NCCN Categories of Evidence and Consensus
Category 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate.
Category 2A: Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate.
Category 2B: Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate.
Category 3: Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate.
All recommendations are category 2A unless otherwise noted.
Clinical trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
Sleep disturbances include insomnia (trouble falling or staying asleep resulting in daytime dysfunction), excessive sleepiness (which can result from insufficient sleep opportunity, insomnia, or other sleep disorders), sleep-related movement or breathing disorders, and parasomnias.1 Sleep disorders affect 30% to 50% of patients with cancer and survivors, often in combination with fatigue, anxiety, or depression.1-10 Improvements in sleep lead to improvements in fatigue, mood, and quality of life.11 Most clinicians, however, do not know how best to evaluate and treat sleep disorders.1
Sleep disorders are common in patients with cancer as a result of multiple factors, including biologic changes, the stress of diagnosis and treatment, and side effects of therapy (eg, pain, fatigue).12 In addition, evidence suggests that changes in inflammatory processes from cancer and its treatment play a role in sleep disorders. These sleep disturbances can be perpetuated in the survivorship phase by chronic side effects, anxiety, depression, medications, and maladaptive behaviors such as shifting sleep times, excessive time in bed because of fatigue, and unplanned naps.12
Additional information about sleep disorders in patients with cancer can be found in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Palliative Care and the NCCN Guidelines for Cancer-Related Fatigue (available at NCCN.org). These guidelines may be modified to fit the individual survivor’s circumstances.
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