Research into Insomnia May Lead to Reduced Fatigue
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SUMMARY
Estimated at 70-100% of cancer patients, those who suffer from fatigue are at a distinct disadvantage in their fight against cancer. CTCA researchers are working to understand the biological basis of insomnia in cancer patients and its relationship to fatigue and depression. Research may lead to innovative insomnia treatments, which could help cancer patients live better and live longer.
If you are fighting cancer, it’s very likely you are also fighting fatigue. Fatigue is the most common side effect of cancer and cancer treatment.1 In fact, the American Cancer Society estimates that 70 to 100 percent of cancer patients suffer from fatigue, which is defined as an overwhelming feeling of exhaustion — physical, emotional and mental.
Patients who suffer from fatigue are at a distinct disadvantage in their fight against cancer. They are less able to tolerate or benefit from treatment,2 they have trouble with daily functioning, they tend to be more anxious and depressed, and, once depressed, they have higher 1-year to 3-year mortality rates.3
Fatigue can be caused by a number of factors, but one of the primary causes is insomnia, which plagues 30 to 50 percent of all cancer patients.4 So, helping patients reduce their fatigue by helping them sleep better is an important goal at Cancer Treatment Centers of America® (CTCA). Here, CTCA researchers are working to understand the biological basis of insomnia in cancer patients and its relationship to fatigue and depression.
A Faulty Biological Clock May Cause Insomnia in Patients with Lung Cancer
We humans, like most animals and plants, have an internal biological clock that tells us when to be awake and when to sleep, in addition to controlling other life processes. Our internal clock works in 24-hour cycles called circadian rhythms, and when any of these rhythms is disrupted, some of our body’s natural processes can be thrown off.
Knowing this, CTCA researchers at Midwestern Regional Medical Center (Midwestern) in Zion, IL, wanted to find out if disruptions in the natural sleep/wake cycles of cancer patients might be the cause of their insomnia and fatigue – two symptoms that significantly reduce their quality of life. To find out, the CTCA researchers collaborated on a study with researchers from the W.J.B. Dorn Veterans Affairs Medical Center (VAMC) in Columbia, SC.
A total of 33 patients from the two institutions participated in the study. All the patients, who ranged in age from 18 to 80, had non-small cell lung cancer (NSCLC). During the study, each patient wore a wrist device that monitored his or her movements over several days and generated data that indicated his or her sleep/wake patterns. The patients also completed standardized questionnaires that measured the quality of their sleep and their self-reported quality of life.
The results of the study, published in the British Journal of Cancer in 2005, indicated that all the patients showed disturbed sleep/wake patterns. In fact, study participants experienced the exact opposite of “normal” sleep patterns: they were often awake during the night and asleep for brief periods during the day. The patients reported that their ability to function was impaired and they were less satisfied with their overall quality of life.
Further research is needed to prove the extent to which sleep/wake cycle disruptions cause insomnia and whether patients with other forms of cancer also experience these disruptions. But if disruptions in the sleep/wake cycle prove to be a primary cause of insomnia in cancer patients, then the CTCA/VAMC research is truly helpful. With this knowledge, doctors may be able to treat insomnia by resetting the body’s internal clock using a natural compound, called melatonin, which has been shown to regulate circadian rhythm.
Other environmental or behavioral therapies may help as well. The end result could be the ability to help patients decrease their fatigue, which could help them better withstand their cancer treatment and have a higher quality of life.
While most hospitals strive for the highest levels of patient satisfaction, CTCA goes one step further. We want CTCA patients to be more than satisfied. In fact,we deliver such high quality care and treatment that most CTCA patients are willing to recommend us to their friends and loved ones.We call this patient loyalty. To earn your loyalty, we do things most hospitals wouldn’t think of doing. For example, a patient recently suggested that a bench near the elevators would help tired patients during treatment. By that afternoon, we had a bench installed next to every elevator door in the hospital. We do thoughtful things like this every day. Before you arrive, our representatives will handle every detail of your visit for you, including your transportation and lodging.
