Declan Walsh

Characteristics of adult patients with cancer completing electronic distress screening (N = 20,416).

Correlates of potentially clinically significant sleep difficulties (≥5/10) among adult patients with cancer in uni- and multivariable logistic regression models (N = 20,416).

Sleep disturbances are underidentified and undertreated in oncology. To inform screening and intervention efforts at a large academic cancer center, we identified the prevalence and correlates of patient-reported sleep difficulties. This retrospective study evaluated 20,416 individuals who completed practice-based distress screening from January 2017 to June 2024. Sleep difficulties in the past 2 weeks were reported from 0 (none) to 10 (severe). Uni- and multivariable regression models evaluated the impact of sociodemographic factors (age, sex, race/ethnicity, financial concerns) and medical/psychosocial factors (cancer type/stage, time since diagnosis, distress, anxiety, depression, pain, relationship problems, tobacco and alcohol use) on clinically significant (≥5) and severe (≥7) sleep difficulties. All variables were obtained from patients’ first screen, except for cancer type, stage, and diagnosis date, which were from the cancer registry. Among the sample (59% female, 78% non-Hispanic white, 49% stage I to II, mixed cancer sites), 36% reported clinically significant sleep difficulties. In a multivariable model, the strongest correlates (OR ≥ 1.35) of sleep difficulties ≥5 were as follows: age 40 to 64 (OR = 1.35), financial concerns (OR = 1.35), distress (OR = 3.06), pain (OR = 2.80), anxiety (OR = 2.31), and depression (OR = 1.69). Risk varied by cancer type, with upper gastrointestinal, genitourinary, thoracic, and hematologic cancers showing modestly higher odds. Sensitivity analyses (cutoff ≥7, within 90 days of diagnosis) showed broadly similar but not identical correlates. Sleep difficulties are prevalent and correlated with psychosocial concerns and cancer type. Future research should explore sleep trajectories and potential care pathways for patients screening positive.Significance:This large, multicenter study demonstrates that sleep difficulties are highly prevalent among oncology outpatients and are strongly associated with psychosocial distress, pain, and cancer type. Routine screening can identify at-risk patients, supporting the need for integrated, multisymptom management strategies to improve outcomes in cancer care.

Sensitivity analyses: correlates of potentially clinically significant sleep difficulties (≥5/10) among adult patients with cancer in uni- and multivariable logistic regression models, limited to patients ± 90 days from diagnosis (N = 15,023).

Characteristics independently associated with greater odds of clinically significant sleep difficulties (≥5/10) among adult patients with cancer (N = 20,416) in a multivariable logistic regression model. *, age 80+; **, none; ***, none/mild; ****, 4–6 times a week or more; *****, breast.

Sensitivity analyses: correlates of severe sleep difficulties (≥7/10) among adult patients with cancer in uni- and multivariable logistic regression models (N = 20,416).

Objective This paper outlines the 13-year development of a comprehensive, multisite patient navigation (PN) programme at Atrium Health Levine Cancer Institute (LCI), aiming to inform institutions seeking to establish or expand navigation services. Methods Between 2010 and 2023, LCI’s PN programme evolved through three distinct phases: initiation, structured development and system-wide consolidation. Key components included appointing a programme director, introducing the Acuity Grading Scale for patient prioritisation, integrating PN documentation into the electronic medical record and developing operational policies aligned with Commission on Cancer standards. Both generalist and tumour-specific nurse navigators were employed across urban and rural settings, supplemented by virtual navigation services. Results The programme demonstrated improved care coordination, timely treatment initiation and equitable access, particularly among racial and ethnic minorities. Virtual navigation proved effective during the COVID-19 pandemic. Challenges included securing clinician buy-in, standardising services across cancer types and sustaining funding amid limited reimbursement models. A navigator academy and ongoing competency evaluations supported workforce development. Conclusions LCI’s experience offers a replicable model for building PN programmes grounded in standardisation, community needs and workforce training. While promising, broader adoption will require further evidence-based standards, financial modelling and strategies to navigate system integration challenges.

Sleep disturbances are underidentified and undertreated in oncology. To inform screening and intervention efforts at a large academic cancer center, we identified the prevalence and correlates of patient-reported sleep difficulties. This retrospective study evaluated 20,416 individuals who completed practice-based distress screening from January 2017 to June 2024. Sleep difficulties in the past 2 weeks were reported from 0 (none) to 10 (severe). Uni- and multivariable regression models evaluated the impact of sociodemographic factors (age, sex, race/ethnicity, financial concerns) and medical/psychosocial factors (cancer type/stage, time since diagnosis, distress, anxiety, depression, pain, relationship problems, tobacco and alcohol use) on clinically significant (≥5) and severe (≥7) sleep difficulties. All variables were obtained from patients’ first screen, except for cancer type, stage, and diagnosis date, which were from the cancer registry. Among the sample (59% female, 78% non-Hispanic white, 49% stage I to II, mixed cancer sites), 36% reported clinically significant sleep difficulties. In a multivariable model, the strongest correlates (OR ≥ 1.35) of sleep difficulties ≥5 were as follows: age 40 to 64 (OR = 1.35), financial concerns (OR = 1.35), distress (OR = 3.06), pain (OR = 2.80), anxiety (OR = 2.31), and depression (OR = 1.69). Risk varied by cancer type, with upper gastrointestinal, genitourinary, thoracic, and hematologic cancers showing modestly higher odds. Sensitivity analyses (cutoff ≥7, within 90 days of diagnosis) showed broadly similar but not identical correlates. Sleep difficulties are prevalent and correlated with psychosocial concerns and cancer type. Future research should explore sleep trajectories and potential care pathways for patients screening positive. Significance: This large, multicenter study demonstrates that sleep difficulties are highly prevalent among oncology outpatients and are strongly associated with psychosocial distress, pain, and cancer type. Routine screening can identify at-risk patients, supporting the need for integrated, multisymptom management strategies to improve outcomes in cancer care.

Purpose: Randomized controlled trials (RCTs) of acupuncture in oncology offer strong internal validity but limited generalizability. Real-world evidence is needed to assess feasibility, effectiveness, and adherence in routine practice. Methods: We conducted a retrospective analysis of real-world data from cancer patients receiving group Traditional Chinese acupuncture (ACP) in an outpatient oncology setting (2015–2022). Symptoms (anxiety, fatigue, hot flashes, neuropathy, pain, sleep) were rated on a 0–10 numeric scale before each session. Clinical improvement was defined as a ≥ 1-point decrease in severity. Results: A total of 2,239 patients underwent ACP (83% female; mean age 57 ± 12; 57% breast cancer). Common symptoms included pain (61%), sleep issues (50%), fatigue (45%), hot flashes (42%), anxiety (40%), and neuropathy (40%); 68% had ≥ 2 symptoms, median baseline severity 5–6. Females and younger patients had higher symptom burden. By session two, all symptoms improved statistically, with anxiety and hot flashes showing clinical improvement; by session three, all improvements were statistically and clinically significant. Benefits were similar across age and gender. Adherent patients (≥ 2 sessions) were older with higher symptom burden. Conclusion: Acupuncture appears effective for common cancer symptoms in real-world settings, with evidence suggesting that benefits are sustained between sessions and requiring multiple treatments for optimal effect. Both sexes and age groups experienced similar improvements, though utilization was lower among males and older adults. Expanding insurance coverage could improve access and reduce disparities. Adherence was high, and integration into outpatient oncology care proved feasible and sustainable. These findings warrant examination in RCTs.