Online Exclusive Article

The Relationship of Sleep Disturbance and Symptom Severity, Symptom Interference, and Hospitalization Among Israeli Inpatients With Cancer

Liza Monas

Suzanne Csorba

Michal Kovalyo

Ruthie Zeligman

Yossi Freier Dror

Catherine F. Musgrave

cancer
ONF 2012, 39(4), E361-E372. DOI: 10.1188/12.ONF.E361-E372

Purpose/Objectives: To examine the relationship of sleep disturbance and symptom severity, symptom interference, and hospitalization among inpatients with cancer.

Design: A descriptive, correlational, comparative design.

Setting: The oncology inpatient unit of a teaching hospital.

Sample: A convenience sample of 82 hospitalized patients.

Methods: Patients completed the Pittsburgh Sleep Quality Index (PSQI)-Home questionnaire, the MD Anderson Symptom Inventory (MDASI), and a demographic data information instrument within 72 hours of admission. Patients hospitalized for 10 days or more completed the PSQI-Hospitalization questionnaire and the MDASI.

Main Research Variables: Sleep disturbance, symptom severity, symptom interference, and hospitalization.

Findings: Although sleep disturbance scores were high at home and during hospitalization, the use of sleeping medication received the lowest score in the PSQI. Patients who were hospitalized for 10 days or more had significantly higher global PSQI scores at home than after being hospitalized for 10 days or more. A significant relationship was noted between global PSQI scores at home and symptom severity total mean scores, with the symptoms of numbness and tingling demonstrating the greatest correlation with sleep disturbance. A tendency existed for a significant relationship between global PSQI scores at hospital and symptom severity total mean scores. The symptom with the greatest correlation with global PSQI scores at hospital was sadness, followed closely by remembering. The interference items with the greatest correlation to global PSQI scores at hospital were patient's enjoyment of life, mood, and relations with others.

Conclusions: Sleep disturbance was less of a problem for patients during their hospitalization than at home. Unlike other studies, numbness was found to be the symptom most closely correlated to sleep disturbance.

Implications for Nursing: Additional investigation should be conducted to identify the factors that influence sleep disturbances in patients with cancer at home and the relationship between sleep disturbance and numbness and tingling.

