title: Sleep wake disturbances in people with cancer and their caregivers: state of the science.
abstract: OBJECTIVE
  To review the state of the science on sleep/wake disturbances in people with cancer and their caregivers.
  
  
  METHODS
  Published articles, books and book chapters, conference proceedings, and MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and the Cochrane Library computerized databases.
  
  
  RESULTS
  Scientists have initiated studies on the prevalence of sleep/wake disturbances and the etiology of sleep disturbances specific to cancer. Measurement has been limited by lack of clear definitions of sleep/wake variables, use of a variety of instruments, and inconsistent reporting of sleep parameters. Findings related to use of nonpharmacologic interventions were limited to 20 studies, and the quality of the evidence remains poor. Few pharmacologic approaches have been studied, and evidence for use of herbal and complementary supplements is almost nonexistent.
  
  
  CONCLUSIONS
  Current knowledge indicates that sleep/wake disturbances are prevalent in cancer populations. Few instruments have been validated in this population. Nonpharmacologic interventions show positive outcomes, but design issues and small samples limit generalizability. Little is known regarding use of pharmacologic and herbal and complementary supplements and potential adverse outcomes or interactions with cancer therapies.
  
  
  CONCLUSIONS
  All patients and caregivers need initial and ongoing screening for sleep/wake disturbances. When disturbed sleep/wakefulness is evident, further assessment and treatment are warranted. Nursing educational programs should include content regarding healthy and disrupted sleep/wake patterns. Research on sleep/wake disturbances in people with cancer should have high priority.
authors.affiliation: College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA. aberger@unmc.edu
authors.forename: Ann M
authors.initials: AM
authors.lastname: Berger
authors.forename: Kathy P
authors.initials: KP
authors.lastname: Parker
authors.forename: Stacey
authors.initials: S
authors.lastname: Young-McCaughan
authors.forename: Gail A
authors.initials: GA
authors.lastname: Mallory
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Barsevick
authors.forename: Susan L
authors.initials: SL
authors.lastname: Beck
authors.forename: Janet S
authors.initials: JS
authors.lastname: Carpenter
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carter
authors.forename: Lynne A
authors.initials: LA
authors.lastname: Farr
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Hinds
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Lee
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
authors.forename: Victoria
authors.initials: V
authors.lastname: Mock
authors.forename: Judith K
authors.initials: JK
authors.lastname: Payne
authors.forename: Martica
authors.initials: M
authors.lastname: Hall
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D017028:Caregivers; D002648:Child; D021081:Chronobiology Disorders / Q000209:etiology; D015928:Cognitive Behavioral Therapy; D000529:Complementary Therapies / Q000379:methods; D003863:Depression / Q000188:drug therapy / Q000209:etiology; D005221:Fatigue / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications* / Q000451:nursing* / Q000523:psychology; D009859:Oncology Nursing / Q000379:methods; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D009626:Terminology as Topic
chemical_list: D000928:Antidepressive Agents; D006993:Hypnotics and Sedatives