Minority Breast Cancer Survivors: The Association between Race/Ethnicity, Objective Sleep Disturbances, and Physical and Psychological Symptoms

Pinky H Budhrani, Cecile A Lengacher, Kevin E Kip, Cindy Tofthagen, Heather Jim, Pinky H Budhrani, Cecile A Lengacher, Kevin E Kip, Cindy Tofthagen, Heather Jim

Abstract

Background. Limited research has been conducted on the moderating effect of race/ethnicity on objective sleep disturbances in breast cancer survivors (BCSs). Objective. To explore racial/ethnic differences in objective sleep disturbances among BCSs and their relationship with self-reported symptoms. Intervention/Methods. Sleep disturbance and symptoms were measured using actigraphy for 72 hours and self-reported questionnaires, respectively, among 79 BCSs. Analysis of covariance, Pearson's correlation, and multivariate regression were used to analyze data. Results. Sixty (75.9%) participants listed their ethnicity as white, non-Hispanic and 19 (24.1%) as minority. Total sleep time was 395.9 minutes for white BCSs compared to 330.4 minutes for minority BCSs. Significant correlations were seen between sleep onset latency (SOL) and depression, SOL and fatigue, and sleep efficiency (SE) and fatigue among minority BCSs. Among white BCSs, significant correlations were seen between SE and pain and wake after sleep onset (WASO) and pain. The association between depression and SOL and fatigue and SOL appeared to be stronger in minority BCSs than white BCSs. Conclusions. Results indicate that white BCSs slept longer than minority BCSs, and race/ethnicity modified the effect of depression and fatigue on SOL, respectively. Implications for Practice. As part of survivorship care, race/ethnicity should be included as an essential component of comprehensive symptom assessments.

Figures

Figure 1
Figure 1
Conceptual framework of the study. The symptom experience was the perception and evaluation of physical and psychological symptoms; the outcome was objective sleep disturbances. This model tested whether the person domain, specifically the demographic variable of race/ethnicity, modified the relationship between the dimensions of symptom experience and outcomes. BPI: Brief Pain Inventory Short Form; CES-D: Center for Epidemiological Studies Depression Scale; FSI: Fatigue Symptom Inventory; SMM: Symptom Management Model; STAI-S: State Trait Anxiety Inventory-State Scale only. Adapted from Humphreys et al. [11].

