Chemotherapy effect on daytime sleepiness and contributing factors in older adults with cancer

Abstract

Background: Excessive daytime sleepiness has been related with several functional and psychological disabilities. The objective of this study was to determine the prevalence of excessive daytime sleepiness (EDS) among older Iranian patients with cancer and to analyze the effect of chemotherapy treatment on patients' sleep problems. The relationship between sleep disturbances and physical activity, psychological factors, and demographic data were also explored. Methods: This cross-sectional study, carried out in Cancer Institute of Iran, consisted of interviews with patients older than 60 years with a solid tumor; once prior to receiving chemotherapy and the second time after two cycles of chemotherapy. Questionnaires consisted of Epworth Sleepiness Scale (ESS), Hospital Anxiety and Depression Scales (HADS), Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), and Eastern Cooperative Oncology Group performance status. Medical data were also gathered from hospital records. Logistic regression was used to identify predictors of excessive daytime sleepiness after chemotherapy. Results: From the cases, 56.8% were female (n=42). Mean participants' age was 68.26 (SD=6.77) and 78.4% had advanced tumors. Bivariate analysis did not show any significant association between education, tumor stage, and the number of comorbidities and daytime sleepiness after receiving chemotherapy. The results showed a significant association between EDS and receiving chemotherapy. Initially EDS rate was reported as 8.1% which increased to 21.6% after chemotherapy (P<0.001). Anxiety before chemotherapy and number of regions of recurrence, were identified as independent predictors of daytime sleepiness. Conclusions: Given that, EDS prevalence increases with chemotherapy treatment, and this can affect patients' quality of life and treatment outcomes, caregivers should bear in mind that older patients with cancer, especially those with anxiety and cancer recurrence, need special attention before decision making over starting chemotherapy in order to prevent and manage EDS in the course of chemotherapy.