OMAHANew research shows that some postchemotherapy fatigue in breast
cancer patients is the result of disordered sleep and can be relieved by
sleep intervention programs. At the 27th Annual Congress of the Oncology
Nursing Society, Ann M. Berger, PhD, RN, AOCN, reported promising data from
one such program that found that daily activity levels, fatigue, and quality
of sleep all improved in cancer patients who went through a sleep
intervention program. Dr. Berger is associate professor and advanced
practice nurse at the University of Nebraska College of Nursing in Omaha.
"Although fatigue is often defined as tiredness that is not relieved
by sleep, I believe that by promoting sleep we can modify fatigue in our
cancer patients, as this study shows," Dr. Berger said.
Sleep problems and fatigue are almost universal among breast cancer
patients during and after chemotherapy. Dr. Berger noted that sleep problems
decrease daytime performance, increase anxiety and depression, and adversely
affect fatigue levels, pain, immune function, and mental health. Despite
these common problems, this is the first prospective study to test sleep
interventions in cancer patients. "In fact, there are few data on sleep
interventions in any disorder except insomnia," Dr. Berger said.
Four Program Components
In this pilot study, 21 patients who had surgery for stage I or II breast
cancer and also had doxorubicin-based chemotherapy participated in a sleep
intervention program. The program had four components:
- A sleep promotion plan. The patient selected three or four
sleep-promoting behaviors from a list of 15 to use each day. These included
such things as exercise at least 4 hours before bedtime, background
"white noise" in the bedroom, no caffeine after noon, and sleeping
in a cool room.
- Relaxation training. The patient selected one or two from a list of
six relaxation techniques to use each day.
- Sleep restriction. The patient had a regular bedtime and morning
"out of bed" time. Time in bed each night was restricted to 7 to 9
hours (usual need plus 1 hour). No more than three naps per day were
permitted, with each nap limited to 45 minutes, and no naps within 4 hours
- Stimulus control. This included getting out of bed if the patient had
not been able to get back to sleep for 20 minutes, going to a predetermined
place in another room, reading or listening to quiet music, and returning to
bed when feeling sleepy again.
Patients were taken through program instructions before each chemotherapy
and again at 30, 60, and 90 days after the last chemotherapy dose. Each
patient education session was reinforced 1 week later.