Proposal for Managing Cancer-Related Insomnia: A Systematic Literature Review of Associated Factors and a Narrative Review of Treatment

Overview

Journal Cancer Med

Specialty Oncology

Date 2024 Nov 25

PMID 39584650

Authors

Yoshinori Saeki

Yukiyoshi Sumi

Yukinori Ozaki

Mari Hosonaga

Yoshiyuki Kenmotsu

Takuma Onoe

Ken Yamaguchi

Yoshihisa Matsumoto

Affiliations

Soon will be listed here.

Abstract

Objective: Insomnia is common in patients with cancer. It has a multifactorial etiology that may include the disease process, adverse effects of anticancer therapies, and/or an association with other comorbidities. The purpose of this review was to identify risk factors for insomnia and suggest optimal management strategies.

Methods: We conducted a systematic literature review to elucidate the risk factors for insomnia and sleep disturbances in patients with solid tumors. The effects of sleep medications in this population were also described.

Results: A total of 75 publications were evaluated, including those on breast, lung, gynecologic, brain, head and neck, gastrointestinal, prostate, thyroid, and mixed cancers. We classified the factors related to insomnia or sleep disturbance in cancer into four categories: (1) patient demographic characteristics (e.g., age, marital or socioeconomic status); (2) mental state (e.g., depression or anxiety); (3) physical state (e.g., fatigue, pain, or restless legs syndrome); and (4) anticancer treatment-related (e.g., use of chemotherapy, opioids, or hormone therapy). Overall, literature on the pharmacologic treatment of insomnia is extremely limited, although some efficacy data for zolpidem and melatonin have been reported.

Conclusions: Demographic characteristics, physical and mental distress, and anticancer treatments are all risks for insomnia in patients with cancer. The limited evidence base for pharmacologic therapy in this patient population means that healthcare professionals need to implement a comprehensive and multidisciplinary pathway from screening to management.

References

He Y, Sun L, Peng K, Luo M, Deng L, Tang T . Sleep quality, anxiety and depression in advanced lung cancer: patients and caregivers. BMJ Support Palliat Care. 2020; 12(e2):e194-e200. DOI: 10.1136/bmjspcare-2018-001684. View

Gao Y, Liu M, Yao L, Yang Z, Chen Y, Niu M . Cognitive behavior therapy for insomnia in cancer patients: a systematic review and network meta-analysis. J Evid Based Med. 2022; 15(3):216-229. DOI: 10.1111/jebm.12485. View

King A, Shuboni-Mulligan D, Vera E, Crandon S, Acquaye A, Boris L . Exploring the prevalence and burden of sleep disturbance in primary brain tumor patients. Neurooncol Pract. 2022; 9(6):526-535. PMC: 9665069. DOI: 10.1093/nop/npac049. View

Rashid A, Baile W, Olubajo T, De La Garza 2nd R . Incidence of antiemetic-induced akathisia in patients at a comprehensive cancer center. Psychooncology. 2017; 27(4):1338-1340. DOI: 10.1002/pon.4597. View

Suh H, Jeong H, Hong S, Kim J, Yoon S, Lee J . The mindfulness-based stress reduction program for improving sleep quality in cancer survivors: A systematic review and meta-analysis. Complement Ther Med. 2021; 57:102667. DOI: 10.1016/j.ctim.2021.102667. View

George G, Iwuanyanwu E, Anderson K, Yusuf A, Zinner R, Piha-Paul S . Sleep quality and its association with fatigue, symptom burden, and mood in patients with advanced cancer in a clinic for early-phase oncology clinical trials. Cancer. 2016; 122(21):3401-3409. DOI: 10.1002/cncr.30182. View

Abebe E, Giru B, Boka A . Sleep Quality and Associated Factors Among Adult Cancer Patients on Treatments at Tikur Anbessa Specialized Hospital Oncology Unit, Addis Ababa, Ethiopia, 2021. Cancer Control. 2023; 30:10732748231160129. PMC: 9950603. DOI: 10.1177/10732748231160129. View

