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Padjadjaran of Nursing Journal

Review

Vol. 10 No. 3 (2022): Jurnal Keperawatan Padjadjaran

Sleep disorder among patients with breast cancer: A concept analysis

  • Nur Aini+
  • Fitria Endah Janitra
  • Anggi Lukman Wicaksana
  • Dang Thi Thuy My
  • Nguyen Van Trung
DOI
https://doi.org/10.24198/jkp.v10i3.2056
Submitted
July 25, 2022
Published
2022-12-31

Abstract

Background: Sleep disorders are a long-term issue for breast cancer survivors (BCS). Sleep disorders are among the top five most bothersome lasting difficulties in BCS, and they have a greater risk of sleep disorders than healthy persons and other cancer patients. Failure to understand sleep disorders in breast cancer patients causes nurses to be unable to give interventions appropriately.Purpose: To clarify the definition of sleep disorders in breast cancer survivors.Method: We comprehensively searched electronic databases from CINAHL, PubMed, and Ovid-MEDLINE. We used the eight steps from Walker and Avant to conduct a concept analysis. This approach was chosen because it gives a philosophical understanding of the concept using linguistic philosophy techniques. Model case and other cases were provided to give a conceptual definition of sleep disorders.Results: Finally, 62 studies were included. We found five antecedents of sleep disorder in breast cancer patients: psychological and emotional stress, physical symptoms, cancer treatment, lack of social support, and sociodemographic factors. This study found four common attributes of sleep disorders 1). abnormal sleep pattern, 2). troubling complaint, 3). persistent complaint, and 4). sleep difficulty. Finally, we found a reduction in quality of life as consequence of sleep disorder in breast cancer patients.Conclusion: Sleep disorders in breast cancer need attention and must be integrated into regular palliative care practices.

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References

  1. Accortt, E. E., Bower, J. E., Stanton, A. L., & Ganz, P. A. (2015). Depression and vasomotor symptoms in young breast cancer survivors: The mediating role of sleep disturbance. Archives of Women's Mental Health, 18(3), 565-568. https://doi.org/10.1007/s00737-015-0504-5
  2. Aggeli, P., Fasoi, G., Zartaloudi, A., Kontzoglou, K., Kontos, M., Konstantinidis, T., Kalemikerakis, I., & Govina, O. (2021). Posttreatment anxiety, depression, sleep disorders, and associated factors in women who survive breast cancer. Asia Pac J Oncol Nurs, 8(2), 147-155. https://doi.org/10.4103/apjon.apjon_65_20
  3. American Psychological Association. (2013). The diagnostic and statistical manual of mental disorders (DSM-5) (Fifth ed.). Washington DC: American Psychiatric Publishing.
  4. Arraras., J. I., Juan Illarramendi, J., de la Cruz, S., Asin, G., Manterola, A., Ibanez, B., Salgado, E., Cambra, K., Zarandona, U., Angel Dominguez, M., & Vera, R. (2016). Quality of life in long-term premenopausal early-stage breast cancer survivors from Spain, effects of surgery and time since surgery. J Buon, 21(5), 1090-1098. https://pubmed.ncbi.nlm.nih.gov/27837609/
  5. Barre, P. V., Padmaja, G., Rana, S., & Tiamongla. (2018). Stress and quality of life in cancer patients: Medical and psychological intervention. Indian J Psychol Med, 40(3), 232-238. https://doi.org/10.4103/ijpsym.Ijpsym_512_17
  6. Berger, A. M., Kupzyk, K. A., Djalilova, D. M., & Cowan, K. H. (2019). Breast cancer collaborative registry informs understanding of factors predicting sleep quality. Support Care Cancer, 27(4), 1365-1373. https://doi.org/10.1007/s00520-018-4417-5
  7. Chang, W.-P., & Chang, Y.-P. (2020). Meta-analysis of changes in sleep quality of women with breast cancer before and after therapy. Breast Care, 15(3), 227-235. https://doi.org/10.1159/000502943
  8. Chean., D. C., Kuo Zang, W., Lim, M., & Zulkefle, N. (2016). Health related quality of life (HRQoL) among breast cancer patients receiving chemotherapy in hospital melaka: Single centre experience. Asian Pac J Cancer Prev, 17(12), 5121-5126. https://doi.org/10.22034/APJCP.2016.17.12.5121
  9. DeLaune, S. C., & Ladner, P. K. (2011). Fundamentals of nursing: Standards and practice (Fourth Edition ed.). USA: Delmar Cengage Learning.
