Factors Affecting Sleep Quality in Women with Cancer Undergoing Radiotherapy

Sung-Hee Seok; Sang-Eun Jun

doi:10.5388/aon.2016.16.1.30

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Seok and Jun: Factors Affecting Sleep Quality in Women with Cancer Undergoing Radiotherapy

Original Article

Asian Oncology Nursing 2016; 16(1): 30-37.

Published online: 31 March 2016

DOI: https://doi.org/10.5388/aon.2016.16.1.30

Factors Affecting Sleep Quality in Women with Cancer Undergoing Radiotherapy

Sung-Hee Seok¹, Sang-Eun Jun²

¹Department of Nursing, Keimyung University Dongsan Medical Center, Daegu, Korea.

²College of Nursing, Keimyung University, Daegu, Korea.

Address reprint requests to: Jun, Sang-Eun. College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-580-3923, Fax: +82-53-580-3904, sejun2@kmu.ac.kr

Received 28 October 2015 Revised 11 February 2016 Accepted 22 March 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

The purpose of this study was to investigate the severity of subjective sleep quality and factors related to sleep disturbances in breast and gynecologic cancer patients undergoing radiotherapy.

Methods

Ninety four women (68 breast cancer and 26 gynecologic cancer) undergoing radiotherapy were recruited and asked to complete the Pittsburg Sleep Quality Index (PSQI), Piper Fatigue Scale, and Hospital Anxiety Depression Scale. The data were analyzed using χ²-test, t-test, ANOVA and logistic regression.

Results

The average global PSQI score was 8.34± 4.41 and 70.2% of the patients reported poor sleep quality (PSQI> 5). There were significant differences between the poor sleepers and the good sleepers in concurrent chemo-radiotherapy (p= .022), number of radiation treatments (p=.013), total amount of radiation dosage (p=.048), sleeping pills (p=.030), fatigue (p< .001), anxiety (p<.001), and depression (p=.024). Logistic regression showed that significant predictors for poor sleep quality were fatigue and concurrent chemo-radiotherapy.

Conclusion

These findings suggest that sleep disturbance was a significant health problem in patients with breast and gynecologic cancer who were receiving radiotherapy. Also that fatigue and concurrent chemo-radiotherapy were highly associated with sleep disturbance. However, limited evidence was found for the role of radiotherapy in the sleep disturbance of these patients.

Keywords: Radiotherapy, Sleep Disturbance, Fatigue, Anxiety, Depression

Figures and Tables

Fig. 1

Mean scores of the PSQI components. Higher scores indicate greater sleep disturbance (PSQI=Pittsburgh Sleep Quality Index).

Table 1

Differences in General and Clinical Characteristics according to Sleep Quality (N=94)

Variables	Categories	Total	Good sleeper (n = 28)	Poor sleeper (n = 66)	χ² or t-test	p
Variables	Categories	n (%) or M ± SD	n (%) or M ± SD	n (%) or M ± SD	χ² or t-test	p
Age (year)		49.8 ± 9.8	48.8 ± 9.5	50.2 ± 10.0	- 0.63	.527
Marital status	Married/partnered	74 (78.7)	23 (82.1)	51 (77.3)	0.27	.598
Marital status	Others^*	20 (21.3)	5 (17.9)	15 (22.7)	0.27	.598
Highest level of education	Middle school	31 (33.0)	8 (28.6)	23 (34.8)	2.73	.255
	High school	34 (36.1)	8 (28.6)	26 (39.4)
	≥College	29 (30.9)	12 (42.8)	17 (25.8)
Caffeinated beverage	Yes (≥1 cup)	48 (51.1)	15 (53.6)	33 (50.0)	0.10	.751
Caffeinated beverage	No	46 (48.9)	13 (46.4)	33 (50.0)	0.10	.751
BMI (kg/m²)		23.36 ± 3.71	23.55 ± 4.82	23.28 ± 3.16	0.33	.746
Sleep medication	Yes	10 (10.6)	0 (0.0)	10 (15.2)	4.74	.030
Sleep medication	No	84 (89.4)	28 (100.0)	56 (84.8)	4.74	.030
Cancer type	Breast	68 (72.3)	24 (85.7)	44 (66.7)	3.56	.059
Cancer type	Gynecologic	26 (27.7)	4 (14.3)	22 (33.3)	3.56	.059
Cancer stage	Stage 0	18 (19.1)	7 (25.0)	11 (16.7)	4.82	.186
	Stage 1	37 (39.4)	12 (42.9)	25 (37.8)
	Stage 2	25 (26.6)	8 (28.5)	17 (25.8)
	≥Stage 3	14 (14.9)	1 (3.6)	13 (19.7)
Time since diagnosis	≤3 months	53 (56.4)	17 (60.7)	22 (33.3)	7.44	.022
	4~6 months	27 (28.7)	9 (32.2)	18 (27.3)
	≥7 months	14 (14.9)	2 (7.1)	26 (39.4)
Current treatment regimen	RT only	29 (30.9)	7 (25.0)	22 (33.3)	7.51	.023
	RT+CTx	20 (21.2)	2 (7.1)	18 (27.3)
	RT+HTx	45 (47.9)	19 (67.9)	26 (39.4)
RT counts	≤10	23 (24.5)	3 (10.7)	20 (30.3)	8.64	.013
	11~20	31 (32.9)	15 (53.6)	16 (24.2)
	≥21	40 (42.6)	10 (35.7)	30 (45.5)
Total cGy	≤2,000	21 (22.3)	5 (17.9)	16 (24.2)	6.05	.048
	2,001~4,000	30 (32.0)	14 (50.0)	16 (24.2)
	≥4,001	43 (45.7)	9 (32.1)	34 (51.6)

