Prevalence of Insomnia and Its Association with Anxiety, Depression, and Quality of Life among Moroccan Cancer Patients
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Objective: The objective was to assess the prevalence and severity of insomnia in patients with cancer, as well as its correlation with Anxiety, depression, and quality of life.
Methods and Materials: A descriptive cross-sectional study conducted from Sep 2023 to December 2024, including 246 patients treated for cancer in the Rabat Cancer Department, with histologically confirmed cancer. Each patient completed questionnaires on insomnia severity (ISI), quality of life (QLQ-C30), and anxiety (HAD). Pain was assessed using a visual analog scale.
Findings: The mean age of patients was 56.33 ± 14.78 years, with a male-to-female sex ratio of 0.71. Certain anxiety was noted in 57.7% of patients (n=142) and depression in 54.1% (n=104). Among 246 participants, 36% reported clinically significant insomnia (ISI ≥ 15), 57.7% had clinically significant anxiety (HADS-A ≥ 11), and 54.1% had clinically significant depression (HADS-D≥ 11). Insomnia, anxiety, and depression were significantly associated with lower global health/QOL scores. The presence of pain, dyspnea, insomnia, and fatigue was a factor associated with the onset of anxiety-depressive disorders in our patients (p<0.001). A statistically significant association was found among fatigue, pain, and the onset of insomnia (p<0.001).
Conclusion: The presence of pain and insomnia was a factor associated with the deterioration of anxiety/depression and of the overall health and QOL of our patients. Appropriate diagnosis and treatment should be integral to disease management.
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Aboufaras, M., Selmaoui, K., & Ouzennou, N. (2024). Quality of life among patients with cancer at the Beni Mellal Oncology Center. Value in Health Regional Issues, 41, 86–93. https://doi.org/10.1016/j.vhri.2023.12.002
Al Maqbali, M., Al Sinani, M., Alsayed, A., & Gleason, A. M. (2022). Prevalence of sleep disturbance in patients with cancer: a systematic review and meta-analysis. Clinical Nursing Research, 31(6), 1107–1123. https://doi.org/10.1177/10547738221092146
Al Maqbali, M., Alsayed, A., Hughes, C., Hacker, E., & Dickens, G. L. (2024). Stress, anxiety, depression, and sleep disturbance among healthcare professionals during the COVID-19 pandemic: An umbrella review of 72 meta-analyses. Plos one, 19(5), e0302597. https://doi.org/10.1371/journal.pone.0302597
Antoni, M. H., & Dhabhar, F. S. (2019). The impact of psychosocial stress and stress management on immune responses in patients with cancer. Cancer, 125(9), 1417–1431. https://doi.org/10.1002/cncr.31943
Barsasella, D., Syed-Abdul, S., Malwade, S., Kuo, T. B., Chien, M.-J., Núñez-Benjumea, F. J., Lai, G.-M., Kao, R.-H., Shih, H.-J., & Wen, Y.-C. (2021). Sleep quality among breast and prostate cancer patients: a comparison between subjective and objective measurements. Healthcare, 9(7), 785. https://doi.org/10.3390/healthcare9070785
Biringen, E. K., Cox-Martin, E., Niemiec, S., Wood, C., Purcell, W. T., & Kolva, E. (2021). Psychotropic medications in oncology. Supportive Care in Cancer, 29(11), 6801–6806. https://doi.org/10.1007/s00520-021-06283-w
Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 68(6), 394–424. https://doi.org/10.3322/caac.21492
Chan, N. Y., Chan, J. W. Y., Li, S. X., & Wing, Y. K. (2021). Non-pharmacological approaches for the management of insomnia. Neurotherapeutics, 18(1), 32–43. https://doi.org/10.1007/s13311-021-01029-2
