Sleep-Wake Disturbances in People With Cancer Part II: Evaluating the Evidence for Clinical Decision Making

Jane C. Clark

Mary Cunningham

Sandra W. McLeskey

Catherine Vena

Kathy P. Parker

ONF 2004, 31(4), 747-771. DOI: 10.1188/04.ONF.747-771

Purpose/Objectives: To evaluate the quality of evidence on sleep-wake disturbances in people with cancer as a basis for clinical decision making and to discuss implications of the evidence for oncology clinicians, educators, and researchers.

Data Sources: Published, peer-reviewed articles.

Data Synthesis: Members of the 2001 Oncology Nursing Society (ONS) Advanced Practice Nurse Retreat Evidence-Based Practice Sleep Working Group selected and evaluated data sources using criteria and processes outlined by ONS.

Conclusions: The development of nursing science related to sleep-wake disturbances among people with cancer and the application of research findings to clinical decision making are limited by the quantity and quality of published evidence.

Implications for Nursing: Clinicians are challenged to develop a plan of care that includes the assessment of sleep-wake disturbances and interventions to address them. Nurse educators are challenged to include sleep-wake content and skills to evaluate empirical data and interventions for sleep-wake disturbances in degree and continuing education curricula. Nurse researchers are challenged to specify consistent conceptual and operational definitions of key variables in sleep-wake models, use measurement instruments with evidence of reliability and validity, and design clinical trials to test interventions for sleep-wake disturbances among people with cancer.

Jump to a section


    Ahsberg, E., & Furst, C.J. (2001). Dimensions of fatigue during radiotherapy: An application of the Swedish Occupational Fatigue Inventory (SOFI) on cancer patients. Acta Oncologica, 40, 37-43.

    American Academy of Sleep Medicine. (2001). The international classification of sleep disorders revised. Rochester, MN: Author.

    Ancoli-Israel, S., Moore, P.J., & Jones, V. (2001). The relationship between fatigue and sleep in cancer patients: A review. European Journal of Cancer Care, 10, 245-255.

    Anderson, K.O., Getto, C.J., Mendoza, T.R., Palmer, S.N., Wang, X.S., Reyes-Gibby, C.C., et al. (2003). Fatigue and sleep disturbance in patients with cancer, patients with clinical depression, and community-dwelling adults. Journal of Pain and Symptom Management, 25, 307-318.

    Berger, A.M., & Farr, L. (1999). The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue. Oncology Nursing Forum, 26, 1663-1671.

    Berger, A.M., & Higginbotham, P. (2000). Correlates of fatigue during and following adjuvant breast cancer chemotherapy: A pilot study. Oncology Nursing Forum, 27, 1443-1448.

    Berger, A.M., VonEssen, S., Kuhn, B.R., Piper, B.F., Agrawal, S., Lynch, J.C., et al. (2003). Adherence, sleep, and fatigue outcomes after adjuvant breast cancer chemotherapy: Results of a feasibility intervention study. Oncology Nursing Forum, 30, 513-522.

    Beszterczey, A., & Lipowski, Z.J. (1977). Insomnia in cancer patients [Letter to the editor]. CMA Journal, 116, 355.

    Bliwise, D.L. (2000). Normal aging. In M.H. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and practice of sleep medicine (3rd ed., pp. 26-42). Philadelphia: Saunders.

    Bower, J.E., Ganz, P.A., Desmond, K.A., Rowland, J.H., Meyerowitz, B.E., & Belin, T.R. (2000). Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. Journal of Clinical Oncology, 18, 743-753.

    Bruera, E., Fainsinger, R.L., Schoeller, T., & Ripamonti, C. (1996). Rapid discontinuation of hypnotics in terminal cancer patients: A prospective study. Annals of Oncology, 7, 855-856.

    Buclin, R., Mazzocato, C., Berney, A., & Stiefel, F. (2001). Psychopharmacology in supportive care of cancer: A review for the clinician. IV. Other psychotropic agents. Supportive Care in Cancer, 9, 213-222.

    Cannici, J., Malcolm, R., & Peek, L.A. (1983). Treatment of insomnia in cancer patients using muscle relaxation training. Journal of Behavioral Therapeutic and Experimental Psychiatry, 14, 251-256.

    Capuron, L., Ravaud, A., & Dantzer, R. (2000). Early depressive symptoms in cancer patients receiving interleukin-2 and/or interferon alfa-2b therapy. Journal of Clinical Oncology, 18, 2143-2151.

    Carpenter, J.S., Gautam, S., Freedman, R.R., & Andrykowski, M. (2001). Circadian rhythm of objectively recorded hot flashes in postmenopausal breast cancer survivors. Menopause, 8, 181-188.

    Cimprich, B. (1999). Pretreatment symptom distress in women newly diagnosed with breast cancer. Cancer Nursing, 22, 185-194.

    Couzi, R.J., Helzlsouer, K.J., & Fetting, J.H. (1995). Prevalence of menopausal symptoms among women with a history of breast cancer and attitudes toward estrogen replacement therapy. Journal of Clinical Oncology, 13, 2737-2744.

