Feasibilty of a sleep intervention during adjuvant breast cancer chemotherapy

Ann M Berger, Susanna VonEssen, Brett R Khun, Barbara F Piper, Lynne Farr, Sangeeta Agrawal, James C Lynch, Patti Higginbotham
Oncology Nursing Forum 2002, 29 (10): 1431-41

PURPOSE/OBJECTIVES: To evaluate the feasibility of an intervention designed to promote sleep and modify fatigue during four cycles of adjuvant breast cancer chemotherapy.

DESIGN: Prospective, repeated measures, quasi-experimental feasibility study.

SETTING: Midwestern urban oncology clinics.

SAMPLE: 25 women between the ages of 40-65 (mean = 54.3) with stage I-II breast cancer receiving doxorubicin-based chemotherapy.

METHODS: Each woman developed, reinforced, and revised an individualized sleep promotion plan (ISPP) with four components: sleep hygiene, relaxation therapy, stimulus control, and sleep restriction techniques. A daily diary, the Pittsburgh Sleep Quality Index, a wrist actigraph, and the Piper Fatigue Scale were used to collect data two days before and seven days after each treatment.

MAIN RESEARCH VARIABLES: Adherence, sleep and wake outcomes, and fatigue.

FINDINGS: Adherence rates with the components of the ISPP varied during treatments one through four: sleep hygiene (68%-78%), relaxation therapy (57%-67%), stimulus control (46%-67%), and sleep restriction (76%-80%). Mean sleep and wake outcomes at baseline, peak, and rebound times were that (a) sleep latency remained brief (less than 30 minutes per night), (b) time awake after sleep onset exceeded the desired less than 30 minutes per night, (c) sleep efficiency scores remained stable at 85%-90%, (d) total rest time remained stable at 8-10 hours per night, (e) subjective ratings of feelings on arising were stable, and (f) nighttime awakenings were 8-10 per night. Fatigue outcomes were that fatigue was stable two days after each treatment and mean daily fatigue intensity was lower at treatment three than at treatment one but rebounded at treatment four.

CONCLUSIONS: The intervention was feasible, adherence rates improved over time, and most sleep and wake patterns were consistent with normal values. Revisions will focus on decreasing nighttime awakenings.

IMPLICATIONS FOR NURSING: Adopting behaviors to promote sleep may assist in maintaining sleep and managing fatigue during chemotherapy.

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