Narayanan Santhosshi, Reddy Akhila, Lopez Gabriel, Liu Wenli, Ali Sara, Bruera Eduardo, Cohen Lorenzo, Yennurajalingam Sriram
Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer, Unit 1414, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
Support Care Cancer. 2022 Mar;30(3):2417-2425. doi: 10.1007/s00520-021-06668-x. Epub 2021 Nov 11.
Sleep disturbance (SD) is highly prevalent in oncology and negatively affects quality of life and mortality. Evidence supports the use of integrative oncology (IO) practices to treat SD, but there is limited published data on the characteristics of SD and factors associated with SD in IO. We determined the prevalence, severity, and factors associated with SD among cancer patients seen in an ambulatory IO consultation.
Patients with cancer referred for initial outpatient IO consultation in 2017 were eligible. Patient demographics, clinical characteristics, and patient-reported outcomes (Edmonton Symptom Assessment Scale (ESAS), Measure Yourself Concerns and Wellbeing (MYCaW), PROMIS-10) were retrospectively reviewed.
One thousand five hundred twenty patients were included in the analysis. The majority (70%) were women with breast cancer (42%). Nine hundred seventy-one (64%) patients reported significant SD with ESAS Sleep ≥ 4, yet only 11% expressed poor sleep as their primary or secondary concern for the IO consultation. The median SD (IQR) was 5 (3,7). ESAS scores for fatigue (adjusted OR 1.16; CI 1.07-1.26, p < 0.001), pain (adjusted OR 1.07; CI 1.00-1.15, p < 0.05), hot flashes (adjusted OR 1.14; CI 1.07-1.22, p < 0.001), well-being (adjusted OR 1.33; CI 1.22-1.46, p < 0.001), and psychological distress score (anxiety and depression) (adjusted OR 1.16; CI 1.01-1.11, p < 0.01) were independently associated with SD in multivariate analysis. Acupuncture was the most frequent intervention prescribed, 175 (35%). Other modalities included oncology massage (15%), health psychology (5%), and meditation (1%).
Although 64% of patients seeking IO consultation reported clinically significant SD, only 11% were seeking integrative approaches for managing SD. ESAS fatigue, hot flashes, well-being, and psychological symptoms were significantly associated with SD.
睡眠障碍（SD）在肿瘤学中极为普遍，会对生活质量和死亡率产生负面影响。有证据支持采用综合肿瘤学（IO）方法来治疗睡眠障碍，但关于综合肿瘤学中睡眠障碍的特征以及与睡眠障碍相关因素的已发表数据有限。我们确定了在门诊综合肿瘤学咨询中就诊的癌症患者中睡眠障碍的患病率、严重程度及相关因素。
2017年首次因门诊综合肿瘤学咨询而转诊的癌症患者符合条件。回顾患者的人口统计学、临床特征以及患者报告的结局（埃德蒙顿症状评估量表（ESAS）、自我测量关注与幸福感量表（MYCaW）、患者报告结果测量信息系统-10（PROMIS-10））。
1520名患者纳入分析。大多数（70%）为女性，其中乳腺癌患者占42%。971名（64%）患者报告ESAS睡眠量表得分≥4，存在显著睡眠障碍，但只有11%的患者将睡眠不佳作为综合肿瘤学咨询的主要或次要关注点。睡眠障碍的中位数（四分位间距）为5（3，7）。在多因素分析中，疲劳（调整后比值比1.16；可信区间1.07 - 1.26，p < 0.001）、疼痛（调整后比值比1.07；可信区间1.00 - 1.15，p < 0.05）、潮热（调整后比值比1.14；可信区间1.07 - 1.22，p < 0.001）、幸福感（调整后比值比1.33；可信区间1.22 - 1.46，p < 0.001）以及心理困扰评分（焦虑和抑郁）（调整后比值比1.16；可信区间1.01 - 1.11，p < 0.01）与睡眠障碍独立相关。针灸是最常开具的干预措施，有175例（35%）。其他方式包括肿瘤按摩（15%）、健康心理学（5%）和冥想（1%）。
尽管64%寻求综合肿瘤学咨询的患者报告有临床显著的睡眠障碍，但只有11%的患者寻求综合方法来管理睡眠障碍。ESAS疲劳、潮热、幸福感和心理症状与睡眠障碍显著相关。
