title: The development and impact of insomnia on cancer survivors: a qualitative analysis.
abstract: OBJECTIVE
  To conduct the first qualitative analysis of the development and impact of insomnia on a cohort of cancer survivors.
  
  
  METHODS
  Twenty-one cancer survivors with a history of chronic insomnia contributed to four focus groups held at the University of Glasgow Sleep Research Centre. Participants' perceptions of the onset, evolution and effects of insomnia were elicited and qualitatively explored using content analysis.
  
  
  RESULTS
  Most participants reported insomnia onset following cancer diagnosis. Participants who had a pre-existing insomnia reported that cancer diagnosis significantly aggravated their sleep complaint. Active cancer treatment was a major contributor to poor sleep quality due to the disruption of normal daily routines. This poor sleep pattern became persistent once active treatment had ceased and participants reported becoming particularly concerned about their sleep when they were discharged into follow-up cancer care. The impact of insomnia was significant for all participants in the study and six major areas emerged as being particularly affected; mood, physical health, relationships, sleep quality, sleep-related behaviour and cognition.
  
  
  CONCLUSIONS
  The majority of cancer survivors in this study developed disturbed sleep as a result of cancer diagnosis and their sleep disruption was exacerbated by active cancer treatment. Insomnia also had a significant impact upon quality of life and these effects persisted long beyond the cessation of active anti-cancer therapy. Early identification of insomnia symptoms in cancer care settings must be a priority to ensure that sleep disturbance is not overlooked or poorly managed.
authors.affiliation: University of Glasgow Sleep Centre, Southern General Hospital, Glasgow, UK. L.Fleming@clinmed.gla.ac.uk
authors.forename: Leanne
authors.initials: L
authors.lastname: Fleming
authors.forename: Stephanie
authors.initials: S
authors.lastname: Gillespie
authors.forename: Colin A
authors.initials: CA
authors.lastname: Espie
mesh_terms: D000339:Affect; D015331:Cohort Studies; D005221:Fatigue; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D036301:Qualitative Research; D011788:Quality of Life; D012606:Scotland; D018434:Sickness Impact Profile; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology* / Q000523:psychology*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D016896:Treatment Outcome