Lung Cancer With COPD Leads to Poor Sleep, Quality of Life

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Black patients with lung cancer and chronic obstructive pulmonary disease (COPD) demonstrated poorer sleep quality compared with those without COPD, highlighting the need for effective assessment strategies, according to findings presented at the 49th Oncology Nursing Society Congress.

“Our assessment study provides new evidence that sleep is an important clinical problem among this minority population and between these diagnostic groups,” Amanda R. Myhren-Bennett, M.S.N., RN, University of South Carolina, said during the presentation. “And this provides support for the need to develop effective assessment strategies to understand and improve sleep and develop management strategies to improve symptom outcomes.”

According to the questionnaires, the mean global sleep score among those with COPD, vs no COPD, was 11.4 (95% CI, 8.7-14.0) vs 8.1 (95% CI, 4.9-11.4; P = .08). Further, from the sleep diaries submitted, mean wake after sleep onset was 24.3 (95% CI, -14.0 to 62.6) vs 2.3 (95% CI, 24.6-184.3), respectively (P = .02). No other differences quantitative variables were significantly significant.

“Lung cancer is still a leading cause of death among those diagnosed with COPD,” Myhren-Bennett explained, adding that COPD affects anywhere from 40% to 70% of lung cancer survivors. “These respiratory comorbidities, including COPD, are the fourth leading cause of death, and they will frequently worsen lung cancer progresses due to their high morbidity and mortality.”

In addition to challenges with comorbidities, like COPD, additional burdens and symptoms such as sleep disturbances can make it difficult to recommend 1 assessment tool for patients.

“So among survivors with lung cancer, the relationship between sleep disturbances and COPD is not well established or understood at this time.” Myhren-Bennett said. “However, we do know that early symptom management can improve quality of life among the survivors. So it is possible that these symptoms of poor sleep quality, quantity, and sleep disturbances experienced by the survivors of early stage lung cancer can be managed, and modifying them could improve the quality of life.”

Therefore, investigators aimed to measure and assess sleep quality and quantity among 16 African American lung cancer survivors, an underrepresented patient population, with or without COPD.

Inclusion criteria included African-American survivors aged 21 years or older with stage I to III lung cancer, completed treatment in the last 10 years, and ability to read/write English. Patients were excluded if they had a second primary cancer or a secondary active cancer diagnosis/treatment.

Investigators conducted home-based assessments where they received written consent, study-specific questionnaires and equipment, and diary overview and explanation, while participants wore a waist accelerometer for 7 days, kept a 7-day sleep diary, and 7-day actigraphy diary during the first meeting. In the second meeting, equipment was collected, an exit interview was performed, and compensation was given.

“We looked at their perception of their symptoms, their response to their symptoms, and also their self-evaluation of their symptoms,” Myhren-Bennett said. “We collected objective data of accelerometer or actigraphy data, and our subjective data included study-specific questionnaires, a sleep diary, and also semi-structured interviews to elucidate the perceived symptom experiences, sleep hygiene, sleep quality, and quality goals.”

Mean age was 68.9 years, and average time since diagnosis was 6.5 years. Eleven patients were female, and the majority (56.3%) had stage I disease. Overall, patients had an average of 4.3 comorbidities, including COPD (50%), lung disease (43.8%), heart disease (31.3%), high blood pressure (62.5%), cancer (43.8%), and arthritis (62.5%).

“Our assessment study provides new evidence that sleep is an important clinical problem among this population,” Myhren-Bennett concluded. “And this provides support for effective assessment strategies to better understand and hopefully improve their sleep, and having a better understanding of the relationship between lung cancer, COPD, and sleep may lead to improved management of these burdens and symptoms, which could lead to improved quality of life for this group.”

Reference

Myhren-Bennett AR, Kane McDonnell K, Davis J, Wirth MD, Fouladbakhsh J. Sleep Quality and Quantity Assessment Among African American Survivors of Lung Cancer With and Without Chronic Obstructive Pulmonary Disease (COPD). Presented at: 49th Oncology Nursing Society Congress; April 24-28, 2024; Washington D.C.