Sleep problems in cancer patients linked with pain, fatigue, depression

NEW YORK (Reuters Health) - Sleep problems are common in cancer patients and are associated with significantly increased fatigue, pain, and depressed mood.

Understanding the "causal direction" among the "myriad of disease- and treatment-related symptoms" experienced by cancer patients will aid in their management, say Dr. Edward J. Stepanski, of Accelerated Community Oncology Research Network, Memphis, Tennessee, and colleagues.

To that end, the researchers assessed relationships among trouble sleeping, fatigue/sleepiness, depressed mood, and pain in more than 11,000 cancer patients.

According to their paper in the April 15th issue of the Journal of Clinical Sleep Medicine, more than half the patients reported trouble sleeping, with 26% reporting moderate or severe trouble sleeping. The subset with moderate-to-severe sleep problems was significantly younger and reported significantly more fatigue, pain, and depressed mood (all p < 0.001) compared to those without trouble sleeping.

Fatigue, which was "best represented as a latent variable," was directly influenced by depressed mood, trouble sleeping, and physical pain. Significant indirect effects of these variables on fatigue were also observed. The effect of depressed mood on fatigue and physical pain was mediated by trouble sleeping, and the effect of trouble sleeping on fatigue was mediated by physical pain.

"Fatigue is a critically important symptom in patients with cancer, and these data suggest that effective treatment of depressed mood, trouble sleeping, and pain will improve fatigue," Dr. Stepanski said in an interview with Reuters Health. "An intervention study aimed at optimizing treatment of depressed mood in cancer patients, with trouble sleeping, pain, and fatigue as outcome measures, is needed."

"These data underscore the importance of use of patient-reported outcomes to provide an important and unique perspective in understanding the cancer experience," he added.

"These data," the researchers conclude, "predict that treatment of trouble sleeping will improve pain management in this population."

Copyright © 2009 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.