Self-reported sleep disturbance in patients with advanced cancer: Frequency, intensity, and factors associated with response to outpatient supportive care consultation - A preliminary report.
Palliat Support Care. 2013 Nov 4:1-9.
Source
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.Abstract
Objectives:
Self-reported sleep disturbance (SD) is a distressing symptom in
patients with advanced cancer. There are limited data on the treatment
of SD and predictors to response of SD to outpatient supportive care
clinic (OPC) consultation. The aims of our study was to determine the
frequency, intensity, and correlates of SD as assessed with the Edmonton
Symptom Assessment System (ESAS) sleep item at the time of initial
consultation and identify the predictors of improvement in SD at
follow-up. Methods: We reviewed the records of consecutive patients with
advanced cancer presenting to the OPC. ESAS scores were obtained at the
initial and subsequent visits between January 2008 and February 2010.
All patients underwent screening for SD (0-10 scale: 0 = best sleep,
presence of SD defined as ≥3) and interdisciplinary assessment and
treatment, including drug review, counseling, sleep hygiene review, and
drug therapy. A response was defined as a 1-point improvement at the
follow-up visit on the Edmonton Symptom Assessment Scale (ESAS) sleep
item score. Baseline patient characteristics, medication use, and ESAS
scores were analyzed to determine their association with response.
Results: The median age was 58 years, and 53% of patients were men. The most common cancer type was head and neck or lung (36%). Of the 442 patients, 330 had baseline SD (score ≥3/10, 75%). Median and mean (standard deviation) baseline SD scores were 5 and 5.1 (2.9). The multivariable regression model found the intensity of baseline ESAS sleep item scores to be associated with baseline sedative use, baseline ESAS pain scores, baseline ESAS fatigue scores, baseline ESAS feeling of well-being scores, and sedative use (R 2 = 0.22). Sleep disturbance response at first follow-up was seen in 196 of 330 patients (59%). Moderate to high SD score and anxiety at initial visit with odds ratios (OR) of 2.53 (p = 0.0007) and 1.59 (p = 0.048), respectively, were associated with a response.
Significance of results: Both the frequency and severity of SD were high. Response to supportive care consultation was substantial. The severity of SD and anxiety at the initial visit predicted a response at first follow-up. Further research is needed.
Results: The median age was 58 years, and 53% of patients were men. The most common cancer type was head and neck or lung (36%). Of the 442 patients, 330 had baseline SD (score ≥3/10, 75%). Median and mean (standard deviation) baseline SD scores were 5 and 5.1 (2.9). The multivariable regression model found the intensity of baseline ESAS sleep item scores to be associated with baseline sedative use, baseline ESAS pain scores, baseline ESAS fatigue scores, baseline ESAS feeling of well-being scores, and sedative use (R 2 = 0.22). Sleep disturbance response at first follow-up was seen in 196 of 330 patients (59%). Moderate to high SD score and anxiety at initial visit with odds ratios (OR) of 2.53 (p = 0.0007) and 1.59 (p = 0.048), respectively, were associated with a response.
Significance of results: Both the frequency and severity of SD were high. Response to supportive care consultation was substantial. The severity of SD and anxiety at the initial visit predicted a response at first follow-up. Further research is needed.
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