Personalized goal for insomnia and clinical response in advanced cancer patients

  • Sebastiano MercadanteEmail author
  • Claudio Adile
  • Federica Aielli
  • Lanzetta Gaetano
  • Kyriaki Mistakidou
  • Marco Maltoni
  • Andrea Cortegiani
  • Luiz Guilherme Soares
  • Stefano De Santis
  • Patrizia Ferrera
  • Marta Rosati
  • Romina Rossi
  • Alessandra Casuccio
Original Article



The aim of this study was to assess the Personalized Insomnia Intensity Goal (PIIG), the achievement of Personalized Goal Response (PGR), and Patient Global Impression (PGI) after a comprehensive symptom management.

Patients and methods

Advanced cancer patients admitted to palliative care units rated pain and symptoms intensity and their PIIG by using the Edmonton Symptom Assessment Score (ESAS) (T0). In patients with significant levels of insomnia, the achievement of target expected (PIIG) was measured (patient goal response, PIGR), as well the patient global impression (PGI), by the minimal clinically important difference (MCID), after a comprehensive symptom management (T7).


Three hundred ninety-seven patients with a level of insomnia of ≥ 3 on ESAS were analyzed in this study. The mean values of PIIG at T0 and T7 were 1.2 (SD 1.5) and 0.9 (SD 1.4), respectively. Most patients (n = 406, 89.8%) indicated a PIIG of ≤ 3 as a target at T0. Such target was significantly lower at T7 (p = < 0.0005). PGI, expressed as MCID, was perceived with a mean decrease in insomnia intensity of − 2.3. In a minority of patients (n = 26; 5.8%) insomnia worsened, with a MCID of 0.50 (SD 2.8). Higher insomnia intensity at T0 and lower insomnia intensity at T7 were independently related to PGI. PIGR was achieved in 87.9% of patients. PIGR was associated with PIIG at T0, and inversely associated to insomnia intensity at T0 and T7, and PIIG at T7.


PGIR and PGI seem to be relevant for evaluating the effects of a comprehensive management of insomnia, suggesting therapeutic decisions according to PIIG. Some factors influencing the individual target and clinical response have been detected.


Advanced cancer Insomnia Symptom assessment Palliative care Personalized symptom goal Global impression of change 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sebastiano Mercadante
    • 1
    Email author
  • Claudio Adile
    • 2
  • Federica Aielli
    • 3
  • Lanzetta Gaetano
    • 4
    • 5
  • Kyriaki Mistakidou
    • 6
  • Marco Maltoni
    • 7
  • Andrea Cortegiani
    • 8
  • Luiz Guilherme Soares
    • 9
  • Stefano De Santis
    • 10
  • Patrizia Ferrera
    • 2
  • Marta Rosati
    • 7
  • Romina Rossi
    • 7
  • Alessandra Casuccio
    • 11
  1. 1.Main Regional Center for Pain Relief & Supportive CareLa Maddalena Cancer CenterPalermoItaly
  2. 2.Pain Relief & Supportive Care, La Maddalena Cancer CenterPalermoItaly
  3. 3.Department of OncologyHospital of TeramoTeramoItaly
  4. 4.Medical Oncology Unit, IRCCS NeuromedPozzilliItaly
  5. 5.Medical Oncology Unit, Italian Neuro-Traumatology InstituteGrottaferrataItaly
  6. 6.Pain Relief and Palliative Care Unit, Department of Radiology, Areteion HospitalNational & Kapodistrian University of Athens, School of MedicineAthensGreece
  7. 7.Palliative Care Unit - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCSMeldolaItaly
  8. 8.Department of AnesthesioloogyUniversity of PalermoPalermoItaly
  9. 9.Post-Acute Care Services and Palliative Care ProgramHospital PlaciRio de JaneiroBrazil
  10. 10.Palliative Care and Oncologic Pain Service - S. Camillo-Forlanini HospitalRomeItaly
  11. 11.Università di PalermoPalermoItaly

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