ScienceDaily
A new study suggests that sleep problems lead to increased pain and fatigue in cancer patients. The results indicate that interventions aimed at trouble sleeping would be expected to improve both pain and fatigue in this patient population.
Results show that more than half the sample reported having trouble sleeping, with 26 percent reporting moderate or severe trouble sleeping. Compared with patients who reported no trouble sleeping, patients with moderate to severe trouble sleeping reported significantly more fatigue, pain and depressed mood. Using structural equation modeling analysis to evaluate causal relations and directions of effect, the best-fitting model indicates that trouble sleeping led to increased ratings of pain.
According to the authors, the relationship between pain and sleep often has been assumed to be reciprocal. In the present study, however, a model of reciprocal causation could not be fit to the data, and models in which pain caused trouble sleeping did not fit as well as the model in which trouble sleeping caused pain.
“We believed we would find a bi-directional relationship between insomnia and pain, but instead found that trouble sleeping was more likely a cause, rather than a consequence, of pain in patients with cancer,” said lead author Edward J. Stepanski, chief operational officer at the Accelerated Community Oncology Research Network in Memphis, Tenn.
The study included demographic, clinical and patient-reported outcomes data from 11,445 cancer patients undergoing treatment at the West Clinic, a large community oncology practice in Memphis. Participants had an average age of 61.5 years, and 74 percent were female. Breast cancer was the most common form of cancer, and about 25 percent of study subjects had received chemotherapy in the last 30 days. Increases in depressed mood also led to increased ratings of pain.
Younger age and recent administration of chemotherapy were both associated with increased trouble sleeping. According to the authors, younger patients often receive more aggressive chemotherapy than older patients; therefore, younger patients may be exposed to more treatment-related toxicity.
Stepanski stated that several studies have shown that cognitive behavioral therapy (CBT) improves sleep in cancer patients who have insomnia. He believes that this type of intervention may decrease patients’ pain and fatigue by improving their sleep.

Adapted from materials provided by American Academy of Sleep Medicine, via EurekAlert!, a service of AAAS.
Journal Reference:
1.The Relation of Trouble Sleeping, Depressed Mood, Pain, and Fatigue in Patients with Cancer. Journal of Clinical Sleep Medicine, April 15, 2009

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By Rita Goldman

Many oncologists are doctors who treat cancer believing that patients should be evaluated for fatigue when undergoing cancer treatment. Fatigue often means that patients have to give up many activities that could be considered normal, because they are too tired to function. There is an argument that you should be discussing your levels of fatigue with your oncologists. They should be providing the initial screening, because they can provide the basic education that those levels of fatigue lead to pain, loss of sleep, emotional disturbances, hypothyroidism and anemia.

If any of those five primary symptoms of fatigue are present they need to be treated within the guidelines of the practise of each patient. Further assessment can include a review of the system of treatment and a total review of all medications, metabolic evaluations and an accurate assessment of current physical activity levels.

There are certain symptoms of fatigue such as electrolyte imbalances, infection and cardiac dysfunction that needs specific treatments but when these are not present then there are non-pharmacological options of treatment. These can include hypnosis to manage the pain, and improve the mood, and aid sleep. This can be in conjunction with a moderate gentle exercise program designed to make activity more tolerable.

Many cancer patients use hypnosis to alleviate their symptoms, but it is estimated that few of them discuss the results of alternative treatment with their oncologists. Many discuss it as a primary option, but once hypnosis is underway it is not discussed again. In fact it should be discussed and incorporated into a regime to manage your levels of fatigue as you undergo treatment. This is because the exact cause of fatigue in cancer patients has not been isolated.

A research study in Pakistan studied one hundred and ninety-one patients (1994) who each had a twenty five minute interview to assess how many of them used alternative therapies. Pakistan is a developing country, 54.5% of all patients used alternative therapies as part of their treatment. Traditional herbal medicines accounted for 70.2% and homeopathy was used by 64.4%. What was interesting is the fact that 36% or just over a third of the people studies used these treatments before conventional treatment was sought.

Only 15% used alternative methods after conventional therapeutic treatment options had been exhausted. Patients perceived that these treatments were less expensive and toxic. They have the opposite problem. The belief in Western therapies is not sufficient, that cancer patients will not use alternative therapies first, thus wasting a great deal of time before employing proven methods of treatment. However a recent American Cancer Society survey revealed that mind therapy which included mental imagery, hypnosis was employed by 49% of the users.

Obviously in Pakistan, dangerous consequences of using unconventional therapies instead of proven medical care mean direct physiological harm and needless deaths, but there has to be a happy medium of using alternative therapies with the full knowledge of your oncologist who is supposed to be coordinating your treatment.

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