  10. Fiorentino, L., Rissling, M., Liu, L., & Ancoli-Israel, S. (2011). The symptom cluster of sleep, fatigue and depressive symptoms in breast cancer patients: Severity of the problem and treatment options. Drug Discov Today Dis Models, 8(4), 167-173. https://doi.org/10.1016/j.ddmod.2011.05.001
  11. Garland, S. N., Barg, F. K., Cakouros, B., Gehrman, P., DuHamel, K. N., & Mao, J. J. (2019). A qualitative examination of the factors related to the development and maintenance of insomnia in cancer survivors. Palliat Support Care, 17(2), 221-226. https://doi.org/10.1017/s1478951518000135
  12. Gavric, Z., & Vukovic-Kostic, Z. (2016). Assessment of quality of life of women with breast cancer. Glob J Health Sci, 8(9), 52792. https://doi.org/10.5539/gjhs.v8n9p1
  13. Giddens, J. F. (2021). Concepts for nursing practice (T. Edition, Ed.). Canada: Elsevier.
  14. Hajj, A., Hachem, R., Khoury, R., Hallit, S., El, J. B., Nasr, F., El Karak, F., Chahine, G., Kattan, J., & Rabbaa Khabbaz, L. (2021). Clinical and genetic factors associated with anxiety and depression in breast cancer patients: A cross-sectional study. BMC Cancer, 21(1), 872. https://doi.org/10.1186/s12885-021-08615-9
  15. Ho, S.-Y., KJ, R., & Parent J, e. a. (2015). A longitudinal study of depression, fatigue, and sleep disturbances as a symptom cluster in women with breast cancer. J Pain Symptom Manage, 49, 707-715. https://doi.org/10.1002/bjs.9766
  16. Huda, N., Shaw, M. K., & Chang, H. J. (2021). Psychological distress among patients with advanced cancer: A conceptual analysis. Cancer Nurs. https://doi.org/10.1097/NCC.0000000000000940
  17. Imanian, M., Imanian, M., & Karimyar, M. (2019). Sleep quality and fatigue among breast cancer patients undergoing chemotherapy. International Journal of Hematology-Oncology and Stem Cell Research, 13(4), 196-200. https://doi.org/10.18502/ijhoscr.v13i4.1894
  18. Irwin, M. R. (2018). Innovation in the treatment of insomnia in breast cancer survivors. Journal of the National Cancer Institute, 110(8), 799-800. https://doi.org/10.1093/jnci/djy006
  19. Irwin, M. R., Olmstead, R. E., Ganz, P. A., & Haque, R. (2013). Sleep disturbance, inflammation and depression risk in cancer survivors. Brain, Behavior, and Immunity, 30, S58-S67. https://doi.org/10.1016/j.bbi.2012.05.002
  20. Ivanauskiene, R., Padaiga, Ž., Šimoliunien, R., Smailyte, G., & Domeikiene, A. (2014). Well-being of newly diagnosed women with breast cancer: Which factors matter more?. Supportive Care in Cancer, 22(2), 519-526. https://doi.org/10.1007/s00520-013-2005-2
  21. Izci, F., Özdem, G., İlgün, A. S., Ağaçayak, F., Duymaz, T., Erdoğan, Z., Alço, G., Elbüken, F., Öztürk, A., Ordu, Ç., Ateşal, K. C., Doğan, Ö. İ., Aktepe, F., & Özmen, V. (2020). Pre-treatment and post-treatment anxiety, depression, sleep and sexual function levels in patients with breast cancer. Eur J Breast Health 16(3), 219-225. https://doi.org/10.5152/ejbh.2020.5259
  22. Jacob, L., Scholten, P. C., Kostev, K., & Kalder, M. (2018). Association between sleep disorders and the presence of breast cancer metastases in gynecological practices in Germany: A case control study of 11,412 women. Breast Cancer Research and Treatment, 171(2), 443-448. https://doi.org/10.1007/s10549-018-4831-x
