Objective To investigate the clinical implications of sleep quality, anxiety and depression in patients with advanced lung cancer (LC) and their family caregivers (FCs).
Methods A total of 98 patients with advanced LC and their FCs (n=98) were recruited from the Oncology Department in Nanfang Hospital. The Pittsburgh Sleep Quality Index (PSQI), consisting of seven components that evaluate subjective sleep quality, sleep latency, duration of sleep, sleep efficiency, sleep disturbances, sleep medication usage and daytime dysfunction, was used to assess sleep quality. Using the tool of Zung Self-rating Anxiety Scale (SAS) and Zung Self-rating Depression Scale (SDS), we tested the patients’ status of anxiety and depression, respectively.
Results The prevalences of poor sleep quality, anxiety and depression in patients were 56.1%, 48.9% and 56.1%, respectively, while those in FCs were 16.3%, 32.6% and 25.5%, respectively. Patients had higher PSQI, SAS and SDS scores than did FCs (p<0.05). Significant correlations were found between the patients’ and FCs’ scores of PSQI/SAS/SDS (p<0.05). Multivariate Cox regression analyses indicated that sleep disturbances in patients (HR 0.413, 95% CI 0.21 to 0.80, p=0.01) and the global PSQI score of FCs (HR 0.31, 95% CI 0.14 to 0.71, p=0.00) were independent risk factors for patients’ first-line progression-free survival (PFS). Moreover, patients’ sleep latency (HR 2.329, 95% CI 1.36 to 3.96, p=0.00) and epidermal growth factor receptor mutations (HR 1.953, 95% CI 1.12 to 3.38, p=0.01) were significant prognostic factors for their overall survival (OS).
Conclusions We demonstrated that presence of sleep disturbances in patients with advanced LC and the global PSQI Score of their FCs may be risk predictors for patients’ poor first-line PFS. Patients’ sleep latency was a potential risk factor for their OS.
- lung cancer
- family caregivers
- sleep quality
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Contributors This study was conceived, designed and interpreted by YCX and HY. HY and SLY undertook the initial systematic search and screening of the literature. HY, SLY, PKW, LMJ, DL and TT contributed to the data acquisition, analysis and interpretation. HY and SLY were major contributors in writing the manuscript and they are co-first authors. YCX revised the subsequent drafts.
Funding This work was supported by the Science and Technology Planning Project of Guangdong Province, China (2017B090901067).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by the ethical committee of Nanfang Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The original research data used to support the findings of this study are included within the article.
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