Chen, J., Li, C., Chen, L., Zhao, Z., Zheng, Y., Yang, X., Huang, H., & Deng, R. (2025). Insomnia comorbid with depression: A bibliometric and visualized analysis of research trends and hotspots from 2000 to 2024. Behavioural Neurology, 2025(1), 7106629. https://doi.org/10.1155/bn/7106629
Cowdery, S. P., Stuart, A. L., Pasco, J. A., Berk, M., Campbell, D., Bjerkeset, O., & Williams, L. J. (2021). Mood disorder and cancer onset: evidence from a population-based sample of Australian women. Brazilian Journal of Psychiatry, 43, 355–361. https://doi.org/10.1590/1516-4446-2020-0932
El Kherchi, O., Aquil, A., Elkhoudri, N., Guerroumi, M., El Azmaoui, N., Mouallif, M., Aitbouighoulidine, S., Chokri, A., Benider, A., & Elgot, A. (2023). Relationship between sleep quality and anxiety-depressive disorders in Moroccan women with breast cancer: a cross-sectional study. Iranian Journal of Public Health, 52(7), 1457. https://doi.org/10.18502/ijph.v52i7.13247
Ell, K., Sanchez, K., Vourlekis, B., Lee, P.-J., Dwight-Johnson, M., Lagomasino, I., Muderspach, L., & Russell, C. (2005). Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer. Journal of Clinical Oncology, 23(13), 3052–3060. https://doi.org/10.1200/JCO.2005.08.041
Fennane, R., Chakit, M., Kerouad, J., & Laboudi, F. (2025). Prevalence and Associated Factors of Anxiety and Depression among Patients with Cancer at Ibn Sina University Hospital, Rabat: A Cross-Sectional Study. International Journal of Body, Mind & Culture, 12(9), 158–168. https://doi.org/10.61838/ijbmc.v12i9.1248
Gao, T., Xiang, H., Wu, Q. N., Zhu, L. S., Pei, W. J., Fu, W. J., & Chou, T. S. (2025). Advances in the research of comorbid insomnia and depression: mechanisms, impacts, and interventions. Frontiers in Psychiatry, 16, 1468212. https://doi.org/10.3389/fpsyt.2025.1468212
Golboni, F., Ahmadzadeh, H., Nadrian, H., Babazadeh, T., Najafi, S., Ghahremaninasab, P., Pirehbabi, K., Heizomi, H., & Mahmoodi, H. (2024). Effects of a short-time health literacy promotion program (HeLPP) on biochemical factors, self-care, and quality of life among rural patients with type-2 diabetes: a field trial with Solomon four-group design. Health Promotion Perspectives, 14(2), 175. https://doi.org/10.34172/hpp.42787
Grassi, L., Zachariae, R., Caruso, R., Palagini, L., Campos-Ródenas, R., Riba, M. B., Lloyd-Williams, M., Kissane, D., Rodin, G., & McFarland, D. (2023). Insomnia in adult patients with cancer: ESMO Clinical Practice Guideline. Esmo Open, 8(6), 102047. https://doi.org/10.1016/j.esmoop.2023.102047
Gyawali, S., Tiwari, S., Sah, G. S., Panthi, B., Upreti, A., Pokhrel, B., Gyawali, B., Khanal, P., Shrestha, R., & Paudel, B. (2024). Prevalence of sleep disorders in patients with advanced cancer: a cross-sectional study. Annals of Medicine and Surgery, 86(7), 3954–3958. https://doi.org/10.1097/MS9.0000000000002232
Habibi, F., Hashemi, M., Hemati, S., & Gholamrezaei, A. (2016). Sleep quality and its associated factors in Iranian patients with breast cancer. International Journal of Body, Mind & Culture, 3, 121–131. https://doi.org/10.22122/ijbmc.v3i2.54
Knoop, V., Cloots, B., Costenoble, A., Debain, A., Azzopardi, R. V., Vermeiren, S., Jansen, B., Scafoglieri, A., Bautmans, I., & Bautmans, I. (2021). Fatigue and the prediction of negative health outcomes: a systematic review with meta-analysis. Aging Research Reviews, 67, 101261. https://doi.org/10.1016/j.arr.2021.101261
Marrakchi, A., Chakit, M., Obtel, M., Ouasmani, F., Qouhafa, M., Elmorabit, N., El Kababri, M., El Hessni, A., & Mesfioui, A. (2025). Factor structure and measurement invariance by gender of the GHQ12 scale among parents of children with cancer. Immunopathologia Persa, 11(2), e43842-e43842. https://doi.org/10.34172/ipp.2025.43842
