Can Improving Quality of Sleep Reduce the Symptoms of Cancer-Related Fatigue? A Systematic Review

Background
Cancer-related fatigue (CRF) is a debilitating condition that results in reduced quality of life for cancer patients. The relationship between tiredness and fatigue has been established in cancer patients and has been shown to be reciprocal, with tiredness influencing fatigue and vice versa. This aim of this study is to determine whether an improvement in sleep quality can ease the symptoms of CRF and whether this can support the theory that CRF symptoms stem from the effect of tiredness.

 Methods
Three databases were searched resulting in an initial identification of 259 papers. The papers were filtered using an inclusion criteria, resulting in a final list of 20 papers for analysis. The remaining papers (20) were critically appraised using the CASP RCT checklist and assessed for bias using the Cochrane Collaboration’s tool for assessing risk of bias in randomised trials before being used in the systematic review.

 Results
Of the 20 papers, 9 used a form of cognitive behavioural therapy (CBT) to improve sleep, 3 papers used a sleep education program, 8 used an exercise program. The remaining interventions used were “energy and sleep enhancement” (EASE) intervention, Individualized Sleep Promotion Plan (ISPP), acupuncture, armodafinil, Cognitive behavioural stress management (CBSM) intervention and reflexology. In total, 14 papers showed an increase in sleep quality that also resulted in an improvement in fatigue symptoms.

 Key messages

Improving quality of sleep does ease the symptoms of CRF, however, the ‘chicken or the egg’ question regarding CRF and tiredness cannot be answered at this stage.