌症患者生活质量的作用不明显。     

晚期癌症患者疼痛的护理进展

疼痛是晚期癌症患者临床上常见的症状,70%以上的晚期癌症患者伴有疼痛,它不仅影响患者的正常生活,而且容易引起患者心理失衡。据世界卫生组织统计[1],每年约有500万人癌症患者疼痛的治疗需要医生、护士、患者及家属共同关心才能达到满意的效果,其中护士起着重要的作用。随着疼痛越来越被国内外护理界所重视,如何有效的控制疼痛,现将近年来晚期癌症患者疼痛的护理进展综述如下。     

三级疼痛管理模式在中晚期癌症患者疼痛控制中的应用

目的:探讨三级疼痛管理模式在中晚期癌症患者疼痛控制中的应用。方法:将128例中晚期癌症疼痛患者按照随机数字表分为观察组和对照组各64例,对照组给予常规疼痛教育、心理健康教育和三阶梯癌症疼痛治疗方案,观察组给予三级疼痛管理模式,比较两组干预前和干预后1、5、10 d的疼痛评分和疼痛控制满意度。结果:干预后1、5、10 d观察组疼痛状况评分和疼痛控制满意度均明显优于对照组(P0.05)。结论:三级疼痛管理模式有效减轻了中晚期癌症患者的疼痛程度,提高了患者的疼痛控制满意度,值得临床推广应用。     

Life-extending therapies among patients with advanced cancer: patients' levels of pain and family caregivers' concerns about pain relief.

The purposes of this article are to explore the extent to which oncology unit patients with advanced cancer in Taiwan receive life-extending therapies and to examine the relationship of care goals (curative vs palliative) to levels of pain and family caregivers' concerns about pain reporting and analgesic administration. Forty pairs of patients with advanced cancer and their family caregivers (N = 80) were recruited from inpatient oncology units in Taiwan. Of these patients, 53% were receiving chemotherapy or radiotherapy for life-extending or curative reasons as opposed to palliative goals. Patients with advanced cancer who were receiving life-extending therapies experienced lower levels of pain intensity than did those who were not receiving life-extending therapies. Moreover, Taiwanese family caregivers of patients with advanced cancer had concerns about reporting pain and administering analgesics regardless of whether the patient was receiving life-extending therapies. However, the family caregivers whose patients were receiving life-extending therapies were less concerned about using analgesics than were those caregivers whose patients were not receiving life-extending therapies. Finally, family caregivers' concerns about pain management as measured by the Barriers Questionnaire-Taiwan (BQT) form were related to family caregivers' reluctance to report their patients' pain. Implications of this study are discussed in terms of palliative care and pain educational programs.     

Fatigue and sleep disturbance in patients with cancer,patients with clinical depression,and community-dwelling adults

This study compared the severity of fatigue in patients with cancer to the fatigue reported by depressed psychiatric patients and community-dwelling adults. Data were collected for this study during the process of validating a new fatigue assessment tool, the Brief Fatigue Inventory (BFI). The sample included 354 cancer patients, 72 psychiatric patients, and 290 non-patient volunteers. Study subjects reported severity of fatigue and the degree to which fatigue interfered with various aspects of life. Data were also collected on sleep disturbance and demographic variables that might correlate with fatigue. The psychiatric patients reported significantly higher levels of fatigue and fatigue-related interference than the cancer patients, who reported more severe fatigue and interference than the community subjects. The sleep disturbance scores of the cancer patients and the community subjects were significantly correlated with fatigue severity. Although the majority of the psychiatric patients reported sleep disturbance, their sleep disturbance scores were not significantly associated with fatigue severity.     

Prevalence and severity of suffering among patients with advanced cancer

Background

Suffering is an expression commonly used to describe distressing experience of cancer patients. Suffering experience among patients with advanced cancer has not been studied before in Saudi Arabia.

Objective

The objective of this study is to determine the pattern of suffering and the feasibility of measuring its severity on a numerical scale for cancer patients attending a palliative care outpatient clinic.

Methods

This is part of a larger survey studying the pattern of symptomatology in an outpatient palliative care clinic. Over a 5-month period, cancer patients attending an outpatient palliative care clinic were requested to rate their suffering as well as 11 listed symptoms on a 0–10 numerical scale.

Results

Of the 124 patients interviewed, 73 (59?%) were females. Only 15 patients (12?%) reported no suffering. For those who were suffering (88?%), the median score is 5. Suffering scores did not differ based on sex, age, or type of cancer. Patients with a Palliative Performance Scale of ≤50?% had significantly higher mean suffering score (6.8) compared to those with better performance status (4.8; P?=?0.003). Multivariate analysis resulted in three independent variables showing a significant relationship to suffering score, namely pain (P?=?0.018), tiredness (P?=?0.022), and depression (P?=?0.022).

Conclusion

Patients with advanced cancer were able to easily rate their suffering on a numerical scale. Pain, tiredness, and depression were associated with the suffering scores. Suffering scores might help in tracing the trend of suffering in the individual patient over time.     

Readiness to self-manage pain is associated with coping and with psychological and physical functioning among patients with chronic pain

A patient's readiness to adopt a self-management approach to pain has been suggested as a construct that may explain differences among patients in coping, adjustment, and response to multidisciplinary pain treatment. The pain stages of change questionnaire (PSOCQ; Pain, 72 (1997) 227) was designed to assess four components of this construct. The current study tested the following two hypotheses in two different samples of persons with chronic pain. PSOCQ scales are associated with (1) coping strategies used to manage pain and (2) patient disability and depression. The findings supported the first hypothesis and provided mixed support for the second. The implications of the findings for understanding the readiness to self-manage pain construct and the validity of the PSOCQ for assessing this construct are discussed.     

The frequency of alcoholism among patients with pain due to terminal cancer

The purpose of this retrospective study was to determine the prevalence of alcoholism among terminally ill cancer patients when assessed by multidisciplinary interviews and by the CAGE Questionnaire. We reviewed the charts of 100 consecutive patients assessed by a multidisciplinary team for the presence of alcoholism during 1989, and 100 consecutive patients assessed by the CAGE Questionnaire during 1992. Alcoholism was diagnosed in 28/100 patients during 1989 (28%) and 18/66 patients during 1992 (27%). Thirty-four patients were unable to complete the CAGE Questionnaire in 1992 because of sedation or cognitive impairment; six of these patients (17%) were found to be alcoholics after multidisciplinary assessment. Only 9/28 (32%) and 8/24 (33%) patients diagnosed as alcoholics during 1989 and 1992, respectively, had been previously diagnosed as alcoholics according to the medical charts. The mean equivalent daily dose of morphine during admission and on Day 2 during 1992 were 1.53±193 mg and 183±198 for alcoholic patients, versus 58±80 and 70±79 mg for nonalcoholics (P = 0.06 and 0.03, respectively). The maximal dose of opioid and the pain intensity during admission, however, were not significantly different between alcoholics and nonalcoholics. Our results suggest that alcoholism is highly prevalent and underdiagnosed among symptomatic terminally ill cancer patients. The CAGE Questionnaire should be used for screening for alcoholism in this population. When multidimensional assessment and management of pain is applied, the outcome of alcoholic patients appears to be similar to that of nonalcoholics.