Personalized goal for insomnia and clinical response in advanced cancer patients

Sebastiano Mercadante, Claudio Adile, Federica Aielli, Lanzetta Gaetano, Kyriaki Mistakidou, Marco Maltoni, Andrea Cortegiani, Luiz Guilherme Soares, Stefano De Santis, Patrizia Ferrera, Marta Rosati, Romina Rossi, Alessandra Casuccio

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: The aim of this study was to assess the Personalized Insomnia Intensity Goal (PIIG), the achievement of Personalized Goal Response (PGR), and Patient Global Impression (PGI) after a comprehensive symptom management. Patients and methods: Advanced cancer patients admitted to palliative care units rated pain and symptoms intensity and their PIIG by using the Edmonton Symptom Assessment Score (ESAS) (T0). In patients with significant levels of insomnia, the achievement of target expected (PIIG) was measured (patient goal response, PIGR), as well the patient global impression (PGI), by the minimal clinically important difference (MCID), after a comprehensive symptom management (T7). Results: Three hundred ninety-seven patients with a level of insomnia of ≥ 3 on ESAS were analyzed in this study. The mean values of PIIG at T0 and T7 were 1.2 (SD 1.5) and 0.9 (SD 1.4), respectively. Most patients (n = 406, 89.8%) indicated a PIIG of ≤ 3 as a target at T0. Such target was significantly lower at T7 (p = < 0.0005). PGI, expressed as MCID, was perceived with a mean decrease in insomnia intensity of − 2.3. In a minority of patients (n = 26; 5.8%) insomnia worsened, with a MCID of 0.50 (SD 2.8). Higher insomnia intensity at T0 and lower insomnia intensity at T7 were independently related to PGI. PIGR was achieved in 87.9% of patients. PIGR was associated with PIIG at T0, and inversely associated to insomnia intensity at T0 and T7, and PIIG at T7. Conclusion: PGIR and PGI seem to be relevant for evaluating the effects of a comprehensive management of insomnia, suggesting therapeutic decisions according to PIIG. Some factors influencing the individual target and clinical response have been detected.

Original languageEnglish
Pages (from-to)1089-1096
Number of pages8
JournalSupportive Care in Cancer
Volume28
Issue number3
DOIs
Publication statusPublished - Mar 1 2020

Keywords

  • Advanced cancer
  • Global impression of change
  • Insomnia
  • Palliative care
  • Personalized symptom goal
  • Symptom assessment

ASJC Scopus subject areas

  • Oncology

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