Insomnia in Cancer - Associations and Implications


Background: Insomnia is a common condition in cancer patients. In spite of the high prevalence its associationshave not been well studied. Existing data suggests that insomnia is related to depression and pain. However, theimpact of ongoing chemotherapy on sleep is not investigated. Aim: To study the relationship between insomniaand chemotherapy after analysing confounding variables. Materials and
Methods: Consecutive patients whovisited New England Oncology Clinic in Tamworth were recruited. Insomnia was assessed with the Bergeninsomnia scale. The Montgomery Asberg Depression rating scale was used to measure depression. Pain wasassessed with the Brief Pain inventory. Chronic medical conditions, type of cancer, side effects to chemotherapy,role of steroids and other drugs were studied as confounders.
Results: A total of 56 patients participated in thestudy. Age ranged from 33 to 83 years (mean: 63.6, SD=10.97). There were 29 men and 27 women. 42 patientsreceived at least one form of chemotherapy and 15 were receiving radiotherapy at the time of assessment. Meaninsomnia score was significantly higher in those receiving chemotherapy than in those without chemotherapy(8.92 vs 17.2, two tailed p=0.005, 95% CI=2.63-13.71). There was no significant variation in insomnia scoresin terms of chronic medical condition, type of cancer, psychiatric history, use of steroids or adverse effects ofchemotherapy. However, total insomnia score was correlated with depression rating score (Pearson correlation,r=0.39, p=0.003) and magnitude of pain (r=0.37, p=0.006). On regression analysis only pain was found to bepredictive of insomnia.
Conclusions: Insomnia in patients with cancer is found to be associated with concurrentchemotherapy and correlated with degree of depression and pain. Identifying factors related to insomnia incancer population has implications in its management and patient education.