Feasibility of a Sleep Intervention During Adjuvant Breast Cancer Chemotherapy
Purpose/Objectives: To evaluate the feasibility of an intervention designed to promote sleep and modify fatigue during four cycles of adjuvant breast cancer chemotherapy.
Design: Prospective, repeated measures, quasi-experimental feasibility study.
Setting: Midwestern urban oncology clinics.
Sample: 25 women between the ages of 40-65 (X = 54.3) with stage l-ll breast cancer receiving doxorubicin-based chemotherapy.
Methods: Each woman developed, reinforced, and revised an individualized sleep promotion plan (ISPP) with four components: sleep hygiene, relaxation therapy, stimulus control, and sleep restriction techniques. A daily diary, the Pittsburgh Sleep Quality Index, a wrist actigraph, and the Piper Fatigue Scale were used to collect data two days before and seven days after each treatment.
Main Research Variables: Adherence, sleep and wake outcomes, and fatigue.
Findings: Adherence rates with the components of the ISPP varied during treatments one through four: sleep hygiene (68%-78%), relaxation therapy (57%-67%), stimulus control (46%-67%), and sleep restriction (76%-80%). Mean sleep and wake outcomes at baseline, peak, and rebound times were that (a) sleep latency remained brief (less than 30 minutes per night), (b) time awake after sleep onset exceeded the desired less than 30 minutes per night, (c) sleep efficiency scores remained stable at 85%-90%, (d) total rest time remained stable at 8-10 hours per night, (e) subjective ratings of feelings on arising were stable, and (f) nighttime awakenings were 8-10 per night. Fatigue outcomes were that fatigue was stable two days after each treatment and mean daily fatigue intensity was lower at treatment three than at treatment one but rebounded at treatment four.
Conclusions: The intervention was feasible, adherence rates improved over time, and most sleep and wake patterns were consistent with normal values. Revisions will focus on decreasing nighttime awakenings.
Implications for Nursing: Adopting behaviors to promote sleep may assist in maintaining sleep and managing fatigue during chemotherapy.
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References
Becker, M. (1990). Theoretical models of adherence and strategies for improving adherence. In S. Shumaker, E. Schron, & J. Ockene (Eds.), Health behavior changes (pp. 5-43). New York: Springer.
Berger, A. (1996). Patterns of fatigue and factors influencing fatigue in women undergoing adjuvant breast cancer chemotherapy. Dissertation Abstracts International, B57(10), 6174. (UMI No. 9710329)
Berger, A. (1998). Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy. Oncology Nursing Forum, 25, 51-62.
Berger, A., & Farr, L. (1999). The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue. Oncology Nursing Forum, 26, 1663-1671.
Berger, A., & Higginbotham, P. (2000). Correlates of fatigue during and following adjuvant breast cancer chemotherapy. Oncology Nursing Forum, 27, 1443-1448.
Berger, A., & Walker, S.N. (2001). An explanatory model of fatigue in women receiving adjuvant breast cancer chemotherapy. Nursing Research, 50(1), 43-52 [published erratum appears in Nursing Research, 50(3), 164].
Berger, A.M., VonEssen, S., Kuhn, B.R., Piper, B.F., Farr, L., Agrawal, S., et al. (in press). Adherence, sleep, and fatigue outcomes after adjuvant breast cancer chemotherapy: Results of a feasibility intervention study. Oncology Nursing Forum.
Beszterczey, A., & Lipowski, Z.J. (1977). Insomnia in cancer patients. Canadian Medical Association Journal, 116, 355.
Bootzin, R., Engle-Friedman, M., & Wood, J. (1991). Stimulus control instructions. In P. Hauri (Ed.), Case studies in insomnia (pp. 19-28). New York: Plenum Medical Book.
Bootzin, R.R., & Perlis, M.L. (1992). Nonpharmacologic treatments of insomnia. Journal of Clinical Psychiatry, 53(Suppl.), 37-41.
Broeckel, J.A., Jacobsen, P.B., Horton, J., Balducci, L., & Lyman, G.H. (1998). Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 16, 1689-1696.
Brown, A., Smolensky, M., D'Alonzo, G., & Redman, D. (1990). Actigraphy: A means of assessing circadian patterns in human activity. Chronobiology International, 7, 125-133.
Buysse, D.J., Reynolds, C.F., Monk, T.H., Hoch, C.C., Yeager, A.L., & Kupfer, D.J. (1989). The Pittsburgh Sleep Quality Index: New instrument for psychiatric practice and research. Psychiatry Research, 28, 193-213.
Carpenter, J., & Andrykowski, M. (1998). Psychometric evaluation of the Pittsburgh Sleep Quality Index. Journal of Psychosomatic Research, 45(1 Spec. No.), 5-13.
