Sleep Disturbance and its Related Factors in Gynecological Cancer Patients

Sleep disturbance is commonly seen in gynecological cancer survivors. Even after having sleep pills treatment, their sleep disturbance still could not be solved. As we know, just few of literatures investigate on the prevalence of psychological distress such as cancer related posttraumatic stress, fear of recurrence and its contribution to sleep disturbance among gynecologic population. Thus, the purposes of this study are to examine (1) sleep disturbance of cancer survivors and (2) identify related factors（time of disease diagnosis, stage of disease, types of treatment and whether usage of chemotherapy regimens）, cancer related posttraumatic stress, fear of recurrence，and symptoms are related.
This study is a cross-sectional research design. Data were collected at the Outpatient Department of a medical center in North Taiwan by consecutive samplings method. Patients were assessed by trained nurses with structured interview using several scales, including (1) Background information form, (2) EORTC Core Quality of Life Questionnaire（QLQ-C30）-Physical Function Domain and 28-items Ovarian Cancer-Specific Questionnaire Module (OV-28),(3) Chinese Version of Impact of Events-Revised scale(CIES-R),(4) Fear of Recurrence Inventory(FCRI),(5) Sleep Disturbance Questionnaire-Physical Tension and Mental Anxiety Subscale(SDQ).
An estimated of 130 patients were recruited. They are divided into Ovarian cancer (24%), cervical cancer(38%) and endometrial cancer(38%). About 70% of gynecologic cancer patients was Stage 1 in diagnosis, cancer with non-metastasis (88.4%) and with metastasis (11.6%).Time since diagnosis with range from 1-5year and 5-10year were in the majority which showed (43.8%) and (31.3) respectively. The results showed that (1) anxiety induce sleep disturbance among the early stage gynecologic cancer survivors was low in intensity; (2) the level of cancer-related posttraumatic stress and fear of recurrence was low; (3) the severity of symptoms after treatments was low; (4) patients with low cancer related stress and symptoms reported to have less sleep disturbance analyzed by Pearson correlation; (5) Overall, patients’ sleep disturbance was significantly predicted by hyper-arousal of posttraumatic stress, insight of fear recurrence and time since diagnosis and these factors accounted for 29.7% of the variance of sleep analyzed by regression.
Even most of gynecologic cancer patients are in early stage with non-metastasis, we yet find out a minority of them still worried about the disease when to come back and sustained under mild posttraumatic stress after being diagnosis of cancer. Even the total score of sleep disturbance was low but we find out that a minority of them was disturbed by their mind kept turning over their sleep. And it might relevant to our sample as early stage with low level of psychological distress and less symptoms burden. Hence, our finding suggest the importance for clinical healthcare members of screening the possibility cause of sleep disturbance among cancer patients of not only emphasized on cancer symptoms but also on psychological stress as our research has shown.