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A qualitative study of sleep in young breast cancer survivors: “No longer able to sleep through the night”

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Abstract

Sleep disturbance is common among women with breast cancer and is associated with greater symptom distress and poorer outcomes. Yet, for the unique subgroup of young women with breast cancer (YWBC), there is limited information on sleep. To address the gap in our understanding of sleep health in YWBC, we explored their perspective on sleep quality, sleep changes over time, contributing factors, and any strategies used to promote sleep. As part of an explanatory sequential mixed method study, we recruited a sub-sample of 35 YWBC (≤ 50 years of age at the time of diagnosis) from the larger quantitative study phase. These participants were within the first 5 years since diagnosis and completed primary and systemic adjuvant therapy. We conducted virtual semi-structured interviews, transcribed them verbatim, and analyzed data with an interpretive description approach. YWBC experience difficulty falling asleep, waking up at night, and not feeling refreshed in the morning. They attributed interrupted sleep to vasomotor symptoms, anxiety/worry, ruminating thoughts, everyday life stressors, and discomfort. The sleep disturbance was most severe during and immediately after treatment but persisted across the 5 years of survivorship. The participants reported trying pharmacologic and non-pharmacologic strategies to improve the quantity and quality of their sleep. Future research would benefit from longitudinal designs to capture temporal changes in sleep and develop interventions to improve sleep health. Clinically, assessment of sleep health is indicated for YWBC related to the prevalence of disturbed sleep.

Implications for Cancer Survivors

Early access to sleep assessment and management, ideally before cancer treatment, would be beneficial for young breast cancer survivors. In addition, cancer treatment plans should include physical and psychological symptoms, especially those reported by women in this study: vasomotor symptoms, anxiety and worry, discomfort, and pain.

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Data Availability

The datasets generated during and/or analysed during the current study are not publicly available due to privacy considerations but are available from the corresponding author on reasonable request.

References

  1. Ellington TD, et al. Trends in breast cancer incidence, by race, ethnicity, and age among women aged≥ 20 years—United States, 1999–2018. Morb Mortal Wkly Rep. 2022;71(2):43.

    Article  Google Scholar 

  2. DeSantis CE, et al. Breast cancer statistics. CA: A Cancer J Clin. 2019;69(6):438–51.

    Google Scholar 

  3. Assi HA, et al. Epidemiology and prognosis of breast cancer in young women. J Thorac Dis. 2013;5(Suppl 1):S2–8.

    Google Scholar 

  4. Champion VL, et al. Comparison of younger and older breast cancer survivors and age-matched controls on specific and overall quality of life domains. Cancer. 2014;120(15):2237–46.

    Article  Google Scholar 

  5. Sanford SD, et al. Symptom burden among young adults with breast or colorectal cancer. Cancer. 2014;120(15):2255–63.

    Article  Google Scholar 

  6. Cleeland CS, et al. The symptom burden of cancer: evidence for a core set of cancer-related and treatment-related symptoms from the Eastern Cooperative Oncology Group Symptom Outcomes and Practice Patterns study. Cancer. 2013;119(24):4333–40.

    Article  Google Scholar 

  7. Van Onselen C, et al. Trajectories of sleep disturbance and daytime sleepiness in women before and after surgery for breast cancer. J Pain Symptom Manage. 2013;45(2):244–60.

    Article  Google Scholar 

  8. Otte JL, et al. Prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors. J Pain Symptom Manage. 2010;39(3):535–47.

    Article  Google Scholar 

  9. Ancoli-Israel S, et al. Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer. 2006;14(3):201–9.

    Article  Google Scholar 

  10. Sanford SD, et al. Longitudinal prospective assessment of sleep quality: before, during, and after adjuvant chemotherapy for breast cancer. Support Care Cancer. 2013;21(4):959–67.

    Article  Google Scholar 

  11. Beverly CM, et al. Change in longitudinal trends in sleep quality and duration following breast cancer diagnosis: results from the Women’s Health Initiative. NPJ Breast Cancer. 2018;4(1):15.

    Article  Google Scholar 

  12. Lowery-Allison AE, et al. Sleep problems in breast cancer survivors 1–10 years posttreatment. Palliat Support Care. 2018;16(3):325–34.

    Article  Google Scholar 

  13. Hwang Y, Knobf M. Sleep health in young women with breast cancer: a narrative review. Supportive Care Cancer. 2022;30(8):6419–28.

    Article  Google Scholar 

  14. Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. SAGE Publications; 2017. p. 521.

    Google Scholar 

  15. Curry LA, Nunez-Smith M. Mixed methods in health sciences research: a practical primer. Thousand Oaks, CA: SAGE Publications; 2015.

    Book  Google Scholar 

  16. Hwang Y, et al. Factors associated with sleep health in young women after breast cancer treatment. Res Nurs Health. 2022;45(6):680–92.

    Article  Google Scholar 

  17. Thorne S. Interprative description: qualitatvie research for applied practice. Walnut Creek, CA: Left Coast Press; 2008.

    Google Scholar 

  18. Thorne S, Kirkham SR, O’Flynn-Magee K. The analytic challenge in interpretive description. Int J Qual Methods. 2004;3(1):1–11.

    Article  Google Scholar 

  19. Buysse DJ, et al. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.

    Article  CAS  Google Scholar 

  20. Fetters MD. The mixed methods research workbook: activities for designing, implementing, and publishing projects, vol. 7. Thousand Oaks, CA: SAGE Publications; 2019.

