Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer

Abstract

Sleep problems are highly prevalent in cancer patients undergoing chemotherapy. This article reviews existing evidence on etiology, associated symptoms, and management of sleep problems associated with chemotherapy treatment during cancer. It also discusses limitations and methodological issues of current research. The existing literature suggests that subjectively and objectively measured sleep problems are the highest during the chemotherapy phase of cancer treatments. A possibly involved mechanism reviewed here includes the rise in the circulating proinflammatory cytokines and the associated disruption in circadian rhythm in the development and maintenance of sleep dysregulation in cancer patients during chemotherapy. Various approaches to the management of sleep problems during chemotherapy are discussed with behavioral intervention showing promise. Exercise, including yoga, also appear to be effective and safe at least for subclinical levels of sleep problems in cancer patients. Numerous challenges are associated with conducting research on sleep in cancer patients during chemotherapy treatments and they are discussed in this review. Dedicated intervention trials, methodologically sound and sufficiently powered, are needed to test current and novel treatments of sleep problems in cancer patients receiving chemotherapy. Optimal management of sleep problems in patients with cancer receiving treatment may improve not only the well-being of patients, but also their prognosis given the emerging experimental and clinical evidence suggesting that sleep disruption might adversely impact treatment and recovery from cancer.

Keywords: cancer; chemotherapy; circadian rhythm; cognitive behavioral therapy; intervention; sleep.

Figure 1

Conceptual model of the development of chronic insomnia and the changing factors that play a role over the course of the disorder. Notes: In this particular case, at the onset of the insomnia, precipitating factors predominate. When the insomnia becomes chronic, perpetuating factors become the main feature contributing to the sleep disturbance. Reprinted from Principles and Practices of Sleep Medicine, 5th ed. In: Spielman, Yang, Glovinsky, editors. Chapter 144-Assessment Techniques for Insomnia; Pages 1632–1645, adapted from Spielman, Caruso, Glovinsky. Copyright Elsevier 2011. Reprinted with permission from Elsevier.