J Korean Med Sci.  2023 Aug;38(31):e236. 10.3346/jkms.2023.38.e236.

Cancer-Related Dysfunctional Beliefs About Sleep Mediate the Influence of Sleep Disturbance on Fear of Progression Among Patients With Surgically Resected Lung Cancer

• Kim H
• Ji W
• Lee JW
• Jo MW
• Yun SC
• Lee SW
• Choi CM
• Lee GD
• Lee HJ
• Cho E
• Lee Y
• Chung S

• KMID: 2544955
• DOI: http://doi.org/10.3346/jkms.2023.38.e236

Abstract

Background
Lung cancer is associated with significant psychological distress, including fear of progression (FoP). Because insomnia and depression are highly prevalent and associated with FoP, we examined the association between FoP, insomnia, and depression in cancer patients. Furthermore, we tested the mediation effect of cancer-related dysfunctional beliefs about sleep (C-DBS) on this association.
Methods
We analyzed data collected from patients with surgically resected non-small cell lung cancer from a single-center randomized controlled study investigating digital healthcare applications. Baseline demographic and clinical variables were collected. In addition, selfreported questionnaires including the Fear of Progression Questionnaire-Short Form, Patients Health Questionnaire-9 items (PHQ-9), Insomnia Severity Index, and C-DBS were administered.
Results
Among the 320 enrolled patients with lung cancer, a regression model showed that FoP was predicted by age (β = −0.13, P = 0.007), PHQ-9 (β = 0.35, P < 0.001), and C-DBS (β = 0.28, P < 0.001). Insomnia did not directly influence FoP, but C-DBS mediated the association. Depression directly influenced FoP, but C-DBS did not mediate this association.
Conclusion
Among patients with surgically resected lung cancer, C-DBS mediated the effects of severity of insomnia on FoP. Depression directly influenced FoP, but C-DBS did not influence this association. To reduce FoP among patients with lung cancer, C-DBS should be addressed in the cognitive behavioral therapy module.

Keyword

Fear of Progression; Insomnia; Lung Cancer; Psychological Distress

Figure

• 

  Fig. 1 Mediation model showing the pathway from the effect of depression or insomnia (independent variables) on the fear of disease progression (outcome) through cancer-related dysfunctional beliefs about sleep (mediator).**P < 0.01.

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