Meaklim, H., Saunders, W. J., Byrne, M. L., Junge, M. F., Varma, P., Finck, W. A., & Jackson, M. L. (2023). Insomnia is a key risk factor for persistent anxiety and depressive symptoms: A 12-month longitudinal cohort study during the COVID-19 pandemic. Journal of Affective Disorders, 322, 52–62. https://doi.org/10.1016/j.jad.2022.11.021
Muthanna, F. M., Hassan, B. A. R., Karuppannan, M., Ibrahim, H. K., Mohammed, A. H., & Abdulrahman, E. (2023). Prevalence and impact of fatigue on quality of life (QOL) of cancer patients undergoing chemotherapy: a systematic review and meta-analysis. Asian Pacific Journal of Cancer Prevention: APJCP, 24(3), 769. https://doi.org/10.31557/APJCP.2023.24.3.769
Page, J. M., Morgans, A. K., Hassett, M. J., Haakenstad, E., Manni, M., McCleary, N. J., & Zhou, E. S. (2025). Insomnia prevalence and correlates in cancer patients undergoing treatment. Psycho‐Oncology, 34(1), e70079. https://doi.org/10.1002/pon.70079
Qiao, Y., Guo, J., Luo, J., Huang, R., Wang, X., Su, L., Xia, W., & Xiao, Y. (2024). Early bone loss in patients with obstructive sleep apnea: a cross-sectional study. BMC Pulmonary Medicine, 24(1), 28. https://doi.org/10.1186/s12890-024-02848-7
Roberts, D. (2018). Chronic fatigue syndrome and quality of life. Patient-related outcome measures, 253–262. https://doi.org/10.2147/PROM.S155642
Savard, J., Davidson, J. R., Ivers, H., Quesnel, C., Rioux, D., Dupéré, V., Lasnier, M., Simard, S., & Morin, C. M. (2004). The association between nocturnal hot flashes and sleep in breast cancer survivors. Journal of Pain and Symptom Management, 27(6), 513–522. https://doi.org/10.1016/j.jpainsymman.2003.10.013
Savard, J., & Morin, C. M. (2001). Insomnia in the context of cancer: a review of a neglected problem. Journal of Clinical Oncology, 19(3), 895–908. https://doi.org/10.1200/JCO.2001.19.3.895
Savard, J., Simard, S., Ivers, H., & Morin, C. M. (2005). Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects. Journal of Clinical Oncology, 23(25), 6083–6096. https://doi.org/10.1200/JCO.2005.09.548
Scher, N., Guetta, L., Draghi, C., Yahiaoui, S., Terzioglu, M., Butaye, E., Henriques, K., Alavoine, M., Elharar, A., & Guetta, A. (2022). Sleep Disorders and quality of life in patients with cancer: prospective observational study of the Rafael institute. JMIR Formative Research, 6(11), e37371. https://doi.org/10.2196/37371
Sharbafchi, M. R., Sheshboluki, F., Ghaderi, S., Sharifi, S., Mousavi, S. Z., & Taslimi, F. (2022). Couple's Educational Program Reduces Depression, Anxiety, and Stress in Breast Cancer Patients Undergoing Mastectomy: A Randomized Controlled Clinical Trial. International Journal of Body, Mind & Culture, 9(sp), 162–172. 10.22122/ijbmc.v9isp.362
Silberfarb, P. M., Hauri, P., Oxman, T. E., & Schnurr, P. (1993). Assessment of sleep in patients with lung cancer and breast cancer. Journal of Clinical Oncology, 11(5), 997–1004. https://doi.org/10.1200/JCO.1993.11.5.997
Wang, G., & Pan, S. (2025). Integrated sleep and psychological interventions enhance postoperative recovery and quality of life in colorectal cancer: a randomized controlled trial. Clinical and Translational Oncology, 1–11. https://doi.org/10.1007/s12094-025-04101-x
Zhang, J., Chen, Y., Lu, Y., Jiang, X., Lin, C., & Ke, X. (2025). The impact of health literacy on quality of life in patients with chronic diseases. Frontiers in Public Health, 13, 1544259. https://doi.org/10.3389/fpubh.2025.1544259
Zhao, K., Yu, Z., Wang, Y., & Feng, W. (2025). Prevalence of insomnia and related factors among cancer outpatients in China. Nature and Science of Sleep, 69–79. https://doi.org/10.2147/NSS.S492373
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