Volume 3, Number 5, March 2022 e-ISSN: 2797-6068 and p-ISSN: 2777-0915
THE RELATIONSHIP BETWEEN ANXIETY AND SLEEP QUALITY IN CHEMOTHERAPY
PATIENTS
|
KEYWORDS Breast Cancer, Chemotherapy, Anxiety, sleep
quality. ARTICLE
INFO Accepted: March, 10th 2022 Revised: March, 12th 2022
Approved: March, 13th 2022 |
ABSTRACT Cancer is the
number one cause of death in the world at the end of this century. The impact
of the treatment of breast cancer patients on the psychological aspects of
experiencing anxiety, and disturbed sleep patterns. The lower the anxiety
experienced, the better the quality of sleep, and vice versa. The aim of the
study was to analyze the relationship between anxiety levels and patient
sleep quality. This research method is cross section with sampling using
Accidental Sampling technique. Respondents were 40 breast cancer patients who
underwent chemotherapy. The results showed that 82.5% of patients experienced
severe anxiety 82.5% and 82.5% had poor sleep quality. The Spearman Rank test
results show a correlation value (r) of 0.342 (34.2%) and a p-value of 0.031.
P value < (0.05). There is a relationship between anxiety and sleep
quality in patients undergoing chemotherapy. It is hoped that it can provide
information for health care institutions, which can then be developed for the
provision of nursing care in meeting the need for quality sleep for
chemotherapy patients. |
INTRODUCTION
According to the World Health
Organization, cancer will be the leading cause of death by the end of the
century. Cancer will be the greatest impediment to humans living longer lives.
Breast cancer is the most frequent type of cancer, according to data collected
from 185 countries. According to the findings of the survey, lung cancer is the
deadliest cancer, accounting for 1.8 million fatalities or 18.4 percent of all
deaths, while breast cancer is the second most common cancer in women, though
men can also acquire breast cancer. The effects of breast cancer treatment for
patients on the psychological components are anxiety and sleep pattern
disruption.
Patients with breast cancer must
receive medical treatment in order to recover. Chemotherapy is one of the
suggested therapies. Chemotherapy is an anti-cancer treatment that kills tumor
cells by interfering with their function and reproduction in order to heal,
regulate, or relieve symptoms. Chemotherapy is the practice of providing
anti-cancer medications in the form of liquid pills, capsules, or infusions
with the goal of killing cancer cells. Chemotherapy patients frequently
experience anxiety and sleep difficulties, which is more common in breast
cancer patients having chemotherapy in the first, second, and third phases. As
a nurse, you can provide treatment by educating patients about emotional
support, assessing patient requirements, anxieties, and coping techniques (Oetami, 2014)
Anxiety is a negative emotional
reaction to real or imagined threat that is accompanied by changes in the
autonomic nervous system and subjective tension, fear, and anxiety sensations.
Anxiety can have a harmful influence on breast cancer sufferers. Anxiety in
breast cancer patients can worsen pain, make it difficult to sleep, increase
nausea and vomiting after chemotherapy, and affect their overall quality of
life. Anxiety experienced by cancer patients during chemotherapy might
negatively impair the treatment process as well as medical and psychological
rehabilitation (Bintang, 2012).
Anxiety is classified into multiple
levels, each with its own set of traits and manifestations. Personal maturity,
understanding of how to deal with tension, self-esteem, and coping techniques
all play a role in how anxiety manifests. Client's basic requirements are
addressed through nursing procedural approaches, concepts, and applications.
Mild anxiety, moderate anxiety, severe anxiety, very severe anxiety, or panics
are the four types of anxiety. Anxiety does not address a person's mental
problems; instead, it burns more energy and disrupts sleep habits. A person who
has poor sleep quality will have a lower quality of life. A person's sleep
needs in a day can be different, influenced by the demands in life and the work
they do every day (Afrianto, 2018)
.
Sleep quality is a state of sleep
experienced by an individual that results in freshness and fitness when
awakened. Sleep quality includes both quantitative and qualitative aspects of
sleep, such as sleep duration, sleep latency, and subjective aspects of sleep.
Good sleep quality and poor sleep quality using assessments, namely: the time
it takes to start sleeping (sleep latency), sleep duration (sleep duration),
the percentage of sleep time spent in bed (sleep efficiency), sleep disturbance
experienced at night (sleep disturbance). So that everyone's ability to
maintain a state of sleep and to get the appropriate stages of REM and NREM
sleep (Hastuti., 2016)
.
RSUD dr. Saiful Anwar Malang is one
of the regional hospitals that is able to provide chemotherapy treatment for
cancer patients. The data obtained from the medical records of RSUD dr. Saiful
Anwar Malang, that for patients suffering from cancer in 2019 there were 795
patients and 423 patients underwent chemotherapy. In a preliminary study
conducted from December 28, 2020 to January 8, 2021, data from medical records
showed that from August 2020 to January 2021 there were 565 patients suffering
from cancer and 448 of them underwent chemotherapy. From the results of
preliminary observations conducted on ten patients undergoing chemotherapy, it
was found that six out of ten patients had received chemotherapy for the first
time, while four out of ten patients had undergone chemotherapy more than once.
The results of preliminary
observations showed that patients who were about to undergo chemotherapy said
they had difficulty sleeping and were anxious. On average, new patients who
will undergo chemotherapy say they are afraid and worried about the effects of
chemotherapy they will experience. Seven out of ten patients said they
experienced anxiety because they were afraid of the disease they were currently
suffering from and three of them claimed to experience sleep disturbances
because they were worried about their illness and the area around the eyes
looked black and often yawned.
This study is in line with Melanie &
Jamaludin (2018), which stated that more than half of
respondents (52.1%) experienced moderate levels of anxiety and more than half
of respondents (64.6%) experienced poor sleep quality. The study also stated
that there was a relationship between anxiety levels and sleep quality in
preoperative sectio caesarea patients in the Burangrang ward of the
Dustira Level II Hospital. The results of this study are in line with the
research of Harahap et
al. (2021), which found that there was a relationship
between anxiety levels and sleep quality of lung disease patients in Arifin
Achmad Hospital, Riau Province. Thus, the researcher interested in exploring
the anxiety and sleep quality in chemoteraphy patient in general.
The lower the anxiety experienced,
the better the sleep quality will be, and the higher the anxiety level, the
worse the sleep quality will be (Laia, 2019). The purpose of this study was to determine
the relationship between anxieties and sleep quality
in patients undergoing chemotherapy at RSUD Dr. Saiful Anwar Malang. This
research is expected to add other information concerning anxiety and sleep
quaility in chemoterapy patient to developing its intervention.
METHOD
RESEARCH
The research approach method used is
a quantitative approach. The design used in this research is a correlation
study, which is a study to study the relationship between two variables. This
study will obtain the prevalence or effect of a phenomenon (dependent variable)
associated with the cause (independent variable). The independent variable in
this study was the level of anxiety and the dependent variable in this study
was sleep quality.
The populations
in this study were all chemotherapy patients in the
Chemotherapy Action Room at dr. Saiful Anwar Malang in a period of 2 months,
namely in July and August 2021, totaling 80 respondents. While the number of
samples calculated based on the Slovin formula
obtained as many as 40 patients with inclusion criteria in this study were willing to be respondents, the first chemotherapy patient to the 3rd
chemotherapy at RSUD dr. Saiful Anwar Malang and the age of the
respondent is 40-70 years. While the exclusion
criteria are patients who have diseases or other
factors that can cause difficulty sleeping. The Sampling took from accidental sampling method. The test used is the Pearson correlation test if the data meets the
assumption of normality and the Spearman
Rank correlation test if it
does not meet the normality assumption.
RESULT AND DISCUSSION
Research result
This
research was conducted. The location of this research was
carried out in the Chemotherapy Action Room, RSUD Dr. Saiful Anwar Malang. RSUD
dr Saiful Anwar is a type A East Java Provincial Hospital in Malang. The
research was conducted from July 15, 2021 to August 20, 2021. The
characteristics of the respondents in this study were collected to determine
the description of the respondents who were appointed as
research subjects. The characteristics of the respondents are shown in Table 1.
Table 1 show
almost half of respondents aged
41-50 years, namely as many as 15 respondents 37.5%. Almost half of the
respondents (40%) underwent 1st chemotherapy. Based on the latest level of
education, it was found that almost half of the respondents, namely 15 (37.5%)
graduated from junior high school and most of the respondents worked as a
private sector, namely 28 (70%) respondents.
Table 1. Distribution
of respondent characteristic data
|
Characteristics of Respondents |
Frequency (n) |
Percentage (%) |
|
Age |
||
|
41-50 years old |
15 |
37.5 |
|
51-60 years old |
14 |
35 |
|
> 60 years old |
11 |
27.5 |
|
Total |
40 |
100 |
|
Chemotherapy |
|
|
|
1 |
16 |
40 |
|
2 |
11 |
27.5 |
|
3 |
13 |
32.5 |
|
Total |
40 |
100 |
|
Last education |
|
|
|
SD |
6 |
15 |
|
junior high school |
15 |
37.5 |
|
senior High School |
14 |
35 |
|
College Total |
5 40 |
12.5 100 |
|
Profession |
|
|
|
Private |
28 |
70 |
|
Housewife |
7 |
17.5 |
|
civil servant |
5 |
12.5 |
|
Total |
40 |
100 |
Source:
processed data
Table 2.
Distribution of Patient Anxiety Levels
|
Anxiety Level |
Frequency (n) |
Percentage (%) |
|
Light |
0 |
0 |
|
Currently |
7 |
17.5 |
|
Heavy |
33 |
82.5 |
|
Very heavy |
0 |
0 |
|
Total |
40 |
100 |
Source:
processed data
Based on Table 2, it is known that
most of the respondents (82.5%) have severe anxiety, while the rest have
moderate anxiety.
Table 3. Distribution of Patient
Sleep Quality
|
Sleep Quality |
Frequency (n) |
Percentage (%) |
|
Bad |
33 |
82.5 |
|
Well |
7 |
17.5 |
|
Total |
40 |
100 |
Source:
processed data
Based on Table 3, it is known that
most of the respondents (82.5%) have poor sleep quality, while the rest have
good sleep quality. The results of the normality test showed that the anxiety scale (HARS) did not
meet the normality assumption (p<0.05) and the sleep quality (PSQI) did not
meet the normality assumption (p<0.05), so the test used was the Spearman Rank test. The Spearman Rank test results are presented
in Figure 1.
Figure 1. The Relationship between Anxiety and
Sleep Quality
Source: processed data
Spearman
Rank correlation test shows a correlation
value (r) of 0.342 (34.2%) and a p-value of 0.031. P-value < a(0.05), which means that there is a
relationship between anxiety (HARS) and sleep quality of patients (PSQI) who
will undergo chemotherapy in the chemotherapy treatment room at RSUD Dr. Saiful
Anwar Malang. The closeness of the relationship is 34.2% in the low category.
The correlation is positive, the higher the HARS, the higher the PSQI, in other
words, the higher the level of anxiety, the lower the sleep quality of patients
undergoing chemotherapy in the chemotherapy treatment room at RSUD Dr. Saiful
Anwar Malang.
Discussion
Chemotherapy
is the process of administering anti-cancer drugs in the form of liquid pills
or capsules or through infusions that aim to kill cancer (Putra, 2015). Patients with chemotherapy often experience
anxiety and cause sleep pattern disturbances, usually anxiety that often occurs
in breast cancer patients undergoing chemotherapy in the first, second and
third stages, the management that can be done as a nurse is to provide
education about emotional support, assess needs patients, fears and patient
coping mechanisms.
The anxiety level of patients who will undergo chemotherapy at RSUD
Dr. Saiful Anwar Malang
The results
of this study showed that most of the respondents (82.5%) had severe anxiety.
The results of this study are in line with Purwati's
research (2016) which shows that of the 40 female respondents with breast
cancer studied, most of the respondents in their study experienced severe
anxiety levels, namely 35 respondents (87.5%). While Dewi's research (2019), out of 55
respondents, most of the breast cancer respondents who did chemotherapy with
moderate anxiety levels were 60.00% and the remaining 40.00% had mild anxiety
levels.
The anxiety
felt by cancer patients is a blunt emotional reaction or depression and a
sensitive context response (Dewi, 2019). Another opinion states that anxiety
occurs as a manifestation of feeling depressed, this condition requires the
right solution so that individuals feel safe, but research shows that not all problems can be solved
properly by the individual. This feeling of anxiety causes anxiety and fear.
The results of research conducted by Oetami (2014) show that the psychological impact of breast
cancer patients is felt by respondents the most, namely feeling helplessness in
the form of emotional disturbances such as crying and experiencing anxiety in
the form of worrying about the impact of treatment.
The results showed that most of the
respondents experienced severe anxiety, this could be caused by several
factors. Anxiety predisposing factors are explained by several theories that
have been developed according to Stuart (2006) including interpersonal theory, according to
this theory anxiety arises from feelings of fear of the absence of
interpersonal acceptance and rejection. According to Stuart and Sundeen in Purwati et al. (2016) severe anxiety greatly reduces a person's
field of perception. A person tends to focus on details and specifics and
cannot think about anything else. All behavior is aimed at reducing tension.
The person needs a lot of direction to be able to focus on another area.
According to researchers, cancer
patients undergoing chemotherapy have different levels of anxiety with various
factors causing anxiety such as age and education, anxiety disorders can occur
at all ages, more often in adulthood. As an adult, a person usually has a
heavier mind load, lasts a long time and is accompanied by many physiological
components such as sleep disturbances, restlessness, imagining, fear, anxiety,
and so on. In addition, the possibility of anxiety also occurs because almost
half of patients have just undergone the first chemotherapy. The anxiety felt
by the respondent also has an impact on the patient's recovery because if the
patient always experiences anxiety, it is possible that the respondent can stop
the chemotherapy, the symptoms felt by the patient who experience anxiety such
as restlessness, difficulty sleeping, difficulty concentrating, headaches,
frequent urination, and so on.
Sleep quality of patients undergoing chemotherapy At Dr. Hospital.
Saiful Anwar Malang
Most of the
respondents (82.5%) had poor sleep quality. This is in line with Dewi's research (2019), the results of the
study explained that most of the respondents as many as 63.6% of the 55 breast
cancer respondents who underwent chemotherapy stated poor sleep patterns. Hop (2019) stated sleep is a mental need as well as a
physical need for humans because during sleep it will provide an opportunity
for muscles to rest. Sleep is also a time when all the experiences that are
felt by humans every day are processed and integrated by the mind. This is very
influential on babies and children, but everything depends on how well they
sleep. Potter and Perry in Purwati et al. (2016), good
quality sleep is important for health. Patients often need more sleep and rest
than healthy people do and disease usually prevents some patients from getting
adequate sleep and rest. The environment of a hospital or long-term care
facility and the activities of the service provider often make it difficult for
patients to sleep.
Based on the results of research that has been carried out by Anggraini et al. (2020), The majority of responders (78%) had poor sleep quality. Sleep latency, sleep duration, efficiency, sleep patterns, and daytime dysfunction are components that influence the assessment of respondents' low sleep quality ratings, according to the PSQI's seven components of sleep quality. According to Pratiwi's research (2016), several types of sleep disorders that occur in breast cancer patients undergoing chemotherapy, namely insomnia (66.67%) and circadian rhythm disorders (57.33%). The perceived sleep disturbances were Restless Legs Syndrome (44.0%), sleep apnea (34.67%), and narcolepsy (23.33%). Sleep disturbances that occur can result in poor sleep quality.
According to
research results, most cancer patients
who will undergo chemotherapy have poor sleep quality, which can be influenced by various factors such
as medical conditions (disease diagnosis) and environmental conditions. Where
the medical condition is the incidence of the disorder varies for each medical
condition. The patient’s body needs good quality sleep, a sick body will have
difficulty starting and maintaining sleep. If the body experiences a lack of
sleep, the body will experience decreased endurance, decreased daily
activities, feel tired and can have an impact on the body, psychological health
and also has an impact on healing from the respondent's disease, in the
research that has been carried out it was found that
breast cancer patients underwent chemotherapy.
The relationship between anxiety levels and sleep quality of
patients undergoing chemotherapy at RSUD Dr. Saiful Anwar Malang
Spearman
Rank correlation test showed that there
was a relationship between anxiety (HARS) and sleep quality of patients (PSQI)
who were to undergo chemotherapy in the chemotherapy treatment room at RSUD Dr.
Saiful Anwar Malang (p<0.05). The closeness of the relationship is 34.2% in
the low category. The correlation is positive, the higher the HARS, the higher
the PSQI, in other words, the higher the level of anxiety, the lower the sleep
quality of patients undergoing chemotherapy in the chemotherapy treatment room
at RSUD Dr. Saiful Anwar Malang. The results of this study are in line with Wahyuningsih's research
(2019), which states that there is a significant
relationship between anxiety and sleep quality disorders in preoperative femur
fracture patients at Prof. Hospital. Dr. Soekandar Mojokerto (p<0.05). The
results of this study are also in line with Purwantiri's
research (2013), the results of statistical tests with the
spearman rank test (rho) obtained a p value of 0.008 (p value <α) and a
correlation (rho) of 0.412. These results indicate a relationship between
anxiety levels and sleep quality in breast cancer patients.
Anxiety is an emotional response to
an unpleasant situation and is experienced by all living things in everyday
life that cannot be observed directly and is an emotional state without a
specific object and can provide motivation to achieve something in an effort to
maintain a balance of life. Richardson et
al. (2019) stated that the effects of anxiety in breast
cancer patients can increase pain, interfere with sleep ability, increase
nausea and vomiting after chemotherapy, as well as disrupt their own quality of
life.
The quality
of sleep as a basic human need is strongly influenced
by various factors that result in disruption of sleep fulfillment in a person. WHO (2015) suggests that there
are 4 factors that affect sleep, namely physical,
psychological, lifestyle, and environmental factors. A patient with respiratory
disorders may also have difficulty sleeping. This difficulty in sleeping can be
caused by the structure of respiratory function being disturbed, for example
constriction in asthmatic patients. Clinical experience shows that there is a
significant interaction between respiratory function disorders and sleep.
According to the results of the
study, cancer patients who will undergo chemotherapy have moderate levels of
anxiety and poor sleep quality, this is because many breast cancer patients who
undergo chemotherapy are worried about the effects of chemotherapy, the anxiety
that occurs in respondents is also influenced by age, where the age of the
respondents in this study was 41-70 years.
CONCLUSION
Based on the results of the analysis, several conclusions can be drawn as
follows; most of the anxiety levels of
respondents who will undergo chemotherapy at RSUD dr Saiful Anwar Malang
(82.5%) have severe anxiety, while the rest have moderate anxiety. Most of the sleep qualities of
respondents who will undergo chemotherapy at RSUD dr Saiful Anwar Malang
(82.5%) have poor quality and only 17.5% have good sleep quality. There is a relationship between
anxiety (HARS) and sleep quality of patients (PSQI) who will undergo
chemotherapy in the chemotherapy treatment room at RSUD Dr. Saiful Anwar Malang
(p<0.05). The closeness of the relationship is 34.2% in the low category.
The correlation is positive, the higher the HARS, the higher the PSQI, in other
words, the higher the level of anxiety, the lower the sleep quality of patients
undergoing chemotherapy in the chemotherapy treatment room at RSUD Dr. Saiful
Anwar Malang.
REFERENCES
Afrianto, Hendri. (2018). Hubungan tingkat stres dengan kualitas
tidur pada mahasiswa yang sedang menyusun skripsi di program studi matematika
di STKIP PGRI kabupaten Pacitan. Journal of Linguistics, 3(2),
139–157. https://doi.org/10.18041/2382-3240/saber.2010v5n1.2536
Anggraini, Dian, Marfuah, Dewi, & Puspasari, Susy. (2020). Kualitas tidur
pasien kanker payudara yang menjalani kemoterapi. Jurnal Ilmiah Kesehatan
Keperawatan, 16(2), 91–100.
