Prevalence and determinants of sleep problems in cancer survivors compared to a normative population: a PROFILES registry study

Charles David; Sandra Beijer; Floortje Mols; Simone Oerlemans; Olga Husson; Matty P Weijenberg; Nicole Pm Ezendam

doi:10.1007/s11764-024-01641-z

Prevalence and determinants of sleep problems in cancer survivors compared to a normative population: a PROFILES registry study

J Cancer Surviv. 2024 Jul 24. doi: 10.1007/s11764-024-01641-z. Online ahead of print.

Authors

Charles David¹, Sandra Beijer¹, Floortje Mols^{1

2}, Simone Oerlemans¹, Olga Husson^{3

4

5}, Matty P Weijenberg⁶, Nicole Pm Ezendam^{7

8}

Affiliations

¹ Department of Research and Development, Netherlands, Comprehensive Cancer Organisation , Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands.
² CoRPS-Center of Research on Psychological Disorders and Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
³ Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
⁴ Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
⁵ Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands.
⁶ Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.
⁷ Department of Research and Development, Netherlands, Comprehensive Cancer Organisation , Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands. n.ezendam@iknl.nl.
⁸ CoRPS-Center of Research on Psychological Disorders and Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands. n.ezendam@iknl.nl.

PMID: 39044052
DOI: 10.1007/s11764-024-01641-z

Abstract

Purpose: To (1) identify the prevalence of sleep problems in cancer survivors across cancer types and survivorship durations compared to a normative population and (2) determine demographic, clinical, lifestyle, and psychosocial determinants.

Method: Cancer survivors diagnosed between 2008 and 2015 (N = 6736) and an age- and sex-matched normative cohort (n = 415) completed the single sleep item of the EORTC QLQ-C30: Have you had trouble sleeping? Participants who responded with "quite a bit"/ "very much" were categorized as poor sleepers. A hierarchical multinomial logistic regression was used to identify determinants of sleep problems.

Result: The prevalence of sleep problems was higher in cancer survivors (17%) compared to the normative population (11%) (p < 0.001), varied across cancer types (10-26%) and did not vary based on survivorship duration. The full model showed that survivors who were female (adjusted odds ratio (AOR) 2.26), overweight (AOR 1.50), had one (AOR 1.25) and ≥ 2 comorbidities (AOR 2.15), were former (AOR 1.30) and current (AOR 1.53) smokers and former alcohol drinkers (AOR 1.73), had a higher level of fatigue (AOR 1.05), anxiety (AOR 1.14), depression (AOR 1.11), and cognitive illness perceptions (AOR 1.02), had a higher odds for sleep problems. Higher education compared to lower education (AOR 0.67), having a partner (AOR 0.69), and obesity compared to normal BMI (AOR 0.86) were protective to sleep problems as well as high physical activity before adjusting for psychological factors (AOR 0.91).

Conclusion: Modifiable determinants of sleep problems include physical activity, fatigue, anxiety, depression, and illness perception.

Implications for cancer survivors: Sleep problems after cancer deserve clinical attention. They may be improved by addressing modifiable lifestyle factors: increasing physical activity, stop smoking, and reducing alcohol consumption. As fatigue, depression, and illness perception seem related to sleep problems, lifestyle improvements may also improve these outcomes.

Keywords: Cancer survivors; Determinants of sleep quality; Prevalence; Sleep quality.