Determinants of sleep quality in cancer patients: a tertiary center experience from Punjab, Pakistan

Background: Cancer diagnosis and treatment can trigger and/or worsen insomnia. This is a double-edged sword as sleep disturbances then exacerbate cancer symptoms. Objectives: To determine the sleep quality in cancer patients as well as the relationship of sleep quality with socioeconomic status, financial burden, marital status, Eastern Cooperative Oncology Group (ECOG) performance status, pain, use of analgesia, and type of cancer. Materials and Methods: An analytical cross-sectional study was carried out with 100 adult and pediatric cancer patients presenting to Mayo Hospital, Lahore. The Urdu version of the Pittsburg Sleep Quality Index (PSQI-U), Numerical Rating Scale (NRS), and Eastern Cooperative Oncology Group (ECOG) score were used to determine the quality of sleep, the intensity of pain, and performance status respectively. Statistical analysis was carried out using SPSS software version 26. Binary logistic regression was used to assess factors associated with sleep quality (defined by a cutoff value of ≥5 on the PSQI scale). Variables with p-value <0.25 were used to build the final multivariable regression model. Results: A total of 100 participants, with a mean age of 40.2 ± 19.7 years, and a male gender predilection (88%) were enrolled in the study. Non-hematological malignancies accounted for 62% of all patients while 80% of the participants were suffering from stage 4 cancer. The mean PSQI score was 11.56 ± 5.70. Sleep quality was associated with increasing age, marital status, employment status, pain incidence, increasing ECOG status, and undergoing chemotherapy on univariate analysis. On the multivariable model, increasing age and increasing ECOG scores were independent predictors of sleep quality. Conclusion: Cancer patients have poor sleep quality which is linked with advanced disease, aging, pain, and poor performance status. Medical, behavioral, and psychological interventions can help in alleviating the sleep problems faced by these patients.