A Pan-Canadian practice guideline: prevention, screening, assessment, and treatment of sleep disturbances in adults with cancer

• Published in: Supportive care in cancer 2013-10, Vol.21 (10), p.2695-2706
• Main Authors: Howell, Doris, Oliver, Thomas K., Keller-Olaman, Sue, Davidson, Judith, Garland, Sheila, Samuels, Charles, Savard, Josée, Harris, Cheryl, Aubin, Michèle, Olson, Karin, Sussman, Jonathan, MacFarlane, James, Taylor, Claudette
• Format: Article
• Language: English
• Subjects: Adult; Adults; Canada; Cancer; Humans; Insomnia; Medical personnel; Medical screening; Medicine; Medicine & Public Health; Neoplasms - complications; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Practice guidelines (Medicine); Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Rehabilitation Medicine; Sleep; Sleep disorders; Sleep Initiation and Maintenance Disorders - diagnosis; Sleep Initiation and Maintenance Disorders - etiology; Sleep Initiation and Maintenance Disorders - prevention & control; Sleep Initiation and Maintenance Disorders - therapy
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-013-1823-6

Purpose This study aims to provide recommendations on the optimal strategies and interventions for the prevention, screening, assessment, and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) in adult cancer populations. Methods A systematic search of the published health literature was conducted to identify randomized controlled trials, clinical practice guidelines, systematic reviews, and other guidance documents. The Sleep Disturbance Expert Panel [comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers, and guideline methodologists] reviewed, discussed, and approved the final version of the guideline. Health care professionals across Canada were asked to provide feedback through an external review process. Results Three clinical practice guidelines and 12 randomized controlled trials were identified as the evidence base. Overall, despite the paucity of evidence, the evidence and expert consensus suggest that it is important to screen and assess adult cancer patients for sleep disturbances using standardized screening tools on a routine basis. While prevention of sleep disturbance is the desired objective, cognitive behavioral therapies are effective in improving sleep outcomes. As part of the external review with 16 health care providers, 81 % indicated that they agreed with the recommendations as written. Conclusions Sleep difficulty is a prevalent problem in cancer populations that needs greater recognition by health professionals. Prevention, screening, assessment, and treatment strategies supported by the best available evidence are critical. Recommendations and care path algorithms for practice are offered.