Prevalence, risk factors, and trajectories of sleep disturbance in a cohort of African-American breast cancer survivors

Support Care Cancer. 2021 May;29(5):2761-2770. doi: 10.1007/s00520-020-05786-2. Epub 2020 Sep 29.


Purpose: Sleep disturbance may be an overlooked modifiable risk factor for health disparities among African-American breast cancer survivors (AABCS). This study aimed to identify the prevalence of and risk factors for sleep disturbance in a cohort of AABCS.

Methods: The study was conducted among participants in the Women's Circle of Health Follow-up Study, a longitudinal study of breast cancer in 10 counties in New Jersey. Cases were identified shortly after diagnosis by the New Jersey State Cancer Registry. Self-reported sleep disturbance (Pittsburgh Sleep Quality Index) and other factors (e.g., socioeconomic status, menopausal status) were assessed at pre-diagnosis (n = 637), 10 months post-diagnosis (n = 261), and 24 months post-diagnosis (n = 632). Clinical data were obtained via medical record abstraction, and height and weight were measured by study staff.

Results: Most AABCS (57%) reported clinically significant sleep disturbance before diagnosis, and this rate remained largely unchanged at 10 months (53%) and 24 months post-diagnosis (61%). Average sleep disturbance scores indicated clinically significant disturbance at all three assessments (M range = 6.67-7.57). Most reported sleeping fewer than the recommended 7 hours per night at each assessment (range 57-65%). Risk factors for sleep disturbance were identified at each assessment, including pre-diagnosis (less education), 10 months post-diagnosis (lack of insurance, treatment with chemotherapy), and 24 months post-diagnosis (younger age, less education, lower income, obesity, and lymphedema). Treatment with endocrine therapy was a protective factor at 10 months post-diagnosis.

Conclusion: Most AABCS report clinically significant sleep disturbance from before diagnosis through 24 months post-diagnosis. These rates appear indicate AABCS experience significant sleep-related disparities.

Keywords: African-American or African-American cancer survivors; Breast neoplasms; Cancer; Oncology; Quality of life; Sleep; Survivorship.

MeSH terms

  • Adult
  • Aged
  • Black or African American
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / mortality
  • Cancer Survivors / statistics & numerical data*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Middle Aged
  • Prevalence
  • Risk Factors
  • Sleep Wake Disorders / epidemiology
  • Sleep Wake Disorders / etiology*
  • Survivors
  • Young Adult