Factors Influencing Quality of Sleep among Patients with Colorectal Cancer Receiving Chemotherapy

Hee Soon Jang; Eun Ok Choi

doi:10.5388/aon.2016.16.2.103

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Jang and Choi: Factors Influencing Quality of Sleep among Patients with Colorectal Cancer Receiving Chemotherapy

Original Article

Asian Oncology Nursing 2016; 16(2): 103-111.

Published online: 30 June 2016

DOI: https://doi.org/10.5388/aon.2016.16.2.103

Factors Influencing Quality of Sleep among Patients with Colorectal Cancer Receiving Chemotherapy

Hee Soon Jang¹, Eun Ok Choi²

¹Graduate School of Inje University, Busan, Korea.

²Department of Nursing, Inje University College of Medicine, Busan, Korea.

Address reprint requests to: Choi, Eun-Ok. Department of Nursing, College of Medicine Inje University, Boji-ro 75, Busanjin-gu, Busan, 614-735 Korea. Tel: +82-51-890-6822, Fax: +82-51-896-9840, nurceo@inje.ac.kr

Received 16 June 2016 Revised 28 June 2016 Accepted 28 June 2016

(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

This study aimed to find the relationships between quality of sleep, symptoms, depression, and anxiety in patients with colorectal cancer.

Methods

A cross-sectional correlation study was used. Participants were 138 colorectal cancer patients undergoing chemotherapy. Measurements included the self-reported Pittsburgh Sleep Quality Index (PSQI), the Hospital Anxiety Depression Scale (HADS), the M. D. Anderson Symptom Inventory (MDASI-GI) and the patients' medical history.

Results

87.0% of subjects were assessed as poor sleepers. The most severe symptoms reported were feeling bloated, followed by fatigue, and sadness. The prevalence of anxiety and depression were 68.2%, and 77.5% respectively. According to the result of multiple regression analysis, symptoms, depression, cancer severity, and comorbidity of chronic illness were significant predictors of quality of sleep scores (Adj. R²=.392, p<.001)

Conclusion

The independent variables of symptoms were the major contributing factors to poor sleep quality. Oncology nursing professionals need to assess the symptoms to improve quality of sleep for colorectal cancer patients undergoing chemotherapy.

Keywords: Anxiety, Colorectal Neoplasms, Depression, Sleep, Symptom

Figures and Tables

Table 1

Differences in Quality of Sleep by Characteristics (N=138)

Variables	Categories	n (%)	Quality of sleep
Variables	Categories	n (%)	M±SD	t or F (Scheffé)	p
Gender	Male	96 (69.6)	10.67±4.43	0.03	.977
Gender	Female	42 (30.4)	10.64±4.24	0.03	.977
Age (year)	<50	18 (13.1)	10.44±5.58	0.14	.870
	50~59	46 (33.3)	10.93±4.59
	≥60	74 (53.6)	10.54±3.91
Marital status	Single	5 (3.6)	8.60±6.80	-1.08	.283
Marital status	Married	133 (96.4)	10.74±4.26	-1.08	.283
Social situation	Lives with family	121 (87.7)	10.74±4.40	0.55	.586
Social situation	Lives alone	17 (12.3)	10.12±4.11	0.55	.586
Education level	≤Middle school	55 (39.8)	10.44±4.02	0.14	.871
	High school	60 (43.5)	10.87±4.63
	≥College	23 (16.7)	10.65±4.57
Occupation	Yes	52 (37.7)	10.62±4.28	-0.09	.927
Occupation	No	86 (62.3)	10.69±4.43	-0.09	.927
Religion	None	36 (26.1)	9.53±4.19	1.34	.263
	Buddhism	74 (53.6)	11.08±4.31
	Christianity	25 (18.1)	11.24±3.93
	Others	3 (2.2)	9.00±9.54
Economic status	Low	34 (24.6)	12.12±4.65	2.6	.078
	Middle	94 (68.1)	10.20±4.27
	High	10 (7.3)	10.00±3.20
Medical expenditure	Self	74 (53.6)	10.81±4.10	1.11	.347
	Spouse	30 (21.7)	9.93±4.63
	Children	24 (17.4)	10.25±4.39
	Others	10 (7.3)	12.70±5.21
Family support	Very satisfied~satisfied	87 (63.0)	10.21±4.60	1.32	.271
	Moderate	40 (29.0)	11.53±4.13
	Dissatisfied~very dissatisfied	11 (8.0)	11.09±2.55
Primary caregiver	Yes	102 (73.9)	10.43±4.38	-1.04	.302
Primary caregiver	No	36 (26.1)	11.31±4.27	-1.04	.302
Cancer severity	Not serious^a	12 (8.7)	7.42±3.65	14.27 (a, b<c)	<.001
	A little serious^b	72 (52.2)	9.60±3.97
	Very serious^c	54 (39.1)	12.80±4.07
Total chemotherapy cycles	<10	69 (50.0)	10.57±3.87	-0.15	.883
	10~19	26 (18.8)	10.15±3.75
	≥20	20 (14.5)	11.50±6.15
	Do not recognize	23 (16.7)	10.78±4.72
Comorbidity of chronic illness	Yes	78 (56.5)	11.32±4.00	-2.06	.042
Comorbidity of chronic illness	No	60 (43.5)	9.80±4.68	-2.06	.042
Postdiagnosis duration (year)	<1	59 (42.8)	9.88±4.28	1.97	.143
	1~5	71 (51.4)	11.11±4.39
	>5	8 (5.8)	12.38±4.07
Recurrence or metastasis	None^a	63 (45.7)	9.49±4.08	3.45 (a<d)	.019
	Recurrence^b	20 (14.5)	11.30±3.76
	Metastasis^c	45 (32.6)	11.44±4.55
	Recurrence & metastasis^d	10 (7.2)	13.20±4.78
Type of treatment	CTX alone	39 (28.3)	9.08±4.95	2.84	.041
	CTX and OP	66 (47.8)	10.98±3.80
	CTX and XRT	8 (5.8)	11.50±4.38
	CTX and OP and XRT	25 (18.1)	12.00±4.28
Colostomy	No	105 (76.1)	10.50±4.58	-0.74	.459
Colostomy	Yes	33 (23.9)	11.15±3.56	-0.74	.459
Post colostomy duration (if colostomy yes)	≤12 months^a	14 (42.4)	11.57±2.38	5.99 (a, b>c)	.006
	13~24 months^b	11 (33.3)	12.91±3.73
	≥25 months^c	8 (24.3)	8.00±3.34

