Female cancers, including breast and gynecological malignancies, are among the most prevalent oncological conditions worldwide. Advances in screening, diagnosis, and treatment have markedly improved survival, resulting in a growing population of female cancer survivors. Consequently, long-term health and quality of life have become essential aspects of comprehensive cancer care. Among survivorship issues, sleep disturbances—particularly insomnia—are highly prevalent and associated with adverse outcomes including mood and cognitive impairment, fatigue, immune and cardiometabolic dysregulation, and reduced adherence to therapy. Insomnia, defined as difficulty initiating or maintaining sleep or experiencing poor sleep quality with daytime impairment, affects 6–10% of the general population and is more common in women. In cancer survivors, poor sleep quality appears to be three times more frequent, reaching 62% in breast cancer survivors, although these data may be underestimated, especially for other cancer types, due to the small sample size and heterogeneity of the studies. The pathogenesis of insomnia in female cancer patients is multifactorial, involving cancer-related inflammation, hypothalamic–pituitary–adrenal axis dysregulation, neuroimmune alterations, treatment effects, psychological distress, and behavioral factors. Hormonal disruption plays a central role, as oncological treatments are often the cause of iatrogenic menopause, leading to vasomotor symptoms, mood and cognitive disturbances, sexual dysfunction, and genitourinary complaints, all contributing to sleep disruption. Importantly, estrogens and progesterone independently regulate sleep–wake pathways via central mechanisms, influencing sleep quality even in the absence of vasomotor symptoms. Management requires a multidisciplinary approach integrating oncology, gynecology, and sleep medicine. Cognitive Behavioral Therapy for Insomnia (CBT-I) is first-line, while pharmacologic options include benzodiazepines, Z-drugs, SSRIs/SNRIs, melatonin, or new medication like DORAs. Menopausal hormone therapy (MHT) should be considered for premature menopause management in selected women without contraindications, improving both vasomotor symptoms and sleep quality. Emerging neurokinin receptor (NK-R) antagonists show promise, and ongoing trials suggest significant potential even in breast cancer survivors.
女性癌症，包括乳腺及妇科恶性肿瘤，是全球范围内最为普遍的肿瘤类型之一。筛查、诊断和治疗手段的进步显著提高了患者生存率，使得女性癌症幸存者群体日益扩大。因此，长期健康状况与生活质量已成为肿瘤综合治疗中至关重要的组成部分。在癌症生存期问题中，睡眠障碍——尤其是失眠——极为常见，且与情绪认知障碍、疲劳、免疫及心脏代谢失调、治疗依从性下降等多种不良结局相关。失眠定义为入睡困难、睡眠维持障碍或睡眠质量低下并伴有日间功能受损，在普通人群中的发生率为6%-10%，且女性更为高发。在癌症幸存者中，睡眠质量不佳的发生率约为普通人群的三倍，乳腺癌幸存者中甚至高达62%；但由于样本量有限及研究异质性，这些数据可能存在低估，尤其对于其他癌症类型。女性癌症患者失眠的发病机制涉及多因素，包括癌症相关炎症、下丘脑-垂体-肾上腺轴失调、神经免疫改变、治疗副作用、心理压力及行为因素。激素紊乱在其中起核心作用，肿瘤治疗常导致医源性绝经，引发血管舒缩症状、情绪认知障碍、性功能障碍及泌尿生殖系统症状，这些均会干扰睡眠。值得注意的是，雌激素和孕激素通过中枢机制独立调节睡眠-觉醒通路，即使在没有血管舒缩症状的情况下仍会影响睡眠质量。临床管理需要肿瘤科、妇科与睡眠医学的多学科协作。失眠认知行为疗法（CBT-I）是一线治疗方案，药物选择包括苯二氮䓬类药物、Z-药物、SSRIs/SNRIs、褪黑素及食欲素受体拮抗剂等新型药物。对于无禁忌症的特定女性患者，可考虑采用绝经激素疗法（MHT）管理早发性绝经，以改善血管舒缩症状并提升睡眠质量。新兴的神经激肽受体拮抗剂显示出应用前景，正在进行的临床试验表明其在乳腺癌幸存者中亦具有显著潜力。
肿瘤(癌症)患者之家