Tailored interventions may mitigate sleep disturbances among women with breast cancer
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Tailored interventions that address pain, anxiety, fatigue or perceived stress may benefit women with breast cancer who experience sleep disturbance, according to study results presented at the virtual Oncology Nursing Society Congress.
These interventions should be considered prior to and during chemotherapy, researchers noted.
“The level of sleep disturbances has positive associations with levels of several concurrent symptoms, providing insight into important factors that could be considered for preventing or mitigating sleep disturbances [among] breast cancer survivors,” Gee Su Yang, PhD, RN, assistant professor at University of Connecticut School of Nursing, said during a presentation. “There may be optimal strategies for managing sleep disturbances considering associated predictors at different timing.”
Breast cancer survivors often experience poor sleep quality, and many report staying awake throughout the night as their biggest challenge.
More than half of breast cancer survivors report sleep disturbances and other symptom clusters within the first 3 months of chemotherapy or radiation. These disturbances — which often lead to fatigue and depression — can worsen through treatment trajectories and last as long as 10 years after cancer treatment cessation, according to study background.
Yang and colleagues aimed to identify the characteristics and potential predictors of sleep disturbances among 74 women (mean age, 51.3 years ± 10.2; 70.3% non-Hispanic white) for up to 2 years after chemotherapy.
Researchers performed a secondary data analysis of the longitudinal prospective EPIGEN study, which evaluated psychoneurological symptoms and epigenetic alterations among women with early-stage breast cancer.
Yang and colleagues assessed survivors at five predetermined time points: baseline, midpoint of chemotherapy, and 6 months, 1 year and 2 years after chemotherapy.
They used the General Sleep Disturbance Scale total score to measure the outcome variable. They also analyzed several potential predictor variables, including cancer- and sociodemographic-related factors, DNA methylation age, telomere length, psychoneurological symptoms, perceived stress and health-promoting lifestyle profiles.
Investigators used linear mixed effects models with a random intercept to obtain temporal changes. A parsimonious linear regression model with backward selection was fitted with sleep disturbance total score to assess potentially significant predictors of sleep disturbance.
Results showed severe sleep disturbances among study participants at the midpoint of chemotherapy, but this gradually improved over time. Researchers observed significant temporal changes in early awakenings, midsleep awakenings and fatigue at work, again with these disturbances elevated at the midpoint of chemotherapy.
Univariate analysis identified an association between higher levels of health-promoting lifestyles and lower levels of sleep disturbances across all time points.
Significant predictors of sleep disturbances at specific time points included anxiety (baseline, midpoint of chemotherapy and 1 year after chemotherapy), pain (baseline only), fatigue (6 months and 1 year after chemotherapy) and perceived stress (6 months and 2 years after chemotherapy).
Researchers acknowledged study limitations, including a relatively small sample size and lack of use of objective measurement tools, such as actigraphy.
This investigation is one of the first longitudinal studies to evaluate a potential link between multiple behavioral risk factors and temporal changes of outcomes, according to the researchers.
“Tailored interventions and self-awareness of anxiety, pain, fatigue and perceived stress could be beneficial for mitigating sleep disturbances throughout the cancer trajectory,” Yang and colleagues wrote. “Health-promoting lifestyle behaviors, such as nutrition and physical activity, are encouraged to improve sleep quality.”
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Yang GS, et al. Sleep disturbances and associated factors among breast cancer survivors: A 2-year longitudinal study. Presented at: Oncology Nursing Society Congress (virtual meeting); April 20-29, 2021.
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