Pharmacological interventions for sleep disturbance ("insomnia") in patients with advanced cancer receiving specialist palliative care: a scoping review.

PURPOSE: Sleep disturbance ("insomnia") is common in patients with advanced cancer receiving specialist palliative care. The aim of this scoping review was to determine the evidence for the various pharmacological interventions utilised for sleep disturbance in this cohort of patients.

METHODS

Standard scoping review methodology was employed, and four databases were searched from inception (Medline, CINAHL, Embase, and the Cochrane Library). Hand searching of relevant sources was also undertaken. The search excluded non-English publications, and studies involving herbal remedies, and "complementary therapies".

RESULTS

Ten studies met the criteria for inclusion. The studies involved benzodiazepines (n = 5), "Z-drugs" (n = 2), melatonin (n = 2), antidepressants (n = 1), antipsychotics (n = 2), and dual orexin receptor antagonists (n = 1). Only three studies were randomised controlled trials, and only five of the studies used validated sleep assessment tools. The studies were mostly small in size (median - 47 patients).

CONCLUSIONS

This scoping review highlights that the evidence to support pharmacological interventions for sleep disturbance in patients with advanced cancer receiving specialist palliative care is extremely limited. Further research is required not only to assess efficacy, but also tolerability, given the side effect profile of these drugs (and the frailty of the patients).