Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Sch Inq Nurs Pract 14(4):275-290; discussion 291-278

College of Nursing Rutgers, The State University of New Jersey, Newark, NJ, USA.
Research and Theory for Nursing Practice 02/2000; 14(4):275-90; discussion 291-8.
Source: PubMed


The purposes of this study were to examine: (a) the relationships between the symptoms of insomnia and fatigue and the psychological factors of anxiety and depression, and; (b) the relationships between these psychological and symptom variables and quality of life in cancer patients who were receiving chemotherapy. The Theory of Unpleasant Symptoms was the framework for the study. A descriptive correlational design was used in a secondary analysis of data obtained from a sample of 263 cancer patients who were undergoing chemotherapy. Insomnia, fatigue, depression, and anxiety were positively correlated with one another (r = .26 to r = .69, p < .001) and negatively correlated with quality of life (r = -.28 to r = -.63, p < .001). Women had more anxiety and fatigue and poorer quality of life than did men. Older age was associated with better quality of life and less insomnia, fatigue, anxiety, and depression. Multiple regression analysis revealed that the symptoms and psychological variables explained 47% of the variance in quality of life, with the largest proportion of the variance explained by depression. Fatigue and insomnia explained only 4% of the variance in quality of life in excess of that contributed by the psychological factors. Although overall depression levels were low in this sample, these findings suggest that insomnia and fatigue are related to depression and that depression is more closely associated with quality of life than are insomnia and fatigue.

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    • "La fatiga relacionada con el cáncer se caracteriza por una crónica y anormal experiencia de cansancio en todo el cuerpo, la cual disminuye la capacidad física y mental por el persistente agotamiento desproporcionado , en relación con el esfuerzo y no se alivia con el reposo (Bower et al., 2000; Patarca-Montero, 2004). Por sus características, la fatiga se ha relacionado positivamente con sintomatología depresiva y alteraciones de sueño, estos síntomas ocurren simultáneamente , puede compartir una causa común y se relacionan con una menor calidad de vida (Jacobsen, Donovan y Weitzner, 2003; Redeker, Lev y Ruggiero, 2000; Roscoe et al., 2007). Por lo que actualmente la investigación se enfoca no solamente en la etiología de estos síntomas sino en comprender como se relacionan e influencian (Fiorentino, Rissling, Liu y Ancoli-Israel, 2011). "
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    ABSTRACT: El objetivo de este estudio fue evaluar la relación entre la fatiga, la sintomatología de depresión y la calidad de sueño con indicadores de cortisol y determinar cuáles son las variables que explican la fatiga en mujeres con cáncer de mama. Participaron 17 mujeres con cáncer de mama previo al tratamiento de quimioterapia, las cuales proporcionaron 12 muestras de saliva durante dos días consecutivos y respondieron las escalas de Fatiga (MFI), Depresión (BDI) y Calidad de Sueño (ICSP). Los resultados obtenidos muestran que la latencia de sueño explica en un 41.7% la reducción de la actividad y que la disfunción diurna explica en un 48.8% de la fatiga mental, lo que nos sugiere un enfoque de intervención en esta fase del proceso del cáncer.
    Anuario de Psicologia 01/2015; 45(1):101-113.
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    • "During cancer treatment, many patients nap during the day, leading to circadian rhythm problems, which exacerbate sleep problems.2 While there is some awareness of sleep–wake disturbances in the context of symptom clusters5,7–9 during a patient’s cancer trajectory, what is not known is the impact of sleep on the physical, functional, and social aspects of quality of life (QOL).10 "
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    ABSTRACT: Purpose Evidence suggests a high prevalence of sleep–wake disturbances in patients with cancer, occurring at diagnosis, during treatment, and continuing to survivorship. Yet associations between sleep–wake disturbances and the impact on quality of life outcomes is less clear. The purpose of this narrative review of the literature is to evaluate sleep–wake disturbances in patients with cancer, to describe the influence of poor sleep on quality of life as an outcome, and to evaluate the evidence to recommend future interventions. Framework and methods This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach. Four databases (CINAHL, MEDLINE, PsycINFO, and Embase) were searched using terms “cancer OR neoplasm”, “sleep, sleep disturbance, sleep disorders or insomnia”, and “quality of life”; the search included all years, English language, and peer-reviewed articles on research studies. Studies included measurements of sleep and quality of life in cancer patients at a minimum of two time points and demonstrated relationships between sleep and quality of life. Data were collected on date, patient demographics, cancer type and treatment, timeframe, design, measurement, variables, and results. Results This narrative review demonstrates that sleep–wake disturbance is a major problem/symptom in patients with cancer. Of the 18 studies included, measurement of sleep-related variables included objective and subjective measures; however, direct measurement of the associations between sleep and quality of life was not common. Cognitive behavioral therapy for insomnia and mind–body interventions demonstrated feasibility when implemented into cancer care settings. In addition, the majority of interventions exhibited moderate effectiveness in improving sleep–wake disturbance and quality of life outcomes. Conclusion The studies predominantly reported that poor sleep negatively impacts quality of life. The intervention studies included nonpharmacologic interventions such as cognitive behavioral treatment and mind–body and exercise interventions with moderate-to-high levels of evidence for improvement in sleep measures and quality of life.
    Nature and Science of Sleep 07/2014; 6:85-100. DOI:10.2147/NSS.S34846
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    • "It is well known that sleep is an important factor for individuals to sustain their life quality. Consequently, the nurse is supposed to handle all symptoms, rather than just one symptom such as pain, fatigue and evaluate their relation with one another (Redeker and Lev, 2000; Beck et al., 2005). After chemotherapy, self-reported sleep impairment is present and sleep efficiency is reduced, without significant change in sleep architecture (Zarogoulidis et al., 2013). "
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    ABSTRACT: Background: The aim of this study was to determine factors affecting sleep quality of 100 patients with advanced stage lung cancer. Methods and results: it was a descriptive study. A variety of assessment tools were used to provide sleep scores to examine the relation between adverse effects caused by the treatment (nausea, vomiting, fatigue) and sleep quality. As a result, no statistically significant relation between coughing and respiratory problems of patients, or existing depression, and average sleep quality score was found (KW:0.872, p=0.646, KW: 3.174, p=0.205, u: 441.000 p=0.916). It was revealed that nausea and loss of appetite experienced also did not affect the sleep quality score (p>0.05), whereas problems such as vomiting and fatigue did exert effects (p<0.01). Conclusions: Patients with advanced stage lung cancer suffer from sleep problems and cancer related symptoms also affect their sleep quality negatively. Nurses should plan interventions that can control symptoms such as pain, vomiting and fatigue, which affect the sleep of patients.
    Asian Pacific journal of cancer prevention: APJCP 05/2013; 14(5):2909-2913. DOI:10.7314/APJCP.2013.14.5.2909 · 2.51 Impact Factor
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