Sleep Quality and Associated Factors Among Adult Cancer Patients Under Treatment at Oncology Units in Amhara Region, Ethiopia

Figures & data

Table 1 Socio-Demographic Characteristics of Study Participants Attending Oncology Units in Amhara Region Hospitals, 2021 (n = 410)

Variables		Total n (%)	Sleep Quality		X^2 value	P value
			Poor n (%)	Good n (%)
Sex	Male	153 (37.3)	97 (33.1)	56 (47.9)	7.79	0.005
	Female	257 (62.7)	196 (66.9)	61 (52.1)
Age (year)	20–34	113 (27.6)	64 (21.8)	49 (41.9)	29.21	<0.001
	35–50	182 (44.4)	127 (43.3)	55 (47.0)
	50–64	76 (18.5)	67 (22.9)	9 (7.7)
	≥65	39 (9.5)	35 (11.9)	4 (3.4)
Residence	Rural	216 (52.7)	162 (55.3)	54 (46.2)	2.80	0.094
	Urban	194 (47.3)	131 (44.7)	63 (53.8)
Marital status	Married	275 (67)	200 (68.3)	75 (64.1)	19.82	<0.001
	Single	49 (12.0)	23 (7.8)	26 (22.2)
	Divorced	48 (11.7)	37 (12.6)	11 (9.4)
	Widowed/widower	38 (9.3)	33 (11.3)	5 (4.3)
Occupation	Unemployed	30 (7.3)	23 (7.8)	7 (6.0)	13.86	0.017
	Student	19 (4.6)	7 (2.4)	12 (10.3)
	Employed	55 (13.4)	37 (12.6)	18 (15.4)
	Farmer	101 (24.6)	74 (25.3)	27 (23.1)
	Merchant	81 (19.8)	57 (19.5)	24 (20.5)
	Housewife	124 (30.2)	95 (32.4)	29 (24.8)
Religion	Orthodox Christian	328 (80.0)	239 (81.6)	89 (76.1)	1.97	0.373
	Muslim	70 (17.1)	47 (16.0)	23 (19.7)
	Protestant	12 (2.9)	7 (2.4)	5 (4.3)
Educational status	Uneducated	210 (51.2)	156 (53.2)	54 (46.2)	2.94	0.400
	Completed elementary school	97 (23.7)	70 (23.9)	27 (23.1)
	Completed high school	62 (15.1)	40 (13.7)	22 (18.8)
	Higher education and above	41 (10.0)	27 (9.2)	14 (12.0)
Social support (OSSS)	Poor	216 (52.7)	183 (62.5)	33 (28.2)	40.26	<0.001
	Moderate	160 (39.0)	93 (31.7)	67 (57.3)
	Strong	34 (8.3)	17 (5.8)	17 (14.5)

Abbreviation: OSSS, Oslo Social Support Scale.

Table 2 Behavioral Characteristics of Study Participants Attending Oncology Units in Amhara Region Hospitals, 2021 (n = 410)

Variables		Total n (%)	Sleep Quality		X^2 value	P value
			Poor n (%)	Good n (%)
Coffee drinking	Never	91 (22.2	73 (24.9)	18 (15.4)	11.64	0.003
	Daily	226 (55.1)	146 (49.8)	80 (68.4)
	Occasionally	93 (22.7)	74 (25.3)	19 (16.2)
Alcohol drinking	Never drinker	150 (36.6)	106 (36.2)	44 (37.6)	4.16	0.125
	Former drinker	211 (51.5)	146 (49.8)	65 (55.6)
	Current drinker	49 (12.0)	41 (14.0)	8 (6.8)
Khat chewing	Never chewer	361 (88.0)	256 (87.4)	105 (89.7)	1.66	0.437
	Former chewer	35 (8.5)	28 (9.6)	7 (6.0)
	Current chewer	14 (3.4)	9 (3.1)	5 (4.3)
Cigarette smoking	Never smoker	389 (94.9)	282 (96.2)	107 (91.5)	4.01	0.135
	Former smoker	11 (2.7)	6 (2.0)	5 (4.3)
	Current smoker	10 (2.4)	5 (1.7)	5 (4.3)

Table 3 Clinical Characteristics of Study Participants Attending Oncology Units in Amhara Region Hospitals, 2021 (n = 410)

