Skip to main content

Advertisement

SpringerLink
Log in

Sleep quality after initial chemotherapy for breast cancer

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Goals of work

The goal of this study is to characterize sleep quality and quantity prior to and in the first three nights after initial chemotherapy for breast cancer.

Materials and methods

This study makes use of secondary analysis of data from two separate randomized clinical trials (RCT) of behavioral interventions to improve fatigue and sleep. Patients came from two comprehensive cancer centers, three clinical cancer centers, and 10 community clinics in five states. Participants were women with stage I–IIIA breast cancer treated with anthracycline and/or cyclophosphamide-based regimens.

Main results

Baseline data from each RCT were used in the analysis. Sixty-five percent of women self-reported poor sleep in the month preceding chemotherapy using the Pittsburgh Sleep Quality Index (PSQI) score >5. Three nights of actigraphy data indicated a wide range of sleep experience with an average of 10 awakenings and time (minutes) awake after sleep onset (WASO-M) averaging 61 min per night. The first night’s sleep was the worst. There was no statistically significant relationship between self-reported poor sleep and sleep measures obtained by actigraphy. Women with poor sleep at baseline (global PSQI >5) had significantly lower (p < 0.001) physical (PCS) and mental (MCS) health status. However, neither the PCS nor MCS was associated with any of the average actigraphy sleep parameters or night 1 parameters in the aggregated sample. Increasing age was also associated with poorer sleep.

Conclusions

A high percent of women with breast cancer begin chemotherapy with disturbed sleep and the initial nights after chemotherapy are characterized by sleep fragmentation that disrupts sleep maintenance. Interventions should focus on strategies to decrease the number and duration of night awakenings. Further research is needed to identify predictors of poor sleep during this time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Berger AM, Parker KP, Young-McCaughan S, Mallory GA, Barsevick AM, Beck SL et al (2005) Sleep wake disturbances in people with cancer and their caregivers: State of the science. Oncol Nurs Forum 32:E98–E1126

    Article  PubMed  Google Scholar 

  2. Savard J, Morin CM (2001) Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19:895–908

    CAS  PubMed  Google Scholar 

  3. Lee K, Cho M, Miaskowski C, Dodd M (2004) Impaired sleep and rhythms in persons with cancer. Sleep Med Rev 8:199–212

    Article  PubMed  Google Scholar 

  4. Clark J, Cunningham M, McMillan S, Vena C, Parker K (2004) Sleep-wake disturbances in people with cancer part ii: evaluating the evidence for clinical decision making. Oncol Nurs Forum 31:747–771

    Article  PubMed  Google Scholar 

  5. Savard J, Simard S, Blanchet J, Ivers H, Morin CM (2001) Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep 24:583–590

    CAS  PubMed  Google Scholar 

  6. Carpenter JS, Andrykowski MA (1998) Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res 45:5–13

    Article  CAS  PubMed  Google Scholar 

  7. Berger AM, Farr L (1999) The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue. Oncol Nurs Forum 26:1663–1671

    CAS  PubMed  Google Scholar 

  8. Berger AM, Higginbotham P (2000) Correlates of fatigue during and following adjuvant breast cancer chemotherapy: a pilot study. Oncol Nurs Forum 27:1443–1448

    CAS  PubMed  Google Scholar 

  9. Broeckel JA, Jacobsen PB, Horton J, Balducci L, Lyman GH (1998) Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. J Clin Oncol 16:1689–1696

    CAS  PubMed  Google Scholar 

  10. Redeker NS, Lev EL, Ruggiero J (2000) Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Sch Inq Nurs Pract 14:275–298

    CAS  PubMed  Google Scholar 

  11. Berger AM (1998) Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy. Oncol Nurs Forum 25:51–62

    CAS  PubMed  Google Scholar 

  12. Berger AM, VonEssen S, Khun BR, Piper BF, Farr L, Agrawal S et al (2002) Feasibilty of a sleep intervention during adjuvant breast cancer chemotherapy. Oncol Nurs Forum 29:1431–1441

    Article  PubMed  Google Scholar 

  13. Payne J, Piper B, Rabinowitz I, Zimmerman B (2006) Biomarkers, fatigue, sleep, and depressive symptoms in women with breast cancer: a pilot study. Oncol Nurs Forum 33:775–783

    Article  PubMed  Google Scholar 

  14. Lee-Chiong TL Jr (2004) Sleep and sleep disorders: an overview. Med Clin North Am 88:xi–xiv. doi:10.1016/j.mcna.2004.02.005

