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. 2024 Nov;13(22):e70365.
doi: 10.1002/cam4.70365.

Proposal for Managing Cancer-Related Insomnia: A Systematic Literature Review of Associated Factors and a Narrative Review of Treatment

Yoshinori Saeki  1 , Yukiyoshi Sumi  2 , Yukinori Ozaki  3 , Mari Hosonaga  3 , Yoshiyuki Kenmotsu  4 , Takuma Onoe  5 , Ken Yamaguchi  6 , Yoshihisa Matsumoto  1
Affiliations

Proposal for Managing Cancer-Related Insomnia: A Systematic Literature Review of Associated Factors and a Narrative Review of Treatment

Yoshinori Saeki et al. Cancer Med. 2024 Nov.

Abstract

Objective: Insomnia is common in patients with cancer. It has a multifactorial etiology that may include the disease process, adverse effects of anticancer therapies, and/or an association with other comorbidities. The purpose of this review was to identify risk factors for insomnia and suggest optimal management strategies.

Methods: We conducted a systematic literature review to elucidate the risk factors for insomnia and sleep disturbances in patients with solid tumors. The effects of sleep medications in this population were also described.

Results: A total of 75 publications were evaluated, including those on breast, lung, gynecologic, brain, head and neck, gastrointestinal, prostate, thyroid, and mixed cancers. We classified the factors related to insomnia or sleep disturbance in cancer into four categories: (1) patient demographic characteristics (e.g., age, marital or socioeconomic status); (2) mental state (e.g., depression or anxiety); (3) physical state (e.g., fatigue, pain, or restless legs syndrome); and (4) anticancer treatment-related (e.g., use of chemotherapy, opioids, or hormone therapy). Overall, literature on the pharmacologic treatment of insomnia is extremely limited, although some efficacy data for zolpidem and melatonin have been reported.

Conclusions: Demographic characteristics, physical and mental distress, and anticancer treatments are all risks for insomnia in patients with cancer. The limited evidence base for pharmacologic therapy in this patient population means that healthcare professionals need to implement a comprehensive and multidisciplinary pathway from screening to management.

Keywords: cancer; insomnia; psycho‐oncology; review; sleep disturbance.

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Conflict of interest statement

Although authors received payment for advisory board services, this present manuscript was prepared independently with funding for medical writing only. Yukiyoshi Sumi received funding for the present manuscript from Eisai Co. Ltd., and received payment or honoraria for lectures or presentations from MSD K.K., Sumitomo Pharma Co. Ltd., Kyowa Kirin Co. Ltd., Viatris Pharmaceuticals Japan Inc., Takeda Pharmaceutical Co. Ltd., and Eisai Co. Ltd. Yukinori Ozaki received payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Daiichi Sankyo Co. Ltd., Pfizer Japan Inc., Kyowa Kirin Co. Ltd., and Eli Lilly Japan K.K. Yoshiyuki Kenmotsu received funding for the present manuscript, payment or honoraria for lectures, payment for expert testimony, and payment for buiness meetings from Eisai Co. Ltd.; payment or honoraria for lectures from Chugai Pharmaceutical Co. Ltd., AstraZeneca K.K., Takeda Pharmaceutical Co. Ltd., KYORIN Pharmaceutical Co. Ltd., Eli Lilly Japan K.K., Janssen Pharmaceutical K.K., and Nippon Boehringer Ingelheim Co. Ltd. TO received funding for the present manuscript, grants to the author's institution, and consulting fees from Eisai Co. Ltd. and payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Eisai Co. Ltd., Chugai Pharmaceutical Co. Ltd., Taiho Pharmaceutical Co. Ltd., and Bristol‐Myers Squibb K.K. KY received funding for the present manuscript from Eisai Co. Ltd.; grants, consulting fees, and payment associated with a patent held by DUMSCO Inc.; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing, or educational events from Eisai Co. Ltd., Takeda Pharmaceutical Co. Ltd., Chugai Pharmaceutical Co. Ltd., Daiichi Sankyo Co. Ltd., and Merck & Co. Inc.; and served a leadership or fiduciary role (unpaid) in the Japan Society of Obstetrics and Gynecology and Japan Society of Endometriosis. YM received funding for the present manuscript from Eisai Co. Ltd. Yukinori Ozaki and Mari Hosonaga declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Factors associated with insomnia in patients with cancer. RLS, restless legs syndrome.
FIGURE 2
FIGURE 2
Suggestions for the management and treatment of insomnia in patients with cancer. †As insomnia is often not reported by the patient, a detailed interview should be conducted. ‡Consider consulting a neurologist or psycho‐oncologist if RLS is severe. ESS, Epworth Sleepiness Scale; ISI, Insomnia Severity Index; OSA, obstructive sleep apnea; PSQI, Pittsburgh Sleep Quality Index; RLS, restless legs syndrome.
See this image and copyright information in PMC

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