Jump to a section

    References

    Ancoli-Israel, S., Liu, L., Marler, M.R., Parker, B.A., Jones, V., Sadler, G.R., … Fiorentino, L. (2006). Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Supportive Care in Cancer, 14, 201-209. doi:10.1007/s00520-005-0861-0
    Anderson, K.O., Giralt, S.A., Mendoza, T.R., Brown, J.O., Neumann, J.L., Mobley, G.M., … Cleeland, C.S. (2007). Symptom burden in patients undergoing autologous stem cell transplantation. Bone Marrow Transplantation, 39, 759-766. doi:10.1038/sj.bmt.1705664
    Armstrong, T.S., Gning, I., Mendoza, T.R., Weinberg, J.S., Gilbert, M.R., Tortorice, M.L., & Cleeland, C.S. (2009). Clinical utility of the MDASI-BT in patients with brain metastases. Journal of Pain and Symptom Management, 37, 331-340. doi:10.1016/j.jpainsymman .2008.02.011
    Bakitas, M.A. (2007). Background noise: The experience of chemotherapy-induced peripheral neuropathy. Nursing Research, 56, 323-331. doi:10.1097/01.NNR.0000289503.22414.79
    Bardwell, W.A., Profant, J., Casden, D.R., Dimsdale, J.E., Ancoli-Israel, S., Natarajan, L., … Pierce, J.P. (2008). The relative importance of specific risk factors for insomnia in women treated for early-stage breast cancer. Psycho-Oncology, 17, 9-18. doi:10.1002/pon.1992
    Beck, S.L., Berger, A.M., Barsevick, A.M., Wong, B., Stewart, K.A., & Dudley, W.N. (2010). Sleep quality after initial chemotherapy for breast cancer. Supportive Care in Cancer, 18, 679-689. doi:10.1007 s00520-009-0662-y
    Beck, S.L., Dudley, W.N., & Barsevick, A. (2005). Pain, sleep disturbance, and fatigue in patients with cancer: Using a mediation model to test a symptom cluster [Online exclusive]. Oncology Nursing Forum, 32, E48-E55. doi:10.1188/05.ONF.E48-E55
    Berger, A.M., Parker, K.P., Young-McCaughan, S., Mallory, G.A., Barsevick, A.M., Beck, S.L., … Hall, M. (2005). Sleep wake disturbances in people with cancer and their caregivers: State of the science [Online exclusive]. Oncology Nursing Forum, 32, E98-E126. doi:10.1188/05.ONF.E98-E126
    Boehmke, M.M., & Dickerson, S.S. (2005). Symptom, symptom experiences, and symptom distress encountered by women with breast cancer undergoing current treatment modalities. Cancer Nursing, 28, 382-389. doi:10.1097/00002820-200509000-00008
    Buysse, D.J., Reynolds III, C.F., Monk, T.H., Berman, S.R., & Kupfer, D.J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193-213. doi:10.1016/0165-1781(89)90047-4
    Byar, K.L., Berger, A.M., Bakken, S.L., & Cetak, M.A. (2006). Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life [Online exclusive]. Oncology Nursing Forum, 33, E18-E26. doi:10.1188/06.ONF.E18-E26
    Carpenter, J.S., & Andrykowski, M.A. (1998). Psychometric evaluation of the Pittsburgh Sleep Quality Index. Journal of Psychosomatic Research, 45, 5-13. doi:10.1016/S0022-3999(97)00298-5
    Chen, M.L., & Chang, H.K. (2004). Physical symptom profiles of depressed and nondepressed patients with cancer. Palliative Medicine, 18, 712-718. doi:10.1191/0269216304pm950oa
    Chen, M.L., Yu, C.T., & Yang, C.H. (2008). Sleep disturbances and quality of life in lung cancer patients undergoing chemotherapy. Lung Cancer, 62, 391-400. doi:10.1016/j.lungcan.2008.03.016
    Chichashvilli, M. (2009). Quality of life and quality of sleep in patients 65 years and older with heart failure(Unpublished master's thesis). Henrietta Szold Hadassah Hebrew University School of Nursing, Jerusalem, Israel.
    Cleeland, C.S. (2007). Symptom burden: Multiple symptoms and their impact as patient-reported outcomes. Journal of the National Cancer Institute. Monographs, 37, 16-21. doi:10.1093/jncimonographs/lgm005
    Cleeland, C.S., Mendoza, T.R., Wang, X.S., Chou, C., Harle, M.T., Morrissey, M., & Engstorm, M.C. (2000). Assessing symptom distress in cancer patients: The M.D. Anderson Symptom Inventory. Cancer, 89, 1634-1646. doi:10.1002/1097-0142(20001001)89:7<1634::AID-CNCR29>3.0.CO;2-V
    Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155-159. doi:10.1037/0033-2909.112.1.155
    Davidson, J.R., MacLean, A.W., Brundage, M.D., & Schulze, K. (2002). Sleep disturbance in cancer patients. Social Science and Medicine, 54, 1309-1321. doi:10.1016/S0277-9536(01)00043-0
    Furlani, R., & Ceolim, M.F. (2006). Sleep quality of women with gynecological and breast cancer. Revista Latino-Americana de Enfermagem, 14, 872-878. doi:10.1590/S0104-11692006000600007
    Gibbins, J., McCoubrie, R., Kendrick, A.H., Senior-Smith, G., Davies, A.N., & Hanks, G.W. (2009). Sleep-wake disturbances in patients with advanced cancer and their family carers. Journal of Pain and Symptom Management, 38, 860-870. doi:10.1016/j.jpainsymman.2009.04.025
    Given, B.A., Given, C.W., Sikorskii, A., & Hadar, N. (2007). Symptom clusters and physical function for patients receiving chemotherapy. Seminars in Oncology Nursing, 23, 121-126. doi:10.1016/j.soncn.2007.01.005
    Gning, I., Trask, P.C., Mendoza, T.R., Harle, M.T., Gutierrez, K.A., Kitaka, S.A., … Cleeland, C.S. (2009). Development and initial validation of the thyroid cancer module of the M.D. Anderson Symptom Inventory. Oncology, 76, 59-68. doi:10.1159/000178809
    Gooneratne, N.S., Dean, G.E., Rogers, A.E., Nkwuo, J.E., Coyne, J.C., & Kaiser, L.R. (2007). Sleep and quality of life in long-term lung cancer survivors. Lung Cancer, 58, 403-410. doi:10.1016/j.lung can.2007.07.011
    Graci, G. (2005). Pathogenesis and management of cancer-related insomnia. Journal of Supportive Oncology, 3, 349-359.
