Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. A bidirectional relationship between anxiety and depression, and insomnia? A prospective study in the general population. The economic burden of insomnia: direct and indirect costs for individuals with insomnia syndrome, insomnia symptoms, and good sleepers. Epidemiology of insomnia: a longitudinal study in a UK population. Age of menopause among women who remain premenopausal following treatment for early breast cancer: long-term results from International Breast Cancer Study Group Trials V and VI. Sleep, fatigue, and depressive symptoms in breast cancer survivors and matched healthy women experiencing hot flashes. Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer. Acute effects of tamoxifen and third-generation aromatase inhibitors on menopausal symptoms of breast cancer patients Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program.
BACKGROUND Poor sleep , prevalent among cancer survivors , is associated with disrupted hormonal circadian rhythms and poor quality of life . Using a prospect i ve research design , this study aim ed to clarify the relationship between objective measures of sleep efficiency and sleep disruption with survival among women with advanced breast cancer . METHOD We examined sleep quality and duration via wrist-worn actigraphy and sleep diaries for 3 days among 97 women in whom advanced breast cancer was diagnosed ( age = 54.6 ± 9.8 years ) .  Sleep efficiency was operationalized using actigraphy as the ratio of total sleep time to total sleep time plus wake after sleep onset . RESULTS As hypothesized , better sleep efficiency was found to predict a significant reduction in overall mortality ( hazard ratio [ HR ] , 0.96 ; 95 % confidence interval [ CI ] , 0.94 - 0.98 ; P < 0.001 ) at median 6 y follow-up . This relationship remained significant ( HR , 0.94 ; 95 % CI , 0.91 - 0.97 ; P < 0.001 ) even after adjusting for other known prognostic factors ( age , estrogen receptor status , cancer treatment , metastatic spread , cortisol levels , and depression ) . Secondary hypotheses were also supported ( after adjusting for baseline prognostic factors ) showing that less wake after sleep onset ( HR , 0.41 ; 95 % CI , 0.25 - 0.67 ; P < 0.001 ) , fewer wake episodes , ( HR , 0.93 ; 95 % CI , 0.88 - 0.98 ; P = 0.007 ) ; and shorter wake episode duration ( HR , 0.29 ; 95 % CI , 0.14 - 0.58 ; P < 0.001 ) also contributed to reductions in overall mortality . CONCLUSIONS These findings show that better sleep efficiency and less sleep disruption are significant independent prognostic factors in women with advanced breast cancer . Further research is needed to determine whether treating sleep disruption with cognitive behavioral and /or pharmacologic therapy could improve survival in women with advanced breast cancer OBJECTIVE The purpose of this study was to examine whether there is a bidirectional relationship between , on one h and , anxiety and depression and , on the other h and , insomnia over the course of a year . METHODS A r and omly selected sample of 3000 participants from the general population filled out a  baseline survey ( N=1812 ) and a 1-year follow-up survey ( N=1498 ) on  anxiety , depression , and insomnia .  RESULTS On cross-sectional analyses , bivariate correlations showed that anxiety , depression , and insomnia were significantly intercorrelated ( varphi=.31-.54 ) . On prospect i ve analyses , logistic regression analyses demonstrated that anxiety at baseline [ odds ratio (OR)=4.27 ( 8 % of variance ) ] and depression at baseline [ OR=2.28 ( 2 % of variance ) ] were related to new cases of insomnia on follow-up . Furthermore , insomnia at baseline was related to new episodes of high anxiety and high depression on follow-up [ OR=2.30 ( 2 % of variance ) and OR=3.51 ( 4 % of variance ) , respectively ] . CONCLUSION Evidence suggests that there is a bidirectional relationship between , on one h and , anxiety and depression and , on the other h and , insomnia . This suggests that anxiety , depression , and insomnia are intertwined over time , implying implication s for theoretical conceptualizations and interventions BACKGROUND AND PURPOSE Insomnia is a highly prevalent problem that is associated with increased use of health care services and products , as well as functional impairments . This study estimated from a societal perspective the direct and indirect costs of insomnia . PARTICIPANTS AND METHODS A r and omly selected sample of 948 adults ( mean age = 43.7 years old ; 60 % female ) from the province of Quebec , Canada completed question naires on sleep , health , use of health-care services and products , accidents , work absences , and reduced productivity . Data were also obtained from the Quebec government administered health insurance board regarding consultations and hospitalizations . Participants were categorized as having insomnia syndrome , insomnia symptoms or as being good sleepers using a st and ard algorithm . Frequencies of target cost variables were obtained and multiplied by unit costs to generate estimates of total costs for the adult population of the province of Quebec . RESULTS The total annual cost of insomnia in the province of Quebec was estimated at $ 6.6 billion ( Cdn$ ) . This includes direct costs associated with insomnia-motivated health-care consultations ( $ 191.2 million ) and transportation for these consultations ( $ 36.6 million ) , prescription medications ( $ 16.5 million ) , over the-counter products ( $ 1.8 million ) and alcohol used as a sleep aid ( $ 339.8 million ) . Annual indirect costs associated with insomnia-related absenteeism were estimated at $ 970.6 million , with insomnia-related productivity losses estimated at $ 5.0 billion . The average annual per-person costs ( direct and indirect combined ) were $ 5,010 for individuals with insomnia syndrome , $ 1431 for individuals presenting with symptoms , and $ 421 for good sleepers . CONCLUSIONS This study suggests that the economic burden of insomnia is very high , with the largest proportion of all expenses ( 76 % ) attributable to insomnia-related work absences and reduced productivity . As the economic burden of untreated insomnia is much higher than that of treating insomnia , future clinical trials should evaluate the cost- benefits , cost-utility , and cost-effectiveness of insomnia therapies STUDY OBJECTIVES To investigate the incidence , persistence , and consequences of insomnia and their associations with psychological health and pain . DESIGN A population based , longitudinal , cohort study using postal question naires at baseline and 12-month follow-up . Sleep problems in the past month were assessed using 4 questions : insomnia was defined as having at least 1 of the sleep problems " on most nights . " Questions about psychological health , presence of pain at different sites , and demographic details were included in the question naire . SETTING Five general practice s in Staffordshire , UK . PARTICIPANTS The question naire was mailed to a r and om sample of 4885 adults aged 18 years and over registered with these practice s. There were 2662 question naires returned . RESULTS Of the responders , 2363 completed all 4 sleep questions at baseline : 870 ( 37 % ) had insomnia and 1493 ( 63 % ) did not have insomnia . Of those without insomnia at baseline , the incidence of insomnia at 12 months was 15 % , and this was significantly associated with baseline anxiety , depression , and pain . Of those who did have insomnia at baseline , 69 % had insomnia at 12-month follow-up ; persistence of insomnia was significantly associated with older age . Insomnia at baseline was significantly associated with incidence of anxiety , depression , and widespread pain at 12-month follow-up . CONCLUSIONS Insomnia is common and often persistent . Older people appear more vulnerable to persistent symptoms . Our results provide evidence that the common problems of insomnia , pain , and psychological distress are intertwined and suggest that combined approaches to treatment may be needed to reduce the onset and persistence of these problems in the community BACKGROUND The likelihood of premature menopause has not been thoroughly explored in women who remain premenopausal after adjuvant chemotherapy for breast cancer . METHODS We used data from the International Breast Cancer Study Group ( IBCSG ) Trials V and VI . Trial V enrolled 1407 eligible premenopausal women r and omised to no systemic therapy ( No CT ) or 1 cycle of perioperative CMF-based chemotherapy ( PeCT ) if node negative , and 6 cycles of CMF-based chemotherapy postoperatively ( CMFx6 ) or 1 cycle perioperative CMF-based chemotherapy plus CMFx6 postoperatively ( CMFx7 ) if node positive . From Trial VI ( a 2x2 factorial design ed study of 3 versus 6 initial cycles of CMF and a re introduction of three additional courses of CMF ) , we included 375 women r and omised to receive only six initial cycles of CMF ( CMFx6 ) . FINDINGS We excluded women who reported no menses during 12 - 24 months after r and omisation ( N=934 ) , hysterectomy ( N=16 ) or bilateral oophorectomy ( N=8 ) , or missing menses data ( N=57 ) , creating a cohort of 767 women ; 540 women had been r and omised to PeCT or no CT , 227 r and omised to CMFx6 or 7 . A Cox proportional hazards model revealed that CMFx6 or 7 ( HR=2.03 , p<0.0001 ) and temporary amenorrhea ( HR=1.96 , p<0.0001 ) were associated with premature menopause . INTERPRETATION Women who remain premenopausal after 6 or 7 cycles of CMF-based chemotherapy have a higher likelihood of going through menopause at an earlier age than women who received little or no chemotherapy .  