An Exploratory Study of Sleep-Wake Disturbances in Advanced Lung Cancer Patients

• Author / Creator

  Taylor, Claudette

• ABSTRACT Sleep-wake disturbances are a common problem for people with cancer. Prior research of sleep-wake disturbances in cancer patients has focused predominantly on patients with early-stage disease. Consequently, little is known about sleep-wake disturbances in patients with advanced cancer. The significance of sleep-wake disturbances in advanced cancer patients and the factors associated with them is also not well understood. The purpose of this study was to identify the sleep-wake disturbances in individuals with advanced lung cancer and to explore the relationships amongst sleep, fatigue and quality of life in this population. All patients with newly diagnosed advanced non-small cell lung cancer attending outpatient clinics at the Cape Breton Cancer Centre (01/06/2013 to 30/06/2014) were invited to participate in the study. Seventy-two patients agreed to participate. Data were collected during the pre-treatment period. Questionnaires were used to collect symptoms, sleep quality, fatigue and quality of life data. Demographic and clinical data including co-morbidities, stage of disease and use of medications were collected from patients’ medical charts. Data were analyzed using SPSS-21. Descriptive statistics were computed to describe the characteristics of the study sample and the study variables. Bivariate correlations amongst all study variables were conducted using Spearman’s rho correlation coefficient. Multiple regression analyses were performed to examine the associations between the predictor variables. The conceptual framework that guided this study was the ‘Borbely Two-Process Model of Sleep Regulation’. Borbely (1982) proposed two processes, a homeostatic process (Process S) and a circadian rhythm process (Process C) interact to regulate the timing and the duration of both sleep and wake states. A central hypothesis of this study was that Process S was influenced by mediator factors (i.e. pain, dyspnea) and psychological factors (i.e. anxiety). It was proposed that Process C was affected by moderator factors such as age and sex. Medications were proposed to affect both Process C and Process S. Findings showed that patients with advanced lung cancer experience very poor sleep quality and severe fatigue during the pre-treatment period. Difficulty initiating sleep, nocturnal sleep interruption, decreased sleep efficiency and daytime dysfunction were some of the experiences reported by patients. Difficulty starting and completing activities and requiring assistance with activities of daily living were reported because of severe fatigue. Poor sleep quality and severe fatigue predicted the quality of life of advanced lung cancer patients during the pre-treatment period. The relationship between sleep quality, fatigue and quality of life in advanced lung cancer patients is complex. In the bivariate correlations conducted: pain, dyspnea, anxiety, tiredness, appetite and depression were significantly correlated with all three outcome variables but in the regression analysis, only drowsiness, dyspnea, and appetite predicted fatigue and only depression predicted quality of life. Lastly, the quality of life of participants was significantly associated with the severe fatigue and poor sleep quality reported. Poor sleep quality was the most significant predictor of quality of life. Patients with advanced lung cancer should be screened for sleep disturbance and fatigue when initially diagnosed and those with scores of 3 out of 10 (with 0 being absent and 10 being severe) assessed using comprehensive, valid and reliable assessment tools. Both pharmacological and non-pharmacological evidence-based interventions should be considered to manage poor sleep quality and fatigue in these patients.

• Subjects / Keywords

  • Sleep
  • Advanced Cancer
  • Fatigue, Quality of Life

• Graduation date

  Spring 2015

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R3SM2Z

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.