Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

Background/Aim: Many patients with malignant gliomas are scheduled for radiochemotherapy, which may cause emotional distress associated with sleep problems. This study aimed to determine the prevalence of such sleep problems in these patients and identify risk factors. Patients and Methods: Fifty-seven patients scheduled for radiochemotherapy for grade II-IV gliomas were retrospectively investigated for pre-treatment sleep problems. Fifteen characteristics were evaluated including temporal relation to COVID-19 pandemic, age, gender, performance status, comorbidity, (family) history of malignancies, distress score, emotional problems, physical problems, practical problems, involved sites, glioma grade, upfront surgery, and corticosteroids. Results: Nineteen patients stated pre-treatment sleep problems (prevalence=66.7%). Significant associations with sleep problems were found for female gender (p=0.023), presence of emotional problems (p=0.006), and ≥4 physical problems (p<0.001). A trend was found for distress scores ≥5 (p=0.077). Conclusion: The prevalence of sleep problems was high. Risk factors were determined that can be used to identify patients who likely benefit from psychological support. According to the classification of the World Health Organization (WHO), the group of gliomas includes four grades (grades I to IV), of which grade IV tumors (glioblastoma multiforme) are the most aggressive lesions with a 5-year survival rate of about 5% (1-3). Neurosurgical resection should be performed whenever safely possible. In patients with grade III or IV gliomas, resection is generally followed by radiochemotherapy (4-6). This applies also to selected patients with grade II gliomas, mainly after incomplete resection. Assignment to a course of radiochemotherapy may cause significant distress for the patients who may be afraid particularly of the exposure to radiation and potential treatment-related adverse events (7-10). The distress may lead to sleep problems that can significantly impair the patients’ quality of life and require psychological support already prior to the start of radiochemotherapy (11-13). Therefore, the present study investigated the prevalence and potential risk factors of pre-treatment sleep problems in patients with grade II to IV gliomas assigned to radiochemotherapy. These data can contribute to the identification of patients who would likely benefit from psychological support beginning already prior to their course of radiochemotherapy.