    Gregorio, S.W., Gustin, J., Marks, D., Taylor, R., Coller, K., & Magalang, U. (2010). Worry as a significant predictor of insomnia among palliative care patients with advanced cancer. Journal of Pain and Symptom Management, 39, 335-336. doi:10.1016/j.jpain symman.2009.11.249
    Hugel, H., Ellershaw, J.E., Cook, L., Skinner, J., & Irvine, C. (2004). The prevalence, key causes and management of insomnia in palliative care patients. Journal of Pain and Symptom Management, 27, 316-321. doi:10.1016/j.jpainsymman.2003.09.010
    Ivanova, M.O., Ionova, T.I., Kalyadina, S.A., Uspenskaya, O.S., Kishtovich, A.V., Guo, H., … Wang, X.S. (2005). Cancer-related symptom assessment in Russia: Validation and utility of the Russian M.D. Anderson Symptom Inventory. Journal of Pain and Symptom Management, 30, 443-453. doi:10.1016/j.jpainsymman.2005.04.015
    Mao, J.J., Armstrong, K., Bowman, M.A., Xie, S.X., Kadakia, R., & Farrar, J.T. (2007). Symptom burden among cancer survivors: Impact of age and comorbidity. Journal of the American Board of Family Medicine, 20, 434-443. doi:10.3122/jabfm.2007.05.060225
    McMillan, S.C., Tofthagen, C., & Morgan, M.A. (2008). Relationships among pain, sleep disturbances, and depressive symptoms in outpatients from a comprehensive cancer center. Oncology Nursing Forum, 35, 603-611. doi:10.1188/08.ONF.603-611
    Miaskowski, C., Cooper, B.A., Paul, S.M., Dodd, M., Lee, K., Aouizerat, B.E., … Bank, A. (2006). Subgroups of patients with cancer with different symptom experiences and quality-of-life outcomes: A cluster analysis [Online exclusive]. Oncology Nursing Forum, 33, E79-E89. doi:10.1188/06.ONF.E79-E89
    Mystakidou, K., Parpa, E., Tsilika, E., Gennatas, C., Galanos, A., & Vlahos, L. (2009). How is sleep quality affected by the psychological and symptom distress of advanced cancer patients? Palliative Medicine, 23, 46-53. doi:10.1177/0269216308098088
    Mystakidou, K., Parpa, E., Tsilika, E., Pathiaki, M., Patiraki, E., Galanos, A., & Vlahos, L. (2007). Sleep quality in advanced cancer patients. Journal of Psychosomatic Research, 62, 527-533. doi:10.1016/j.jpsychores.2006.11.008
    Otte, J.L., Carpenter, J.S., Russell, K.M., Bigatti, S., & Champion, V.L. (2010). Prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors. Journal of Pain and Symptom Management, 39, 535-547. doi:10.1016/j.jpainsymman.2009.07.004
    Prigozin, A., Uziely, B., & Musgrave, C.F. (2010). The relationship between symptom severity and symptom interference, education, age, marital status, and type of chemotherapy treatment in Israeli women with early-stage breast cancer [Online exclusive]. Oncology Nursing Forum, 37, E411-E418. doi:10.1188/10.ONF.E411-E418
    Pud, D., Ben Ami, S., Cooper, B.A., Aouizerat, B.E., Cohen, D., Radiano, R., … Miaskowski, C. (2008). The symptom experience of oncology outpatients has a different impact on quality-of-life outcomes. Journal of Pain and Symptom Management, 35, 162-170. doi:10.1016/j.jpainsymman.2007.03.010
    Rischer, J., Scherwath, A., Zander, A.R., Koch, U., & Schulz-Kindermann, F. (2009). Sleep disturbances and emotional distress in the acute course of hematopoietic stem cell transplantation. Bone Marrow Transplantation, 44, 121-128. doi:10.1038/bmt.2008.430
    Savard, J., & Morin, C.M. (2001). Insomnia in the context of cancer: A review of a neglected problem. Journal of Clinical Oncology, 19, 895-908.
    Sela, R.A., Watanabe, S., & Nekolaichuk, C.L. (2005). Sleep disturbances in palliative cancer patients attending a pain and symptom control clinic. Palliative and Supportive Care, 3, 23-31. doi:10.1017/S1478951505050042
    Sendir, M., Acaroglu, R., Kaya, H., Erol, S., & Akkaya, Y. (2007). Evaluation of quality of sleep and effecting factors in hospitalized neurosurgical patients. Neurosciences, 12, 226-231.
    Silberfarb, P.M., Hauri, P.J., Oxman, T.E., & Schnurr, P. (1993). Assessment of sleep in patients with lung cancer and breast cancer. Journal of Clinical Oncology, 11, 997-1004.
    Ugras, G.A., & Oztekin, S.D. (2007). Patient perception of environmental and nursing factors contributing to sleep disturbance in a neurosurgical intensive care unit. Tohoku Journal of Experimental Medicine, 212, 299-308. doi:10.1620/tjem.212.299
    Verstappen, C.C.P., Heimans, J.J., Hoekman, K., & Postma, T.J. (2003). Neurotoxic complications of chemotherapy in patients with cancer: Clinical signs and optimal management. Drugs, 63, 1549-1563. doi:10.2165/00003495-200363150-00003
    Wang, S.Y., Tsai, C.M., Chen, B.C., Lin, C.H., & Lin, C.C. (2008). Symptom clusters and relationships to symptom interference with daily life in Taiwanese lung cancer patients. Journal of Pain and Symptom Management, 35, 258-266. doi:10.1016/j.jpainsymman .2007.03.017
    Wang, X.S., Cleeland, C.S., Mendoza, T.R., Yun, Y.H., Wang, Y., Okuyama, T., & Johnson, V.E. (2010). Impact of cultural and linguistic factors on symptom reporting by patients with cancer. Journal of the National Cancer Institute, 102, 732-738. doi:10.1093/jnci/djq097
    Wang, X.S., Fairclough, D.L., Liao, Z., Komaki, R., Chang, J.Y., Mobley, G.M., & Cleeland, C.S. (2006). Longitudinal study of the relationship between chemoradiation therapy for non-small-cell lung cancer and patient symptoms. Journal of Clinical Oncology, 24, 4485-4491. doi:10.1200/JCO.2006.07.1126
    Yi, Z., Wang, X.S., & Ping-Ping, L. (2008). Investigation of common symptoms of cancer and reliability analysis. Chinese Journal of Integrative Medicine, 7, 195-199.