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  • br contributing factors to sleep problems are necessary


    contributing factors to sleep problems are necessary for planning prevention strategies [28].
    The objective of this λ-Carrageenan study was to determine the prevalence of excessive daytime sleepiness among older Iranian patients with cancer and to analyze the effect of chemotherapy treatment on patients' sleep problems. The relationship between sleep disturbances and physical activity, psychological factors as well as demographic data, are also explored.
    2. Material and Method
    This is a cross-sectional study with two times repeated measure-ments which had been carried out from October 2015 λ-Carrageenan to November 2016 in Cancer Institute of Iran, a national referral facility for patients with cancer. Included patients, had the following criteria: (a) age N60 years(this cut-point was selected based on the previous clinical as-sessment of Iranian patients experiencing geriatric syndrome);
    (b) pathologic report of solid tumors (c) an estimated a life expectancy of more than two months; (d) selected for chemotherapy in the Medical Oncology Ward. Written informed consent was obtained from all study participants prior to their contribution. The study was reviewed and approved by the Deputy of Research Ethics Committee of Tehran University Medical School.
    2.2. Participants
    83 patients with mentioned criteria participated in this study; these were selected by census sampling method from all available patients (outpatient & inpatient) of Medical Oncology ward of Iran Cancer Institute, on certain dates. From 83 patients who signed informed consent initially, nine died during the treatment process and before the second interview; hence, excluded from our analysis.
    2.3. Measurements
    According to the National Consensus, carried out by Iranian Statistics Center in 2016, N53% of the population older than 60 years old are illit-erate. So, we chose direct interview to fill the questionnaires. We also used patients' medical records in hospital archives to gather following medical data:(1) tumor type, (2) tumor stage, (3) number of regions of tumor reccurence (if any), (4) Number of comorbidities, (5) patient's weight, (6)patient's height. BMI was calculated from patient weight and height. BMI was categorized into 4 groups, underweight (BMI b 18.5), normal (18.5 ≤ BMI b 25), overweight (25 ≤ BMI b 30) and obese (BMI
    ≥ 30). The interviews were carried out twice for each participant, once
    prior to receiving chemotherapy and a second time after the first cycles of chemotherapy. The interviews consisted of four main parts:
    (a) A set of general questions to determine patients' demographic information; including gender, age, education, marital status and number of people whom they are living with.
    (b) A survey consisted of Persian translated version of Epworth Sleepiness Scale (ESS), a set of eight questions to determine their tendency to sleep during daytime. Those participants with an ESS score equal to or greater than ten were considered to have Excessive Daytime Sleepiness (EDS) [29]. (c) A set of questions to determine the following parameters:
    (1) Activities of Daily Living (ADL), whether they can perform their self-care activities, e.g. self-feeding, bathing, dressing, etc., without any help (2) Instrumental Activities of Daily Living (IADL),whether they can perform activities which help them live independently as a community member, e.g. cooking, shop-ping, housework, etc. (3) Eastern Cooperative Oncology Group 
    performance status(ECOG PS), a widely accepted measure to quantify patients physical condition. This score ranges from zero, being able to carry out all pre-disease performance without any restrictions, to five, being dead. (4) Fall: whether they have experienced falling in the past three months.