    Article  PubMed  Google Scholar 

  15. Miaskowski C, Lee KA (1999) Pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: a pilot study. J Pain Symptom Manage 17:320–332. doi:10.1016/S0885-3924(99)00008-1

    Article  CAS  PubMed  Google Scholar 

  16. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213. doi:10.1016/0165-1781(89)90047-4

    Article  CAS  PubMed  Google Scholar 

  17. Beck SL, Schwartz AL, Towsley G, Dudley W, Barsevick A (2004) Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients. J Pain Symptom Manage 27:140–148. doi:10.1016/j.jpainsymman.2003.12.002

    Article  PubMed  Google Scholar 

  18. Brown AC, Smolensky MH, D'Alonzo GE, Redman DP (1990) Actigraphy: a means of assessing circadian patterns in human activity. Chronobiol Int 7:125–133. doi:10.3109/07420529009056964

    Article  CAS  PubMed  Google Scholar 

  19. Kripke DF, Mullaney DJ, Messin S, Wyborney VG (1978) Wrist actigraphic measures of sleep and rhythms. Electroencephalogr Clin Neurophysiol 44:674–676. doi:10.1016/0013-4694(78)90133-5

    Article  CAS  PubMed  Google Scholar 

  20. Hauri P, Wisbey J (1994) Actigraphy and insomnia: a closer look. Part 2. Sleep: 408–410.

  21. Jean-Louis G, von Gizycki H, Zizi F, Spielman A, Hauri P, Taub H (1997) The actigraph data analysis software: II. A novel approach to scoring and interpreting sleep-wake activity. Percept Mot Skills 85:219–226

    Article  CAS  PubMed  Google Scholar 

  22. Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP (2003) The role of actigraphy in the study of sleep and circadian rhythms. Sleep 26:342–392

    PubMed  Google Scholar 

  23. Blackwell T, Ancoli-Israel S, Gehrman PR, Schneider JL, Pedula KL, Stone KL (2005) Actigraphy scoring reliability in the study of osteoporotic fractures. Sleep 28:1599–1605

    PubMed  Google Scholar 

  24. Lichstein KL, Stone KC, Donaldson J, Nau SD, Soeffing JP, Murray D et al (2006) Actigraphy validation with insomnia. Sleep 29:232–239

    PubMed  Google Scholar 

  25. Ware JE Jr, Snow KK, Kosinski M, Gandek B (1993) SF-36 health survey manual and interpretation guide. The Health Institute, New England Medical Center, Boston

    Google Scholar 

  26. Tsai C, Bayliss MS, Ware JE (1997) SF-36 health survey annotated bibliography, 2nd edn. Heath Assessment Lab, New England Medical Centre, Boston

    Google Scholar 

  27. Ware JE, Kosinski M (2007) SF-36 physical and mental health summaerty scales: a manual for users of version 1, 2nd edn. Quality Metric, Lincoln

    Google Scholar 

  28. McHorney CA, Ware JE Jr, Raczek AE (1993) The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31:247–263. doi:10.1097/00005650-199303000-00006

    Article  CAS  PubMed  Google Scholar 

  29. Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233. doi:10.1097/00005650-199603000-00003

    Article  PubMed  Google Scholar 

  30. Hurst NP, Ruta DA, Kind P (1998) Comparison of the MOS short form-12 (SF12) health status questionnaire with the SF36 in patients with rheumatoid arthritis. Br J Rheumatol 37:862–869. doi:10.1093/rheumatology/37.8.862

    Article  CAS  PubMed  Google Scholar 

  31. Muller-Nordhorn J, Roll S, Willich SN (2004) Comparison of the short form (SF)-12 health status instrument with the SF-36 in patients with coronary heart disease. Heart 90:523–527. doi:10.1136/hrt.2003.013995

    Article  CAS  PubMed  Google Scholar 

  32. Barker LE, Luman ET, McCauley MM, Chu SY (2002) Assessing equivalence: an alternative to the use of difference tests for measuring disparities in vaccination coverage. Am J Epidemiol 156:1056–1061. doi:10.1093/aje/kwf149

    Article  PubMed  Google Scholar 

  33. Schuirmann DJ (1987) A comparison of the two one-sided tests procedure and the power approach for assessing the equivalence of average bioavailability. J Pharmacokinet Biopharm 15:657–680. doi:10.1007/BF01068419

    Article  CAS  PubMed  Google Scholar 

  34. Lineberger MD, Carney CE, Edinger JD, Means MK (2006) Defining insomnia: quantitative criteria for insomnia severity and frequency. Sleep 29:479–485