  23. Jain, S., Boyd, C., Fiorentino, L., Khorsan, R., & Crawford, C. (2015). Are there efficacious treatments for treating the fatigue-sleep disturbance-depression symptom cluster in breast cancer patients? A rapid evidence assessment of the literature (REAL©). Breast Cancer: Targets and Therapy, 7, 267-291. https://doi.org/10.2147/BCTT.S25014
  24. Jang, M. K., Han, J., Kim, S. H., Ko, Y. H., Kim, S. Y., & Kim, S. (2021). Comparison of fatigue and fatigability correlates in Korean breast cancer survivors and differences in associations with anxiety, depression, sleep disturbance, and endocrine symptoms: A randomized controlled trial. BMC Cancer, 21(1), Article 855. https://doi.org/10.1186/s12885-021-08575-0
  25. Jefford, M., Ward, A. C., Lisy, K., Lacey, K., Emery, J. D., Glaser, A. W., Cross, H., Krishnasamy, M., McLachlan, S. A., & Bishop, J. (2017). Patient-reported outcomes in cancer survivors: A population-wide cross-sectional study. Supportive Care in Cancer, 25(10), 3171-3179. https://doi.org/10.1007/s00520-017-3725-5
  26. Jung, D., Lee, K. M., Kim, W. H., Lee, J. Y., Kim, T. Y., Im, S. A., Lee, K. H., Spiegel, D., & Hahm, B. J. (2016). Longitudinal association of poor sleep quality with chemotherapy-induced nausea and vomiting in patients with breast cancer. Psychosomatic Medicine, 78(8), 959-965. https://doi.org/10.1097/PSY.0000000000000372
  27. Jung, M. S., Visovatti, M. A., Sohn, E. H., Yoo, H. S., Kim, M., Kim, J. R., & Lee, J. S. (2020). Impact of changes in perceived attentional function on postsurgical health-related quality of life in breast cancer patients awaiting adjuvant treatment. Health and Quality of Life Outcomes, 18(1). https://doi.org/10.1186/s12955-020-01485-y
  28. Kamen, C., Garland, S. N., Heckler, C. E., Peoples, A. R., Kleckner, I. R., Cole, C. L., Perlis, M. L., Morrow, G. R., Mustian, K. M., & Roscoe, J. A. (2019). Social support, insomnia, and adherence to cognitive behavioral therapy for insomnia after cancer treatment. Behavioral Sleep Medicine, 17(1), 70-80. https://doi.org/10.1080/15402002.2016.1276019
  29. Kashani, F., & Kashani, P. (2014). The effect of massage therapy on the quality of sleep in breast cancer patients. Iran J Nurs Midwifery Res, 19(2), 113-118. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020018/pdf/IJNMR-19-113.pdf
  30. Khoramirad, A., Mousavi, M., Dadkhahtehrani, T., & Pourmarzi, D. (2015). Relationship between sleep quality and spiritual well-being/religious activities in muslim women with breast cancer. Journal of Religion and Health, 54(6), 2276-2285. https://doi.org/10.1007/s10943-014-9978-0
  31. Kim, J. H., Paik, H. J., Jung, Y. J., Kim, D. I., Jo, H. J., Lee, S., & Kim, H. Y. (2019). A prospective longitudinal study about change of sleep, anxiety, depression, and quality of life in each step of breast cancer patients. Oncology 97(4), 245-253. https://doi.org/10.1159/000500724
  32. Kwak, A., Jacobs, J., Haggett, D., Jimenez, R., & Peppercorn, J. (2020). Evaluation and management of insomnia in women with breast cancer. Breast Cancer Research and Treatment, 181(2), 269-277. https://doi.org/10.1007/s10549-020-05635-0
