The inﬂuence of education level on sleep-related outcomes and sleep management strategies in prostate cancer patients
1Department of Anatomy, University of Otago, 270 Great King St, 9016 Dunedin, New Zealand
2WellSleep, Department of Medicine, University of Otago, Wellington, New Zealand
Submitted: 29 January 2021 Accepted: 04 March 2021
Online publish date: 16 April 2021
Introduction: Insomnia symptoms are common among prostate cancer (PCa) patients. We explore here whether education level is associated with sleep-related outcomes, and preference for sleep management strategies.
Methods: A short online survey was posted on Facebook with the help of Prostate Cancer Foundation New Zealand. The survey consisted of scales on sleep-related parameters, as well as questions about sleep management strategies.
Results: Demographic data were similar between participants with (n = 49) and without (n = 32) university education. Participants with no university education were more likely to receive external beam radiation (P = 0.035) than participants without university education. In addition, those without university education also had signiﬁcantly more comorbidities (P = 0.046), higher body mass index (P = 0.048), and more severe fatigue (P = 0.031) but similar levels of insomnia symptoms (P = 0.50), sleepiness (P = 0.36) and morningness-eveningness (P = 0.07) than those with university education. After controlling for age, number of comorbidities, and insomnia severity, lower education was associated with lower likelihood of having used herbal remedies or supplements for improving sleep (OR = 0.208, P = 0.041). Education level is not related to the use of sleep medication, cognitive behaviour therapy, mindfulness, acupuncture, hypnosis for sleep management in PCa patients.
Conclusion: Education level is not associated with insomnia symptoms, but with fatigue level and the use of herbal remedies or supplements for sleep management in PCa patients.
Prostate cancer; Insomnia; Management strategies; Education; Treatment side effects
Shenyll Delpachitra,Angela J. Campbell,Erik Wibowo. The inﬂuence of education level on sleep-related outcomes and sleep management strategies in prostate cancer patients. Journal of Men's Health. 2021.doi:10.31083/jomh.2021.033.
 Savard J, Simard S, Hervouet S, Ivers H, Lacombe L, Fradet Y. Insomnia in men treated with radical prostatectomy for prostate cancer. Psycho-Oncology. 2005; 14: 147-156.
 Savard J, Hervouet S, Ivers H. Prostate cancer treatments and their side effects are associated with increased insomnia. Psycho-Oncology. 2013; 22: 1381-1388.
 Savard J, Ivers H, Savard M, Morin CM. Cancer treatments and their side effects are associated with aggravation of insomnia: results of a longitudinal study. Cancer. 2015; 121: 1703-1711.
 Grunfeld EA, Halliday A, Martin P, Drudge-Coates L. Andropause syndrome in men treated for metastatic prostate cancer. Cancer Nursing. 2012; 35: 63-69.
 Gonzalez BD, Small BJ, Cases MG, Williams NL, Fishman MN, Jacobsen PB, et al. Sleep disturbance in men receiving androgen deprivation therapy for prostate cancer: the role of hot flashes and nocturia. Cancer. 2018; 124: 499-506.
 Grandner MA. Sleep, health, and society. Sleep Medicine Clinics. 2017; 12: 1-22.
 Zeichner SB, Zeichner RL, Gogineni K, Shatil S, Ioachimescu O. Cognitive behavioral therapy for insomnia, mindfulness, and yoga in patients with breast cancer with sleep disturbance: a literature review. Breast Cancer. 2017; 11: 117822341774556.
 Lam T, Chung K, Yeung W, Yu BY, Yung K, Ng TH. Hypnotherapy for insomnia: a systematic review and meta-analysis of randomized controlled trials. Complementary Therapies in Medicine. 2015; 23: 719-732.
 Choi T, Kim JI, Lim H, Lee MS. Acupuncture for managing cancer-related insomnia: a systematic review of randomized clinical trials. Integrative Cancer Therapies. 2017; 16: 135-146.
 Delpachitra S, Campbell A, Wibowo E. Preference for sleep manage-ment strategies among prostate cancer patients: an Aotearoa/New Zealand perspective. Cancer Treatment and Research Communica-tions. 2020; 25: 100219.