Bintang, Yenni Ade. (2012). Gambaran tingkat kecemasan, stres dan depresi pada
pasien kanker yang menjalani kemoterapi di RSUP dr. Hasan Sadikin Bandung.
Dewi, Susi Putri. (2019). Hubungan tingkat kecemasan dengan pola tidur
pasien kanker payudara yang melakukan kemoterapi di RSAM Bukittinggi tahun 2019.
Universitas Perintis Indonesia.
Globocan 2012 Estimated cancer incidence, mortality and prevalence worldwide in
2012. (2015). France.
Harahap, A. S., Fitriani, I. M., & Putri, R. S. (2021). Tingkat kecemasan
berhubungan dengan kualitas tidur pasien penyakit paru. Jurnal Keperawatan,
13(1), 140.
Hastuti, Retno Yuli, Sukandar, Anis, & Nurhayati, Tri. (2016). Hubungan
Tingkat Kecemasan Dengan Kualitas Tidur Pada Mahasiswa Yang Menyusun Skripsi di
STIKES Muhammadiyah Klaten. Jurnal Motorik, 11(22), 9–21.
Hop, Muflih. (2019). Hubungan tingkat kecemasan dengan kualitas tidur pasien
pre operasi di rumah sakit umum Sundari Medan. Indonesian Trust Health
Journal, 1(2), 98–106. https://doi.org/10.37104/ithj.v1i2.19
Laia, Julianto Julianto. (2019). The relationship between anxiety levels
through sleep quality of Wijaya Husada Nursing Students: hubungan tingkat
kecemasan dengan kualitas tidur pada mahasiswa program studi s1 keperawatan
Stikes Wijaya Husada Bogor. jurnal ilmiah wijaya, 11(1), 55–65.
Melanie, Ritha, & Jamaludin, Wendi. (2018). Hubungan tingkat kecemasan dengan
kualitas tidur pada pasien pre operasi sectio caesarea. Prosiding
PIN-LITAMAS 1, 1(1), 122–131.
Oetami, Fratiwi. (2014). Analisis dampak psikologis pengobatan kanker payudara
di RS. Dr. Wahidin Sudirohusodo Makasar.
Pratiwi, Tiara Dwinda. (2016). Jenis gangguan tidur pada pasien kanker
payudara yang menjalani kemoterapi di RSUP dr. Hasan Sadikin Bandung.
Purwantiri, Amini. (2013). Perbedaan kualitas tidur sebelum dan selama kemoterapi
pada pasien kanker di RSUP DR. Sardjito Yogyakarta. Universitas Gadjah
Mada.
Purwati, Purwati, Ma’rifah, Atun Raudotul, & Maryati, Susio. (2016). Hubungan
tingkat kecemasan dengan kualitas tidur pada pasien kanker payudara di ruang
bougenvil RSUD Prof. dr. Margono Soekarjo purwokerto. Bhamada: Jurnal Ilmu
Dan Teknologi Kesehatan (E-Journal), 7(1), 8.
Putra, AdityaChandra. (2015). Perubahan Kadar NT-proBNP Dan cTn-I Sebagai
Penanda Kardiotoksisitas Akut Pasien Limfoma Non-Hodgkins (LNH) Yang Menerima
Kemoterapi Berbasis Doxorubicin. Universitas Brawijaya.
Richardson, Scott, Lefrid, Mohammed, Jahani, Shiva, Munyon, Matthew D., &
Rasoolimanesh, S. Mostafa. (2019). Effect of dining experience on future
intention in quick service restaurants. British Food Journal.
Stuart, Gail W. (2006). Buku Saku: Keperawatan Jiwa. Egc.
Wahyuningsih, Binarti Dwi. (2019). Hubungan kecemasan dengan gangguan pola tidur
pada pasien pre operasi fraktur femur di rsud prof. Dr. Soekandar mojosari
kabupaten mojokerto.
Copyright holders:
Zainol Ahsan, Wiwik Agustina, Lilla Maria (2022)
First publication right:
Devotion -
Journal of Community Service
This article is licensed under a Creative Commons Attribution-ShareAlike 4.0
International