title: Sleep problems in cancer patients: prevalence and association with distress and pain.
abstract: BACKGROUND
  Although it is increasingly recognized that cancer patients often have sleep problems, we lack data on their prevalence and associations in representative clinical populations. We aimed to determine (i) the prevalence of sleep problems amongst outpatients of a cancer centre and (ii) the association with medical variables, emotional distress and pain.
  
  
  METHODS
  Secondary analysis of self-report and medical data on 2862 cancer centre outpatients. Sleep problems were identified using the sleep item from the Patient Health Questionnaire-9: 'Over the last two weeks, how often have you been bothered by trouble falling or staying asleep or sleeping too much?' scored on a four-point frequency scale. Emotional distress was measured using the Hospital Anxiety and Depression Scale and pain using the subscale of the European Organisation for Research and Treatment of Cancer Quality of Life Core 30 questionnaire. Medical data were obtained from the cancer centre clinical database.
  
  
  RESULTS
  Sleep problems (bothered more than half the days during the previous 2 weeks) were reported by 30.2% (865/2862, 95% CI = 28.5 to 31.9) of the patients. They were common in both patients with active cancer (34.5%) and in cancer survivors (28.0%). There was only a modest association with cancer site and treatment status, but there was a strong association with pain (odds ratio = 2.7, 95% CI = 2.2 to 3.4) and emotional distress (odds ratio = 4.5, 95% CI = 3.7 to 5.6).
  
  
  CONCLUSIONS
  Sleep problems are common in cancer outpatients and are strongly associated with pain and emotional distress. A combined approach to the management of sleep, pain and emotional distress is indicated. Copyright © 2011 John Wiley & Sons, Ltd.
authors: Psychological Medicine Research, Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK.
authors: Neelom
authors: N
authors: Sharma
authors: Christian Holm
authors: CH
authors: Hansen
authors: Mark
authors: M
authors: O'Connor
authors: Parvez
authors: P
authors: Thekkumpurath
authors: Jane
authors: J
authors: Walker
authors: Annet
authors: A
authors: Kleiboer
authors: Gordon
authors: G
authors: Murray
authors: Colin
authors: C
authors: Espie
authors: Dawn
authors: D
authors: Storey
authors: Michael
authors: M
authors: Sharpe
authors: Leanne
authors: L
authors: Fleming
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D016017:Odds Ratio; D010045:Outpatients / Q000523:psychology / Q000706:statistics & numerical data; D010146:Pain / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012606:Scotland / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult