title: Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapy.
abstract: In a sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer who received at least two cycles of chemotherapy (CTX), the purposes were to evaluate for inter-individual differences in the severity of sleep disturbance and determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of sleep disturbance.
  
  
  
  A total of 1331 patients completed study questionnaires in their homes, at six time points over two cycles of CTX (prior to CTX administration, approximately 1 week after CTX administration, and approximately 2 weeks after CTX administration). Questionnaires included demographic, clinical, and symptom assessments (i.e., General Sleep Disturbance Scale, Lee Fatigue Scale, Center for Epidemiological Studies-Depression Scale, Spielberger State-Trait Anxiety Inventories, Attentional Function Index). Hierarchical linear modeling based on full maximum likelihood estimation was performed.
  
  
  
  Characteristics associated with higher initial levels of sleep disturbance included higher body mass index, poorer functional status, higher trait anxiety, higher depressive symptoms, and higher evening fatigue. Characteristics associated with the worse trajectories of sleep disturbance were higher levels of education and higher sleep disturbance at enrollment. Characteristics associated with both higher initial levels and worse trajectories of sleep disturbance were higher morning fatigue and worse attentional function.
  
  
  
  A large amount of inter-individual variability exists in sleep disturbance during CTX. The modifiable and non-modifiable characteristics found in this study can be used to identify higher risk patients and provide earlier interventions to reduce sleep disturbance.
authors.affiliation: School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Sueann
authors.initials: S
authors.lastname: Mark
authors.affiliation: School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Janine
authors.initials: J
authors.lastname: Cataldo
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Dhruva
authors.affiliation: School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Paul
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Lee-May
authors.initials: LM
authors.lastname: Chen
authors.affiliation: Department of Nursing, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Marilyn J
authors.initials: MJ
authors.lastname: Hammer
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Levine
authors.affiliation: School of Nursing, Yale University, New Haven, CT, USA.
authors.forename: Fay
authors.initials: F
authors.lastname: Wright
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Melisko
authors.affiliation: School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lee
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Yvette P
authors.initials: YP
authors.lastname: Conley
authors.affiliation: School of Nursing, University of California, San Francisco, San Francisco, CA, USA. chris.miaskowski@ucsf.edu.|Department of Physiological Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA. chris.miaskowski@ucsf.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Miaskowski
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D010045:Outpatients; D012893:Sleep Wake Disorders / Q000209:etiology*; D011795:Surveys and Questionnaires
keywords: Cancer; Chemotherapy; Depression, anxiety; Fatigue; Hierarchical linear modeling; Sleep disturbance