Temporary cessation of menses appears to be a marker for earlier onset of menopause . These findings may assist women and clinicians when making treatment and reproductive decisions after a diagnosis of breast cancer PURPOSE S/ OBJECTIVES To compare sleep quality and disturbance , fatigue , and depressive symptoms between breast cancer survivors and healthy women experiencing hot flashes and to examine relationships among sleep and remaining variables ( fatigue , depressive symptoms , and frequency of hot flashes ) . DESIGN Cross-sectional , descriptive , comparative pilot study . SETTING University-based outpatient setting . SAMPLE 15 breast cancer survivors and 15 healthy women matched on age , race , and menopausal status . All women had untreated hot flashes ( no hormone replacement therapy or other hot flash treatments ) . METHODS Question naires ( sleep quality and disturbance , fatigue , and depression ) ; two ambulatory , 24-hour sternal skin conductance monitoring sessions ( hot flash frequency ) ; and medical records review . MAIN RESEARCH VARIABLES Sleep quality and disturbance , fatigue , depressive symptoms , and objective hot flash frequency . FINDINGS The majority of participants evidence d poor sleep quality and high sleep disturbance ( 73 % of breast cancer survivors and 67 % of healthy women above a cutoff score of 5 ) . Sleep duration was significantly shorter for breast cancer survivors in contrast to healthy women . Nighttime flashes were experienced by 67 % of breast cancer survivors and 37 % of healthy women . No group differences were found in fatigue , depressive symptoms , or objective hot flash frequency . Global sleep scores were significantly positively correlated with fatigue and depression but not with hot flash frequency . CONCLUSIONS Findings suggest that sleep disturbance is common in menopausal breast cancer survivors and healthy women , is not necessarily related to hot flashes , and may stem from a multifactorial etiology . IMPLICATION S FOR NURSING Menopausal breast cancer survivors who present with any one of these symptoms should be screened for all symptoms both during and after treatment PURPOSE To assess the prevalence of depression among low-income , ethnic minority women with breast or gynecologic cancer , receipt of antidepressant medications or counseling services , and correlates of depression . PATIENTS AND METHODS Study patients were 472 women receiving cancer care in an urban public medical center . Women had a primary diagnosis of breast ( stage 0 to III ) or gynecologic cancer ( International Federation of Gynecology and Obstetrics stage 0 to IIIB ) . A diagnostic depression screen and baseline question naire were administered before or during active treatment or during active follow-up . Self-report data were collected on receipt  of depression treatment  ,  use of supportive counseling ,  pain and receipt of pain medication  , functional status and well-being , and perceived barriers to cancer care . RESULTS Twenty-four percent of women reported moderate to severe levels of depressive disorder ( 30 % of breast cancer patients and 17 % of gynecologic cancer patients ) . Only 12 % of women meeting criteria for major depression reported currently receiving medications for depression , and only 5 % of women reported seeing a counselor or participating in a cancer support group . Neither cancer stage nor treatment status was correlated with depression . Primary diagnosis of breast cancer , younger age , greater functional impairment , poorer social and family well-being , anxiety , comorbid arthritis , and fears about treatment side effects were correlated with depression . CONCLUSION Findings indicate that depressive disorder among ethnic minority , low-income women with breast or gynecologic cancer is prevalent and is correlated with pain , anxiety , and health-related quality of life . Because these women are unlikely to receive depression treatment or supportive counseling , there is a need for routine screening , evaluation , and treatment in this population Endocrine treatments of breast cancer patients antagonize estrogen and may lead to consequences of estrogen deprivation including menopausal symptoms . We analyzed the changes in frequency and severity of menopausal symptoms in patients receiving tamoxifen or aromatase inhibitors  and identified factors influencing these symptoms . One hundred and eighty-one consecutive postmenopausal breast cancer patients scheduled to start endocrine treatment  were included in this prospect i ve study . A menopause symptom question naire covering vasomotor , atrophic , psychological , cognitive and somatic symptoms was filled in at baseline , and after 1 and 3 months of therapy . Both first-line tamoxifen and aromatase inhibitors induced an increase in the occurrence and severity of hot flashes ( p<0.0001 and p=0.014 , respectively ) . Musculoskeletal pain and dyspareunia significantly increased under first-line non-steroidal aromatase inhibitors ( p=0.0039 and p=0.001 , respectively ) , while patients under tamoxifen had significant decrease in sexual interest ( p≤0.0001 ) . Younger age was associated with more hot flashes and vaginal dryness at baseline , and after 1 and 3 months of therapy ( all p<0.02 ) . We conclude that there are significant differences between the early effects of tamoxifen and aromatase inhibitors on menopausal symptoms of breast cancer patients . Our results underscore the need for safe and effective non-hormonal interventions to alleviate vasomotor and musculoskeletal symptoms which were the most prevalent and severe symptoms PURPOSE Sleep disruption is prevalent in patients with cancer and survivors , but the prevalence of insomnia , a distressing sleep disorder , in these population s has yet to be determined in large-scale studies . PATIENTS AND METHODS A total of 823 patients with cancer receiving chemotherapy ( mean age , 58 years ; 597 female patients ) reported on sleep difficulties in a prospect i ve study . RESULTS During day 7 of cycle 1 of chemotherapy , 36.6 % ( n = 301 ) of the patients with cancer reported insomnia symptoms , and 43 % ( n = 362 ) met the diagnostic criteria for insomnia syndrome . Patients with cancer younger than 58 years were significantly more likely to experience either symptoms of insomnia or insomnia syndrome ( chi(2 ) = 13.6 ; P = .0002 ) . Patients with breast cancer had the highest number of overall insomnia complaints . A significant positive association was found between symptoms of insomnia during cycles 1 and 2 of chemotherapy ( phi = .62 , P < .0001 ) , showing persistence of insomnia during the first two cycles of chemotherapy . Sixty percent of the patient sample reported that their insomnia symptoms remained unchanged from cycle 1 to cycle 2 . Those with insomnia complaints had significantly more depression and fatigue than good sleepers ( all P < .0001 ) . CONCLUSION The proportions of patients with cancer in this sample reporting symptoms of insomnia and meeting diagnostic criteria for insomnia syndrome during chemotherapy are approximately three times higher than the proportions reported in the general population . Insomnia complaints persist throughout the second chemotherapy cycle for the majority of patients with cancer in this study . Insomnia is prevalent , underrecognized , undermanaged , and understudied among patients with cancer receiving chemotherapy
Breast cancer remains the most frequently diagnosed malignancy among women worldwide , with rising incidence numbers .
In Belgium , one out of eight women will be diagnosed with breast cancer .
Fortunately , 80 % of those breast cancer patients will still be alive 10 years after diagnosis due to improvements in screening and treatment strategies .
However , an important portion of the breast cancer survivors ( BCS ) will face side effects , such as sleep disturbances , long after treatment ends .
It has been demonstrated that untreated insomnia in BCS negatively impacts mood , physical symptoms , pain sensitivity , fatigue , and quality of life .
Furthermore , insomnia is increasingly considered an independent risk factor for future depression in BCS .
The importance of underst and ing sleep disturbances in cancer population s has been highlighted and recognized as warranting further research .
Therefore , the purpose of this systematic review was to determine the prevalence and the risk factors for the development of sleep disturbances in BCS .