# Risk factors associated with the co-occurrence of severe pain and sleep disturbance in oncology outpatients receiving chemotherapy

## TL;DR

This study identifies two groups of cancer patients undergoing chemotherapy with different levels of pain and sleep issues, showing that severe cases are linked to younger age, lower income, and worse health.

## Contribution

The study introduces a new method to identify subgroups of patients with co-occurring severe pain and sleep disturbance during chemotherapy.

## Key findings

- Two distinct subgroups were identified: 53.4% with moderate and 46.6% with severe pain and sleep disturbance.
- Severe cases were associated with younger age, lower income, and worse functional status.
- Patients with severe symptoms had more trouble initiating and maintaining sleep.

## Abstract

Study purposes were to identify subgroups of patients with distinct co-occurring pain AND sleep disturbance profiles and evaluate for differences in demographic, clinical, pain, and sleep characteristics between the subgroups.

Oncology outpatients receiving chemotherapy (n = 972) completed self-report questionnaires on various demographic and clinical characteristics. Pain and sleep disturbance were assessed six times over two cycles of chemotherapy, using the Brief Pain Inventory and the General Sleep Disturbance Scale, respectively. A joint latent profile analysis was performed using the six ratings of worst pain severity and sleep disturbance. Parametric and non-parametric tests were used to evaluate for differences in modifiable and non-modifiable risk factors between the profiles.

Two subgroups of patients with distinct joint pain and sleep disturbance profiles were identified (i.e., Moderate Pain and Sleep Disturbance (Both Moderate, 53.4%) and Severe Pain and Sleep Disturbance (Both Severe, 46.6%)). Compared to the Both Moderate class, patients in Both Severe class were younger, female, had lower level of education, were unemployed, and had a lower annual income. In addition, they had a higher comorbidity burden and a lower functional status. The Both Severe class had problems with sleep initiation and maintenance.

A significant proportion of patients receiving chemotherapy experience the co-occurrence of severe pain and sleep disturbance. Oncology clinicians need to work with primary care providers to optimize the management of these two symptoms.