CTX= Chemotherapy; OP= Operation; XRT= Radiation therapy.

Table 2

Pittsburgh Sleep Quality Index (PSQI) Global Scores and Component Means (N=138)

Variables	n (%) or M±SD	Min~Max
PSQI global scores	10.66±4.36	0~21
Sleep quality	1.51±0.79	0~3
Sleep latency	1.81±1.01	0~3
Sleep duration	1.80±1.05	0~3
Habitual sleep efficiency	1.75±1.15	0~3
Sleep disturbances	1.71±0.58	0~3
Use of sleep medications	0.49±0.88	0~3
Daytime dysfunction	1.58±0.93	0~3
PSQI global scores≤5 (good sleeper)	18 (13.0)
PSQI global scores>5 (poor sleeper)	120 (87.0)

PSQI= Pittsburgh Sleep Quality Index.

Table 3

Symptom Reported by Respondents

Variables	Moderate^*	Severe^†	M±SD
Variables	n (%)	n (%)	M±SD
Symptom			107.04±43.52
General symptom			76.70±33.03
Pain	30 (21.7)	48 (34.8)	4.57±3.19
Fatigue	34 (24.6)	58 (42.0)	5.28±2.79
Nausea	34 (24.6)	27 (19.6)	3.81±2.88
Disturbed sleep	36 (26.1)	37 (26.8)	4.47±2.94
Distressed (upset)	37 (26.8)	35 (25.4)	4.35±2.92
Shortness of breath	18 (13.0)	26 (18.8)	3.12±2.89
Problem with remembering things	22 (15.9)	20 (14.5)	3.03±2.66
Lack of appetite	31 (22.5)	49 (35.5)	4.90±2.87
Drowsy	21 (15.2)	35 (25.4)	4.03±2.69
Dry mouth	31 (22.5)	43 (31.2)	4.64±2.82
Sad	20 (14.5)	66 (47.8)	5.42±3.48
Vomiting	24 (17.4)	17 (12.3)	2.99±2.64
Numbness or tingling	23 (16.7)	53 (38.4)	4.96±3.12
Gastrointestinal symptom			21.14±10.24
Constipation	22 (15.9)	54 (39.1)	4.67±3.48
Diarrhea or watery stools via stoma	23 (16.7)	38 (27.5)	3.84±3.30
Difficulty swallowing	17 (12.3)	10 (7.2)	1.99±2.49
Change in taste	36 (26.1)	42 (30.4)	4.72±2.91
Feeling bloated	30 (21.7)	67 (48.6)	5.91±2.92
Symptom interference			30.35±15.26
General activity	37 (26.8)	51 (37.0)	5.34±3.01
Mood	33 (23.9)	60 (43.5)	5.61±2.89
Work	34 (24.6)	60 (43.5)	5.70±3.00
Relations with other people	23 (16.7)	49 (35.5)	4.93±3.21
Walking	14 (10.1)	24 (17.4)	2.99±2.98
Enjoyment of life	26 (18.8)	67 (48.6)	5.78±3.34

^*Moderate, between 5 and 6 on a 0~10 scale of MDASI-GI (M. D. Anderson Symptom Inventory); ^†Severe, 7 or greater on a 0~10 scale of MDASI-GI (M. D. Anderson Symptom Inventory).

Table 4

Hospital Anxiety-Depression Reported by Respondents

Variables		n (%)	M±SD
Anxiety	0~7 (normal)	44 (31.9)	9.48±4.46
	8~10 (mild)	39 (28.3)
	11~21 (moderate~severe)	55 (39.8)
Depression	0~7 (normal)	31 (22.5)	10.18±4.02
	8~10 (mild)	37 (26.8)
	11~21 (moderate~severe)	70 (50.7)

Table 5

Contributing Factors to Quality of Sleep (N=138)

Variables	^*Quality of sleep
	B	SE	β	t	p	Collinearity		R²
	B	SE	β	t	p	Tolerance	VIF	R²
(Constant)	5.21	1.02		5.11	<.001
Symptom	0.04	0.01	.39	4.50	<.001	0.61	1.65	.313
Depression	0.26	0.09	.24	2.77	.006	0.59	1.69	.353
Cancer severity	-1.41	0.59	-.16	-2.38	.019	0.96	1.05	.372
Comorbidity of chronic illness	-1.36	0.59	-.16	-2.32	.022	1.00	1.00	.392
	Adj. R²=.392, F=23.07, p<.001

^*Quality of sleep measured by PSQI (Pittsburgh Sleep Quality Index) global score.

Notes

This article is a revision of the first author's master's thesis from Inje University.

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