UCSF

Context – Unrelieved pain and sleep disturbance are common symptoms in patients receiving chemotherapy. Increased stress may be an underlying cause for both symptoms.Objectives – Purposes were to identify subgroups of outpatients with distinct co-occurring pain AND sleep disturbance profiles and to evaluate for differences among these subgroups in demographic and clinical characteristics. In addition, differences in global stress, disease-specific stress, and cumulative life stress, as well as resilience and coping were evaluated. Methods – Patients (n=1343) completed measures of pain, sleep disturbance, stress, resilience and coping. Latent profile analysis was used to identify subgroups of patients with distinct pain AND sleep disturbance profiles. Differences among the subgroups were evaluated using parametric and non-parametric tests. Results – Three distinct profiles were identified (i.e., No Pain + Moderate Sleep Disturbance (SD) (27.6%), Moderate Pain + Moderate SD (38.6%), Severe Pain + High SD (33.8%)). Compared to the other two classes, Severe Pain + High SD class was younger, had fewer years of education, was more likely to be female, more likely to live alone, less likely to be employed, and had a higher level of comorbidity. This class had the highest stress scores and were more likely to report higher rates of adverse childhood experiences (ACEs; e..g, physical and sexual abuse). Conclusions – Given that over 70% of our sample reported clinically meaningful levels of both symptoms and 33.8% reported relatively high rates of ACEs, clinicians need to perform routine assessments; initiate appropriate referrals, and provide effective symptom management interventions including cognitive behavioral therapy.