Influence of Sleep Disturbance and Depression on Quality of Life in Ovarian Cancer Patients during Chemotherapy

Sun-Young Yu; Ju-Hee Nho

doi:10.5388/aon.2015.15.4.203

Journal List > Asian Oncol Nurs > v.15(4) > 1081845

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Yu and Nho: Influence of Sleep Disturbance and Depression on Quality of Life in Ovarian Cancer Patients during Chemotherapy

Original Article

Asian Oncology Nursing 2015; 15(4): 203-210.

Published online: 31 December 2015

DOI: https://doi.org/10.5388/aon.2015.15.4.203

Influence of Sleep Disturbance and Depression on Quality of Life in Ovarian Cancer Patients during Chemotherapy

Sun-Young Yu¹, Ju-Hee Nho²

¹Department of Nursing, Asan Medical Center, Seoul, Korea.

²College of Nursing, Chonnam National University, Gwangju, Korea.

Address reprint requests to: Nho, Ju-Hee. College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 61469, Korea. Tel: +82-62-530-4949, Fax: +82-62-227-4009, jhnho@jnu.ac.kr

Received 30 August 2015 Revised 8 October 2015 Accepted 10 November 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to examine the relationships among sleep disturbance, depression, and quality of life in ovarian cancer during chemotherapy and to identify the influencing effect on quality of life.

Methods

A cross-sectional survey was conducted to measure sleep disturbance, depression and quality of life of 152 ovarian cancer patients between May and July, 2015. The data were analyzed with t-tests, ANOVA, post-hoc comparison (Scheffé), Pearson's correlation coefficients, and multiple regression analysis.

Results

The mean age of the participants was 54.2, and most of them were married. 61.8% of the patients were recurrent, and 50.0% had a performance status of ≤1. The prevalence of poor sleepers was 63.8%, and depression among patients was 52.6%. Sleep disturbance and depression were significantly negatively correlated with quality of life. As a result of stepwise multiple regression analysis, depression, sleep disturbance, monthly income and recurrence were discovered to account for 52.0% of variance. Depression and sleep disturbance were the most important influential factors.

Conclusion

The results of the study indicate that sleep disturbance and depression should be integrated when developing and implementing psychosocial, behavioral intervention to improve quality of life among ovarian cancer patients during chemotherapy.

Keywords: Sleep, Depression, Quality of Life, Ovarian Neoplasm

Figures and Tables

Table 1

Demographic, Clinical, Psychological Characteristics in Patients with Ovarian Cancer (N =152)

Variables	Characteristics	Categories	n (%) or M±SD	Range
Demographic characteristics	Age (year)		54.2±9.2	22~74
	Marital status	Married	128 (84.2)
		Single	8 (5.3)
		Widowed	10 (6.6)
		Divorced	6 (3.9)
	Level of education	≤Middle	36 (23.7)
		High school	66 (43.4)
		≥College	50 (32.9)
	Monthly income (10,000 won)	<200	52 (34.2)
		200~499	69 (45.4)
		≥500	31 (20.4)
Clinical characteristics	Age at onset (year)		51.9±8.9	22~73
	Recurrence (yes)		94 (61.8)
	Stage	1	19 (12.5)
		2	17 (11.2)
		3	90 (59.2)
		4	26 (17.1)
	Length of time after diagnosis (months)		30.78±32.41	1~166
	Pain		2.81±2.92	1~10
	ECOG	≤1	76 (50.0)
	ECOG	≥2	76 (50.0)
	Menopause (yes)		97 (63.8)

ECOG=Eastern cooperative oncology group.

Table 2

Descriptive Statistics for Sleep Disturbance, Depression and Quality of Life (N =152)

Variables	n (%) or M±SD	Min-Max
Sleep disturbance	7.21±3.42	1~19
Poor sleep quality (>5)	97 (63.8)	1~19
Depression	8.12±3.63	1~17
Clinical depression (≥8)	80 (52.6)	1~17
Quality of life (total)	71.11±16.14	22.60~106.00
Physical well-being	20.01±6.82	1~28
Social/family well-being	18.52±5.43	3~28
Emotional well-being	17.48±4.52	4~24
Functional well-being	15.14±5.79	3~28

