Prostate cancer treatments and their side effects are associated with increased insomnia.
OBJECTIVE
Between 25% and 40% of prostate cancer patients report insomnia symptoms. Although a possible role of androgen deprivation therapy (ADT) and radiation therapy (RTH) and some of their side effects have been postulated, this issue has rarely been investigated. This study aimed to (1) compare the evolution of insomnia symptoms and somatic symptoms, which may affect sleep quality (i.e., hot flashes, night sweats, and urinary symptoms), in patients receiving combined ADT and RTH with that in patients receiving RTH only and (2) assess the mediating role of somatic symptoms in the relationship of ADT and RTH with insomnia symptoms.


METHODS
Sixty men scheduled to receive RTH for prostate cancer, with (n = 28) or without (n = 32) ADT, were assessed prior to receiving any treatment (baseline) and at seven additional times over 16 months (1, 2, 4, 6, 8, 12, and 16 months) using the Insomnia Severity Index and the Physical Symptoms Questionnaire.


RESULTS
A significant interaction effect was found indicating an increase in insomnia scores in ADT-RTH patients at 2, 4, and 6 months, as compared with baseline, and stable scores in RTH patients. A significant mediating role of hot flashes and night sweats was found in the relationship between ADT and insomnia symptoms. The relationship with RTH was also significantly mediated by these two symptoms albeit more strongly by excessive urinary frequency.


CONCLUSIONS
Androgen deprivation therapy is associated with an increased risk for insomnia, and side effects of ADT and RTH appear to play a role in the development of insomnia in this population.
School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, Québec, Canada. josee.savard@psy.ulaval.ca
Josée
J
Savard
Séverine
S
Hervouet
Hans
H
Ivers
D000368:Aged; D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000009:adverse effects; D005483:Flushing / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced* / Q000188:drug therapy; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal