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Sleep Disturbance, Treatment-Related Adverse Events, and Psychological Distress in Breast Cancer Patients: A
Fang Zhao1, Yuqiu Li1, Yanjun Zhou2
1Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Background:
Studies on the treatment-related adverse events have mostly overlooked sleep quality and psychological distress in patients with cancer. The aim of this study was to analyze the relationship between sleep disturbance, treatment-related adverse events, and psychological distress in Chinese patients with breast cancer.
Methods:
This was a prospective cohort study of 300 female patients diagnosed with breast cancer, who were recruited from two medical centers in China. Sleep disturbances and psychological distress were assessed before and after every treatment cycle using the Pittsburgh Sleep Quality Index and the Symptom Checklist-90 questionnaire. Treatment-related adverse events were assessed using a validated 26‑item scale after each of 6 chemotherapy cycles. Spearman's rank correlation was used for bivariate analyses and multivariable linear regression was used to test independent associations. False Discovery Rate correction was applied for multiple comparisons.
Results:
The incidence of most treatment-related adverse events was significantly higher in the baseline sleep disorder group than in the normal sleep group (all P values <0.05). Psychological distress at baseline was correlated with the total treatment-related adverse events score (rs=0.54, P<0.001). Multivariate analysis showed that psychological distress was independently associated with the occurrence of treatment-related adverse events (β=0.19, P<0.001). In addition, the pre-treatment total psychological distress score in the baseline sleep disorder group was significantly higher than that in the normal sleep group (P=0.001). Furthermore, the severity of treatment-related adverse events and baseline sleep quality were associated with psychological distress (all P values <0.05).
Conclusion:
Poor baseline sleep quality is correlated with increased occurrence and severity of treatment-related adverse events. In addition, baseline psychological distress is correlated with the occurrence of treatment-related adverse events. Both baseline sleep quality and the severity of treatment-related adverse events were associated with the psychological distress of patients after treatment for breast cancer.