Currie, S., Wilson, K., Pontefract, A., & deLaplante, L. (2000). Cognitive-behavioral treatment of insomnia secondary to chronic pain. Journal of Consulting and Clinical Psychology, 68, 407-416.
Decker, T.W., Cline-Elsen, J., & Gallagher, M. (1992). Relaxation therapy as an adjunct in radiation oncology. Journal of Clinical Psychology, 48, 388-393.
Derogatis, L.R., Feldstein, M., Morrow, G., Schmale, A., Schmitt, M., Gates, C., et al. (1979). A survey of psychotropic drug prescription in an oncology population. Cancer, 44, 1919-1929.
Dodd, M.J. (1988). Patterns of self-care in patients with breast cancer. Western Journal of Nursing Research, 10, 7-20, 22-24.
Dow, K.H., Ferrell, B.R., Leigh, S., Ly, J., & Gulasekaram, P. (1996). An evaluation of the quality of life among long-term survivors of breast cancer. Breast Cancer Research and Treatment, 39, 261-273.
Dunbar-Jacob, J., Erlen, J., Schlenk, E., Ryan, C., Sereika, S., & Doswell, W. (2000). Adherence in chronic disease. Annual Review of Nursing Research, 18, 48-90.
Ferrell, B.R., Grant, M., Dean, G.E., Funk, B., & Ly, J. (1996). "Bone tired": The experience of fatigue and its impact on quality of life. Oncology Nursing Forum, 23, 1539-1547.
Floyd, J. (1999). Sleep promotion in adults. Annual Review of Nursing Research, 17, 27-56.
Ford, D.E., & Kamerow, D.B. (1989). Epidemiologic study of sleep disturbances and psychiatric disorders. JAMA, 262, 1479-1484.
Friedman, L., Furberg, C., & DeMets, D. (1998). Fundamentals of clinical trials (3rd ed.). St. Louis, MO: Mosby Year Book.
Glovinsky, P., & Spielman, A. (1991). Sleep restriction therapy. In P.J. Hauri (Ed.), Case studies in insomnia (pp. 49-63). New York: Plenum Medical Book.
Graydon, J.E., Bubela, N., Irvine, D., & Vincent, L. (1995). Fatigue-reducing strategies used by patients receiving treatment for cancer. Cancer Nursing, 18, 23-28.
Hauri, P.J. (1993). Consulting about insomnia: A method and some preliminary data. Sleep, 16, 344-350.
Hauri, P.J. (1998). Insomnia. Clinics in Chest Medicine, 19, 157-168.
Hauri, P.J., & Wisbey, J. (1992). Wrist actigraphy in insomnia. Sleep, 15, 293-301.
Hauri, P.J., & Wisbey, J. (1994). Actigraphy and insomnia: A closer look. Part 2. Sleep, 17, 408-410.
Haynes, R., Taylor, D., & Sackett, D. (Eds.). (1979). Compliance in health care. Baltimore: Johns Hopkins University Press.
Hu, D., & Silberfarb, P.M. (1991). Management of sleep problems in cancer patients. Oncology, 5, 23-28.
Irvine, D., Vincent, L., Bubela, N., Thompson, L., & Graydon, J.E. (1991). A critical appraisal of the research literature investigating fatigue in the individual with cancer. Cancer Nursing, 14, 188-199.
Irvine, D., Vincent, L., Graydon, J.E., Bubela, N., & Thompson, L. (1994). The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotheraphy. Cancer Nursing, 17, 367-378.
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. Perceptual and Motor Skills, 85, 219-226.
Kaye, J., Kaye, K., & Madow, L. (1983). Sleep patterns in patients with cancer and patients with cardiac disease. Journal of Psychology, 114, 107-113.
Knobf, M.T. (1990). Symptoms and rehabilitation needs of patients with early stage breast cancer during primary therapy. Cancer, 66, 1392-1405.
Kripke, D., Mullaney, D., Messin, S., & Wyborney, V. (1978). Wrist actigraphic measures of sleep and rhythms. Electroencephalography and Clinical Neurophysiology, 44, 674-676.
Lacks, P., & Rotert, M. (1986). Knowledge and practice of sleep hygiene techniques in insomniacs and good sleepers. Behavior Research and Therapy, 24, 365-368.
Lee, K. (1997). An overview of sleep and common sleep problems. American Nephrology Nurses' Association Journal, 24, 614-625, 677.
Lee, K. (2001). Sleep and fatigue. Annual Review of Nursing Research, 19, 249-273.
Libbus, K., Baker, J., Osgood, J., Phillips, T., & Valentine, D. (1995). Persistent fatigue in well women. Women and Health, 23, 57-72.
Lipsey, M. (1990). Design sensitivity. Newbury Park, CA: Sage.
