WASHINGTON (FRONTLINE MEDICAL NEWS) – Fatigue and sleep disturbances are common among patients who have undergone hematopoietic stem cell transplants, but those who feel they have good social support can rest a little easier, say investigators.

Patients who prior to undergoing HSCT had a sense of worth, felt integrated in a social network, and had close attachments were more likely to have better-quality sleep than were their counterparts who felt more isolated and detached, reported Savitri Viozat, a research assistant at the University of Wisconsin Carbone Cancer Center in Madison.

“Devising interventions to optimize social support during the pretransplant period may help to improve sleep quality,” she said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.

The investigators asked 431 adults who were scheduled to undergo either autologous or allogeneic HSCT to complete before transplant the Social Provisions Scale, a validated instrument measuring social support, and to complete the Pittsburgh Sleep Quality Inventory and Fatigue Symptom Inventory before transplant and at 1, 3, 6, and 12 months post HSCT.

To gauge the effects of support on sleep, the researchers created mixed-effects linear regression models controlling for transplant regimen, age, and time since transplant.

They found that in the 12 months following HSCT, patients who reported having better social support before transplant had significantly better sleep quality, fewer nighttime sleep disturbances, less sleep-related dysfunction during waking hours, and longer sleep duration (P less than .05 for all comparisons). In addition, patients with better support had shorter sleep latency (time to fall alseep, P less than .01).

There were no significant associations between social support and either sleep efficiency or use of sleep-aid medications, the authors found.

As Ms. Viozat mentioned, the association between support and better sleep was strongest at the 1- and 3-month post-HSCT intervals.

The three dimensions of support most strongly associated with better quality sleep were worth, social integration, and attachment. The dimension of reliable alliance (assurance of continued assistance) also was associated with better sleep duration and lower disturbance, and the dimension of guidance was significantly associated with lower daytime dysfunction and shorter sleep latency.

Nurturance, the only dimension of social support that includes caring for others as well as being cared for by others, was not associated with any improvements in posttransplant sleep quality.

Insomnia interventions

Two other studies presented at the meeting looked at insomnia interventions in patients with cancer.

Kevin Hochard, Ph.D., and colleagues at the University of Chester, England, conducted a systematic review of studies on insomnia interventions for patients with cancer being treated with curative intent. They found that cognitive behavioral therapy (CBT) and mindfulness interventions were common and generally resulted in small but significant improvement in sleep, quality of life, and mood.

A cognitive behavioral therapy intervention for cancer survivors was the focus of a different study, led by Eric Zhou, Ph.D., of the Dana-Farber Cancer Institute in Boston.

Twenty-five of 34 participants completed a program consisting of three CBT sessions over 4 weeks emphasizing sleep restriction and stimulus control, with brief discussions of cognitive factors related to insomnia and sleep hygiene.

There were overall improvements in both sleep efficiency (from 77.8% to 88.7%), and reductions in the mean Insomnia Severity Index total (16.5 to 10.6) from preintervention to postintervention (P less than .01 for all comparisons).

“All participants believed the program helped to improve their understanding of insomnia and all but one reported overall satisfaction with the program. Only 1 in 3 had discussed their insomnia symptoms with medical providers in the prior year,” Dr. Zhou and colleagues wrote.


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