Sleep disturbances, anxiety and depression- a complex of symptoms at patient with advanced cancer. How we can control them?

Şerpe Mircea, MD, PhD, senior neurologist, coordinator of Palliative Care Department  Municipal Hospital Lugoj, head of neurology discipline, West University “Vasile Goldis” Arad, Romania

Abstract

Sleep disturbances are estimated to occur between 30-50% of cancer patients. These disturbances demonstrate a variable evolution thru the cancer evolution, and therefore periodic evaluation of these disturbances is necessary during the whole neoplastic experience of the patient. The management of sleep disturbances should be concentrated on the asleep difficulties, on the sleep maintenance and on the early in the morning awakenings.

For an efficient control of sleep disturbances non-pharmacological measures might be used that are addressed especially on the hygiene of sleep; if these measures are not efficient, pharmacological measures with different drugs might be used that intervene with the sleep-awake cycle: benzodiazepines, melatonin receptors agonists, antihistaminic drugs, antidepressive and antipsychotic medication.

Depression is a co-morbidity that affect around 15-25% of cancer patients. The risk factors for the occurrence of depression at neoplastic patients maybe on the one hand related to the neoplastic disease itself (uncontrolled pain, advanced stage of neoplastic disease, aggressive chemotherapy with a poor control of side effects), and, on the other hand, to other health problems, like a history of depression, the lack of family support, alcoholism, or associated co-morbidities.

From a therapeutical point of view, there is a wide range of drugs (antidepressants, benzodiazepines, MAO inhibitors, psychostimulant drugs) or it might be used psychotherapy.

Anxiety varies among cancer patients, during the progress of the neoplastic disease or associated with the aggressiveness of the therapeutical procedures. It may be found in about 44% of all cancer patients.

Anxiety may be a normal step during the normal adaptation of patient to its new medical condition. Risk factors that may predict the occurrence of anxiety in cancer patients are: a history of anxiety, severe pain and anxiety that is already present at the moment of establishing the neoplastic disease, some functional boundaries, the lack of an effective social support, and advanced stages of the neoplastic disease.

The effective management of anxiety start with a comprehensive evaluation and a precise diagnosis. The initial management of anxiety relay on the picking up the correct information and offering support to the patients.

The usage of anxiolytic drugs has to be taken into account when patients have severe symptoms or when the results of psycho-social interventions are not adequate. In this case benzodiazepines are preferred.

Key words: sleep disturbances, depression, anxiety, cancer

(Full text in Romanian language)

* * * * * * * *
You need to subscribe in order to have access to full texts! If you already subscribed, please login here.

* * * * * * * *
Trebuie să vă abonaţi pentru a avea acces la întregul conţinut! Dacă sunteţi deja abonat, trebuie să vă autentificaţi aici.