Relation entre l'insomnie et le fonctionnement cognitif chez les femmes traitées pour un cancer du sein

Cette thèse doctorale s'intéresse à l'association entre l'insomnie et le fonctionnement cognitif dans le contexte du cancer du sein non métastatique. L'objectif principal est d'évaluer la relation entre l'insomnie et le fonctionnement cognitif, mesuré objectivement (c.-à-d., par des tests neuropsychologiques) et subjectivement (c.-à-d., par des questionnaires auto-administrés), chez soixante-trois femmes ayant reçu un protocole de traitement homogène (chirurgie, chimiothérapie, radiothérapie et hormonothérapie) contre leur cancer du sein non métastatique (article 1). Le second objectif est d'évaluer le rôle potentiellement modérateur : (a) de l'âge; (b) du niveau d'éducation; (c) du potentiel intellectuel (estimation du quotient intellectuel); (d) du statut ménopausique avant le début des traitements oncologiques; et (e) de l'utilisation d'une médication hypnotique (benzodiazepine ou non-benzodiazépine), dans la relation entre l'insomnie et le fonctionnement cognitif, mesuré objectivement et subjectivement (article 1). Le dernier objectif vise à évaluer le rôle médiateur des facteurs suivants dans la relation entre l'insomnie et le fonctionnement cognitif, mesuré objectivement et subjectivement : (a) une perturbation de l'architecture du sommeil (tel que mesurée par une nuit d'enregistrement polysomnographique ambulatoire); (b) la détresse psychologique (c.-à-d., dépression et anxiété); (c) la fatigue; et (d) le stress (article 2), ces trois dernières variables ayant été évaluées à l'aide de questionnaires auto-rapportés. Les résultats montrent que les participantes qui présentent des symptômes d'insomnie ont une performance significativement plus faible aux domaines de mémoire épisodique verbale et de fonctionnement exécutif, et perçoivent leur fonctionnement cognitif comme significativement plus altéré, comparativement aux bonnes dormeuses. Les résultats révèlent également un rôle modérateur de l'âge et du niveau d'éducation pour certaines des variables cognitives. Finalement, les analyses ont confirmé le rôle médiateur de la perturbation de l'architecture du sommeil, de la détresse psychologique et de la fatigue dans la relation entre l'insomnie et le fonctionnement cognitif, les médiateurs significatifs variant toutefois selon la fonction cognitive mesurée. Dans l'ensemble, cette thèse suggère l'insomnie comme facteur contributoire additionnel aux traitements oncologiques pour expliquer les altérations cognitives chez les femmes traitées pour un cancer du sein et identifie certaines variables qui influenceraient et expliqueraient la relation entre l'insomnie et le fonctionnement cognitif, mesuré objectivement et subjectivement, chez cette population

Treatment of depressive symptoms in patients with breast cancer : a randomized controlled trial comparing cognitive therapy and bright light therapy

Objective : This randomized controlled trial (RCT), conducted in patients with breast cancer, aimed to compare the effects of cognitive therapy (CT), bright light therapy (BLT), and a waiting-list control condition (WLC) on depressive symptoms. Method : Sixty-two women were randomly assigned to an 8-week CT (n = 25), BLT (n = 26), or WLC (n = 11). Participants completed the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), the Beck Depression Inventory-II (BDI-II), and the Hamilton Depression Rating Scale (HDRS) at pre- and posttreatment (and postwaiting for WLC), as well as 3 and 6 months later. Results : At posttreatment, CT patients had a significantly greater reduction of depressive symptoms than WLC on the HADS-D and the BDI-II. BLT patients had a greater reduction of depressive symptoms than WLC on the HADS-D only. After WLC participants were reassigned to CT or BLT, a superiority of CT over BLT was found on the BDI-II at posttreatment. Patients of both active conditions showed a good sustainment of treatment gains at follow-ups. Conclusions : Although replication with larger samples is needed, these results confirm the efficacy of CT for depression in the context of breast cancer and suggest that BLT could be of some utility when CT is not available or desired

Development and feasibility of a group cognitive-behavioral therapy for fear of cancer recurrence

This paper describes the development, content, and preliminary results of a group cognitive-behavioral therapy (CBT) for fear of cancer recurrence (FCR). A manualized CBT intervention was developed and offered to 38 patients with various cancer types and stages in two hospitals. Four weekly group CBT sessions were administered by two licensed psychologists as part of routine care. Patients completed self-report scales before the first treatment session and, a second time, 1 month after the last session. Overall, 33 patients had clinical levels of FCR at baseline. The participants’ satisfaction toward the group CBT for FCR was high. Significant reductions on the total score and most subscales of the Fear of Cancer Recurrence Inventory (FCRI) were observed, as well as significant improvements on most of the other psychological variables measured (i.e., insomnia, anxiety, depression, dysfunctional beliefs about cancer, and intolerance of uncertainty). In addition, 52% of the patients with clinical levels of FCR (FCRI-severity subscale score ≥ 13) at baseline no longer reached this clinical threshold at posttreatment. These preliminary results suggest that our group CBT for FCR is well accepted and feasible, and shows promising efficacy for decreasing FCR and improving other psychological variables among cancer patients. The next step is to investigate the efficacy of this minimal intervention in larger and controlled clinical trials, as well as its usefulness as part of a stepped care approach. This low-cost intervention is easy to implement in various clinical settings and has a strong potential to help large numbers of patients with FCR

