Sleep disturbance trajectories in cancer survivors during the transition to survivorship: a prospective examination of modifiable predictors and physical health outcomes.

BACKGROUND

Sleep disturbance is common among cancer survivors, but more research is needed to understand individual differences and predictors during the transition from primary treatment to early survivorship.

PURPOSE: This study aimed to: (1) model sleep disturbance trajectories among cancer survivors from post-primary treatment into early survivorship, (2) examine the relationships of general (i.e., anxiety, depression, emotion dysregulation) and cancer-specific (i.e., illness beliefs, fear of cancer recurrence) factors with sleep disturbance trajectories, and (3) examine the association between sleep disturbance trajectories and changes in physical health.

METHODS

A total of 501 breast, colorectal, and prostate cancer survivors (24-80 years old, 69.9% female, 84.6% White) completed self-report measures at baseline (approximately 3 months post-primary cancer treatment) and 3-, 6-, 9-, and 12-month follow-ups. Latent class linear mixed modeling identified distinct trajectories of sleep disturbance. Psychosocial correlates of trajectory membership were examined using multinomial logistic regression. A linear regression tested whether sleep trajectory class was associated with changes in physical health over one year.

RESULTS

Three sleep disturbance trajectories were identified: low and slightly improving (44.3%), average and slightly improving (32.9%), and high and slightly improving (22.8%). Individually, higher emotion dysregulation, anxiety, depression, fear of cancer recurrence, and illness beliefs significantly differentiated the high sleep disturbance group from the low and average groups. In the combined model, only anxiety and depression symptoms remained significant. The high sleep disturbance group had significantly less improvement in physical health over one year compared to the low group.

CONCLUSIONS

Both general and cancer-specific psychosocial factors appear to play a key role in identifying individuals at risk for persistent sleep disturbance following cancer treatment. Sleep disturbance trajectories were also associated with changes in physical health over one year, underscoring the importance of early intervention.