Fox R, Ancoli-Israel S, Roesch S, Merz E, Mills S, Wells K . Sleep disturbance and cancer-related fatigue symptom cluster in breast cancer patients undergoing chemotherapy. Support Care Cancer. 2019; 28(2):845-855. PMC: 6959513. DOI: 10.1007/s00520-019-04834-w. View

Peoples A, Pigeon W, Li D, Garland S, Perlis M, Inglis J . Association Between Pretreatment Sleep Disturbance and Radiation Therapy-Induced Pain in 573 Women With Breast Cancer. J Pain Symptom Manage. 2020; 61(2):254-261. PMC: 7854971. DOI: 10.1016/j.jpainsymman.2020.07.041. View

10.

Kurdi M, Muthukalai S . The Efficacy of Oral Melatonin in Improving Sleep in Cancer Patients with Insomnia: A Randomized Double-Blind Placebo-Controlled Study. Indian J Palliat Care. 2016; 22(3):295-300. PMC: 4973490. DOI: 10.4103/0973-1075.185039. View

11.

Lohr J, Eidt C, Abdulrazzaq Alfaraj A, Soliman M . The clinical challenges of akathisia. CNS Spectr. 2015; 20 Suppl 1:1-14. DOI: 10.1017/S1092852915000838. View

12.

Mansano-Schlosser T, Ceolim M, Valerio T . Poor sleep quality, depression and hope before breast cancer surgery. Appl Nurs Res. 2017; 34:7-11. DOI: 10.1016/j.apnr.2016.11.010. View

13.

Fontes F, Goncalves M, Pereira S, Lunet N . Neuropathic pain after breast cancer treatment and its impact on sleep quality one year after cancer diagnosis. Breast. 2017; 33:125-131. DOI: 10.1016/j.breast.2017.03.013. View

14.

He Y, Meng Z, Jia Q, Hu F, He X, Tan J . Sleep Quality of Patients with Differentiated Thyroid Cancer. PLoS One. 2015; 10(6):e0130634. PMC: 4471198. DOI: 10.1371/journal.pone.0130634. View

15.

Chen W, Giobbie-Hurder A, Gantman K, Savoie J, Scheib R, Parker L . A randomized, placebo-controlled trial of melatonin on breast cancer survivors: impact on sleep, mood, and hot flashes. Breast Cancer Res Treat. 2014; 145(2):381-8. PMC: 4060962. DOI: 10.1007/s10549-014-2944-4. View

16.

Alsharif F, Shibily F, Almutairi W, Alsaedi A, Alsubaie T, Alshuaibi B . Fatigue and Sleep Disturbance among Breast Cancer Patients during Treatment in Saudi Arabia. Nurs Res Pract. 2022; 2022:1832346. PMC: 9467781. DOI: 10.1155/2022/1832346. View

17.

Grandner M, Malhotra A . Sleep as a vital sign: why medical practitioners need to routinely ask their patients about sleep. Sleep Health. 2016; 1(1):11-12. PMC: 5102393. DOI: 10.1016/j.sleh.2014.12.011. View

18.

Squires L, Rash J, Fawcett J, Garland S . Systematic review and meta-analysis of cognitive-behavioural therapy for insomnia on subjective and actigraphy-measured sleep and comorbid symptoms in cancer survivors. Sleep Med Rev. 2022; 63:101615. DOI: 10.1016/j.smrv.2022.101615. View

19.

Hoang H, Molassiotis A, Chan C, Nguyen T, Liep Nguyen V . New-onset insomnia among cancer patients undergoing chemotherapy: prevalence, risk factors, and its correlation with other symptoms. Sleep Breath. 2019; 24(1):241-251. DOI: 10.1007/s11325-019-01839-x. View

20.

Weng Y, Hong R, Chen V, Tsai C, Yeh D, Fang Y . Sleep Quality and Related Factors in Patients with Breast Cancer: A Cross-Sectional Study in Taiwan. Cancer Manag Res. 2021; 13:4725-4733. PMC: 8213945. DOI: 10.2147/CMAR.S302966. View