Sleep, like exercise and nutrition, is a cornerstone of good health. Getting enough high-quality sleep promotes health and can help with the management of chronic conditions and health problems, including cancer. But new research finds that sleep problems in patients with cancer appear to be vastly overlooked.
In one study, researchers analyzed data from 3,068 patients with cancer who participated in the U.S. National Health Interview Survey (NHIS) (Cancer 2019; doi: 10.1002/cncr.32469). Of those cancer survivors, 1,865 reported having sleep problems; a representative percentage of 59.2 percent of all cancer survivors in the U.S. And 27.6 percent of those survivors with sleep problems reported using a mind-body medicine practice, compared with 17.9 percent of the cancer survivors who didn't have sleep problems reporting using a mind-body medicine practice.
This analysis used data on the use of complementary health care in the past 12 months, though the survey did not assess the frequency of the complementary medicine practice in the individual. (Each cancer survivor who had used a mind-body medicine practice at least once within the previous year was classified as a mind-body medicine user. Sleep problems included those in individuals who either reported trouble falling asleep or trouble staying asleep within the previous week.)
The data points to the high number of cancer survivors who report sleep problems, the study authors note in the conclusion. And because mind-body medicine is so widely used among those who have sleep problems, it is worth further understanding the potential benefits. "A considerable number of cancer survivors with sleep problems use mind-body medicine. This finding warrants the investigation of mind-body medicine concepts as treatment options for cancer survivors experiencing sleep problems," the study authors note.
In an interview with Oncology Times, Petra Voiss, MD, a senior physician and Medical Director in the Department of Internal and Integrative Medicine at Essen-Mitte Clinic on the Faculty of Medicine of the University of Duisburg-Essen in Essen, Germany, shared more on this study.
1 What were the key findings from this research and how are they different than what was previously known about sleep problems in cancer survivors?
"We sought to elucidate the prevalence of sleep problems and the use of mind-body medicine in adult cancer patients and survivors in the U.S. Recommendations in guidelines support the use of mind-body medicine therapies to reduce anxiety and stress in breast cancer patients. Hence it seems reasonable to apply mind-body medicine, which addresses distress, for the improvement of sleep problems. Also, [previous] evidence shows an improvement of sleep problems in cancer patients through mind-body medicine.
"In the National Cancer Institute's Dictionary of Cancer Terms, mind-body medicine or 'mind-body practice' is defined as 'a health practice that combines mental focus, controlled breathing, and body movements to help relax the body and mind [that] may be used to help control pain, stress, anxiety, and depression, and for overall health.' In the 2017 U.S. NHIS survey, specifically the use of the following mind-body medicine modalities was detected: mantra meditation, mindfulness meditation, spiritual meditation, guided imagery, progressive relaxation, yoga, tai chi, and qigong.
"Overall, it was found that more than 50 percent of cancer survivors in this representative sample reported sleep problems: either trouble falling asleep and/or trouble staying asleep. Approximately 28 percent of these patients reported using mind-body medicine, whereas only approximately 18 percent of the cancer survivors without sleep problems reported doing so. Sleep problems might be a reason for mind-body medicine use."
2 Your conclusion calls for more research to pinpoint which mind-body medicine techniques specifically work to improve cancer survivors' sleep. Can you elaborate on that?
"Cognitive behavioral therapy for insomnia and mind-body medicine have been shown to improve insomnia. Unfortunately, to the best of our knowledge, the availability of cognitive behavioral therapy for insomnia is limited, and patients might prefer to use mind-body medicine.
"Several studies and meta-analyses of studies regarding patients with cancer have demonstrated an improvement in sleep through mindfulness-based stress reduction, yoga, and tai chi. Yoga was the second-leading mind-body medicine therapy reported in this survey, but mindful meditation and tai chi were not found to be as widespread. [Also, other research has found that] cognitive behavioral therapy for insomnia and mind-body medicine appear to reduce pro-inflammatory signaling.
"We do not know yet if the successful treatment of sleep difficulties through mind-body medicine or cognitive behavioral therapy for insomnia improves survival in cancer survivors."
3 What's the bottom line takeaway message about this new data?
"For practicing oncologists and cancer care providers, the high prevalence of sleep problems in cancer survivors is important information [to know about].
"Persistent sleep difficulties lead to daytime impairments with a reduction in quality of life, contribution to cancer-related fatigue and depression, and increased inflammation. [Sleep problems also] might have a negative impact on survival.
"Hence, the screening for sleep problems in routine practice is necessary. In cases of sleep difficulties, cognitive behavioral therapy for insomnia, mindfulness-based stress reduction, yoga, or tai chi can be recommended."