Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Medicine, Eastern Hill Campus, (A.K.W., D.M., J.P.), University of Melbourne, Fitzroy, Victoria, Australia.
Parkville Integrated Palliative Care Service (A.K.W., D.W., B.L., J.P.), The Royal Melbourne Hospital, Parkville, Victoria, Australia.
J Pain Symptom Manage. 2023 Sep;66(3):e335-e342. doi: 10.1016/j.jpainsymman.2023.05.020. Epub 2023 Jun 7.
Insomnia is an under-recognized and undertreated symptom in palliative care and advanced cancer cohorts. Insomnia in an advanced colorectal cancer cohort is yet to be investigated despite colorectal cancer being the third commonest cancer worldwide and one with a high symptom burden.
To examine the prevalence of insomnia and its associations in a large advanced colorectal cancer cohort.
A consecutive cohort study of 18,302 patients with colorectal cancer seen by palliative care services across various settings (inpatient, outpatient, and ambulatory) was conducted from an Australia-wide database (2013-2019). The Symptom Assessment Score (SAS) was used to assess the severity of insomnia. Clinically significant insomnia was defined as SAS score ≥3/10, and used to compare associations with other symptoms and functional scores from validated questionnaires.
The prevalence of any insomnia was 50.5%, and clinically significant insomnia 35.6%, particularly affecting people who were younger (<45-years-old), more mobile (AKPS score ≥70), or physically capable (RUG-ADL score ≤5). Outpatients and patients living at home had higher prevalence of insomnia. Nausea, anorexia and psychological distress were the commonest concurrent symptoms in patients with clinically significant insomnia.
To our knowledge, this study was the first to investigate the prevalence and associations of insomnia in an advanced colorectal cancer cohort. Our findings demonstrate several groups at greater risk of suffering from insomnia (younger, greater physical capacity, living at home, and those with greater psychological distress). This may guide earlier recognition and management of insomnia to improve overall quality of life in this population.
在姑息治疗和晚期癌症患者中，失眠是一种未被充分认识和治疗不足的症状。尽管结直肠癌是全球第三常见的癌症，且症状负担较高，但在晚期结直肠癌患者中，失眠尚未得到研究。
在一个大型晚期结直肠癌队列中研究失眠的患病率及其相关性。
对来自澳大利亚全国数据库（2013-2019 年）的各种环境（住院、门诊和门诊）姑息治疗服务中 18302 例结直肠癌患者进行了连续队列研究。使用症状评估量表（SAS）评估失眠的严重程度。将 SAS 评分≥3/10 定义为有临床意义的失眠，并用于比较与其他症状和来自验证问卷的功能评分的相关性。
任何失眠的患病率为 50.5%，有临床意义的失眠患病率为 35.6%，尤其影响年龄较小（<45 岁）、移动能力较好（AKPS 评分≥70）或身体状况较好（RUG-ADL 评分≤5）的人群。门诊患者和在家居住的患者失眠的患病率更高。恶心、厌食和心理困扰是有临床意义失眠患者最常见的并存症状。
据我们所知，这项研究首次调查了晚期结直肠癌患者中失眠的患病率和相关性。我们的研究结果表明，有几个群体患失眠的风险更高（年龄较小、身体状况较好、在家居住、心理困扰较大）。这可能有助于更早地识别和管理失眠，以提高该人群的整体生活质量。
