ASCO 2008: Intervention Program Improves Sleep Quality During Chemotherapy

May 31, 2008

Adherence to a four-point Individualized Sleep Promotion Plan (ISPP) intervention consisting of stimulus control, sleep restriction, relaxation therapy, and sleep-hygiene practices significantly lowered fatigue and increased sleep quality for patients undergoing adjuvant chemotherapy. Fatigue and sleep disturbances are the most frequently reported symptoms during adjuvant chemotherapy for breast cancer. One-third of breast cancer patients report persistent fatigue and abnormal sleep/wake cycles, said Ann M Berger, PhD, RN, professor, College of Nursing, University of Nebraska Medical Center, Omaha.

Adherence to a four-point Individualized Sleep Promotion Plan (ISPP) intervention consisting of stimulus control, sleep restriction, relaxation therapy, and sleep-hygiene practices significantly lowered fatigue and increased sleep quality for patients undergoing adjuvant chemotherapy. Fatigue and sleep disturbances are the most frequently reported symptoms during adjuvant chemotherapy for breast cancer. One-third of breast cancer patients report persistent fatigue and abnormal sleep/wake cycles, said Ann M Berger, PhD, RN, professor, College of Nursing, University of Nebraska Medical Center, Omaha.

Researchers conducted a randomized, controlled trial of the ISPP including women age 19 or older with stages I to III A breast cancer who had undergone surgery and were scheduled to receive adjuvant chemotherapy. Prior to the initial chemotherapy treatment, participants developed a personalized ISPP, which was reinforced and revised at regular intervals throughout chemotherapy. Data were collected 2 days prior and 7 days after each treatment and 30 days after the last chemotherapy treatment. Fatigue was measured by the Piper Fatigue Scale. Sleep was measured by the Pittsburgh Sleep Quality Index.

A total of 219 women were randomized to the ISPP group or to a control group consisting of a healthy eating plan and equal time and attention. Sleep quality was significantly better over the course of chemotherapy among ISPP patients (p <0.049). Although fatigue in both groups increased significantly throughout treatment and returned to prior to treatment levels by day 30, there were no significant differences in fatigue between the two groups. However, researchers found that those with high adherence (70% or more) to the ISPP reported significantly lower fatigue than those who adhered to the ISPP less than 70% of the time (p = 0.003).

A tailored ISPP should be offered to all women who begin on adjuvant chemotherapy. Clinicians should attempt to identify women who are likely to benefit from an ISPP. Dr. Berger said that motivators can be developed to help women adhere to an ISPP throughout the course of chemotherapy, including looking forward to attending an upcoming event with less tiredness and committing to initially try the ISPP for 5 days or a week to determine if it is helpful. Sleep professionals may be helpful in developing ISPP for patients, she added.