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Psychooncology. 2019 Apr;28(4):903-912. doi: 10.1002/pon.5040. Epub 2019 Mar 14.

Sleep, emotional distress, and physical health in survivors of childhood cancer: A report from the Childhood Cancer Survivor Study.

Author information

1
Department of Psychology, Rutgers University-Camden, Camden, New Jersey.
2
Department of Psychology and Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
3
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee.
4
Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
5
Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
6
Pencer Brain Tumor Centre, Princess Margaret Hospital, Toronto, Ontario, Canada.
7
Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts.
8
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
9
Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas.
10
Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington.
11
Division of Medical Oncology, Departments of Medicine and Community and Family Medicine, Duke University Medical Center, Durham, North Carolina.
12
Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.

Abstract

OBJECTIVE:

Sleep disorders are associated with psychological and physical health, although reports in long-term survivors of childhood cancer are limited. We characterized the prevalence and risk factors for behaviors consistent with sleep disorders in survivors and examined longitudinal associations with emotional distress and physical health outcomes.

METHODS:

Survivors (n = 1933; median [IQR] age = 35 [30, 41]) and siblings (n = 380; age = 33 [27, 40]) from the Childhood Cancer Survivor Study completed measures of sleep quality, fatigue, and sleepiness. Emotional distress and physical health outcomes were assessed approximately 5 years before and after the sleep survey. Multivariable logistic or modified Poisson regression models examined associations with cancer diagnosis, treatment exposures, and emotional and physical health outcomes.

RESULTS:

Survivors were more likely to report poor sleep efficiency (30.8% vs 24.7%; prevalence ratio [PR] = 1.26; 95% confidence interval, 1.04-1.53), daytime sleepiness (18.7% vs 14.2%; PR = 1.31 [1.01-1.71]), and sleep supplement use (13.5% vs 8.3%; PR = 1.56 [1.09-2.22]) than siblings. Survivors who developed emotional distress were more likely to report poor sleep efficiency (PR = 1.70 [1.40-2.07]), restricted sleep time (PR = 1.35 [1.12-1.62]), fatigue (PR = 2.11 [1.92-2.32]), daytime sleepiness (PR = 2.19 [1.71-2.82]), snoring (PR = 1.85 [1.08-3.16]), and more sleep medication (PR = 2.86 [2.00-4.09]) and supplement use (PR = 1.89[1.33-2.69]). Survivors reporting symptoms of insomnia (PR = 1.46 [1.02-2.08]), fatigue (PR = 1.31 [1.01-1.72]), and using sleep medications (PR = 2.16 [1.13-4.12]) were more likely to develop migraines/headaches.

CONCLUSIONS:

Survivors report more sleep difficulties and efforts to manage sleep than siblings. These sleep behaviors are related to worsening or persistently elevated emotional distress and may result in increased risk for migraines. Behavioral interventions targeting sleep may be important for improving health outcomes.

KEYWORDS:

cancer; childhood cancer survivors; emotional distress; late effects; oncology; sleep

PMID:
30817058
PMCID:
PMC6506232
[Available on 2020-04-01]
DOI:
10.1002/pon.5040

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