BUFFALO, N.Y. -- What many of us take for granted -- a good
night's sleep -- may be unattainable for those with lung cancer.
Lung cancer patients comprise a subgroup of cancer patients who are
most vulnerable to sleep disturbances.
Why can't lung cancer patients fall asleep or once asleep, stay
asleep? When interviewed, the patients say that it's not pain or
difficulty breathing that keeps them awake; it's worry -- worry
about what will happen to their families without them and worry
that they may die in their sleep.
The interviews were part of a recently published study in the
Journal of Addictions by University at Buffalo assistant professor
of nursing and primary investigator, Grace Dean, PhD, RN, on the
role anxiety plays in sleeplessness among lung cancer patients and
the subsequent use of alcohol and tobacco to relax.
"Because smoking and alcohol abuse increase morbidity and
mortality for lung cancer patients who undergo treatment, we wanted
to know how much the patients we studied were drinking and smoking,
and whether these variables were related to anxiety and sleep
disturbances," explains Dean.
Excessive smoking, alcohol use and sleep disturbances can be
especially damaging to lung cancer patients, Dean notes.
Individuals who are still smoking at the time of a lung cancer
diagnosis may shorten their years of survival. And, alcohol abuse
recently has been associated with acute lung injury.
These effects when combined with the disproportionately high
rates of sleep disturbances for those living with lung cancer --
second only to breast cancer patients -- can be threatening to
Dean and her colleagues interviewed 50 study participants, the
majority of whom were male, had a mean age of 64 with blacks and
whites being equally represented. More than half were separated or
divorced. The patients had completed one cycle of chemotherapy for
lung cancer, were at least 21 years old and were not able to work
but could care for themselves.
The study found more than three quarters of the participants had
trouble sleeping. But while 25 percent of the respondents suffered
from anxiety, it was not related to alcohol use, the study showed.
However, 42 percent of the study participants admitted they were
still smoking during treatment. And these patients said their
anxiety declined with smoking. "It may seem inconceivable that
someone who has lung cancer would continue smoking," Dean says.
"But our results suggest that for many lung cancer patients smoking
may reduce their worries ."
Dean and colleagues say they hope these study results will
encourage health care providers to routinely ask detailed questions
about the quality of lung cancer patients' sleep and focus more on
anxiety counseling and smoking cessation for lung cancer patients,
particularly those who reported trouble sleeping.
Dean says she chose to study anxiety as the key factor for sleep
disruption because in addition to patients complaining about worry
during their interviews, anxiety is one of the most common mental
disorders and is known to increase the risk for insomnia.
"Anxiety and depression can be as high as 50 percent in patients
with cancer, pointing to the importance for nurses to routinely
screen for anxiety and depression," Dean points out. "And while
pain and difficulty breathing might have been contributing factors,
they were assessed in this study and found not to be
"Anxiety and sleeplessness can also lead to self-medication,"
she says. "And when individuals self-medicate their anxiety, they
often use alcohol and tobacco."
The University at Buffalo is a premier research-intensive
public university, a flagship institution in the State University
of New York system and its largest and most comprehensive campus.
UB's more than 28,000 students pursue their academic interests
through more than 300 undergraduate, graduate and professional
degree programs. Founded in 1846, the University at Buffalo is a
member of the Association of American Universities.