Comparison of sleep quality before and after chemotherapy in locally advanced non-small-cell lung cancer patients: a prospective study and literature review

Abstract

Background Outcome of sleep disturbances in lung cancer patients before and after treatment is not much reported. Their intensity and their correlation to quality of life or to humor disturbances were not widely studied. The aim of this study was to report precisely sleep disturbances in advanced stage lung cancer patients, their outcome after chemotherapy and/or radiotherapy, and their correlation to anxiodepressive humor. Patients and methods It was a prospective study including 64 patients with stage 3 or 4 non-small-cell lung cancer. Patients answered the Tunisian dialectal version of the following questionnaires: Pittsburgh sleep quality index and hospital anxiety depression scale in order to evaluate, respectively, the sleep quality and anxiodepressive troubles. The questionnaires took place before chemotherapy and then were repeated after chemotherapy was over. Results The mean age was 62.9 years. All patients were active smokers. Before chemotherapy, there were 10 (15%) patients with poor sleep quality. Most frequent complaints were daily sleepiness (70%) and nocturnal arousals (100%). Sixteen (25%) patients had depressive humor. Depression was statistically more frequent among patients with poor sleep quality (80 vs 15%, P<0.001). After chemotherapy, the mean Pittsburgh sleep quality index score increased from 2.9 to 5.4 and 45% of all patients had poor sleep quality. Most frequent complaints were extension of sleep latency (69%), daily sleepiness (98%), and nocturnal arousals (100%). After chemotherapy, depressive humor was reported in 34.3% of all patients, with higher prevalence among patients with poor sleep quality (58 vs 14%, P<0.001). Anxious humor was reported in 17% of all patients. A higher prevalence was correlated with poor sleep quality (31 vs 6%, P<0.001). The predicting factors of sleep disturbance according to statistical univariate analysis were delayed diagnosis confirmation (P=0.05), delayed start of treatment (P<0.001), and anxious (P=0.001) or depressive humor (P=0.001). Multivariate analysis confirmed the correlation of sleep disturbance to delayed diagnosis confirmation and treatment onset. Conclusion This study insisted on the persistence and potential intensity worsening of sleep disturbances in advanced stage non-small-cell lung cancer patients. The authors, hereby, reported a statistical correlation between sleep quality and humor quality in patients.

Keywords

• chemotherapy
• depression
• lung cancer
• sleep–wake disturbance