Problems sleeping with prostate cancer: exploring possible risk factors for sleep disturbance in a population-based sample of survivors
This study aimed to investigate the prevalence of sleeping problems in prostate cancer survivors and to explore the role of predisposing, precipitating and perpetuating factors in this process.
Using a cross-sectional design, 3348 prostate cancer survivors between 2 and 18 years post diagnosis reported experiences of insomnia using the QLQC30, along with their sociodemographic characteristics, health status and treatment(s) received. The EQ5D-5L and QLQPR25 assessed survivors’ overall and prostate cancer–specific health-related quality of life. A hierarchical multiple regression analysis was constructed with three blocks: (1) predisposing (e.g. demographics at diagnosis), (2) precipitating (e.g. disease extent, treatment) and (3) perpetuating factors (e.g. side effects).
Nineteen percent of survivors reported significant problems sleeping. The final model accounted for 31% of the variance in insomnia scores (p < .001). In order of magnitude, associates of sleep disturbance were urinary symptoms (β = 0.22; p < .001), experiencing symptoms of depression/anxiety (β = 0.18; p < .001), hormone treatment–related symptoms (β = 0.12; p = .001), pain (β = 0.10; p < .001) and bowel symptoms (β = 0.06; p = .005). Having a lower education and more comorbidities at diagnosis also predicted sleep problems.
Results suggest that it is the ongoing adverse effects of prostate cancer and its treatment (e.g. urinary symptoms) that put survivors most at risk of sleep problems. Strong associations with symptoms of depression/anxiety were also observed. Findings highlight the need for health care practitioners to treat and manage adverse effects of prostate cancer treatment in order to mitigate sleep disturbance in survivors.
KeywordsProstate cancer Insomnia Adverse side effects Depression Anxiety Pain
We would like to thank the men who took the time to complete and return the questionnaire, the health professionals who helped screen men for eligibility to participate in the study, Heather Kinnear who was involved in helping design the questionnaire and Sandra Deady.
This work was funded by the Health Research Board in the Republic of Ireland, (HRA_HSR/2010/17), Prostate Cancer UK (NI09-03 and NI-PG13-001), the R&D Office of the Public Health Agency in Northern Ireland and the National Cancer Control Programme in the RoI. This research received no specific grant from any funding agency in the commercial or not-for-profit sectors. The Northern Ireland Cancer Registry is funded by the Public Health Agency for Northern Ireland and the National Cancer Registry Ireland by the Department of Health.
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Conflict of interest
The authors declare they have no conflict of interest.
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