Researcher Calls on Others Worldwide to Join Efforts to Understand Role of Sleep in Pediatric Cancer

By Tom McLaughlin

Lauren Daniel recalls that, as a clinical psychologist working with pediatric cancer patients at the Children’s Hospital of Philadelphia (CHOP), she would often arrive in the mornings to do therapy sessions and find that her patients were still sleeping.

It was then difficult for her to sit down with them, she remembers, but the predicament was understandable, since they were frequently woken up throughout the night for a variety of reasons, including vital checks, to urinate, and to get pumps and other medical equipment serviced.

“For someone to wake them up during the day, it was torture for them,” says the assistant professor of psychology at Rutgers University–Camden. “They don’t want to talk to you at that point.”

Daniel’s understanding and concern would spark a career research interest in the sleep patterns of children with cancer and the connection to patients’ psychosocial health outcomes.

The Rutgers–Camden researcher is now leading an international team of sleep researchers to establish research priorities for better understanding the role of sleep in pediatric cancer. The team calls on other researchers to join them in their collaborative efforts in their paper, “A call to action for expanded sleep research in pediatric oncology: A position paper on behalf of the International Psycho-Oncology Society Pediatrics Special Interest Group,” in the journal Psycho-Oncology.

“We are excited to put the call out there,” says Daniel, who notes that three of the participating researchers spoke at the 2019 International Psycho-Oncology Society World Congress.

Daniel explains that the pediatric cancer population is thankfully small at any one center, so it is incredibly valuable for researchers to collaborate in pooling data across multiple centers.

The Rutgers–Camden researcher notes that research on adult cancer patients shows a bidirectional relationship linking negative health outcomes with disrupted sleep and circadian rhythms, as well as compelling evidence showing that improved sleep improves health outcomes in adults. However, she says, little is known about these effects on pediatric cancer patients.

“It is essential to increase our understanding because sleep and circadian rhythms are vital components of health and quality of life,” write the researchers in their paper. “In children without cancer, sleep and circadian disturbances respond well to intervention, suggesting that they may also be modifiable in children with cancer.”

In addition to Daniel’s work with the research group, she recently received a $50,000 grant from the New Jersey Commission on Cancer Research to lead the pilot program “Disrupted Sleep and its Association with Symptom Burden and Reduced Engagement in Supportive Care in Pediatric Stem Cell Transplant Patients.”

Daniel will work with medical professionals and psychologists on the study at CHOP to collect data on an intervention to improve sleep in pediatric cancer patients undergoing stem cell transplants.

Lauren Daniel

“I am grateful for the opportunity to branch out into a new area of research and continue the work that we are doing for patients at CHOP,” says Daniel.

The researchers are currently studying how sleep affects the day-to-day symptoms and coping abilities of patients in the peritransplant period, the early stage when cells are starting to graft and grow. The researchers ultimately hope to determine what they can alter to improve sleep patterns of patients – and encourage changes in nursing practices accordingly – in order to improve psychosocial outcomes.

“Even if we can make modest gains, we hope to improve the psychosocial health outcomes in addition to medical outcomes for patients,” says Daniel, who adds that there isn’t a lot of psychosocial research on these patients, in part because these children are already going through intensive research.

Daniel notes an earlier study found that patients need to be woken up an average of 12 times per night.

In their forthcoming study, says the Rutgers–Camden researcher, pediatric patients will wear a wristwatch to measure their motion for a two-week period after receiving transplant cells and be asked to complete daily surveys on what their sleep experience was like the night before. Their symptoms, such as nausea, fatigue, anxiety, and depression, will then be assessed every five days. Researchers will also extend the intervals between vital checks and determine the effects on their symptoms.

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