| ObjectiveTo investigate the level of sleep disturbance(SD) in lung cancer patients undergoing radiotherapy and analyze the effect of clinical factors including social demographic data, disease-related condition, psychological status, pain and treatment-related side effects on SD in different time of radiotherapy and identify the relationship among lymphocyte subsets, inflammatory cytokines and SD, which may provide the basis of etiological mechanism of SD and establishing effective intervention for improving patients’ life quality and prognosis. MethodsUsing convenience sampling method, the study enrolled patients diagnosed with lung cancer received radiotherapy between February 2014 and Februry 2016 at Tianjin Medical University Cancer Institute and Hospital. Patients were asked to fill out the questionnaires including social demographic data, disease-related condition on admission. The survey tools including Pittsburgh sleep quality index(PSQI), Self-Rating Anxiety Scale(SAS), Self-Rating Depression Scale(SDS), Pain visual analogue scale(VAS),National Cancer Institute Common Toxicity Criteria for Adverse Events(CTCAE 4.0, choosing fatigue, weight loss, anorexia, nausea, vomiting, constipation, diarrhea, dry mouth, dysphagia, hoarse, cough, dyspnea, radiodermatitis 13 adverse effects related to treatment) were filled out before receiving radiotherapy, in radiotherapy of 2nd week, 4th week and the time of completing radiotherapy. Meanwhile, we collected patients’ venous blood to detect the level of lymphocyte subsets, pro-inflammatory cytokines including IL-6, IL-1β in the same four time of survey. Data were analyzed by SPSS17.0.Single factor analysis of influential factor related to sleep disturbance was used by χ2 test, t test. Multiple-factor analysis was used by binary logistic regression analysis. ResultsA total of 69 patients were enrolled before radiotherapy and 57 in the time of completing radiotherapy. The incidence of SD was from 33.3% to 52.6% which was a increasing trend with radiotherapy.According to univariate analysis, the level of sleep quality was difference in the patients with different age, and accepting concurrent chemotherapy. The significant variables for sleep disturbance were anxiety, depression, pain, fatigue, constipation, cough before radiotherapy; anxiety, depression, pain, fatigue, weight loss, anorexia, constipation, cough, dyspnea and the level of CD3+ at 2nd week; anxiety, depression, pain, fatigue, anorexia, dry mouth, cough and the level of CD3+, CD4+, CD16+56+ at 4th week; anxiety, depression, pain, fatigue, dry mouth and IL-6 at 6~7th week. There was no difference between two groups on IL-1β. In the Logistic regression analysis, the risk factors of sleep disturbance were anxiety(OR=1.191), pain(OR=28.476), fatigue(OR=4.269), cough(OR=4.482) before radiotherapy; older(OR=2.565), depression(OR=1.112), anorexia(OR=2.825) constipation(OR=8.986), dyspnea(OR=7.256) in radiotherapy of 2nd week; concurrent chemotherapy(OR=1.801), fatigue(OR=4.272), anorexia(OR=1.496) dry mouth(OR=3.884), CD3+(OR=0.361), CD3+CD4+(OR=0.274) in radiotherapy of 4th week; anxiety(OR=1.156), fatigue(OR=1.685), dry mouth(OR=1.711), IL-6(OR=1.441) in the time of completing radiotherapy. There was no difference between two groups on IL-1β. ConclusionThe incidence of SD in lung cancer is high and increase following with radiotherapy. The risk factors of SD vary with the period of treatment which should be paied attention and improved by effective intervention. We are suggested to enhance managing fatigue, cough, pain before receiving radiotherapy; positively monitor and handle elderly and accepting concurrent chemotherapy patients’ symptoms like dyspnea, fatigue, dry mouth, constipation; still manage patients’ fatigue and dry mouth after completing radiotherapy. Psychological nusing can be provided all over radiotherapy. In addition, we found the trend that SD is associated with immunity dysfunction and the rising IL-6, which may provide theoratical basis of predicting symptom burden and carrying out preventability measures. |