Fear of cancer recurrence in breast cancer survivors carrying a BRCA1/2 mutation: A qualitative study

Abstract Background There is preliminary evidence suggesting that FCR is a major problem for breast cancer survivors carrying a BRCA1/2 mutation. The goal of this qualitative study, conducted among women who were treated for breast cancer, was to provide a deeper understanding of how FCR is experienced in the context of a genetic predisposition to breast cancer. Method Three focus groups (90–110 min) were conducted with 19 breast cancer survivors carrying a BRCA1/2 mutation. The semistructured interview probed FCR level and impact, the role FCR played in the decision to have a prophylactic bilateral mastectomy and/or salpingo‐oophorectomy, the effect that surgery had on FCR, and the relevance of offering a psychological intervention targeting FCR to this population. Results Findings indicated that FCR was a significant issue in these women, even though a majority had undergone a prophylactic surgery. Patients strongly affirmed the need to develop and provide access to FCR interventions that are specifically adapted to the needs of this group. Discussion These results suggest that, although being the most effective medical option to reduce the actual risk of local recurrence (or second breast cancer), prophylactic surgery only partially reduces FCR. A psychological intervention targeting specifically FCR would be an appropriate complement to preventive surgery

Stress-buffering effect of social support on immunity and infectious risk during chemotherapy for breast cancer

Objective: This study investigated the stress-buffering effect of social support on immune function and infectious risk in women with breast cancer, during and after chemotherapy. Method: Data were collected from 50 women with breast cancer before and after their chemotherapy, as well as three months later. Stress was measured by daily hassles related to cancer and social support by marital status (MS) and perceived support from friends (Ps-fr). Blood was collected to measure innate immune markers (i.e., T cells, NK cells and neutrophils). Infections were evaluated using a semi-structured interview. Moderation, mediation and moderated mediation models were computed to test the hypotheses. Results: Higher stress at baseline was found to significantly predict a higher occurrence of infections during chemotherapy, but not three months later. The relationship between stress and infections was not significantly explained by any of the immune markers. The interaction between stress and social support was tested using MS alone and combined with Ps-fr. A protective effect of social support on the deleterious effect of stress on infectious risk was found. Single patients reporting lower Ps-fr showed the strongest association between stress and infections, while the weakest association was found in patients in a committed relationship with a higher level of Ps-fr. Conclusions: Women experiencing more stress before the beginning of chemotherapy would appear to be at a higher risk of developing infections during their treatment. Results of this study also suggest that this effect could be buffered by the presence of a romantic partner and by higher Ps-fr

Insomnia, immunity, and infections in cancer patients : results from a longitudinal study

Background: Insomnia is very common in cancer patients receiving chemotherapy. Poor sleep is associated with immune alterations but the actual impact on health resulting from such immune changes has rarely been studied. The aim of this study was to evaluate, in women treated with chemotherapy for breast or gynecological cancer, the relationships between insomnia, immunity, and the occurrence of infections. Method: Fifty-two patients were assessed before chemotherapy (Time [T]1), on 4 occasions during the first 2 cycles of chemotherapy (i.e., on immunosuppression and recovery weeks; T2–T5), at posttreatment (T6), and at 3-month (T7) and 6-month (T8) follow-ups. A clinical interview was administered to assess insomnia (Insomnia Interview Schedule) and the occurrence of infections. Patients were categorized into 1 of these 3 subgroups on the basis of the insomnia interview at T1: good sleepers (GS), insomnia symptoms (SX), and insomnia syndrome (SYN). Finally, blood samples were collected at each time point (T1–T8) to measure several immune parameters (e.g., neutrophils, lymphocytes). Results: Mixed-model analyses of covariance revealed that SYN patients at T1 had significantly lower counts of some blood cells after chemotherapy (T6) as compared to GS (i.e., total white blood cells and neutrophils) and as compared to GS and SX patients (i.e., total lymphocytes, CD3+ and CD4+ cells). At T8, SYN patients at T1 showed significantly lower lymphocytes, CD3+ and CD4+ counts as compared to SX patients. Finally, SYN patients at T1 were at a significantly higher risk of reporting infectious episodes at T5 as compared to SX patients. Conclusions: Although replication is warranted, these results suggest that prechemotherapy insomnia may potentiate the vulnerability to show immune alterations and develop infections due to chemotherapy during the cancer care trajectory. Overall, they further emphasize the need to provide effective treatments for sleep difficulties in patients undergoing chemotherapy