References

    1. National Cancer Institute. SEER Stat Fact Sheets: Breast, 2013, .
    1. Mustian KM, Sprod LK, Janelsins M, et al. Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. Journal of Clinical Oncology. 2013;31(26):3233–3241.
    1. Kotronoulas G, Wengström Y, Kearney N. A critical review of women's sleep-wake patterns in the context of neo-/adjuvant chemotherapy for early-stage breast cancer. Breast. 2012;21(2):128–141.
    1. Savard J, Simard S, Blanchet J, Ivers H, Morin CM. Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep. 2001;24(5):583–590.
    1. Schultz PN, Klein MJ, Beck ML, Stava C, Sellin RV. Breast cancer: relationship between menopausal symptoms, physiologic health effects of cancer treatment and physical constraints on quality of life in long-term survivors. Journal of Clinical Nursing. 2005;14(2):204–211.
    1. Wright CE, Bovbjerg DH, Montgomery GH, et al. Disrupted sleep the night before breast surgery is associated with increased postoperative pain. Journal of Pain and Symptom Management. 2009;37(3):352–362.
    1. Liu L, Rissling M, Natarajan L, et al. The longitudinal relationship between fatigue and sleep in breast cancer patients undergoing chemotherapy. Sleep. 2012;35(2):237–245.
    1. Redline S, Kirchner HL, Quan SF, Gottlieb DJ, Kapur V, Newman A. The effects of age, sex, ethnicity, and sleep-disordered breathing on sleep architecture. Archives of Internal Medicine. 2004;164(4):406–418.
    1. Hale L, Do DP. Racial differences in self-reports of sleep duration in a population-based study. Sleep. 2007;30(9):1096–1103.
    1. Dodd M, Janson S, Facione N, et al. Advancing the science of symptom management. Journal of Advanced Nursing. 2001;33(5):668–676.
    1. Humphreys J, Janson S, Donesky D, et al. Middle Range Theory for Nursing. 3rd edition. New York, NY, USA: Springer; 2014.
    1. Lengacher CA, Reich RR, Post-White J, et al. Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. Journal of Behavioral Medicine. 2012;35(1):86–94.
    1. American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic & Coding Manual. 2nd edition. Westchester, Ill, USA: American Academy of Sleep Medicine; 2005.
    1. Fiorentino L, Rissling M, Liu L, Ancoli-Israel S. The symptom cluster of sleep, fatigue and depressive symptoms in breast cancer patients: severity of the problem and treatment options. Drug Discovery Today: Disease Models. 2011;8(4):167–173.
    1. Phillips KM, Jim HS, Donovan KA, Pinder-Schenck MC, Jacobsen PB. Characteristics and correlates of sleep disturbances in cancer patients. Supportive Care in Cancer. 2012;20(2):357–365.
    1. Nunes J, Jean-Louis G, Zizi F, et al. Sleep duration among black and white Americans: results of the National Health Interview Survey. Journal of the National Medical Association. 2008;100(3):317–322.
    1. Palesh O, Aldridge-Gerry A, Zeitzer JM. Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep. 2014;37(5):837–842.
    1. Mezick EJ, Matthews KA, Hall M, et al. Influence of race and socioeconomic status on sleep: pittsburgh SleepSCORE project. Psychosomatic Medicine. 2008;70(4):410–416.
    1. Lauderdale DS, Knutson KL, Yan LL, Liu K, Rathouz PJ. Self-reported and measured sleep duration: how similar are they? Epidemiology. 2008;19(6):838–845.
    1. Taylor TR, Huntley ED, Makambi K, et al. Understanding sleep disturbances in African-American breast cancer survivors: a pilot study. Psycho-Oncology. 2012;21(8):896–902.
    1. Paskett ED, Alfano CM, Davidson MA, et al. Breast cancer survivors' health-related quality of life: racial differences and comparisons with noncancer controls. Cancer. 2008;113(11):3222–3230.
    1. Palesh OG, Roscoe JA, Mustian KM, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester cancer center-community clinical oncology program. Journal of Clinical Oncology. 2010;28(2):292–298.
    1. Adenekan B, Pandey A, McKenzie S, Zizi F, Casimir GJ, Jean-Louis G. Sleep in America: role of racial/ethnic differences. Sleep Medicine Reviews. 2013;17(4):255–262.
    1. Buxbaum SG, Elston RC, Tishler PV, Redline S. Genetics of the apnea hypopnea index in Caucasians and African Americans: I. Segregation analysis. Genetic Epidemiology. 2002;22(3):243–253.
    1. Simpson L, Mukherjee S, Cooper MN, et al. Sex differences in the association of regional fat distribution with the severity of obstructive sleep apnea. Sleep. 2010;33(4):467–474.
    1. Edinger JD, Bonnet MH, Bootzin RR, et al. Derivation of research diagnostic criteria for insomnia: report of an American academy of sleep medicine work group. Sleep. 2004;27(8):1567–1596.
    1. Fu OS, Crew KD, Jacobson JS, et al. Ethnicity and persistent symptom burden in breast cancer survivors. Journal of Cancer Survivorship: Research and Practice. 2009;3(4):241–250.
    1. Green CR, Hart-Johnson T, Loeffler DR. Cancer-related chronic pain. Cancer. 2011;117(9):1994–2003.
    1. Alexander S, Minton O, Andrews P, Stone P. A comparison of the characteristics of disease-free breast cancer survivors with or without cancer-related fatigue syndrome. European Journal of Cancer. 2009;45(3):384–392.
    1. Dirksen SR, Belyea MJ, Epstein DR. Fatigue-based subgroups of breast cancer survivors with insomnia. Cancer Nursing. 2009;32(5):404–411.
    1. Palesh OG, Collie K, Batiuchok D, et al. A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biological Psychology. 2007;75(1):37–44.