  33. Lai, H. L., Chen, C. I., Lu, C. Y., Yao, Y. C., & Huang, C. Y. (2019). Relationships among personality, coping, and concurrent health-related quality of life in women with breast cancer. Breast Cancer, 26(5), 544-551. https://doi.org/10.1007/s12282-019-00954-7
  34. Lai, H. L., Hung, C. M., Chen, C. I., Shih, M. L., & Huang, C. Y. (2018). Resilience and coping styles as predictors of health outcomes in breast cancer patients: A structural equation modelling analysis. European Journal of Cancer Care, 29(1), e13161. https://doi.org/10.1111/ecc.13161
  35. Lee, J., Youn, S., Kim, C., Yeo, S., & Chung, S. (2019). The influence of sleep disturbance and cognitive emotion regulation strategies on depressive symptoms in breast cancer patients. Sleep Medicine Research, 10(1), 36-42. https://doi.org/10.17241/smr.2019.00388
  36. LeVan, T. D., Xiao, P., Kumar, G., Kupzyk, K., Qiu, F., Klinkebiel, D., Eudy, J., Cowan, K., & Berger, A. M. (2019). Genetic variants in circadian rhythm genes and self-reported sleep quality in women with breast cancer. J Circadian Rhythms, 17, 6. https://doi.org/10.5334/jcr.184
  37. Li, W., Kwok, C. C., Chan, D. C., Ho, A. W., Ho, C. S., Zhang, J., Wing, Y. K., Wang, F., & Tse, L. A. (2018). Disruption of sleep, sleep-wake activity rhythm, and nocturnal melatonin production in breast cancer patients undergoing adjuvant chemotherapy: Prospective cohort study. Sleep Med, 55, 14-21. https://doi.org/10.1016/j.sleep.2018.11.022
  38. Liang, Z. Z., Zhang, Y. X., Lin, Y., Liu, Q., Xie, X. M., Tang, L. Y., & Ren, Z. F. (2018). Joint effects of multiple sleep characteristics on breast cancer progression by menopausal status. Sleep Med, 54, 153-158. https://doi.org/10.1016/j.sleep.2018.10.025
  39. Lima, S. M., Kehm, R. D., & Terry, M. B. (2021). Global breast cancer incidence and mortality trends by region, age-groups, and fertility patterns. EClinicalMedicine, 38, 100985. https://doi.org/10.1016/j.eclinm.2021.100985
  40. Liou, K. T., Ahles, T. A., Garland, S. N., Susan Li, Q., Bao, T., Li, Y., Root, J. C., & Mao, J. J. (2019). The relationship between insomnia and cognitive impairment in breast cancer survivors. JNCI Cancer Spectrum, 3(3), Article pkz041. https://doi.org/10.1093/jncics/pkz041
  41. Lipschitz, D. L., Kuhn, R., Kinney, A. Y., Grewen, K., Donaldson, G. W., & Nakamura, Y. (2015). An exploratory study of the effects of mind-body interventions targeting sleep on salivary oxytocin levels in cancer survivors. Integrative Cancer Therapies, 14(4), 366-380. https://doi.org/10.1177/1534735415580675
  42. Liu, L., Mills, P. J., Rissling, M., Fiorentino, L., Natarajan, L., Dimsdale, J. E., Sadler, G. R., Parker, B. A., & Ancoli-Israel, S. (2012). Fatigue and sleep quality are associated with changes in inflammatory markers in breast cancer patients undergoing chemotherapy. Brain Behav Immun, 26(5), 706-713. https://doi.org/10.1016/j.bbi.2012.02.001
  43. Liu, W., Schaffer, L., Herrs, N., Chollet, C., & Taylor, S. (2015). Improved sleep after Qigong exercise in breast cancer survivors: A pilot study. Asia Pac J Oncol Nurs, 2(4), 232-239. https://doi.org/10.4103/2347-5625.170537
