Background/Objectives: Insomnia is associated with immune function. This study evaluated the association between insomnia and febrile neutropenia in women treated with adjuvant chemotherapy for breast cancer.Methods: This secondary analysis used data from the Canadian Cancer Trial Group MA.21 trial, which compared three chemotherapy regimens (CEF, EC/T dose-dense, or AC/T) in 2104 women with high-risk locoregional breast cancer. A total of 1731 patients completed the EORTC QLQ-C30 questionnaire. We compared “insomnia patients” with patients considered “good sleepers” based on the sleep item of this questionnaire. The primary endpoint was the occurrence of febrile neutropenia. Secondary endpoints were the occurrences of leucopenia and infection. Chemotherapy dose reduction was added as a secondary outcome in an unplanned analysis.Results: Patients with insomnia (16.3%) had a significantly higher rate of febrile neutropenia than good sleepers (12.2%;p= 0.01). After controlling for various confounders, the contribution of insomnia in explaining febrile neutropenia remained statistically significant (OR 1.45, 95% CI 1.07–1.97,p= 0.02). Chemotherapy dose reductions were significantly more frequent in patients with insomnia (30.6%) than in good sleepers (21.8%;p< 0.0001). The relationship remained significant in the multivariate analysis (OR 1.67, 95% CI 1.30–2.15,p< 0.0001).Conclusions: In the MA21 trial, insomnia was associated with febrile neutropenia. Furthermore, chemotherapy dose reductions were more common in women with insomnia. These results suggest that the role of insomnia in potential cancer outcomes needs to be confirmed in other studies, given the possible implication of dose reductions on the prognosis of women receiving chemotherapy for breast cancer.
背景/目的：失眠与免疫功能相关。本研究评估了接受乳腺癌辅助化疗的女性患者中失眠与发热性中性粒细胞减少症之间的关联。 方法：本二次分析采用加拿大癌症试验组MA.21试验数据，该试验在2104例高危局部区域乳腺癌患者中比较了三种化疗方案（CEF、EC/T剂量密集方案或AC/T）。共有1731例患者完成了EORTC QLQ-C30问卷。根据问卷中的睡眠条目，我们将"失眠患者"与"睡眠良好者"进行比较。主要终点为发热性中性粒细胞减少症的发生情况，次要终点包括白细胞减少症和感染的发生率。在非预设分析中增加了化疗剂量减少作为次要结局指标。 结果：失眠患者（16.3%）发热性中性粒细胞减少症发生率显著高于睡眠良好者（12.2%；p=0.01）。在控制多种混杂因素后，失眠对发热性中性粒细胞减少症的影响仍具有统计学意义（OR 1.45，95% CI 1.07–1.97，p=0.02）。失眠患者的化疗剂量减少发生率（30.6%）显著高于睡眠良好者（21.8%；p<0.0001），多变量分析中该关联仍保持显著（OR 1.67，95% CI 1.30–2.15，p<0.0001）。 结论：在MA21试验中，失眠与发热性中性粒细胞减少症相关。此外，失眠女性患者更常出现化疗剂量减少。鉴于剂量减少可能影响乳腺癌化疗患者的预后，这些结果表明失眠在潜在癌症结局中的作用需在其他研究中进一步验证。
肿瘤(癌症)患者之家