 Albano JD, Ward E, Jemal A, Anderson R, Cokkinides VE, Murray T, et al. Cancer mortality in the United States by education level and race. Journal of the National Cancer Institute. 2007; 99: 1384-1394.
 Aarts MJ, Kamphuis CBM, Louwman MJ, Coebergh JWW, Macken-bach JP, van Lenthe FJ. Educational inequalities in cancer survival: a role for comorbidities and health behaviours? Journal of Epidemiology and Community Health. 2013; 67: 365-373.
 Kane CJ, Lubeck DP, Knight SJ, Spitalny M, Downs TM, Grossfeld GD, et al. Impact of patient educational level on treatment for patients with prostate cancer: data from CaPSURE. Urology. 2003; 62: 1035-1039.
 Knight SJ, Latini DM, Hart SL, Sadetsky N, Kane CJ, DuChane J, et al. Education predicts quality of life among men with prostate cancer cared for in the department of veterans affairs: a longitudinal quality of life analysis from CaPSURE. Cancer. 2007; 109: 1769-1776.
 Hammond C. What is it about education that makes us healthy?Exploring the education-health connection. International Journal of Lifelong Education. 2002; 21: 551-571.
 Ashikaga T, Bosompra K, O’Brien P, Nelson L. Use of complimentary and alternative medicine by breast cancer patients: prevalence, patterns and communication with physicians. Supportive Care in Cancer. 2002; 10: 542-548.
 Paltiel O, Avitzour M, Peretz T, Cherny N, Kaduri L, Pfeffer RM, et al. Determinants of the use of complementary therapies by patients with cancer. Journal of Clinical Oncology. 2001; 19: 2439-2448.
 Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine. 2001; 2: 297-307.
 Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991; 14: 540-545.
 Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, et al. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer. 1999; 85: 1186-1196.
 Adan A, Almirall H. Horne & Ostberg morningness-eveningness questionnaire: a reduced scale. Personality and Individual Differences. 1991; 12: 241-253.
 Mastin DF, Bryson J, Corwyn R. Assessment of sleep hygiene using the Sleep Hygiene Index. Journal of Behavioral Medicine. 2006; 29: 223-227.
 Loh KP, Zittel J, Kadambi S, Pandya C, Xu HW, Flannery M, et al. Elucidating the associations between sleep disturbance and depression, cheek for fatigue, and pain in older adults with cancer. Journal of Geriatric Oncology. 2018; 9: 464-468.
 Humpel N, Iverson DC. Sleep quality, fatigue and physical activity following a cancer diagnosis. European Journal of Cancer Care. 2010; 19: 761-768.
 Devaux M, Sassi F. Social inequalities in obesity and overweight in 11 OECD countries. The European Journal of Public Health. 2013; 23: 464-469.
 Ogden CL, Fakhouri TH, Carroll MD, Hales CM, Fryar CD, Li X, et al. Prevalence of obesity among adults, by household income and education - United States, 2011-2014. Morbidity and Mortality Weekly Report. 2017; 66: 1369-1373.
 Green HJ, Wells DJN, Laakso L. Coping in men with prostate cancer and their partners: a quantitative and qualitative study. European Journal of Cancer Care. 2011; 20: 237-247.
 Engl T, Drescher D, Bickeböller R, Grabhorn R. Fatigue, depression, and quality of life in patients with prostatic diseases. Central European Journal of Urology. 2017; 70: 44-47.
 Schmidt ME, Chang-Claude J, Seibold P, Vrieling A, Heinz J, Flesch-Janys D, et al. Determinants of long-term fatigue in breast cancer survivors: results of a prospective patient cohort study. Psycho-Oncology. 2015; 24: 40-46.
 Luo H, Lei Y, Cheng H, Fu Z, Liao S, Feng J, et al. Long-term cancer-related fatigue outcomes in patients with locally advanced prostate cancer after intensity-modulated radiotherapy combined with hormonal therapy. Medicine. 2016; 95: e3948.