Table 3

Comparison of Sleep Disturbance, Depression, and Quality of Life according to Patients Characteristics (N =152)

Variables	Categories	n (%)	Sleep disturbance		Depression		Quality of life
Variables	Categories	n (%)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)
Demographic characteristics
Age (year)	<40	7 (4.6)	4.71 ± 1.83	2.04 (.110)	7.43 ± 3.91	1.92 (.128)	71.56 ± 16.10	0.98 (.402)
	40~49	32 (21.1)	6.53 ± 3.56		6.91 ± 3.30		75.32 ± 14.90
	50~59	75 (49.3)	7.63 ± 3.45		8.21 ± 3.67		69.66 ± 17.63
	≥ 60	38 (25.0)	7.18 ± 3.39		8.87 ± 3.36		70.14 ± 13.54
Marital status	Married	128 (84.2)	7.35 ± 3.42	1.22 (.304)	7.87 ± 3.41	0.99 (.398)	71.19 ± 15.77	0.95 (.419)
	Single	8 (5.3)	7.00 ± 3.55		8.63 ± 4.03		65.56 ± 24.10
	Widowed	10 (6.6)	5.50 ± 3.21		9.70 ± 5.21		78.86 ± 11.94
	Divorced	6 (3.9)	5.83 ± 3.87		8.33 ± 3.06		65.97 ± 16.09
Level of education	≤ Middle	36 (23.7)	6.89 ± 3.56	0.24 (.787)	8.94 ± 3.56	1.44 (.239)	69.63 ± 14.20	0.29 (.748)
	High school	66 (43.4)	7.11 ± 3.48		7.80 ± 3.40		72.10 ± 14.78
	≥ College	50 (32.9)	7.40 ± 3.34		7.78 ± 3.74		70.71 ± 18.94
Monthly income (10,000 won)	< 200	52 (34.2)	6.71 ± 3.43	0.94 (.392)	8.65 ± 3.28	2.22 (.113)	68.40 ± 16.16^a	4.02 (.020) c > a
	200~499	69 (45.4)	7.20 ± 3.11		8.12 ± 3.54		70.45 ± 14.50^b
	≥ 500	31 (20.4)	7.77 ± 4.08		6.97 ± 3.93		77.99 ± 16.84^c
Clinical characteristics
Age at onset	<40	11 (7.2)	6.36 ± 1.36	1.87 (.089)	7.36 ± 3.41	0.64 (.592)	71.45 ± 13.48	0.29 (.834)
	40~49	45 (29.6)	7.64 ± 3.55		7.80 ± 3.52		71.02 ± 17.03
	50~59	70 (46.1)	7.19 ± 3.42		8.06 ± 3.70		71.97 ± 16.84
	≥ 60	26 (17.1)	7.38 ± 3.48		8.85 ± 3.38		68.52 ± 13.58
Recurrence	Yes	94 (61.8)	7.21 ± 3.66	0.28 (.780)	8.14 ± 3.55	0.33 (.751)	68.82 ± 17.14	- 2.22 (.028)
Recurrence	No	58 (38.2)	7.05 ± 3.06	0.28 (.780)	7.95 ± 3.62	0.33 (.751)	74.69 ± 13.52	- 2.22 (.028)
Stage	1	19 (12.5)	6.16 ± 3.18	1.64 (.182)	5.84 ± 2.77	2.40 (.089)	78.36 ± 14.58	1.64 (.183)
	2	17 (11.2)	7.06 ± 2.88		8.12 ± 3.26		67.85 ± 18.16
	3	90 (59.2)	7.62 ± 3.65		8.16 ± 3.47		70.21 ± 15.68
	4	26 (17.1)	6.31 ± 2.99		8.69 ± 4.08		70.75 ± 16.41
Length of time after diagnosis (months)	< 12	57 (37.5)	7.09 ± 3.11	1.66 (.179)	7.63 ± 3.37	1.55 (.205)	75.12 ± 13.23^a	4.06 (.008) a > c,d
	12~35	40 (26.3)	6.73 ± 3.39		7.73 ± 3.88		72.07 ± 16.41^b
	36~59	30 (19.8)	6.79 ± 2.86		8.59 ± 3.71		67.90 ± 17.25^c
	≥ 60	25 (16.4)	8.52 ± 4.54		9.24 ± 2.99		62.88 ± 16.86^d
Pain	None	52 (34.2)	6.10 ± 3.04^a	3.50 (.017) a	6.56 ± 2.89^a	10.93 (<.001) a<c,d	77.38 ± 13.20^a	8.00 (<.001) a > b,c,d
	Mild (1~3)	44 (29.0)	7.33 ± 3.34^b		7.35 ± 3.21^b		72.85 ± 14.67^b
	Moderate (4~6)	33 (21.7)	8.48 ± 3.91^c		9.52 ± 3.50^c		66.20 ± 15.10^c
	Severe (7~10)	23 (15.1)	7.13 ± 3.17^d		10.48 ± 3.63^d		66.70 ± 19.37^d
ECOG	≤ 1	76 (50.0)	6.91 ± 3.30	- 0.87 (.384)	6.83±3.46	- 4.55 (<.001)	75.66±15.25	3.67 (<.001)
ECOG	≥ 2	76 (50.0)	7.39 ± 3.57	- 0.87 (.384)	9.30 ± 3.24	- 4.55 (<.001)	66.46 ± 15.63	3.67 (<.001)
Menopause	Yes	97 (63.8)	7.21 ± 3.42	0.26 (.795)	8.22 ± 3.64	0.69 (.490)	71.39 ± 16.33	0.34 (.734)
Menopause	No	55 (36.2)	7.05 ± 3.49	0.26 (.795)	7.80 ± 3.44	0.69 (.490)	70.47 ± 15.71	0.34 (.734)