    Google Scholar 

  21. Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–60.

    Article  Google Scholar 

  22. Thorne S. The great saturation debate: what the “S word” means and doesn’t mean in qualitative research reporting. Can J Nurs Res. 2020;52(1):3–5.

    Article  Google Scholar 

  23. Thorne S. Interpretive description: qualitative research for applied practice. Routledge; 2016.

    Book  Google Scholar 

  24. Elliott R, Timulak L. Why a generic approach to descriptive-interpretive qualitative research? In: Elliott R, Timulak L, editors. Essentials of descriptive-interpretive qualitative research: a generic approach. American Psychological Association; 2021. p. 3–14. https://doi.org/10.1037/0000224-001

  25. Creswell JW, Báez JC. 30 essential skills for the qualitative researcher. Sage Publications; 2020.

    Google Scholar 

  26. Miles M, Huberman A, Saldana J. Qualitative data analysis: a mehtod sourcebook (fourth edi). Singapour: Sage Publications; 2020.

    Google Scholar 

  27. Saldaña J. The coding manual for qualitative researchers. The coding manual for qualitative researchers. 2021;1–440.

  28. Creswell JW, Poth CN. Qualitative inquiry and research design: choosing among five approaches. Thousand Oaks, CA: SAGE Publications; 2018.

    Google Scholar 

  29. Kuckartz U, Rädiker S. Analyzing qualitative data with MAXQDA. Springer; 2019.

    Book  Google Scholar 

  30. Yang GS, et al. Longitudinal analysis of sleep disturbance in breast cancer survivors. Nurs Res. 2022;71(3):177–88.

    Article  Google Scholar 

  31. Baker FC, et al. Sleep and sleep disorders in the menopausal transition. Sleep Med Clin. 2018;13(3):443–56.

    Article  Google Scholar 

  32. Loprinzi CL, Barton DL, Rhodes D. Management of hot flashes in breast-cancer survivors. Lancet Oncol. 2001;2(4):199–204.

    Article  CAS  Google Scholar 

  33. Kingsberg SA, Larkin LC, Liu JH. Clinical effects of early or surgical menopause. Obstet Gynecol. 2020;135(4):853–68.

    Article  Google Scholar 

  34. Kamgar M, et al. Prevalence and predictors of peripheral neuropathy after breast cancer treatment. Cancer Med. 2021;10(19):6666–76.

    Article  Google Scholar 

  35. Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev. 2004;8(2):119–32.

    Article  Google Scholar 

  36. Gormley M, et al. An integrative review on factors contributing to fear of cancer recurrence among young adult breast cancer survivors. Cancer Nurs. 2022;45(1):E10-e26.

    Article  Google Scholar 

  37. Takano K, Iijima Y, Tanno Y. Repetitive thought and self-reported sleep disturbance. Behav Ther. 2012;43(4):779–89.

    Article  Google Scholar 

  38. Redeker NS. Social and environmental factors that influence sleep in women, in Reference module in neuroscience and biobehavioral psychology. Elsevier; 2022.

    Google Scholar 

  39. Schutte-Rodin S, et al. Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med. 2008;04(05):487–504.

    Article  Google Scholar 

  40. Sateia MJ, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(02):307–49.

    Article  Google Scholar 

  41. Zhou ES, et al. Adapting cognitive-behavior therapy for insomnia in cancer patients. Sleep Med Res. 2017;8(2):51–61.

    Article  Google Scholar 

  42. Thorne S, Kirkham SR, MacDonald-Emes J. Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge. Res Nurs Health. 1997;20(2):169–77.

    Article  CAS  Google Scholar 

  43. Hunt MR. Strengths and challenges in the use of interpretive description: reflections arising from a study of the moral experience of health professionals in humanitarian work. Qual Health Res. 2009;19(9):1284–92.

    Article  Google Scholar 

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Funding

This work was supported by the Global Korean Nursing Foundation and the Sigma Theta Tau International Delta Mu Chapter.

Author information

Authors and Affiliations

  1. School of Nursing, Yale University, New Haven, USA

    Youri Hwang & M. Tish Knobf

  2. Department of Nursing, Mayo Clinic, Rochester, USA

    Samantha Conley

  3. School of Nursing, University of Connecticut, New Haven, USA

    Nancy S. Redeker

  4. School of Medicine, Yale University, New Haven, USA

    Tara Sanft

Authors
  1. Youri Hwang
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  2. Samantha Conley
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  3. Nancy S. Redeker
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  4. Tara Sanft
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  5. M. Tish Knobf
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Contributions

All authors contributed to the study conception and design and material preparation. Data collection and analysis were performed by Youri Hwang and M. Tish Knobf. The first draft of the manuscript was written by Youri Hwang, and all authors reviewed and commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Youri Hwang.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study was approved by The Yale University Institutional Review Board and The Yale Cancer Center Protocol Review Committee (HIC #: 2000029349). All participants provided written and verbal informed consent prior to enrollment in the study.

Conflict of interest

The authors declare no competing interests.

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Hwang, Y., Conley, S., Redeker, N.S. et al. A qualitative study of sleep in young breast cancer survivors: “No longer able to sleep through the night”. J Cancer Surviv (2023). https://doi.org/10.1007/s11764-023-01330-3

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  • DOI: https://doi.org/10.1007/s11764-023-01330-3

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