    PubMed  Google Scholar 

  35. Fortner BV, Stepanski EJ, Wang SC, Kasprowicz S, Durrence HH (2002) Sleep and quality of life in breast cancer patients. J Pain Symptom Manage 24:471–480. doi:10.1016/S0885-3924(02)00500-6

    Article  PubMed  Google Scholar 

  36. Ancoli-Israel S, Liu L, Marler MR, Parker BA, Jones V, Sadler GR et al (2006) Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer 14:201–209. doi:10.1007/s00520-005-0861-0

    Article  PubMed  Google Scholar 

  37. Berger AM, Sankaranarayanan J, Watanabe-Galloway S (2007) Current methodological approaches to the study of sleep disturbances and quality of life in adults with cancer: a systematic review. Psychooncology 16:401–420. doi:10.1002/pon.1079

    Article  PubMed  Google Scholar 

  38. Nail LM (2002) Fatigue in patients with cancer. Oncol Nurs Forum 29:537–546. doi:10.1188/ONF.537-546

    Article  PubMed  Google Scholar 

  39. Buysse DJ, Hall ML, Strollo PJ, Kamarck TW, Owens J, Lee L et al (2008) Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. J Clin Sleep Med 4:563–571

    PubMed  Google Scholar 

  40. Espie CA, Fleming L, Cassidy J, Samuel L, Taylor LM, White CA et al (2008) Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. J Clin Oncol 26:4651–4658. doi:10.1200/JCO.2007.13.9006

    Article  PubMed  Google Scholar 

  41. Vitiello MV, Larsen LH, Moe KE (2004) Age-related sleep change: gender and estrogen effects on the subjective-objective sleep quality relationships of healthy, noncomplaining older men and women. J Psychosom Res 56:503–510. doi:10.1016/S0022-3999(04)00023-6

    Article  PubMed  Google Scholar 

  42. Vitiello MV (2007) Growing old should not mean sleeping poorly: recognizing and properly treating sleep disorders in older adults. J Am Geriatr Soc 55:1882–1883. doi:10.1111/j.1532-5415.2007.01401.x

    Article  PubMed  Google Scholar 

  43. Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV (2004) Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 27:1255–1273

    PubMed  Google Scholar 

  44. Friedman EM, Love GD, Rosenkranz MA, Urry HL, Davidson RJ, Singer BH et al (2007) Socioeconomic status predicts objective and subjective sleep quality in aging women. Psychosom Med 69:682–691. doi:10.1097/PSY.0b013e31814ceada

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

We would like to thank Sangeeta Agrawal for her assistance in statistical analysis; Patricia A. Fischer, Jia-Wen Guo, and Bharathi Vedula for their assistance in actigraphy analysis; project staff, Tracey Newhall, Susan Brown & Karen Lindau; physicians, nurses, and support staff in participating clinics; and the women with breast cancer who participated in our studies.

Funding was provided by NINR 2 R01 NR04573 and NINR 5R01NR007762-05

Author information

Authors and Affiliations

  1. University of Utah College of Nursing, 10 South 2000 East, Salt Lake City, UT, 84112-5880, USA

    Susan L. Beck & Bob Wong

  2. College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198-5330, USA

    Ann M. Berger

  3. Fox Chase Cancer Center, 510 Township Line Road, Cheltenham, PA, 19012, USA

    Andrea M. Barsevick & Katie A. Stewart

  4. School of Health and Human Performance, University of North Carolina Greensboro, Greensboro, 126 HHP Building, PO Box 26170, Greensboro, NC, 27402-6170, USA

    William N. Dudley

Authors
  1. Susan L. Beck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ann M. Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrea M. Barsevick
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bob Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Katie A. Stewart
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. William N. Dudley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susan L. Beck.

Additional information

This work was performed at University of Utah College of Nursing and the Huntsman Cancer Institute in Salt Lake City, UT, USA; University of Nebraska Medical Center/Eppley Cancer Center, Oncology Hematology West PC, and the Southeastern Nebraska Hematology/Oncology Consultants in Omaha, NE, USA; and Fox Chase Cancer Center in Philadelphia, PA, USA, Helen F. Graham Cancer Center in Newark, DE, USA, and University of Cincinnati in Cincinnati, OH, USA

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beck, S.L., Berger, A.M., Barsevick, A.M. et al. Sleep quality after initial chemotherapy for breast cancer. Support Care Cancer 18, 679–689 (2010). https://doi.org/10.1007/s00520-009-0662-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-009-0662-y

Keywords

Search

Navigation