ECOG=Eastern cooperative oncology group.

Table 4

Correlation between Sleep Disturbance, Depression and Quality of Life (N =152)

Variables	Sleep disturbance	Depression
Variables	r (p)	r (p)
Depression	.19 (.017)
Quality of life	- .33 (< .001)	- .67 (< .001)

Table 5

Influencing Factors on Quality of Life

Variables	Step 1		Step 2		Step 3		Step 4
Variables	B	β (p)	B	β (p)	B	β (p)	B	β (p)
(Constant)	95.66		101.33		94.14		96.39
Depression	- 3.06	- .67 (< .001)	- 2.88	- .63 (< .001)	- 2.86	- .63 (< .001)	- 2.85	- .63 (< .001)
Sleep disturbance			- 1.00	- .21 (< .001)	- 0.98	- .21 (< .001)	- 0.97	- .21 (< .001)
Recurrence					- 4.98	- .15 (.010)	- 4.54	- .14 (.017)
Monthly income							3.88	.12 (.036)
Adjusted R²	.45		.49		.51		.52
F (p)	92.71 (< .001)		60.44 (< .001)		48.39 (< .001)		40.69 (< .001)

References

1. Sankaranarayanan R, Ferlay J. Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol. 2006; 20(2):207–225.

2. Su Z, Graybill WS, Zhu Y. Detection and monitoring of ovarian cancer. Clin Chim Acta. 2013; 415:341–345.

3. American Cancer Society. Cancer facts & figures 2010. Adanca, GA: American Cancer Society;2010.

4. Gil KM, Gibbons HE, Jenison EL, Hopkins MP, von Gruenigen VE. Baseline characteristics influencing quality of life in women undergoing gynecologic oncology surgery. Health Qual Life Outcomes. 2007; 5:25.

5. Sela RA, Watanabe S, Nekolaichuk CL. Sleep disturbances in palliative cancer patients attending a pain and symptom control clinic. Palliat Support Care. 2005; 3(1):23–31.

6. Lindley C, Vasa S, Sawyer WT, Winer EP. Quality of life and preferences for treatment following systemic adjuvant therapy for early-stage breast cancer. J Clin Oncol. 1998; 16(4):1380–1387.

7. Clevenger L, Schrepf A, Degeest K, Bender D, Goodheart M, Ahmed A, et al. Sleep disturbance, distress, and quality of life in ovarian cancer patients during the first year after diagnosis. Cancer. 2013; 119(17):3234–3241.