    Davidson, J.R., MacLean, A.W., Brundage, M.D., & Schulze, K. (2002). Sleep disturbance in cancer patients. Social Science Medicine, 54, 1309-1321.

    Davidson, J.R., Waisberg, J.L., Brundage, M.D., & MacLean, A.W. (2001). Nonpharmacologic group treatment of insomnia: A preliminary study with cancer survivors. Psycho-oncology, 10, 389-397.

    Degner, L.F., & Sloan, J.A. (1995). Symptom distress in newly diagnosed ambulatory cancer patients and as a predictor of survival in lung cancer. Journal of Pain and Symptom Management, 10, 423-431.

    de Moor, C., Sterner, J., Hall, M., Warneke, C., Gilani, Z., Amato, R., et al. (2002). A pilot study of the effects of expressive writing on psychological and behavioral adjustment in patients enrolled in a phase II trial of vaccine therapy for metastatic renal cell carcinoma. Health Psychology, 21, 615-619.

    Derogatis, L.R., Feldstein, M., Morrow, G., Schmale, A., Schmitt, M., Gates, C., et al. (1979). A survey of psychotropic drug prescriptions in an oncology population. Cancer, 44, 1919-1929.

    Dietrich, B. (1997). Polysomnography in drug development. Journal of Clinical Pharmacology, 37(1, Suppl.), 70S-78S.

    Earlam, S., Glover, C., Fordy, C., Burke, D., & Allen-Mersh, T.G. (1996). Relation between tumor size, quality of life, and survival in patients with colorectal liver metastases. Journal of Clinical Oncology, 14, 171-175.

    Engstrom, C.A., Strohl, R.A., Rose, L., Lewandowski, L., & Stefanek, M.E. (1999). Sleep alterations in cancer patients. Cancer Nursing, 23, 143-148.

    Faithfull, S. (1991). Patients' experiences following cranial radiotherapy: A study of the somnolence syndrome. Journal of Advanced Nursing, 16, 939-946.

    Fortner, B.V., Stepanski, E.J., Wang, S.C., Kasprowicz, S., & Durrence, H.H. (2002). Sleep and quality of life in breast cancer patients. Journal of Pain and Symptom Management, 24, 471-480.

    Friedman, M., Landsberg, R., Pryor, S., Syed, Z., Ibrahim, H., & Caldarelli, D.D. (2001). The occurrence of sleep-disordered breathing among patients with head and neck cancer. Laryngoscope, 111(11, Pt. 1), 1917-1919.

    Ginsburg, M.L., Quirt, C., Ginsburg, A.D., & MacKillop, W.J. (1995). Psychiatric illness and psychosocial concerns of patients with newly diagnosed lung cancer. Canadian Medical Association Journal, 152, 701-708.

    Given, B., Given, C., Azzouz, F., & Stommel, M. (2001). Physical functioning of elderly cancer patients prior to diagnosis and following initial treatment. Nursing Research, 50, 222-232.

    Jaeger, H., Morrow, G.R., Carpenter, P.J., & Brescia, F. (1985). A survey of psychotropic drug utilization by patients with advanced neoplastic disease. General Hospital Psychiatry, 7, 353-360.

    Kay, D.C., & Samiuddin, Z. (1988). Sleep disorders associated with drug abuse and drugs of abuse. In R.L. Williams, I. Karacan, & C.A. Moore (Eds.), Sleep disorders: Diagnosis and treatment (2nd ed., pp. 315-371). New York: John Wiley and Sons.

    Kaye, J., Kaye, K., & Madow, L. (1983). Sleep patterns in patients with cancer and patients with cardiac disease. Journal of Psychology, 114, 107-113.

    Kim, Y., Roscoe, J.A., & Morrow, G.R. (2002). The effects of information and negative affect on severity of side effects from radiation therapy for prostate cancer. Supportive Care in Cancer, 10, 416-412.

    Krech, R.L., & Walsh, D. (1991). Symptoms of pancreatic cancer. Journal of Pain and Symptom Management, 6, 360-367.

    Lamb, M.A. (1982). The sleeping patterns of patients with malignant and nonmalignant diseases. Cancer Nursing, 5, 389-396.

    Malone, M., Harris, A.L., & Luscombe, D.K. (1994). Assessment of the impact of cancer on work, recreation, home management, and sleep using a general health status measure. Journal of the Royal Society of Medicine, 87, 386-389.

    Miaskowski, C., & Lee, K.A. (1999). Pain, fatigue, and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: A pilot study. Journal of Pain and Symptom Management, 17, 320-332.

    Monga, U., Jaweed, M., Kerrigan, A.J., Lawhon, L., Johnson, J., Vallbona, C., et al. (1997). Neuromuscular fatigue in prostate cancer patients undergoing radiation therapy. Archives of Physical Medicine Rehabilitation, 78, 961-966.

    Monga, U., Kerrigan, A.J., Thornby, J., & Monga, T.N. (1999). Prospective study of fatigue in localized prostate cancer patients undergoing radiotherapy. Radiation Oncology Investigations, 7, 178-185.

