Insomnia more prevalent among patients treated with chemotherapy

Reporting of insomnia symptoms and insomnia syndrome was almost three times higher among patients with cancer treated with chemotherapy than among those in the general population.

Researchers conducted a prospective study of 823 patients from the National Cancer Institute’s Community Clinical Oncology Program. They enrolled those with cancer who were assigned to chemotherapy between 1997 and 1999. The mean age of patients was 58, and about 72% were women.

For the first cycle of chemotherapy, 36.6% had insomnia symptoms and 43% had insomnia syndrome. For the second cycle, 33.1% of patients had insomnia symptoms and 35.2% had insomnia syndrome.

The highest prevalence of insomnia syndrome was noted in patients with lung cancers. Patients with alimentary cancers had the lowest prevalence. The highest number of overall insomnia complaints was reported in patients with breast cancer.

From cycle one to cycle two, 60% of patients reported no change in their sleep complaints. Almost two-thirds of patients reporting insomnia during cycle one continued to meet clinical criteria for insomnia during cycle two. Among good sleepers, 10% developed insomnia syndrome following cycle one and 24.6% developed insomnia symptoms by the second cycle.

Patients aged 58 or older had a lower rate of insomnia. A 10-year increase in age was associated with a 71% (95% CI, 0.62-0.82) decrease in reported insomnia. In addition, nonwhites were 56% (95% CI, 0.34-0.92) less likely to report insomnia than whites, according to the researchers.

“Future research should examine insomnia in other populations experiencing stress and major health issues to improve our understanding of the causes of insomnia,” the researchers said. “And most importantly, interventions to prevent and treat insomnia in cancer patients must be developed and tested.”

Palesh OG. J Clin Oncol. 2009;doi:10.1200/JCO.2009.22.5011.

In a post-hoc analysis of 823 patients receiving their first two cycles of chemotherapy for a variety of cancer diagnoses, 36.6% reported insomnia syndrome, 43% met the more strict criteria for the insomnia syndrome and 20.4% were good sleepers. Clearly, sleeplessness is a common and underappreciated complaint of patients undergoing chemotherapy. The authors state that these rates are three times higher than the general population. Hematologists/oncologists need guidance in helping our patients who have insomnia, which can affect quality of life during their treatment. Additional studies will be required to confirm these studies and test interventions that can improve quality of life during chemotherapy.

– Samuel M. Silver, MD, PhD
HemOnc Today Editorial Board member