Disrupted Sleep/Wake Cycles Linked to Depression
Perhaps the most startling aspect of disrupted sleep/wake cycles in cancer patients is the potential relationship between fatigue and depression, which can lead to higher mortality rates. In fact, a 2009 University of British Columbia study found that death rates are 25 to 39 percent higher in cancer patients who have been diagnosed with minor or major depression.5 Because depression can have such a marked effect on the well-being of patients, researchers from CTCA and VAMC again collaborated on a study which aimed to determine if disrupted sleep can be a common root cause of anxiety and depression.
Eighty-four NSCLC patients participated in this study, half from each institution. All the patients completed a survey, called the Hospital Anxiety and Depression Scale, which measured the severity of each patient’s self-reported anxiety and depression. Patients also wore a wrist monitor that kept track of their sleep/wake patterns over the course of several days.
Results of the study, which were published in the journal Psycho-Oncology in 2010,6 confirmed that NSCLC patients whose sleep was disturbed were also the most anxious and depressed. So, the question for further research is:Would resetting the patients’ biological clock relieve cancer-associated depression or would relieving the depression normalize the sleep/wake cycles? Either way, correcting patients’ circadian function could decrease their depression, which, in turn,may help increase their quality of life and reduce mortality.
There is much more research to be done on the causes and effects of sleep/wake cycle disturbances in cancer patients, but these studies of the relationship between circadian rhythm, insomnia, fatigue and depression are an important starting point. Further research may lead to innovative insomnia treatments, which could help cancer patients live better and live longer.
Dr. Lund’s goal – and the goal of interventional pulmonology – is to improve patients’ lung function by removing the obstruction, which can be a benign or malignant tumor. The procedure may improve their quality of life and better enable them to receive and respond to treatments. “The patient’s functional status needs to be improved before pneumonia can be cured or chemotherapy can be used. In fact, if their functional status is not ideal, chemotherapy can do more damage than good,” he says.
Dr. Lund and his colleague David Visco,MD, also a CTCA pulmonologist, often use a rigid bronchoscope and a laser to remove lung obstructions, and they are among the few pulmonologists in the country who do. “The advantage in using a rigid bronchoscope is that we can ventilate the patient directly through it during the procedure, and because of its large size, we can use it to insert stents to keep airways open, and literally cut tumors out of airways, like coring an apple, or vaporize them with a laser.
The physician needs to be highly experienced in using a rigid scope, though, or the procedure can be very dangerous. That’s why only about ten percent of U.S. pulmonologists use them.”
Using a bronchoscope, Dr. Lund and his team remove airway obstructions in a way that prevents the tumor from growing back quickly. “We will open the airway by cutting the tumor out.We then treat the area with radiation or chemotherapy.”
Helping patients breathe easier is the primary objective of IP. And, says Dr. Lund, the positive effect of IP can be remarkably quick. “Ninety to 97 percent of patients have immediate relief after an interventional bronchoscopy,” he says, “and they experience a significant improvement in their quality of life following the procedure.”4
1 http://www.cancer.org/docroot/MIT/content/MIT_2_4x_Fatigue_in_people_with_cancer.asp?sitearea=MIT
2 http://www.talkaboutsleep.com/sleep-disorders/archives/insomnia_cancer2.htm
3 Journal of Clinical Oncology, http://www.jco.ascopubs.org/cgi/content/full/23/25/6063
4 http://www.talkaboutsleep.com/sleep-disorders/archives/insomnia_cancer.htm
5 Satin, J. 2009 http://www.balita.com/index.php?view=article&catid=30%3Ahealth-a-beauty&id=1026%
6 Du-Quiton, J., et al. Actigraphic assessment of daily sleep-activity pattern abnormalities reflects
self-assessed depression and anxiety
