Psychosom Med 2018 06;80(5):483-491
From the Departments of Surgery, Psychiatry, and Psychology (Steel), Occupational Therapy (Terhorst), Surgery, Mathematica Policy Research (Collins), Surgery (Geller, Vodovotz, Kim, Krane, Marsh, Tsung), University of Pittsburg, Pennsylvania; Department of Psychology (Antoni), University of Miami, Florida; School of Nursing (Burke), and Department of Medicine, Surgery and Immunology (Butterfield), University of Pittsburgh, Pennsylvania; Department of Medical Social Sciences, Psychology, and Psychiatry and Behavioral Sciences (Penedo), Northwestern University, Evantson, Illinois; and Department of Psychiatry (Buysse), University of Pittsburgh, Pennsylvania.
Objective: The aims of this study were to examine the potential association between sleep problems, symptom burden, and survival in patients with advanced cancer.
Methods: A prospective study of 294 patients with gastrointestinal cancer administered questionnaires assessing sleep, depression, anxiety, stress, pain, fatigue, and health-related quality of life. Serum levels of cytokines including interleukin (IL)-1α, IL-1β, tumor necrosis factor α, IL-10, IL-2, and interferon-γ were measured to assess biological mediation between sleep and survival. Survival was measured as time from diagnosis to death.
Results: Fifty-nine percent of patients reported poor sleep quality, 53% reported poor sleep efficiency, 39% reported sleep latency greater than 30 minutes, and 45% reported sleeping less than 6 hours or greater than 10 hours. We found a significant association between sleep duration and symptom burden. Shorter sleep duration was significantly associated with higher levels of fatigue (r = -0.169, p = .01), pain (r = -0.302, p = .01), anxiety (r = -0.182, p = .01), depression (r = -0.172, p = .003), and lower levels of quality of life (r = 0.240, p = .01). After adjustment for demographic, psychological, and disease-specific factors, short sleep duration was associated with reduced survival (hazard ratio [HR] linear = 0.485, 95% confidence interval = 0.275-0.857) and there was also evidence for a quadratic pattern (HR quadrati = 1.064, 95% confidence interval = 1.015-1.115) suggesting a curvilinear relationship between sleep duration and survival. Interleukin 2 was the only cytokine significantly related to survival (HR = 1.01, p = .003) and sleep duration (β = -30.11, p = .027). When of IL-2 was added to the multivariable model, short and long sleep (β = -0.557, p = .097; β = 0.046, p = .114) were no longer significantly related to survival, suggesting mediation by IL-2.
Conclusion: Sleep duration was associated with symptom burden and poorer survival and IL-2 was found to mediate the association between sleep and survival. Screening and treatment of sleep problems in patients diagnosed with cancer are warranted.