 Mao H, Bao T, Shen X, Li Q, Seluzicki C, Im E, et al. Prevalence and risk factors for fatigue among breast cancer survivors on aromatase inhibitors. European Journal of Cancer. 2018; 101: 47-54.
 Akechi T, Kugaya A, Okamura H, Yamawaki S, Uchitomi Y. Fatigue and its associated factors in ambulatory cancer patients: a preliminary study. Journal of Pain and Symptom Management. 1999; 17: 42-48.
 Smith C, Wilson NC, Parnell WR. Dietary supplements: characteris-tics of supplement users in New Zealand. Nutrition & Dietetics. 2005; 62: 123-129.
 O’Brien SK, Malacova E, Sherriff JL, Black LJ. The prevalence and predictors of dietary supplement use in the australian population. Nutrients. 2017; 9: 1154.
 Timbo BB, Ross MP, McCarthy PV, Lin CJ. Dietary Supplements in a national survey: prevalence of use and reports of adverse events. Journal of the American Dietetic Association. 2006; 106: 1966-1974.
 Parnell WR, Wilson NC, Smith C. Dietary supplements: prevalence of use in the New Zealand population. Nutrition & Dietetics. 2006; 63: 199-205.
 van den Berg SW, Peters EJ, Kraaijeveld JF, Gielissen MFM, Prins JB. Usage of a generic web-based self-management intervention for breast cancer survivors: substudy analysis of the BREATH trial. Journal of Medical Internet Research. 2013; 15: e170.
 Cillessen L, van de Ven MO, Compen FR, Bisseling EM, van der Lee ML, Speckens AE. Predictors and effects of usage of an online mindfulness intervention for distressed cancer patients: usability study. Journal of Medical Internet Research. 2020; 22: e17526.
 Oh B, Eade T, Kneebone A, Pavlakis N, Clarke S, Eslick G, et al. Factors affecting whether or not cancer patients consider using acupuncture. Acupuncture in Medicine. 2017; 35: 107-113.
 Fourrier A, Letenneur L, Dartigues JF, Moore N, Bégaud B. Benzodiazepine use in an elderly community-dwelling population. Characteristics of users and factors associated with subsequent use. European Journal of Clinical Pharmacology. 2001; 57: 419-425.
 Manthey L, van Veen T, Giltay EJ, Stoop JE, Neven AK, Penninx BWJH, et al. Correlates of (inappropriate) benzodiazepine use: the Netherlands Study of Depression and Anxiety (NESDA). British Journal of Clinical Pharmacology. 2011; 71: 263-272.
 Liou KT, Hung TKW, Meghani SH, Epstein AS, Li QS, Romero SAD, et al. What if acupuncture were covered by insurance for pain management? A cross-sectional study of cancer patients at one academic center and 11 community hospitals. Pain Medicine. 2019; 20: 2060-2068.
 Sohl SJ, Stossel L, Schnur JB, Tatrow K, Gherman A, Montgomery GH. Intentions to use hypnosis to control the side effects of cancer and its treatment. The American Journal of Clinical Hypnosis. 2010; 53: 93-100.
 Wiltz AL, Shikanov S, Eggener SE, Katz MH, Thong AE, Steinberg GD, et al. Robotic radical prostatectomy in overweight and obese patients: oncological and validated-functional outcomes. Urology. 2009; 73: 316-322.
 Ahlering TE, Eichel L, Edwards R, Skarecky DW. Impact of obesity on clinical outcomes in robotic prostatectomy. Urology. 2005; 65: 740-744.
 Jayarathne W, de Zoysa P. The impact of a progressive muscular relaxation exercise programme for reducing insomnia in an elderly population: results from a preliminary study at two elderly homes in the Colombo District of Sri Lanka. Sri Lanka Journal of Social Sciences. 2016; 39: 47-52.
 Neeru, Khakha DC, Satapathy S, Dey AB. Impact of Jacobson Progressive Muscle Relaxation (JPMR) and deep breathing exercises on anxiety, psychological distress and quality of sleep of hospitalized older adults. Journal of Psychosocial Research. 2015; 10: 211-223.
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