title: Sleep-wake functioning along the cancer continuum: focus group results from the Patient-Reported Outcomes Measurement Information System (PROMIS(®)).
abstract: OBJECTIVE
  Cancer and its treatments disturb sleep-wake functioning; however, there is little information available on the characteristics and consequences of sleep problems associated with cancer. As part of an effort to improve measurement of sleep-wake functioning, we explored the scope of difficulties with sleep in a diverse group of patients diagnosed with cancer.
  
  
  METHODS
  We conducted 10 focus groups with patients recruited from the Duke University tumor registry and oncology/hematology clinics. Separate groups were held with patients scheduled to begin or currently undergoing treatment for breast, prostate, lung, colorectal, hematological, and other cancer types and with patients who were in posttreatment follow-up. The content of the focus group discussions was transcribed and analyzed for major themes by independent coders.
  
  
  RESULTS
  Participants not only reported causes of sleep disturbance common in other populations, such as pain and restless legs, but they also reported causes that may be unique to cancer populations, including abnormal dreams, anxiety about cancer diagnosis and recurrence, night sweats, and problems with sleep positioning. Many participants felt that sleep problems reduced their productivity, concentration, social interactions, and overall quality of life. Many also shared beliefs about the increased importance of sleep when fighting cancer.
  
  
  CONCLUSIONS
  The findings underscore the need for interventions that minimize the negative impact of cancer and its treatments on sleep. This study will inform efforts now underway to develop a patient-reported measure of sleep-wake functioning that reflects the breadth of concepts considered important by patients with cancer.
authors.affiliation: Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27715, USA. kathryn.flynn@duke.edu
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Flynn
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Shelby
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Mitchell
authors.forename: Maria R
authors.initials: MR
authors.lastname: Fawzy
authors.forename: N Chantelle
authors.initials: NC
authors.lastname: Hardy
authors.forename: Aatif M
authors.initials: AM
authors.lastname: Husain
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Keefe
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krystal
authors.forename: Laura S
authors.initials: LS
authors.lastname: Porter
authors.forename: Bryce B
authors.initials: BB
authors.lastname: Reeve
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Weinfurt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017144:Focus Groups; D006801:Humans; D007256:Information Systems; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D017063:Outcome Assessment, Health Care; D036301:Qualitative Research; D011788:Quality of Life; D012650:Self Disclosure; D020178:Sleep Disorders, Circadian Rhythm / Q000150:complications* / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires