International Association for Hospice & Palliative Care

International Association for Hospice & Palliative Care

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Promoting Hospice & Palliative Care Worldwide


2005; Volume 6, No 12, December



Many ways to help support palliative care.

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Message from the Chair & Executive Director:
Kathleen M. Foley, MD
Liliana De Lima, MHA

Article of the Month:
Dr. Ripamonti

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Teaching in Cuba

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Roger Woodruff, MD

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Article of the Month

Carla Ripamonti, MD

Sleep disturbances in palliative cancer patients attending a pain and symptom control clinic

Author(s): Sela RA, Watanabe S, Nekolaichuk CL.
Journal: Palliative and Supportive Care 2005; 3: 23-31

The authors conducted a prospective study of cancer patients who were a minimum of 21 years old, and did not have brain metastases, psychiatric disorders, or cognitive impairments. They all attended a Palliative Care out-patient Clinic at a comprehensive Cancer Centre in Western Canada . The aims of the study were to investigate in this patient-population: 1. the frequency and severity of sleep disturbances and the degree to which patients’ communicated their problems to health care providers; 2. the association between sleep disturbances and physical/emotional symptoms such as pain, fatigue, anxiety, depression; and 3. the type of treatment used and its efficacy and tolerability as reported by the patients.

One hundred patients (mean age 60.1 years, 52 males) gave their consent to participate in the study. They received and completed the sleep questionnaire administered by a graduate student in psychology. The sleep questionnaire (10-point numerical scale) was drawn up by the authors who used items from sleep questionnaires reported in the literature with the addition of new items covering many aspects of sleep-related features and the efficacy of treatment. The Edmonton Symptom Assessment Scale ( ESAS) was used to assess the intensity of pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath.

Nineteen percent of the patients reported sleep disturbances prior to cancer diagnosis and 72% of the patients after the diagnosis of cancer. The patients reported the intensity of the symptoms ≥ 5 in the following categories: not feeling rested in the morning (72%), difficulty staying asleep (63%), difficulty falling asleep (40%), and early awakening (37%). Fifty-two per cent of the patients slept too few hours and 31% of the patients slept too many hours, while 49% of the patients had sleeping problems 5 or more nights per week. Fifty-two percent of the patients with sleeping problems of an intensity ≥ 5 reported feelings of strong anxiety and 77% of them spoke about it with their health care professionals.

Fifty-three per cent of the patients used different strategies to relieve their sleeping problems and 37% of the patients involved in the study used drugs with a moderately high efficacy.

Correlations were found between the difficulty in falling asleep and fatigue, early awakening and fatigue, and difficulty in falling asleep and anxiety.

Why I Chose this article

Despite published questionnaires to evaluate sleep disturbances, there is frequently still an underestimation, and under treatment, of this clinical problem in patients with cancer during the various stages of their disease.

This is one of the few studies conducted on this subject which reveals that sleep disturbances should be evaluated by means of simple tools in routine clinical practice

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC

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