Zhou Eric S, Partridge Ann H, Syrjala Karen L, Michaud Alexis L, Recklitis Christopher J
Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA.
Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
J Cancer Surviv. 2017 Feb;11(1):74-79. doi: 10.1007/s11764-016-0564-1. Epub 2016 Aug 5.
Insomnia is commonly experienced by cancer survivors. Chronic insomnia is associated with significant physical and psychosocial consequences if not properly treated. Both the National Cancer Institute (NCI) and the National Comprehensive Cancer Network (NCCN) recommend the evaluation of sleep disturbances and evidence-based treatment of insomnia during routine survivorship care. To better understand current clinical practices, we conducted a survey of major cancer centers across the United States (US).
Adult survivorship programs at the 25 US cancer centers that are both NCI-designated comprehensive cancer centers and NCCN member institutions were surveyed about the evaluation and treatment of insomnia in their hospital.
All institutions responded to the survey. Thirteen centers (56 %) reported screening <25 % of survivors for sleep disorders, and few clinicians providing survivorship care were well-prepared to conduct a proper sleep evaluation. Insomnia was most commonly treated with sleep hygiene, or pharmacotherapy, rather than cognitive-behavioral therapy. No program reported that >50 % of their survivors were receiving optimal insomnia-related care. A variety of methods to improve insomnia care were endorsed by respondents.
There is a clear need to improve the evaluation and treatment of insomnia for cancer survivors at institutions across the country. Cancer centers deemed a number of modalities relevant for improving provider confidence in addressing sleep challenges.
To improve the quality of insomnia care for survivors, systematic interventions to increase standardized screening for sleep disorders, providing additional sleep medicine training for survivorship clinicians, and optimizing the role of sleep medicine specialists in the oncology setting should be considered.
癌症幸存者常经历失眠。若不妥善治疗，慢性失眠会带来严重的身体和心理社会后果。美国国立癌症研究所（NCI）和美国国立综合癌症网络（NCCN）均建议在常规生存护理期间对睡眠障碍进行评估，并对失眠进行循证治疗。为更好地了解当前临床实践，我们对美国各地的主要癌症中心进行了一项调查。
对美国25家既是NCI指定的综合癌症中心又是NCCN成员机构的癌症中心的成人生存项目进行调查，了解其医院对失眠的评估和治疗情况。
所有机构均回复了调查。13个中心（56%）报告称，对不到25%的幸存者进行了睡眠障碍筛查，而且很少有提供生存护理的临床医生做好了进行适当睡眠评估的准备。失眠最常用睡眠卫生或药物治疗，而非认知行为疗法。没有项目报告称其超过50%的幸存者接受了最佳的失眠相关护理。受访者认可了多种改善失眠护理的方法。
全国各机构显然需要改善对癌症幸存者失眠的评估和治疗。癌症中心认为有多种方式有助于提高医疗人员应对睡眠挑战的信心。
为提高幸存者失眠护理的质量，应考虑采取系统性干预措施，增加对睡眠障碍的标准化筛查，为生存护理临床医生提供更多睡眠医学培训，并优化睡眠医学专家在肿瘤治疗环境中的作用。
