Quality of Life Ql-01. Hyperarousal/hypervigilance in Patients with Brain Cancer Creates a Cycle of Sleep Disturbance and Daytime Sleepiness

INTRODUCTION: Cancer-related fatigue is the most frequently reported symptom of patients with cancer. The National Cancer Institute describes it as “an extreme tiredness, one that decreases a patient’s ability to function, causing them distress.” The National Comprehensive Cancer Network defines distress as “a continuum, ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and spiritual crisis.” Hyperarousal is defined here as a heightened state of psychological and physiological tension, and hypervigilance is a state of excessive wakefulness, watchfulness, and arousal. The loss of control, feelings of helplessness and hopelessness, and the unpredictability of brain cancer propel patients into a psychologically complex state. They fear exposure and embarrassment, secondary to their cognitive injuries, and loss of independence and dignity. METHODS: A search was conducted that included the databases OVID Medline, OVID Nursing, and the American Psychological Association’s PsycINFO for articles written about cancer symptom clusters, psychological comorbidities related to the diagnosis of brain cancer, and articles about cancer-related fatigue, daytime sleepiness, and insomnia. RESULTS: Some studies supported the theory that the hyperaroused/hypervigilant state related to the psychological comorbidities of depression, anxiety, and stress associated with being diagnosed with brain cancer disrupts patients’ Circadian rhythm and thus prohibits them from getting sufficient restorative sleep. Consequently, patients experience daytime sleepiness, which affects all physical and cognitive function and perpetuates the cycle of the psychological comorbidities and hyperaroused/hypervigilant state. CONCLUSION: I hypothesize that this continuous cycle is one of the major contributing factors to brain cancer-related fatigue and one of the most deleterious interferences with the health-related quality of life of patients with brain cancer.