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  “It may seem inconceivable that someone who has lung cancer would continue smoking. But our results suggest that for many lung cancer patients smoking may reduce their worries.”

  Grace Dean

  Assistant Professor of Nursing

By SARA SALDI

Published: January 17, 2011

What many of us take for granted—a good night’s sleep—may be unattainable for those with lung cancer. Lung cancer patients comprise a subgroup of cancer patients who are most vulnerable to sleep disturbances.

Why can’t lung cancer patients fall asleep or once asleep, stay asleep? When interviewed, the patients say that it’s not pain or difficulty breathing that keeps them awake: It’s worry—about what will happen to their families without them and that they may die in their sleep.

The interviews were part of a recently published study in the Journal of Addictions by Grace Dean, assistant professor of nursing, on the role anxiety plays in sleeplessness among lung cancer patients and the subsequent use of alcohol and tobacco to relax.

“Because smoking and alcohol abuse increase morbidity and mortality for lung cancer patients who undergo treatment, we wanted to know how much the patients we studied were drinking and smoking, and whether these variables were related to anxiety and sleep disturbances,” Dean explains.

Excessive smoking, alcohol use and sleep disturbances can be especially damaging to lung cancer patients, Dean notes. Individuals who are still smoking at the time of a lung cancer diagnosis may shorten their years of survival. And, alcohol abuse recently has been associated with acute lung injury.

These effects when combined with the disproportionately high rates of sleep disturbances for those living with lung cancer—second only to breast cancer patients—can be threatening to overall health.

Dean and her colleagues interviewed 50 study participants, the majority of whom were male and had a mean age of 64, with blacks and whites being equally represented. More than half were separated or divorced. The patients had completed one cycle of chemotherapy for lung cancer, were at least 21 years old and were not able to work but could care for themselves.

The study found more than three quarters of the participants had trouble sleeping. But while 25 percent of the respondents suffered from anxiety, it was not related to alcohol use, the study showed. However, 42 percent of the study participants admitted they were still smoking during treatment. And these patients said their anxiety declined with smoking. “It may seem inconceivable that someone who has lung cancer would continue smoking,” Dean says. “But our results suggest that for many lung cancer patients smoking may reduce their worries.”

Dean and colleagues say they hope these study results will encourage health care providers to routinely ask detailed questions about the quality of lung cancer patients’ sleep and focus more on anxiety counseling and smoking cessation for these patients, particularly those who reported trouble sleeping.

Dean says she chose to study anxiety as the key factor for sleep disruption because in addition to patients complaining about worry during their interviews, anxiety is one of the most common mental disorders and is known to increase the risk for insomnia.

“Anxiety and depression can be as high as 50 percent in patients with cancer, pointing to the importance for nurses to routinely screen for anxiety and depression,” Dean points out. “And while pain and difficulty breathing might have been contributing factors, they were assessed in this study and found not to be significant.

“Anxiety and sleeplessness also can lead to self-medication,” she says. “And when individuals self-medicate their anxiety, they often use alcohol and tobacco.”