  44. Lourenço, A., Dantas, A. A. G., de Souza, J. C., Araujo, C. M., Araujo, D. N., Lima, I. N. D. F., & Dantas, D. S. (2020). Sleep quality is associated with disability and quality of life in breast cancer survivors: A cross-sectional pilot study. European Journal of Cancer Care, e13339. https://doi.org/10.1111/ecc.13339
  45. Lyon, D., Kelly, D., Walter, J., Bear, H., Thacker, L., & Elswick, R. K. (2015). Randomized sham controlled trial of cranial microcurrent stimulation for symptoms of depression, anxiety, pain, fatigue and sleep disturbances in women receiving chemotherapy for early-stage breast cancer. Springerplus, 4, 369. https://doi.org/10.1186/s40064-015-1151-z
  46. Mansano-Schlosser, T. C., Ceolim, M. F., & Valerio, T. D. (2017). Poor sleep quality, depression and hope before breast cancer surgery. Applied Nursing Research: ANR, 34, 7-11. https://doi.org/10.1016/j.apnr.2016.11.010
  47. Marion, L. P., Ivers, H., & Savard, J. (2019). Feasibility of a preventive intervention for insomnia in women with breast cancer receiving chemotherapy. Behavioral Sleep Medicine, 19(1), 70-82. https://doi.org/10.1080/15402002.2019.1707203
  48. Marshall, S. A., Yang, C. C., Ping, Q., Zhao, M., Avis, N. E., & Ip, E. H. (2016). Symptom clusters in women with breast cancer: An analysis of data from social media and a research study. Quality of Life Research, 25(3), 547-557. https://doi.org/10.1007/s11136-015-1156-7
  49. Medic, G., Wille, M., & Hemels, M. E. (2017). Short and long term health consequences of sleep disruption. Nat Sci Sleep, 9, 151-161. https://doi.org/10.2147/NSS.S134864
  50. Mercadante, S., Aielli, F., Adile, C., Ferrera, P., Valle, A., Cartoni, C., Pizzuto, M., Caruselli, A., Parsi, R., Cortegiani, A., Masedu, F., Valenti, M., Ficorella, C., & Porzio, G. (2015). Sleep disturbances in patients with advanced cancer in different palliative care settings. Journal of Pain and Symptom Management, 50(6), 786-792. https://doi.org/10.1016/j.jpainsymman.2015.06.018
  51. Molassiotis, A., Yates, P., Li, Q., So, W. K. W., Pongthavornkamol, K., Pittayapan, P., Komatsu, H., Thandar, M., Li, M. S., Titus Chacko, S., Lopez, V., Butcon, J., Wyld, D., Chan, R. J., Doolan, M., Litam, M. E., Onofre, R., Lluch, C., Nacion, R., . . . Si, S. Y. H. (2017). Mapping unmet supportive care needs, quality-of-life perceptions and current symptoms in cancer survivors across the Asia-Pacific region: Results from the international STEP study. Annals of Oncology, 28(10), 2552-2558. https://doi.org/10.1093/annonc/mdx350
  52. Otte, J. L., Davis, L., Carpenter, J. S., Krier, C., Skaar, T. C., Rand, K. L., Weaver, M., Landis, C., Chernyak, Y., & Manchanda, S. (2016). Sleep disorders in breast cancer survivors. Supportive Care in Cancer, 24(10), 4197-4205. https://doi.org/10.1007/s00520-016-3247-6
  53. Overcash, J., Tan, A., Patel, K., & Noonan, A. M. (2018). Factors associated with poor sleep in older women diagnosed with breast cancer. Oncology Nursing Forum, 45(3), 359-371. https://doi.org/10.1188/18.ONF.359-371
  54. Palesh, O., Aldridge-Gerry, A., Ulusakarya, A., Ortiz-Tudela, E., Capuron, L., & Innominato, P. F. (2013). Sleep disruption in breast cancer patients and survivors. JNCCN Journal of the National Comprehensive Cancer Network, 11(12), 1523-5930. https://doi.org/10.6004/jnccn.2013.0179