    Nicholson, A.N., Bradley, C.M., & Pascoe, P. (1994). Medications: Effects on sleep and wakefulness. In M.H. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and practice of sleep medicine (2nd ed., pp. 364-371). Philadelphia: Saunders.

    Northouse, L.L., Caffey, M., Deichelbohrer, L., Schmidt, L., Guziatek-Trojniak, L., West, S., et al. (1999). The quality of life of African American women with breast cancer. Research in Nursing and Health, 22, 449-460.

    Owen, D.C., Parker, K.P., & McGuire, D.B. (1999). Comparison of subjective sleep quality in patients with cancer and healthy subjects. Oncology Nursing Forum, 26, 1649-1651.

    Portenoy, R.K., Thaler, H.T., Kornbilth, A.B., Lepore, J.M., Friedlander-Klar, H., Coyle, N., et al. (1994). Symptom prevalence, characteristics and distress in a cancer population. Quality of Life Research, 3, 183-189.

    Quesnel, C., Savard, J., Simard, S., Ivers, H., & Morin, C.M. (2003). Efficacy of cognitive-behavioral therapy for insomnia in women treated for non-metastatic breast cancer. Journal of Consulting and Clinical Psychology, 71, 189-200.

    Redeker, N.S., Lev, E.L., & Ruggiero, J. (2000). Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Scholarly Inquiry for Nursing Practice, 14, 275-290.

    Ropka, M.E., & Spencer-Cisek, P. (2001). PRISM: Priority Symptom Management project phase I: Assessment. Oncology Nursing Forum, 28, 1585-1594.

    Sarna, L. (1993). Correlates of symptom distress in women with lung cancer. Cancer Practice, 1, 21-28.

    Sarna, L., & Brecht, M.L. (1997). Dimensions of symptom distress in women with advanced lung cancer: A factor analysis. Heart and Lung, 26, 23-30.

    Savard, J., & Morin, C.M. (2001). Insomnia in the context of cancer: A review of a neglected problem. Journal of Clinical Oncology, 19, 895-908.

    Savard, J., Simard, S., Blanchet, J., Ivers, H., & Morin, C.M. (2001). Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep, 24, 583-590.

    Schweitzer, P.K. (2000). Drugs that disturb sleep and wakefulness. In M.H. Kryger, T. Roth, & W.C. Dement (Eds.), Principles and practice of sleep medicine (3rd ed., pp. 441-461). Philadelphia: Saunders.

    Shapiro, S.L., Bootzin, R.R., Figueredo, A.J., Lopez, A.M., & Schwartz, G.E. (2003). The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: An exploratory study. Journal of Psychosomatic Research, 54, 85-91.

    Shaver, J.L. (1999). Managing sleep and waking behaviors and the symptom of fatigue. In A.S. Hinshaw, S.L. Feetham, & J.L. Shaver (Eds.), Handbook of clinical nursing research (pp. 435-456). Thousand Oaks, CA: Sage.

    Sheely, L.C. (1996). Sleep disturbances in hospitalized patients with cancer. Oncology Nursing Forum, 23, 109-111.

    Silberfarb, P.M., Hauri, P.J., Oxman, T.E., & Lash, S. (1985). Insomnia in cancer patients. Social Science Medicine, 20, 849-850.

    Silberfarb, P.M., Hauri, P.J., Oxman, T.E., & Schnurr, P. (1993). Assessment of sleep in patients with lung cancer and breast cancer. Journal of Clinical Oncology, 11, 997-1004.

    Spelten, E.R., Verbeek, J.H., Uitterhoeve, A.L., Ansink, A.C., van der Lelie, J., de Reijke, T.M., et al. (2003). Cancer, fatigue, and the return of patients to work—A prospective cohort study. European Journal of Cancer, 39, 1562-1567.

    Stam, H.J., & Bultz, B.D. (1986). The treatment of severe insomnia in a cancer patient. Journal of Behavioral Therapy and Experimental Psychiatry, 17(1), 33-37.

    Stiefel, F.C., Kornblith, A.B., & Holland, J.C. (1990). Changes in the prescription patterns of psychotropic drugs for cancer patients during a 10-year period. Cancer, 65, 1048-1053.

    Sutherland, H.J., Lockwood, G.A., & Boyd, N.F. (1990). Ratings of the importance of quality of life variables: Therapeutic implications for patients with metastatic breast cancer. Journal of Clinical Epidemiology, 43, 661-666.

    Walker, L.O., & Avant, K.C. (1995). Strategies for theory construction in nursing (3rd ed.). Englewood Cliffs, NJ: Prentice Hall Health.

    Walsh, D., Donnelly, S., & Rybicki, L. (2000). The symptoms of advanced cancer: Relationship to age, gender, and performance status in 1,000 patients. Supportive Care in Cancer, 8, 175-179.

    Weitzner, M.A., Moncello, J., Jacobsen, P.B., & Minton, S. (2002). A pilot trial of paroxetine for the treatment of hot flashes and associated symptoms in women with breast cancer. Journal of Pain and Symptom Management, 23, 337-345.