Longman, A.J., Braden, C.J., & Mishel, M.H. (1996). Side effects burden in women with breast cancer. Cancer Practice, 4, 274-280.
MacVicar, M., Winningham, M., & Nickel, J. (1989). Effect of aerobic interval training on cancer patient's functional capacity. Nursing Research, 38, 348-351.
McCorkle, R., & Quint-Benoliel, J.Q. (1983). Symptom distress, current concerns, and mood disturbance after diagnosis of life-threatening disease. Social Science Medicine, 17, 431-438.
Mock, V., Burke, M., Sheehan, P., Creaton, E., Winningham, M., McKenney-Tedder, S., et al. (1994). A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Oncology Nursing Forum, 21, 899-907.
Mock, V., Hassey-Dow, K., Meares, C., Grimm, P., Dienemann, J., & Haisfield-Wolfe, M. (1997). Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncology Nursing Forum, 24, 991-1000.
Morin, C.M. (1993). Insomnia: Psychological assessment and management. New York: Guilford Press.
Morin, C.M., Colecchi, C., Stone, J., Sood, R., & Brink, D. (1999). Behavioral and pharmacological therapies for late-life insomnia. JAMA, 281, 991-999.
Morin, C.M., Culbert, J.P., & Schwartz, S.M. (1994). Nonpharmacological interventions for insomnia: A meta-analysis of treatment efficacy. American Journal of Psychiatry, 151, 1172-1180.
Murtagh, D.R., & Greenwood, K.M. (1995). Identifying effective psychological treatments for insomnia: A meta-analysis. Journal of Clinical and Consulting Psychology, 63, 79-89.
Owen, D., Parker, K., & McGuire, D. (1999). Comparison of subjective sleep quality in patients with cancer and healthy subjects. Oncology Nursing Forum, 26, 1649-1651.
Piper, B. (1992). Subjective fatigue in women receiving six cycles of adjuvant chemotherapy for breast cancer. Dissertation Abstracts International, B54(1), 168. (UMI No. 9303553)
Piper, B. (1999). Improving the clinical measurement of cancer treatment-related fatigue [Abstract]. In Better Health Through Nursing Research: State of the Science Congress Proceedings (p. 99). Washington, DC: American Nurses Association.
Piper, B., Dibble, S., Dodd, M., Weiss, M., Slaughter, R., & Paul, S. (1998). The revised Piper Fatigue Scale: Psychometric evaluation in women with breast cancer. Oncology Nursing Forum, 25, 677-684.
Piper, B., Lindsey, A., & Dodd, M. (1987). Fatigue mechanisms in cancer patients: Developing nursing theory. Oncology Nursing Forum, 14(6), 17-23.
Portenoy, R., & Itri, L. (1999). Cancer-related fatigue: Guidelines for evaluation and management. Oncologist, 4, 1-10.
Ream, E., & Richardson, A. (1999). From theory to practice: Designing interventions to reduce fatigue in patients with cancer. Oncology Nursing Forum, 26, 1295-1303.
Redmond, D., & Hegge, F. (1985). Observations on the design and specification of a wrist-worn human activity monitoring system. Behavior Research Methods, Instruments and Computers, 17, 659-669.
Richards, K. (1996). Sleep promotion. Critical Care Nursing Clinics of North America, 8, 39-52.
Richardson, A. (1995). Fatigue in cancer patients: A review of the literature. European Journal of Cancer Care, 4, 20-32.
Richardson, A., & Ream, E. (1997). Self-care behaviours initiated by chemotherapy patients in response to fatigue. International Journal of Nursing Studies, 34, 35-43.
Rogers, A., Caruso, C., & Aldrich, M. (1993). Reliability of sleep diaries for assessment of sleep/wake patterns. Nursing Research, 42, 368-372.
Sarna, L. (1993). Correlates of symptom distress in women with lung cancer. Cancer Practice, 1, 21-28.
Savard, J., & Morin, C. (2001). Insomnia in the context of cancer: A review of a neglected problem. Journal of Clinical Oncology, 19, 895-908.
Sheely, L. (1996). Sleep disturbances in hospitalized patients with cancer. Oncology Nursing Forum, 23, 109-111.
Tiesinga, L., Dassen, T., & Halfens, R. (1996). Fatigue: A summary of the definitions, dimensions, and indicators. Nursing Diagnosis, 7, 51-62.
Winningham, M. (1992). How exercise mitigates fatigue: Implications for people receiving cancer therapy. In R. Johnson (Ed.), The biotherapy of cancer--V (pp. 16-21). Pittsburgh, PA: Oncology Nursing Society.
Winningham, M., Nail, L., Burke, M., Brophy, L., Cimprich, B., Jones, L., et al. (1994). Fatigue and the cancer experience: The state of the knowledge. Oncology Nursing Forum, 21, 23-36--2.5