    1. Enderlin CA, Coleman EA, Cole C, et al. Subjective sleep quality, objective sleep characteristics, insomnia symptom severity, and daytime sleepiness in women aged 50 and older with nonmetastatic breast cancer. Oncology Nursing Forum. 2011;38(4):E314–E325.
    1. Otte JL, Carpenter JS, Russell KM, Bigatti S, Champion VL. Prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors. Journal of Pain and Symptom Management. 2010;39(3):535–547.
    1. Delgado-Guay M, Yennurajalingam S, Parsons H, Palmer JL, Bruera E. Association between self-reported sleep disturbance and other symptoms in patients with advanced cancer. Journal of Pain and Symptom Management. 2011;41(5):819–827.
    1. Lewis PE, Sheng M, Rhodes MM, Jackson KE, Schover LR. Psychosocial concerns of young African American breast cancer survivors. Journal of Psychosocial Oncology. 2012;30(2):168–184.
    1. Taylor TR, Huntley ED, Sween J, et al. An exploratory analysis of fear of recurrence among African-American breast cancer survivors. International Journal of Behavioral Medicine. 2012;19(3):280–287.
    1. Thompson T, Rodebaugh TL, Perez M, Schootman M, Jeffe DB. Perceived social support change in patients with early stage breast cancer and controls. Health Psychology. 2013;32(8):886–895.
    1. Grutsch JF, Wood PA, Du-Quiton J, et al. Validation of actigraphy to assess circadian organization and sleep quality in patients with advanced lung cancer. Journal of Circadian Rhythms. 2011;9, article 4
    1. Webster JB, Kripke DF, Messin S, Mullaney DJ, Wyborney G. An activity-based sleep monitor system for ambulatory use. Sleep. 1982;5(4):389–399.
    1. American Academy of Sleep Medicine. International classification of sleep disorders, revised: Diagnostic and coding manual. 2013, .
    1. Hann DM, Jacobsen PB, Azzarello LM, et al. Measurement of fatigue in cancer patients: development and validation of the Fatigue Symptom Inventory. Quality of Life Research. 1998;7(4):301–310.
    1. Jacobsen PB. Assessment of fatigue in cancer patients. Journal of the National Cancer Institute. Monographs. 2004;(32):93–97.
    1. Cleeland CS. Pain assessment in cancer. In: Osoba D, editor. Effect of Cancer on Quality of Life. Boca Raton, Fla, USA: CRC Press; 1991. pp. 293–305.
    1. Radloff LS. The CES-D scale: a self-report depression scale for researching the general population. Application of Psychological Measures. 1977;1:385–401.
    1. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto, Calif, USA: CA Consulting Psychologists Press; 1983.
    1. National Sleep Foundation. Poll Reveals Sleep Differences among Ethnic Groups, 2010,
    1. Gamaldo AA, McNeely JM, Shah MT, Evans MK, Zonderman AB. Racial differences in self-reports of short sleep duration in an urban-dwelling environment. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences. 2013
    1. Lauderdale DS, Knutson KL, Yan LL, et al. Objectively measured sleep characteristics among early-middle-aged adults: the CARDIA study. The American Journal of Epidemiology. 2006;164(1):5–16.
    1. Ruiter ME, DeCoster J, Jacobs L, Lichstein KL. Normal sleep in African-Americans and Caucasian-Americans: a meta-analysis. Sleep Medicine. 2011;12(3):209–214.
    1. Donovan KA, Jacobsen PB. Fatigue, depression, and insomnia: evidence for a symptom cluster in cancer. Seminars in Oncology Nursing. 2007;23(2):127–135.
    1. Nishiura M, Tamura A, Nagai H, Matsushima E. Assessment of sleep disturbance in lung cancer patients: relationship between sleep disturbance and pain, fatigue, quality of life, and psychological distress. Palliative and Supportive Care. 2014:1–7. 10.1017/S1478951513001119.
    1. Finney JM, Hamilton JB, Hodges EA, Pierre-Louis BJ, Crandell JL, Muss HB. African American cancer survivors: do cultural factors influence symptom distress? Journal of Transcultural Nursing. 2014
    1. Sheppard VB, Llanos AA, Hurtado-de-Mendoza A, Taylor TR, Adams-Campbell LL. Correlates of depressive symptomatology in African-American breast cancer patients. Journal of Cancer Survivorship. 2013;7(3):292–299.
    1. Zhang AY, Gary F. Discord of measurements in assessing depression among African Americans with cancer diagnoses. International Journal of Culture and Mental Health. 2013;6(1):58–71.
    1. Deimling GT, Bowman KF, Sterns S, Wagner LJ, Kahana B. Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psycho-Oncology. 2006;15(4):306–320.
    1. Berger AM, Visovsky C, Hertzog M, Holtz S, Loberiza FR., Jr. Usual and worst symptom severity and interference with function in breast cancer survivors. Journal of Supportive Oncology. 2012;10(3):112–118.
    1. Thompson CL, Li L. Association of sleep duration and breast cancer OncotypeDX recurrence score. Breast Cancer Research and Treatment. 2012;134(3):1291–1295.
    1. Savard J, Liu L, Natarajan L, et al. Breast cancer patients have progressively impaired sleep-wake activity rhythms during chemotherapy. Sleep. 2009;32(9):1155–1160.
    1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Survivorship, 2014, .
    1. Epstein LJ, Kristo D, Strollo PJ, Jr., et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Journal of Clinical Sleep Medicine. 2009;5(3):263–276.
    1. Yoon J, Malin JL, Tisnado DM, et al. Symptom management after breast cancer treatment: is it influenced by patient characteristics? Breast Cancer Research and Treatment. 2008;108(1):69–77.

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