Insomnia management for patients with advanced cancer in a psycho-oncology symptom-management clinic: a cohort study

Abstract Background The aims of this study were to evaluate insomnia status in advanced cancer patients been served for 4 weeks symptom management in psycho-oncology service, and to explore predictors for the persistent or worsen insomnia. Methods This was a real world longitudinal study among advanced cancer patients been referred to the psycho-oncology symptom management clinic in Peking University Cancer Hospital. Patients repeatedly completed the Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale (HADS), and MD Anderson Symptom Inventory (MDASI) on Day 0 (baseline), Day 14, and Day 28 by using an electronic patient-reported outcomes (ePRO) system. Results At baseline, 50.6% of the sample (78/161) had moderate to severe insomnia (> 14 on ISI). Totally 111 (68.9%) patients had completed the assessments at all 3 time points. The patients with insomnia and pain (66.7%) were more symptomatic with fatigue, distress, shortness of breath, drowsiness, dry mouth, and numbness (all P < 0.05) at baseline. While observed 21% patients with significantly alleviated insomnia by Day 28 ( P < 0.001), more severe disturbed sleep on MDASI (> = 6) at baseline is a predictor for 30% of patients who had significant insomnia on Day 28 ( P < 0.001). Conclusions Half of referred patients for symptom management consultation in psycho-oncology service reported moderate to severe insomnia, while 30% had significant insomnia after 4 weeks symptom management, highlighted the needs for routine insomnia monitoring in the clinic. Insomnia with pain is more symptomatic than insomnia without pain. More severe disturbed sleep at baseline is a predictor to persist or worsen insomnia.