How do I best manage insomnia and other sleep disorders in older adults with cancer?
Insomnia is common in older adults with cancer, with a reported prevalence of 19-60% in prior studies. Cancer treatments are associated with increased risk of insomnia or aggravation of pre-existing insomnia symptoms, and patients who are receiving active cancer treatments are more likely to report insomnia. Insomnia can lead to significant physical and psychological consequences with increased mortality. We discuss physiological sleep changes in older adults, and illustrated the various sleep disorders. We present a literature review on the prevalence and the effects of insomnia on the quality of life in older adults with cancer. We discuss the risk factors and presented a theoretical framework of insomnia in older adults with cancer. We present a case study to illustrate the assessment and management of insomnia in older adults with cancer, comparing and contrasting a number of tools for sleep assessment. There are currently no guidelines on the treatment of sleep disorders in older adults with cancer. We present an algorithm developed at the City of Hope Comprehensive Cancer Center by a multidisciplinary team for managing insomnia, using evidence-based pharmacologic and non-pharmacologic interventions.
James Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14620, United States. Electronic address: melissalkp@gmail.com.
Kah Poh
KP
Loh
City of Hope Cancer Center, 1500 E. Duarte Road, Duarte, CA 91010, United States.
Peggy
P
Burhenn
City of Hope Cancer Center, 1500 E. Duarte Road, Duarte, CA 91010, United States.
Arti
A
Hurria
City of Hope Cancer Center, 1500 E. Duarte Road, Duarte, CA 91010, United States.
Finly
F
Zachariah
James Wilmot Cancer Institute, University of Rochester, 601 Elmwood Avenue, Box 704, Rochester, NY 14620, United States.
Supriya Gupta
SG
Mohile
D000368:Aged; D000465:Algorithms; D000553:Ambulatory Care; D019091:Critical Pathways; D005260:Female; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D010348:Patient Care Team; D011788:Quality of Life; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology
Insomnia; Non-pharmacological interventions; Pharmacological interventions; Prevalence