Over half of patients treated with immune checkpoint inhibitors experienced clinically relevant sleep disturbance, with poor performance status, advanced disease burden, and later-line therapy independently predicting impaired sleep.
Clinically relevant sleep disturbance was observed in more than half of metastatic cancer patients receiving immune checkpoint inhibitors.
The most affected Pittsburgh Sleep Quality Index components were sleep disturbance and daytime dysfunction.
ECOG performance status ≥ 1 was an independent predictor of sleep disturbance in multivariate analysis.
Receiving second-line or beyond ICI therapy was an independent predictor of sleep disturbance.
Having two or more metastatic sites was an independent predictor of sleep disturbance.
Receiving six or more ICI cycles was associated with sleep disturbance in univariate analysis but did not remain significant in multivariate analysis.
The study supports routine assessment of sleep quality in patients receiving immune checkpoint inhibitors.
This research studied sleep problems in 187 cancer patients with advanced or metastatic disease who were being treated with a type of immunotherapy called immune checkpoint inhibitors (ICIs). Using a validated questionnaire called the Pittsburgh Sleep Quality Index, researchers assessed patients' sleep quality at three months into their treatment. They found that more than half of patients (51.9%) had clinically meaningful sleep disturbances, with the most problematic areas being sleep disruption during the night and difficulty functioning during the day. The study identified three key factors that independently predicted worse sleep quality: having a poorer physical functioning status (measured by the ECOG scale), being on a second or later line of cancer treatment (indicating the cancer had progressed through prior therapies), and having cancer spread to two or more sites in the body. These findings suggest that patients with a greater overall burden of disease and those who are further along in their treatment journey are particularly vulnerable to sleep problems. This research suggests that sleep disturbance is a common and underappreciated issue for cancer patients on immunotherapy, and that clinicians should routinely screen for sleep problems—especially in patients with more advanced disease or reduced physical function. Identifying at-risk patients early could open the door to interventions that may improve quality of life during treatment.
Aktepe B, Ulasli T, Dama P, Unek I, Karaoglu A, Boztas M, et al.. (2025). Sleep Quality and Its Determinants Among Patients with Metastatic Cancer Treated with Immune Checkpoint Inhibitors: A Two-Center Cross-Sectional Study.. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina61122131