Efficacy of interventions to improve sleep quality among patients with breast cancer : a systematic review

Abstract

Introduction: Breast cancer is the most common cancer in women. While advances in therapeutic approaches have improved the survival of breast cancer patients, it is important to improve the quality of life among the cancer survivors. Sleep disturbance is one of the most important problems for breast cancer patients that substantially reduced their quality of life. Many interventions have been developed for improving sleep quality for breast cancer patients. The aim of this review is firstly to compare the efficacy of interventions used to improve sleep quality among breast cancer patients, and secondly to compare the strength and weakness of different interventions used to improve sleep quality among breast cancer patients.

Methods: A systematic review was conducted with randomized controlled trials retrieved from three main databases (PubMed, MEDLINE and Cochrane Library) and additionally from Google Scholar for interventions to improve sleep quality among breast cancer patients. Data on different types of interventions to improve sleep quality among breast cancer patients were extracted. The side effects and the strength of the interventions were extracted to further assess the interventions.

Results: A total of 16 RCT were included in this review which included 7 interventions including cognitive behavioral therapy for insomnia (CBT-I), yoga, exercise, Tibetan sound meditation (TSM), mindfulness-based therapy, electroacupuncture (EA), Qigong, and melatonin. CBT-I has no side effects and can significantly improve sleep quality among breast cancer patients. Studies on the effect of yoga to improve sleep quality did not have consistent findings. Exercise can reduce sleep disturbances and lead to other better health outcomes including physical, social and role function. Electroacupuncture can significantly improve sleep quality and has very minor side effects. Mindfulness meditation and melatonin can significantly improve subjective sleep disturbances. TMS and Qigong were found to have no significant effect on sleep quality.

Conclusions: The review suggests the high vulnerability of cancer patients to sleep problems. Many interventions can be used to improve sleep quality among breast cancer patients suffered from cancer treatment, and their efficacy has been demonstrated. Further research should replicate the findings in this review to increase the generalizability of the efficacy of different interventions. Cost analysis could also be done for different efficacious interventions.