  55. Palesh, O., Scheiber, C., Kesler, S., Mustian, K., Koopman, C., & Schapira, L. (2018). Management of side effects during and post-treatment in breast cancer survivors. Breast Journal, 24(2), 167-175. https://doi.org/10.1111/tbj.12862
  56. Patel, S. R., Zhu, X., Storfer-Isser, A., Mehra, R., Jenny, N. S., Tracy, R., & Redline, S. (2009). Sleep duration and biomarkers of inflammation. Sleep, 32(2). https://doi.org/10.1093/sleep/32.2.200
  57. Peate, M., Saunders, C., Cohen, P., & Hickey, M. (2021). Who is managing menopausal symptoms, sexual problems, mood and sleep disturbance after breast cancer and is it working? Findings from a large community-based survey of breast cancer survivors. Breast Cancer Research and Treatment, 187(2), 427-435. https://doi.org/10.1007/s10549-021-06117-7
  58. Pedraza-Flechas, A. M., Lope, V., Moreo, P., Ascunce, N., Miranda-García, J., Vidal, C., Sánchez-Contador, C., Santamariña, C., Pedraz-Pingarrón, C., Llobet, R., Aragonés, N., Salas-Trejo, D., Pollán, M., & Pérez-Gómez, B. (2017). Sleep patterns, sleep disorders and mammographic density in Spanish women: The DDM-Spain/var-DDM study. Maturitas, 99, 105-108. https://doi.org/10.1016/j.maturitas.2017.02.015
  59. Phipps, A. I., Bhatti, P., Neuhouser, M. L., Chen, C., Crane, T. E., Kroenke, C. H., Ochs-Balcom, H., Rissling, M., Snively, B. M., Stefanick, M. L., Treggiari, M. M., & Watson, N. F. (2016). Pre-diagnostic sleep duration and sleep quality in relation to subsequent cancer survival. J Clin Sleep Med, 12(4), 495-503. https://doi.org/10.5664/jcsm.5674
  60. Pinto, S., Fumincelli, L., Mazzo, A., Caldeira, S., & Martins, J. C. (2017). Comfort, well-being and quality of life: Discussion of the differences and similarities among the concepts. Porto Biomed J, 2(1), 6-12. https://doi.org/10.1016/j.pbj.2016.11.003
  61. Putri, D. S. R., & Makiyah, S. N. N. (2021). Factors affecting sleep quality of breast cancer patients with chemotherapy. Open Access Maced J Med Sci, 9(T4), 130-136. https://doi.org/10.3889/oamjms.2021.5816
  62. Rades, D., Narvaez, C. A., Dziggel, L., Tvilsted, S., & Kjaer, T. W. (2021). Sleep disorders in patients with breast cancer prior to a course of radiotherapy prevalence and risk factors. Anticancer research, 41(5), 2489-2494. https://doi.org/10.21873/ANTICANRES.15026
  63. Reynolds-Cowie, P., & Fleming, L. (2021). Living with persistent insomnia after cancer: A qualitative analysis of impact and management. Br J Health Psychol, 26(1), 33-49. https://doi.org/10.1111/bjhp.12446
  64. Rumble, M. E., Keefe, F. J., Edinger, J. D., Affleck, G., Marcom, P. K., & Shaw, H. S. (2010). Contribution of cancer symptoms, dysfunctional sleep related thoughts, and sleep inhibitory behaviors to the insomnia process in breast cancer survivors: A daily process analysis. Sleep, 33(11), 1501-1509. https://doi.org/10.1093/sleep/33.11.1501
  65. Schreier, A. M., Johnson, L. A., Vohra, N. A., Muzaffar, M., & Kyle, B. (2019). Post-treatment symptoms of pain, anxiety, sleep disturbance, and fatigue in breast cancer survivors. Pain Management Nursing 20(2), 146-151. https://doi.org/10.1016/j.pmn.2018.09.005
