Supportive Care in Cancer

, Volume 25, Issue 4, pp 1301–1306 | Cite as

Sleep disturbances in advanced cancer patients admitted to a supportive/palliative care unit

  • Sebastiano MercadanteEmail author
  • Claudio Adile
  • Patrizia Ferrera
  • Francesco Masedu
  • Marco Valenti
  • Federica Aielli
Original Article


The aim of this study was to assess the prevalence of sleep disturbances and possible correlations with associated factors in a sample of patients admitted to an acute palliative/supportive care unit.

A consecutive sample of patients with advanced cancer was prospectively assessed for a period of 6 months. Epidemiological and clinical data, treatments received in the last month, Karnofsky status, Edmonton Symptom Assessment System (ESAS), and concomitant medical treatment were also recorded. Patients were administered the Athens Insomnia Scale (AIS) and the Hospital Anxiety and depression scale (HADS).

Two hundred nineteen patients met the inclusion criteria. The mean age was 65.4 years (SD 12.4), and 111 patients were males. The mean Karnofsky status was 46.6 (SD = 12). All patients had consistent sleep disturbances (AIS ≥6), with a large number of patients having intense-maximum sleep disturbances. No relationships of AIS with gender, age, primary diagnosis, socio-educational factors, and anticancer treatments were found. AIS score was significantly associated with Karnofsky; intensities of pain, asthenia, anorexia, anxiety, depression, drowsiness, and well-being; and the use of corticosteroids and benzodiazepines. There was a positive correlation of HADS anxiety and HADS depression with sleep disturbances (p = 0.000). In the multivariate analysis, AIS increased only with the level of anxiety and depression assessed by HADS.

Sleep disturbances were ubiquitous in advanced cancer patients admitted to a supportive/palliative care unit and were strongly correlated with psychological distress. Assessment of sleep disorders is mandatory in this population for the obvious interference with quality of life.


Sleep disturbances Insomnia Palliative care Advanced cancer 


Compliance with ethical standards

Informed consent was obtained. The study conforms to the principal outline by the Declaration of Helsinki and was approved by the local ethical committee.

Conflict of interest

The authors declare that they have no conflict of interest.

Financial support

The study did not receive any financial support.


