Sleep: An Unmet Need in Patients, Survivors, and Caregivers

Insomnia, restless leg syndrome, sleep apnea, and other sleep issues often affect quality of life in cancer patients, their caregivers, and survivors. Unfortunately, sleep complaints can often be overlooked by the medical staff or not mentioned by the patient.

Understanding and addressing sleep issues for those affected by cancer is the focus of studies presented at this year’s ONS 40th Annual Congress, including one by Patricia Carter, PhD, RN, CNS, and colleagues sharing the results of a clinic-based behavioral sleep intervention aimed at both patients and their caregivers.

Carter explained that sleep complaints are very often not addressed by healthcare professionals because they often are more focused on symptoms that they feel confident in treating, such as nausea, fatigue, and weight loss.

However, lack of sleep or lack of quality sleep can affect a patient’s memory, mood, immunity, and pain and result in poorer quality of life, which is why medical professionals should broach the conversation around sleep issues and hygiene.

“Talking with patients and caregivers about sleep is important because patients and caregivers often accept that poor sleep is a 'price to pay' for having and being treated for cancer, when, in fact, we have several empirically supported therapies that can help to improve sleep quality for patients and caregivers,” Carter says in an pre-conference interview with CURE. Carter, an associate professor at the University of Texas at Austin School of Nursing, specializes in behavioral sleep medicine not only for patients, but also caregivers.

The Patient—Caregiver Dyad

Carter and colleagues presented a small, four-week study at ONS which found, not surprisingly, that both patients and caregivers reported similar levels of sleep disturbance, with nearly half reporting symptoms of insomnia.

“There are a number of studies that have explored the effectiveness of behavioral sleep therapies in patients or caregivers; however, there were no studies that explored providing these therapies to both the patient and the caregiver at the same time,” Carter noted.

“We hypothesized that treating both members of the dyad would offer support for the behavioral changes needed to improve sleep. Sort of a 'sleep buddy' would help you keep your sleep goals, like an 'exercise buddy' helps you to keep your physical activity goals.”

The researchers developed an hour-long informational discussion with two short follow-ups that could be given during the patient’s infusion therapy, which encouraged the patient and caregiver to improve their sleep together. Information was provided to the duo on stimulus control, sleep hygiene, relaxation techniques, and other cognitive behavioral therapy to increase quality sleep.

“We also observed a synergistic effect of providing the therapy to both partners at the same time in that they were able to plan and coordinate their sleep goals to support each other,” Carter continued. She also noted that the results showed that it is possible to provide behavior sleep therapies to both patient and caregivers during chemotherapy with minimal disruption to the workflow while maximizing the learning opportunity.

“It is always a good time to talk about sleep quality and ways to improve it,” Carter says. “The conversations should happen throughout the treatment and survivorship care… Sleep quality can impact both physical and psychological health and research is beginning to support the relationships between sleep quality and treatment effectiveness.”

Sleep Disorders in Breast Cancer Survivors

Not all sleep complaints point to a disorder; however, research is lacking on sleep complaints in breast cancer survivors in the context of possible sleep disorders. This information, according to researchers from Indiana University (IU), is needed for medical staff to offer treatment options, including referring patients to a specialist or suggesting cognitive—behavioral treatment, such as improving sleep hygiene and behaviors.

Julie Otte, RN, PhD, OCN, of the IU School of Nursing, and colleagues are presenting data at ONS that show how sleep complaints in breast cancer survivors may be more common than initially thought and that comprehensive evaluations of sleep complaints may signal a need for patients to be referred to a specialist.

The researchers conducted patient interviews and questionnaires, and analyzed biomarker data from a sample of 38 breast cancer survivors. All participants were postmenopausal with a mean age of 58 years. The sample group was composed of African-American and Caucasian women.

Although preliminary, the resulting evidence points to a very large percentage of survivors who have sleep complaints that should be referred to a sleep specialist for further evaluation and treatment. The IU researchers’ data revealed, for example, that 97 percent of participants had symptoms of a sleep disorder, including insomnia (97 percent), sleep apnea (71 percent), and restless leg syndrome (53 percent), with a majority of participants having more than one sleep disorder.

Researchers found that integrating basic screening questions during clinic visits helps nursing staff identify potential problems that could be used to triage patients needing specialist referrals.