  66. Strollo, S. E., Fallon, E. A., Gapstur, S. M., & Smith, T. G. (2020). Cancer-related problems, sleep quality, and sleep disturbance among long-term cancer survivors at 9-years post diagnosis. Sleep Medicine, 65, 177-185. https://doi.org/10.1016/j.sleep.2019.10.008
  67. Tag Eldin, E. S., Younis, S. G., Aziz, L., Eldin, A. T., & Erfan, S. T. (2019). Evaluation of sleep pattern disorders in breast cancer patients receiving adjuvant treatment (chemotherapy and/or radiotherapy) using polysomnography. J Buon, 24(2), 529-534. https://pubmed.ncbi.nlm.nih.gov/31128001/
  68. Tejada, M., Viele, C., Kober, K. M., Cooper, B. A., Paul, S. M., Dunn, L. B., Hammer, M. J., Wright, F., Conley, Y. P., Levine, J. D., & Miaskowski, C. (2019). Identification of subgroups of chemotherapy patients with distinct sleep disturbance profiles and associated co-occurring symptoms. Sleep, 42(10). https://doi.org/10.1093/sleep/zsz151
  69. Van Dyk, K., Joffe, H., & Carroll, J. E. (2021). Sleep and endocrine therapy in breast cancer. Current Opinion in Endocrine and Metabolic Research, 18, 165-170. https://doi.org/10.1016/j.coemr.2021.03.007
  70. Vin-Raviv, N., Akinyemiju, T. F., Galea, S., & Bovbjerg, D. H. (2018). Sleep disorder diagnoses and clinical outcomes among hospitalized breast cancer patients: A nationwide inpatient sample study. Supportive Care in Cancer, 26(6), 1833-1840. https://doi.org/10.1007/s00520-017-4012-1
  71. Vincent, A. J., Ranasinha, S., Sayakhot, P., Mansfield, D., & Teede, H. J. (2014). Sleep difficulty mediates effects of vasomotor symptoms on mood in younger breast cancer survivors. Climacteric, 17(5), 598-604. https://doi.org/10.3109/13697137.2014.900745
  72. Walker, L. O., & Avant, K. C. (2018). Strategies for theory construction in nursing (6th ed.). USA: Pearson Education Limited.
  73. Wang, M. L., Liu, J. E., Su, Y. L., & Xue, C. C. (2016). Experiences and insomnia-associated factors in Chinese breast cancer survivors: A qualitative study. Journal of Clinical Nursing, 25(13-14), 1923-1930. https://doi.org/10.1111/jocn.13208
  74. Weng, Y. P., Hong, R. M., Chen, V. C., Tsai, C. J., Yeh, D. C., & Fang, Y. H. (2021). Sleep quality and related factors in patients with breast cancer: A cross-sectional study in Taiwan. Cancer Manag Res, 13, 4725-4733. https://doi.org/10.2147/cmar.S302966
  75. World Health Organization. (2021). Breast cancer. Retrieved March, 26 2021 from https://www.who.int/news-room/fact-sheets/detail/breast-cancer.
  76. Wu, I. H. C., Tsai, W., McNeill, L. H., & Lu, Q. (2020). The associations of self-stigma, social constraints, and sleep among Chinese American breast cancer survivors. Supportive Care in Cancer, 28(8), 3935-3944. https://doi.org/10.1007/s00520-019-05233-x
  77. Yeung, N. C. Y., Ramirez, J., & Lu, Q. (2017). Perceived stress as a mediator between social constraints and sleep quality among Chinese American breast cancer survivors. Supportive care in cancer, 25(7), 2249-2257. https://doi.org/10.1007/s00520-017-3632-9
  78. Zhu, B., Vincent, C., Kapella, M. C., Quinn, L., Collins, E. G., Ruggiero, L., Park, C., & Fritschi, C. (2018). Sleep disturbance in people with diabetes: A concept analysis. J Clin Nurs, 27(1-2), e50-e60. https://doi.org/10.1111/jocn.14010