Sleep disturbance in patients with advanced cancer disease 

Posted on August 10, 2014 by pallcare

Gunnhild Jakobsen, Anne Kari Knudsen and Pål Klepstad, The European Palliative Care Research Centre, NTNU, Norway, explain the background to their longer article published in the July/August issue of the European Journal of Palliative Care.

Left to right: Pål Klespads (photo courtesy Geir Mogen, NTNU); Gunnhild Jakobsen and Anne Kari Knudsen (courtesy Lena Sæternes)

Have you ever experienced poor sleep quality? If so, you may imagine the discomfort patients with advanced cancer experience as a result of sleep disturbance. We know that patients entering the door to our clinic experience bad sleep quality, but we do not yet know enough about the specifics of sleep disturbance, the consequences of sleep disturbance and the best treatment for sleep disturbance in patients with advanced cancer. As health care providers we give sleep disturbance too little attention, both in clinical cancer research and in daily oncology and palliative care.

Why does sleep quality in patients with advanced cancer receive so little attention? The answer is complex because it is related to the complexity of the advanced cancer itself. Patients with advanced cancer have multiple symptoms. Pain, nausea and other debilitating physical symptoms are often in focus in clinical consultations. Thus, assessment and treatment of sleep disturbance is not in the forefront of clinicians’ priorities. Of course, if pain is the main problem for the patient and sleep quality is influenced by the intensity of this severe pain, the focus should be on removing the causative condition, pain. Nevertheless, we see that assessment of sleep quality is often not a priority even when symptom control is reached.

What should we do? We should simply ask the patients about their sleep quality the very same day as they are admitted to our clinic. We can learn about their sleep habits outside the hospital, and get to know their difficulty with initiating sleep or maintaining sleep. We can ask for how many nights each week the sleep difficulty is present and perhaps most importantly assess whether a sleep difficulty causes impairment of daytime functioning or not. This knowledge is essential in later stages when the complexity of symptoms is high.

Keep it simple! Let the patient understand that we really care about his or her sleep quality and that we want to pay attention to it. We know that patients sometimes do not talk about their sleep disturbance. Because we rarely ask, they do not think that we care about sleep. Let us contribute to good sleep quality, it is important for the patients.

Read more about how to screen for sleep disturbance in advanced cancer and the available treatment options in our article in this month’s European Journal of Palliative Care.

Read a copy of the full article…
This post relates to a longer article, ‘Sleep disturbance in patients with advanced cancer disease’ by Gunnhild Jakobsen, Anne Kari Knudsen and Pål Klepstad, which is published in the July/August 2014 issue of the European Journal of Palliative Care (vol. 21.4). If you have a web-based subscription to the journal you can download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.

Links and resources The European Palliative Care Research Centre.