^*Single, divorced and widowed; BMI=Body mass index; Rt=Radiotherapy; CTx=Chemotherapy; HTx=Hormone therapy; cGy=Centigray.

Table 2

Differences in the Levels of Fatigue, Anxiety and Depression according to Sleep Quality (N=94)

Variables	Categories	Total	Good sleeper (n=28)	Poor sleeper (n=66)	χ² or t	p
Variables	Categories	n (%) or M±SD	n (%) or M±SD	n (%) or M±SD	χ² or t	p
Fatigue	Total PFS score	4.99±2.29	3.47±2.14	5.64±2.06	-4.61	<.001
	Behavioral severity factor	5.04±2.60	3.32±2.32	5.78±2.39	-4.61	<.001
	Affective meaning factor	5.11±2.66	3.52±2.29	5.80±2.53	-4.10	<.001
	Sensory factor	5.15±2.52	3.51±2.30	5.86±2.30	-4.53	<.001
	Cognitive mood factor	4.66±2.39	3.55±2.35	5.13±2.27	-3.05	0.003
Anxiety	Total HADS-A score	8.49±4.19	6.18±3.94	9.47±3.93	-3.71	<.001
	Normal (0~7)	41 (43.6)	20 (71.4)	21 (31.8)
	Moderate (8~10)	24 (25.5)	4 (14.3)	20 (30.3)
	Severe (11~21)	29 (30.9	4 (14.3)	25 (37.9)
Depression	Total HADS-D score	9.20±4.07	7.75±3.47	9.82±4.18	-2.30	0.024
	Normal (0~7)	36 (38.3)	13 (46.4)	23 (34.8)
	Moderate (8~10)	25 (26.6)	10 (35.7)	15 (22.7)
	Severe (11~21)	33 (35.1)	5 (17.9)	28 (42.4)

PFS=Piper fatigue scale; HADS-A=Hospital anxiety scale-anxiety; HADS-D=Hospital anxiety scale-depression.

Table 3

PSQI Component Scores of Participants (N=94)

Variables	Categories	n (%)	M ± SD
Global PSQI score			8.34 ± 4.41
Subjective sleep quality	0. very good	13 (13.8)	1.35 ± 0.81
	1. fairly good	42 (44.7)
	2. fairly bad	32 (34.0)
	3. very bad	7 (7.5)
Sleep latency	0. 0	13 (13.8)	1.68 ± 1.07
	1. 1~2	34 (36.2)
	2. 3~4	17 (18.1)
	3. 5~6	30 (31.9)
Sleep duration	0. > 7 hr	21 (22.3)	1.57 ± 1.11
	1. 6~7 hr	23 (24.5)
	2. 5~6 hr	25 (26.6)
	3. < 5 hr	25 (26.6)
Habitual sleep efficiency	0. ≥ 85%	58 (61.7)	0.77 ± 1.11
	1. 75~84%	13 (13.8)
	2. 65~74%	10 (10.7)
	3. < 65%	13 (13.8)
Sleep disturbance	0. None	3 (3.2)	1.28 ± 0.58
	1. 1~9	65 (69.1)
	2. 10~18	23 (24.5)
	3. 19~27	3 (3.2)
Use of sleep medication	0. Never during the previous month	80 (85.1)	0.33 ± 0.86
	1. Less than once/week	4 (4.3)
	2. Once or twice/week	3 (3.2)
	3. ≥ 3 times/week	7 (7.4)
Daytime dysfunction	0. No problems	21 (22.3)	1.36 ± 0.96
	1. Minor problems	29 (30.9)
	2. Considerable problems	33 (35.1)
	3. Major problems	11 (11.7)

PSQI=Pittsburgh sleep quality index.

Table 4

Predictors of Sleep Quality of Women with Cancer undergoing Radiation Therapy by Multiple Logistic Regression (N=94)

Variables	Categories	OR	95% CI		p
Variables	Categories	OR	Lower	Upper	p
Fatigue		1.61	1.25	2.08	<.001
Current Treatment	RT	2.03	0.64	6.46	.203
	RT+CTx	6.96	1.30	37.22	.023
	RT+HTx	1

OR=Odds ratio; CI=Confidence interval; RT=Radiotherapy; CTx=Chemotherapy; HTx=Hormone therapy; cGy=Centigray.

Notes

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

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