Fatigue and Sleep Disturbance Are Persistent Issues for Patients Undergoing TACE

Fatigue and sleep disturbance are significant threats to quality of life for patients undergoing transarterial chemoembolization (TACE) for advanced intermediate hepatocellular cancer. Therefore, interventions that identify and address the factors that influence sleep quality are needed. These findings were recently published in Supportive Care in Cancer.

A research team conducted a cross-sectional study to explore the characteristics that affect sleep quality components in patients undergoing TACE. Fifty adult patients and 45 nurses from a tertiary hospital in South Korea were recruited. 

Mean age of the patients was 68.82±8.91 years, 39 (78%) were male, and 42 (84%) were married. Sleep quality was not significantly different across the study population based on patients’ general characteristics. Average age of the nurses was 28.82±2.98 years, 45 (100%) were female, and 16 (35.6%) were married.

Patients’ sleep quality was measured with the Korean version of the Verran and Snyder-Halpern Sleep Scale, which measures 4 subcategories: sleep fragmentation, length of time spent sleeping, time it takes to fall asleep, and depth of sleep. The subcategories were each scored from 0 to 10, with 10 representing the highest possible score for sleep quality. The mean total score for sleep quality was 40.28±14.10. 

Heat sensation (t, −2.08; P =.043) and fatigue (t, −4.47; P <.001) were significant predictors of sleep fragmentation, predicting sleep fragmentation in 38.6% of the patients. Abdominal pain, nausea, and anxiety also negatively correlated with sleep fragmentation.

Abdominal pain (t, −2.54; P =.014), vomiting (t, −2.21; P =.032), and nurse-expected fatigue (t, 2.68; P =.010) were significant predictors of sleep length. These symptoms predicted sleep length in 41.7% of the patients. Nausea, heat sensation, fatigue, anxiety, and depression negatively correlated with sleep length; whereas nurse-expected abdominal pain, fever, and fatigue positively correlated with sleep length.

Symptoms nurses expected to predict sleep quality — such as postembolization symptoms, depression, anxiety, and comfort care — actually were not predictive of sleep quality. 

Overall, sleep quality is low among patients undergoing TACE. Sleep fragmentation is influenced by heat sensation and fatigue; sleep length is affected by abdominal pain, vomiting, and fatigue. As such, efforts to control vomiting might help prolong the patients’ sleep, and efforts to address temperature may help with sleep fragmentation. 

“Based on these results, oncology nurses should recognize patients’ symptoms and sleep quality early and focus on providing comfort care to alleviate and manage their symptoms,” the researchers wrote. 

“Further studies are needed to explore the roles of common symptoms and comfort care provided by oncology nurses in influencing sleep quality in patients undergoing TACE,” they concluded.