Hypnotic Use for Sleep Disturbances in Breast Cancer: A Systematic Review

Aims: Sleep disturbances are common in patients with breast cancer. The aim of this systematic review was to present the literature on pharmacological interventions against sleep disturbances and use of hypnotics in patients with breast cancer. We wanted to study patients both in the perioperative period as well as when they were receiving oncological (medical) treatment.
Study Design: Systematic review.
Methodology: According to the PRISMA guidelines, a literature search was performed on May 10th 2012 in Pubmed and Embase. Primary outcomes were pharmacological interventions against sleep disturbances. No restriction on publication status was made. Only articles in English were included. Case reports and studies with less than ten patients were excluded.
Results: Five studies met the inclusion criteria and were included in the review. One study investigated pharmacological intervention in the perioperative period and showed that treatment with triazolam significantly improved sleep three consecutive nights after surgery. Two studies investigated patients undergoing endocrine oncological treatment. The studies showed that zolpidem combined with an SSRI/SNRI improved sleep in patients having hot flashes, and that hypnotics were prescribed significantly more often in patients undergoing endocrine treatment compared with healthy patients not receiving endocrine treatment. Two studies investigated patients receiving chemotherapy. The studies showed that hypnotics were prescribed to almost every second patient. Prior users of hypnotics and patients with a psychiatric diagnosis were more likely to take hypnotics during chemotherapy.
Conclusion: Sleep disturbances occur frequently in patients with breast cancer indicated by the high prevalence of hypnotic use. It therefore is of concern that only few clinical trials exist on pharmacological intervention against sleep disturbances in the different treatment time periods. At present, there is insufficient evidence to recommend one single pharmacological intervention in this patient group.