Variables		Total n (%)	Sleep Quality		X^2 value	P value
			Poor n (%)	Good n (%)
Type of cancer	Breast cancer	102 (24.9)	71 (24.2)	31 (26.5)	3.68	0.596
	Cancer of GIT	131 (32.0)	90 (30.7)	41 (35)
	Gynecological cancer	63 (15.4)	49 (16.7)	14 (12.0)
	Lymphomas	24 (5.9)	17 (5.8)	7 (6.0)
	Ca of skin, bone, and soft tissues	46 (11.2)	31 (10.6)	15 (12.8)
	Others^a	44 (10.7)	35 (11.9)	9 (7.7)
Treatment type	Chemotherapy	216 (52.7)	176 (60.1)	40 (34.2)	25.12	<0.001
	Surgery + Chemotherapy	145 (35.4)	83 (28.3)	62 (53.0)
	Others^b	49 (12.0)	34 (11.6)	15 (12.8)
Distant metastasis	No	292 (71.2)	183 (62.5)	109 (93.2)	38.46	<0.001
	Yes	118 (28.8)	110 (37.5)	8 (6.8)
Stage of cancer	Early stage	168 (41)	107 (36.5)	61 (52.1)	8.43	0.004
	Advanced	242 (59)	186 (63.5)	56 (47.9)
Comorbid disease	Absent	362 (88.3)	253 (86.3)	109 (93.2	3.756	0.053
	Present	48 (11.7)	40 (13.7)	8 (6.8)
Anxiety (HADS)	No	271 (66.1)	159 (54.3)	112 (95.7)	64.14	<0.001
	Yes	139 (33.9)	134 (45.7)	5 (4.3)
Depression (HADS)	No	274 (66.8)	164 (56.0)	110 (94.0)	54.59	<0.001
	Yes	136 (33.2)	129 (44.0)	7 (6.0)
BMI	Underweight	122 (29.8)	87 (29.7)	35 (29.9)	0.573	0.751
	Normal weight	261 (63.7)	185 (63.1)	76 (65.0)
	Overweight	27 (6.6)	21 (7.2)	6 (5.1)
Performance status (ECOG)	Good	260 (63.4)	158 (53.9)	102 (87.2)	39.85	<0.001
	Poor	150 (36.6)	135 (46.1)	15 (12.8)
Time since diagnosis	≤ 6 month	271 (66.1)	179 (61.1)	92 (78.6)	11.48	0.001
	> 6 month	139 (33.9)	114 (38.9)	25 (21.4)
The duration of time between diagnosis and treatment (days)	≤ 28 days	260 (63.4)	178 (60.8)	82 (70.1)	3.14	0.076
	> 28 days	150 (36.6)	115 (39.2)	35 (29.9)

Notes: ^aOthers include (lung cancer, bladder cancer, prostatic cancer, sinonasal cancer, hepatocellular cancer, pharyngeal cancer, testicular cancer, nasopharyngeal cancer, thyroid cancer, laryngeal cancer, pancreatic cancer, and cancer of unknown). ^bOthers include (surgery + hormonal therapy, surgery + chemotherapy+ hormonal therapy, chemotherapy + radiotherapy, chemotherapy+ hormonal therapy).

Abbreviations: HADS, Hospital Anxiety and Depression Scale; BMI, body mass index; ECOG, Eastern Cooperative Oncology Group; GIT, gastrointestinal tract.

Table 4 Descriptive Statistics of Symptom Severity Points Among Patients with Cancer Attending Oncology Units in Amhara Region Hospitals, 2021 (n = 410)

MDASI Core Symptoms	Median	IQR (Q1-Q3)	% of No Symptom	% of Mild Symptom	% of Moderate to Severe Symptom
Pain	3	1–5	24.1	43.4	32.4
Fatigue	3	0–5	30.7	37.3	32.0
Nausea	1	0–5	46.1	22.9	31.0
Psychological distress	2	0–5	44.9	23.4	31.7
Shortness of breath	0	0–5	57.6	12.2	30.2
Difficulty of remembering	0	0–4	67.8	10.7	21.5
Lack of appetite	3	0–5	36.6	30.0	33.4
Drowsiness	0	0–3	57.3	23.7	19.0
Dry mouth	0	0–4	54.6	21.0	24.4
Feeling sad	1	0–5	47.8	20.0	32.2
Vomiting	0	0–5	57.8	14.6	27.6
Numbness	0	0–3	63.4	16.3	20.2

Abbreviations: IQR, interquartile range; MDASI, MD Anderson Symptom Inventory Q1, quartile 1; Q3, quartile 3.

Table 5 Descriptive Statistics of Component and Global Sleep Quality Index Score Among Patients with Cancer Attending Oncology Units in Amhara Region Hospitals, 2021 (n = 410)

Components of Sleep Quality	Median	IQR (Q1-Q3)	Minimum	Maximum
Subjective sleep quality	1	1–2	0	3
Sleep latency score	2	1–3	0	6
Sleep duration (hour)	8	6–8	2	12
Habitual sleep efficiency (%)	75.0	63.6–87.5	13.3	94.7
Sleep disturbance score	4	1–10	0	21
Medication use	0	0–0	0	3
Daytime dysfunction score	2	0–3	0	6
Global PSQI score	7	5–10	0	19

Abbreviations: IQR, interquartile range; Q1, quartile 1; Q3, quartile 3.

Table 6 Factors Associated with Poor Sleep Quality of Study Participants at Oncology Units in Amhara Region Hospitals, 2021

Characteristics	Crude Odds Ratio (95% C.I)	Adjusted Odds Ratio (95% C.I)
Depressive symptom
Yes	12.36 (5.57, 27.46)	2.86 (1.13, 7.23)*
No (reference)	–	–
Distant metastasis
Yes	8.19 (3.85, 17.44)	3.76 (1.59, 8.91)**
No (reference)	–	–
Age	1.06 (1.04, 1.08)	1.04 (1.01, 1.06)**
Severity of pain	1.78 (1.56, 2.04)	1.33 (1.11, 1.60)**
Psychological distress	1.77 (1.53, 2.05)	1.20 (0.98, 1.47)***
Lack of appetite	1.66 (1.47, 1.88)	1.17 (0.98, 1.39)***

Notes: Age, severity of pain, psychological distress, and lack of appetite were entered as continuous variables. *Indicates variables significant at a p-value less than 0.05. **Indicates variables significant at a p-value less than 0.01. ***Indicates variables significant at a p-value less than 0.1. NB: Since the step-wise backward LR method was used in the multiple logistic regression, only variables displayed at the final step were reported here.