To Recur, To Sleep: There's a Rub for Cancer Survivors

Roxanne Nelson, BSN, RN

June 26, 2015

Cancer survivors often fear disease recurrence, and this can affect the quality of their sleep, according to a new report.

In a survey of 67 cancer survivors, 52% reported poor sleep quality during the previous month. People with some college education and those more afraid of a recurrence appeared to be at greater risk for poor sleep.

The survey results were published in the June issue of the Journal of Psychosocial Oncology.

"Previous literature suggests that both sleep and fear of cancer recurrence are significant, and often unaddressed, concerns in cancer survivorship," said lead author Julie Berrett-Abebe, LICSW, from the School of Social Work at Simmons College in Boston.

There are significant clinical implications from this survey, she and her colleagues point out. Although sleep quality is often categorized as a physical symptom of illness, these findings support the fact that emotions and cognition affect sleep quality.

"To provide holistic care in cancer survivorship, I think medical providers should ask about emotional concerns, such as the fear of cancer recurring, and physical concerns, such as sleep," Berrett-Abebe told Medscape Medical News. "For survivors with higher levels of fear of cancer recurrence, a referral to a mental health professional to specifically address this might have an impact on sleep."

Clinicians working with patients who have received cancer treatment should be "openly asking about their concerns and worries about progression and recurrence," said Helen L. Coons, PhD, ABPP, president and clinical director of Women's Mental Health Associates in Denver.

"They should also be asking about the quantity and quality of their sleep," she told Medscape Medical News.

Providers should be inviting patients throughout the course of the disease to bring up concerns about sleeping, especially if they are struggling with intrusive thoughts about disease progression, Dr Coons explained.

"Anxiety is understandable in this population, but problems occur when anxiety becomes so intrusive that the patient is up at night," she said.

Fear and Sleep Disruption Related

Because sleep disturbances are common in cancer patients undergoing therapy and in survivors, a number of studies have looked at different techniques to resolve the issue. In one study, cancer survivors reduced their need for sleep medication once they began a yoga program. In another study, interventions such as mind–body bridging and mindfulness meditation helped reduce sleep disturbances.

Cancer survivors face multiple psychosocial challenges, so are at increased risk for psychological distress. Fear of cancer recurrence is a significant concern among survivors, and is associated with poorer quality of life and higher distress, Berrett-Abebe and her colleagues report.

In their survey, the team examined the relations between sociodemographic characteristics, fear of cancer recurrence, and sleep disturbance.

The 67 participants surveyed were a mean of 52 years of age. The cohort was 61.0% women, 92.5% white, 67.2% married or partnered, and 74.6% had at least a college-level education.

The three most common diagnoses were breast cancer (31.3%), lymphoma or myeloma (17.9%), and gastrointestinal cancer (17.9%).

The 4-point cancer worry subscale of the Assessment of Survivors Concerns was used to assess fear of recurrence. The mean score was 2.60, indicating that patients felt "a little bit" and "somewhat" worried about a recurrence.

On hierarchical logistic regression, a significant relation was observed between higher levels of fear of cancer and self-reported poor sleep quality.

The Pittsburgh Sleep Quality Index was used to asses sleep quality. Education level was the only sociodemographic factor significantly associated with sleep quality.

J Psychosoc Oncol. 2015;33:297-309. Abstract

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