Nonpharmacologic Interventions for Improving Sleep Disturbances in Patients With Lung Cancer: A Systematic Review and Meta-analysis

Context. Lung cancer patients experience higher levels of sleep disturbances compared to other cancer patients, and this leads to greater distress, poorer function, and lower quality of life. Nonpharmacologic interventions have demonstrated improvements in the context of breast cancer, but their efficacy in the lung cancer population is unclear. Objectives. The aim of this review was to determine the effects of any nonpharmacologic intervention on sleep quality of lung cancer patients. Methods. Intervention studies of any design that reported primary or secondary outcomes on sleep quality were included. Databases searched were Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and PsycINFO. Risk of bias was assessed regarding randomization, allocation concealment, blinding, incomplete outcome data, selective reporting, and other biases. Results. Twenty-two studies were identified with a total of 1272 participants. Pittsburgh Sleep Quality Index was the most common instrument used. Statistically significant results were observed for all intervention categories examined in the short-term follow-up period: exercise and rehabilitation programs (standardized mean difference [SMD]: -0.43, 95% CI: -0.68, -0.19, P = 0.0005); information, psychoeducation, and symptom screening interventions (SMD: -0.87, 95% CI: -1.21, -0.54, P < 0.00001); and mind-body interventions (SMD: -0.88, 95% CI: -1.59, -0.16, P = 0.02). However, effectiveness was lower and nonsignificant when evaluated over one month after completion. Conclusion. Limitations include the high heterogeneity of interventions and outcome measures, in addition to small sample sizes and high risk of bias within studies. Because they do not allow for a clear interpretation of the results, it is recommended that every patient should be assessed individually to guide a possible referral. (C) 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.