New grant-funded project works toward improving sleep in pediatric cancer patients

Pediatric cancer patients may soon get a better night's sleep and experience improved comfort levels, thanks to a new grant-funded project led by a Rutgers University-Camden researcher.

Lauren Daniel, an assistant professor of psychology and a licensed clinical psychologist, has 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, a former fellow at Children's Hospital of Philadelphia (CHOP) with niche expertise in the sleep patterns of children with cancer, will collaborate with members of CHOP's behavioral oncology research team, including Jason Freedman, inpatient medical director and an attending physician within the Division of Oncology; Kim Venella, a nurse practitioner in bone marrow transplant; and Lamia Barakat, director of psychosocial services and behavioral oncology research.

The study will be assisted by data provided by CHOP, which will be collected on an intervention to improve sleep in pediatric cancer patients undergoing stem cell transplants.

I am grateful for the opportunity to branch out into a new area of research aimed at improving the quality of life of patients at CHOP."

Lauren Daniel, assistant professor of psychology and licensed clinical psychologist

Daniel explains that she had been working on quality improvement initiatives with colleagues at CHOP focused on improving sleep for pediatric cancer patients. The team began with a survey of children and families about elements of hospitalizations that disrupted overnight sleep. Families cited frequent awakenings for nighttime care as the most disruptive factor to sleep. The current study will try to reduce nighttime awakenings for care by six hours for sleep overnight.

The team is 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.

"Sleep is closely related to many aspects of quality of life in pediatric cancer patients," says Daniel, who notes that Rutgers-Camden students will be working with her on project. "Our goal is to improve sleep so that we can affect change in psychological and physical functioning during treatment."

An earlier study from Cincinnati Children's Hospital, explains Daniel, found that pediatric patients undergoing stem cell transplants are woken up on an average of 12 times per night for a variety of reasons, including vital checks, to urinate, and to get pumps and other medical equipment serviced.

In their forthcoming study, says the Rutgers-Camden researcher, pediatric stem cell transplant patients will wear an actigraph, 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.

"Nurses go into rooms every four hours, so we are trying to increase the time between visits to six hours overnight in order to minimize the disruptions," says Daniel. "It may not seem like a long time, but hopefully it can make modest improvements in how they are sleeping overnight."

In addition to her work at CHOP, Daniel is leading an international team of sleep researchers to establish research priorities for better understanding the role of sleep in pediatric cancer. 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," is forthcoming in the journal Psycho-Oncology.