  1. 1.
    Mystakidou K, Parpa E, Tsilika E, Pathiaki M, Gennatas K, Smymiotis V, Vassilou Y (2007) The relationship of subjective sleep quality, pain, and quality of life in advanced cancer patients. Sleep 30:737–742CrossRefGoogle Scholar
  2. 2.
    Nishiura M, Tamura A, Nagai H, Matsushima E (2015) Assessment of sleep disturbance in lung cancer patients: relationship between sleep disturbance and pain, fatigue, quality of life, and psychological distress. Palliat Support Care 13:575–581CrossRefGoogle Scholar
  3. 3.
    Palesh OG, Roscoe JA, Mustian KM, Roth T, Savard J, Ancoli-Israel S, Heckler C, Purnell JQ, Janelsins MC, Morrow GR (2010) Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol 8:292–298CrossRefGoogle Scholar
  4. 4.
    Savard J, Morin CM (2001) Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19:895–908CrossRefGoogle Scholar
  5. 5.
    Renom-Guiteras A, Planas J, Farriols C, Mojal S, Miralles R, Silvent MA, Ruis-Ripoll AI (2014) Insomnia among patients with advanced disease during admission in a palliative care unit: a prospective observational study on its frequency and association with psychological, physical and environmental factors. BMC Palliat Care 13:40CrossRefGoogle Scholar
  6. 6.
    Palesh OG, Roscoe JA, Mustian KM et al (2010) Prevalence, demographics, and psychological association of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol 28:292–298CrossRefGoogle Scholar
  7. 7.
    Mercadante S, Aielli F, Adile C, Ferrera P, Valle A, Cartoni C, Oizzuto M, Caruselli A, Parsi R, Cortegiani A, Masedu F, Valenti M, Ficorella C, Porzio G (2015) Sleep disturbances in patients with advanced cancer in different palliative care settings. J Pain Symptom Manag 50:786–792CrossRefGoogle Scholar
  8. 8.
    Yennurajalingam S, Balachandran D, Pedraza Cardozo SL, Berg EA, Chisholm GB, Reddy A, DeLa Cruz V, Williams JL, Bruera E. (2015) Patient-reported sleep disturbance in advanced cancer: frequency, predictors and screening performance of the Edmonton Symptom Assessment System sleep item. BMJ Support Palliat Care. doi:  10.1136/bmjspcare-2015-000847
  9. 9.
    Delgado-Guay M, Yennurajalingam S, Parson H, Palmer JL, Bruera E (2011) Association between self-reported sleep disturbances and other symptoms in patients with advanced cancer. J Pain Symptom Manag 41:819–827CrossRefGoogle Scholar
  10. 10.
    Soldatos CR, Dikeos DG, Paparrigopoulos TJ (2000) Athens sleep disturbance scale: validation of an instrument based on ICD-281 10 criteria. J Psychosom Res 48:555–560CrossRefGoogle Scholar
  11. 11.
    Soldatos CR, Dikeos DG, Paparrigopoulos TJ (2003) The diagnostic validity of the Athens insomnia scale. J Psycho Res 55:263–267CrossRefGoogle Scholar
  12. 12.
    Herrmann C (1997) International experiences with the hospital anxiety and depression scale-a review of validation data and clinical results. J Psychosom Res 42:17–41CrossRefGoogle Scholar
  13. 13.
    Yennurajalingam S, Chisholm G, Palla SL, Holmes H, Reuben JM, Bruera E. (2013) Self-reported sleep disturbances in patients with advanced cancer: frequency, intensity, and factors associated with response to outpatient supportive care consultation. A preliminary report. Palliat Support Care 1–9Google Scholar
  14. 14.
    Mercadante S, Girelli D, Casuccio A (2004) Sleep disorders in advanced cancer patients: prevalence and factors associated. Support Care Cancer 12:355–359CrossRefGoogle Scholar
  15. 15.
    Miaskowski C, Lee KA (1999) Pain, fatigue, and sleep disturbances in oncology outpatients receiving radioation therapy for bone metastasis. A pilot study J Pain Symptom Manage 17:320–332CrossRefGoogle Scholar
  16. 16.
    Theobald DE. (2004) Cancer pain, fatigue, distress, and insomnia in cancer patients. Clin Cornerstone. Suppl 1D:S15–21.CrossRefGoogle Scholar
  17. 17.
    Hsiao FH, Kuo WH, Jow GM, Chang KJ, Yang PS, Lam HB, Lee JJ, Huang CS, Liu YF, Lai YM (2014) Habitual sleep-wake behaviors and lifestyle as predictors of diurnal cortisol patterns in young breast cancer survivors: a longitudinal study. Psychoneuroendocrinology 53C:60–68Google Scholar
  18. 18.
    Innominato PF, Roche VP, Palesh OG, Ulusakarya A, Spiegel D, Lévi FA (2014) The circadian timing system in clinical oncology. Ann Med 46:191–207CrossRefGoogle Scholar
  19. 19.
    Brennan MJ, Lieberman JA (2009) Sleep disturbances in patients with chronic pain: effectively managing opioid analgesia to improve outcomes. Curr Med Res Opin 25:1045–1055CrossRefGoogle Scholar
  20. 20.
    Rose AR, Catcheside PG, McEvoy RD et al (2014) Sleep disordered breathing and chronic respiratory failure in patients with chronic pain on long term opioid therapy. J Clin Sleep Med 10:847–852PubMedPubMedCentralGoogle Scholar
  21. 21.
    Raj SX, Thronaes M, Brunelli C, Hjermstad MJ, Klepstad P, Kaasa S (2014) A cross-sectional study on prevalence of pain and breakthrough pain among an unselected group of outpatients in a tertiary cancer clinic. Support Care Cancer 22:1965–1971CrossRefGoogle Scholar
  22. 22.
    Cheatle MD, Foster S, Pinkett A, Lesneski M, Qu D, Dhingra L (2016) Assessing and managing sleep disturbance in patients with chronic pain. Anesthesiol Clin 34:379–393CrossRefGoogle Scholar
  23. 23.
    Smith MT, Haythornthwaite JA (2004) How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Med Rev 8:119–132CrossRefGoogle Scholar
  24. 24.
    Roehrs TA, Bentley A, Bonnet M, Fahs J, Jeong DU, Lankford A, Link H, Morin C, Sateia M, Vitiello M, Keam S, Weitz M. (2009) Does effective management of sleep disorders improve pain symptoms? Drugs. 69 Suppl 2:5–11CrossRefGoogle Scholar
  25. 25.
    Wang D, Teichtahl H (2007) Opioids, sleep architecture and sleep-disordered breathing. Sleep Med Rev 11:35–46CrossRefGoogle Scholar
  26. 26.
    Finan PH, Goodin BR, Smith MT (2013) The association of sleep and pain: an update and path forward. J Pain 14:1539–1552CrossRefGoogle Scholar
  27. 27.
    Yennurajalingam S, Williams JL, Chisholm G, Bruera E (2016) Effects of dexamethasone and placebo on symptom clusters in advanced cancer patients: a preliminary report. Oncologist 21:384–390CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Sebastiano Mercadante
    • 1
    Email author
  • Claudio Adile
    • 1
  • Patrizia Ferrera
    • 1
  • Francesco Masedu
    • 2
  • Marco Valenti
    • 2
  • Federica Aielli
    • 2
  1. 1.Pain relief and supportive care unitLa Maddalena Cancer CenterPalermoItaly
  2. 2.Department of Biotechnological and Applied Clinical Sciences, Section of Clinical Epidemiology and Environmental MedicineUniversity of L’AquilaL’AquilaItaly

Personalised recommendations