title: Natural course of insomnia comorbid with cancer: an 18-month longitudinal study.
abstract: OBJECTIVE
  This study aimed to assess the prevalence and natural course (incidence, persistence, remission, and relapse) of insomnia comorbid with cancer during an 18-month period.
  
  
  METHODS
  All patients scheduled to receive a curative surgery for a first diagnosis of nonmetastatic cancer were approached on the day of their preoperative visit to participate in the study. A total of 962 patients with cancer (mixed sites) completed an insomnia diagnostic interview at the perioperative phase (T1), as well as at 2 (T2), 6 (T3) 10 (T4), 14 (T5), and 18 (T6) months after surgery.
  
  
  RESULTS
  Findings revealed high rates of insomnia at baseline (59%), including 28% with an insomnia syndrome. The prevalence of insomnia generally declined over time but remained pervasive even at the end of the 18-month period (36%). Rates were greater in patients with breast (42% to 69%) and gynecologic (33% to 68%) cancer and lower in men with prostate cancer (25% to 39%) throughout the study. Nearly 15% of patients had a first incidence of insomnia during the study, and 19.5% experienced relapse. The evolution of symptoms varied according to sleep status. Remissions (patients becoming good sleepers) were much less likely for patients with an insomnia syndrome (10.8% to 14.9%) than for those with insomnia symptoms (42.0% to 51.3%). Most frequently (37.6%), patients with an insomnia syndrome at baseline kept that status throughout the 18-month period.
  
  
  CONCLUSIONS
  Insomnia is a frequent and enduring problem in patients with cancer, particularly at the syndrome level. Early intervention strategies, such as cognitive-behavioral therapy, could prevent the problem from becoming more severe and chronic.
authors.affiliation: Laval University Cancer Research Center, 11 Côte du Palais, Québec, Québec, Canada G1R 2J6. josee.savard@psy.ulaval.ca
authors.forename: Josée
authors.initials: J
authors.lastname: Savard
authors.forename: Hans
authors.initials: H
authors.lastname: Ivers
authors.forename: Julie
authors.initials: J
authors.lastname: Villa
authors.forename: Aude
authors.initials: A
authors.lastname: Caplette-Gingras
authors.forename: Charles M
authors.initials: CM
authors.lastname: Morin
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D012008:Recurrence; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology* / Q000517:prevention & control