8. Sandadi S, Frasure HE, Broderick MJ, Waggoner SE, Miller JA, von Gruenigen VE. The effect of sleep disturbance on quality of life in women with ovarian cancer. Gynecol Oncol. 2011; 123(2):351–355.

9. Palesh OG, Collie K, Batiuchok D, Tilston J, Koopman C, Perlis ML, et al. A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biol Psychol. 2007; 75(1):37–44.

10. Porenoy RK, Thaler HT, Kornblith AB, Lepore M, Frledlander-Klar H, Coyle N, et al. Symptom prevalence, characteristics and distress in a cancer population. Qual Life Res. 1994; 3:183–189.

11. Nho JH, Kim SR, Kang GS, Kwon YS. Relationships among malnutrition, depression and quality of life in patients with gynecologic cancer receiving chemotherapy. Korean J Women Health Nurs. 2014; 20(2):117–125.

12. Suzuki N, Ninomiya M, Maruta S, Hosonuma S, Nishigaya Y, Kobayashi Y, et al. Psychological characteristics of Japanese gynecologic cancer patients after learning the diagnosis according to the hospital anxiety and depression scale. J Obstet Gynaecol Res. 2011; 37(7):800–808.

13. Lueboonthavatchai P. Prevalence and psychosocial factors of anxiety and depression in breast cancer patients. J Med Assoc Thai. 2007; 90(10):2164–2174.

14. Wenzel L, Huang HQ, Monk BJ, Rose PG, Cella D. Quality-of-life comparisons in a randomized trial of interval secondary cytoreduction in advanced ovarian carcinoma: a gynecologic oncology group study. J Clin Oncol. 2005; 23(24):5605–5612.

15. Fox SW, Lyon D. Symptom cluster and quality of life survivors of ovarian cancer. Cancer Nurs. 2007; 30:354–361.

16. von Gruenigen VE, Huang HQ, Gil KM, Gibbons HE, Monk BJ, Rose PG, et al. A comparison of quality-of-life domains and clinical factors inovarian cancer patients: a gynecologic oncology group study. J Pain Symptom Manage. 2010; 39(5):839–846.

17. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2):193–213.

18. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67(6):361–370.

19. Snaith RP. The Hospital Anxiety And Depression Scale. Health Qual Life Outcomes. 2003; 1:29.

20. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol. 1993; 11(3):570–579.

21. Chen ML, Yu CT, Yang CH. Sleep disturbances and qualtiy of life in lung cancer patients undergoing chemotherapy. Lung Cancer. 2008; 62(3):391–400.

22. Manber R, Chambers AS. Insomnia and depression: a multifaceted interplay. Curr Psychiatry Rep. 2009; 11(6):437–442.

23. Barnes NM, Sharp T. A review of central 5-HT receptors and their function. Neuropharmacology. 1999; 38(8):1083–1152.

24. Kalueff AV, Nutt DJ. Role of GABA in anxiety and depression. Depress Anxiety. 2007; 24(7):495–517.

25. Lutgendorf SK, Weinrib AZ, Penedo F, Russell D, DeGeest K, Costanzo ES, et al. Interleukin-6, cortisol, and depressive symptoms in ovarian cancer patients. J Clin Oncol. 2008; 26(29):4820–4827.

26. Oh S, Heflin L, Meyerowitz BE, Desmond KA, Rowland JH, Ganz PA. Quality of life of breast cancer survivors after a recurrence: a follow-up study. Breast Cancer Res Treat. 2004; 87(1):45–47.

27. Price MA, Bell ML, Sommeijer DW, Friedlander M, Stockler MR, Defazio A, et al. Physical symptoms, coping styles and qualtiy of life in recurrent ovarian cancer: a prospective population-based study over the last year of life. Gynecol Oncol. 2013; 130(1):162–168.

28. Maly RC, Liu Y, Liang LJ, Ganz PA. Quality of life over 5 years after a breast cancer diagnosis among low-income women: effects of race/ethnicity and patient-physician communication. Cancer. 2015; 121(6):916–926.

29. Vardy J, Chiew KS, Galica J, Pond GR, Tannock IF. Side effects associated with the use of dexamethasone for prophylaxis of delayed emesis after moderately emetogenic chemotherapy. Br J Cancer. 2006; 94(7):1011–1015.

TOOLS

Similar articles