Cancer-related problems, sleep quality, and sleep disturbance among long-term cancer survivors at 9-years post diagnosis

Sleep Med. 2020 Jan:65:177-185. doi: 10.1016/j.sleep.2019.10.008.


Objective: To estimate the prevalence of sleep difficulties in a large cohort of long-term cancer survivors (>5 years) and examine associations with four domains of cancer-related problems.

Methods: This study analyzed a nationwide sample (N = 1903) of cancer survivors (31% Breast; 20% prostate) at nine years (m = 8.9 sd = 0.6) post-diagnosis with a mean age of 64.5 years. Sleep quality and sleep disturbance were assessed by the Pittsburgh Sleep Quality Index. Multivariable logistic regression models examined associations between cancer-related problems (physical distress, emotional distress, economic distress, and fear of recurrence) and sleep difficulty (poor vs. low sleep quality and high vs. low sleep disturbance). Odds ratios (OR) and 95% confidence intervals (CI) were estimated, adjusting for medico-demographics, behavioral factors, and sleep medication use.

Results: In sum, 20% percent of the sample reported poor sleep quality, 51% reported high sleep disturbance and 17% reported both. Sleep medication use was reported by 28% of the total sample. All four domains of cancer-related problems were significantly associated with poor sleep quality and high sleep disturbance. Above median cancer-related physical distress had the strongest association with both poor sleep quality (OR = 3.42; 95% CI = 2.44-4.79) and high sleep disturbance (OR = 4.06; 95% CI = 3.09-5.34).

Conclusions: Among nine-year cancer survivors, multiple domains of cancer-related health problems were associated with sleep difficulties. Knowledge of the relationship between cancer-related problems and sleep may aid clinicians during the evaluation and treatment of sleep problems in long-term cancer survivors. Future research should utilize prospective data to better understand the causal nature of the associations.

Keywords: Cancer; Sleep disturbance; Sleep problems; Sleep quality.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cancer Survivors / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Prospective Studies
  • Quality of Life / psychology
  • Sleep Wake Disorders / epidemiology*
  • Stress, Psychological / psychology*
  • Surveys and Questionnaires
  • Time Factors