Skip to main content

Advertisement

SpringerLink
Log in

Sleep duration change across breast cancer survivorship: associations with symptoms and health-related quality of life

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Sleep duration among breast cancer survivors correlates with fatigue, depression, and health-related quality of life (HRQOL); however, this has not been studied longitudinally. This study investigated patterns of sleep duration change across the early breast cancer survivorship period, their demographic and clinical predictors, and their relationships with subsequent cancer-related symptoms and HRQOL. Breast cancer survivors (n = 572), were assessed 6 months post-diagnosis (current sleep & retrospective reports of pre-diagnosis sleep), 30 months post-diagnosis (sleep), and 39 months post-diagnosis (symptoms, HRQOL). Sleep duration change was determined by examining sleep at each time point in relation to published norms. Analysis of variance and logistic regression models tested demographic and clinical differences between the sleep change groups; linear regression models tested differences in symptoms and HRQOL. Half of the survivors reported no sleep duration change over time; however, 25% reported sleep changes indicating a temporary (5.6%), late-occurring (14%), or sustained (5.9%) change. Survivors reporting sustained or temporary sleep changes were more likely to have been treated with chemotherapy (OR = 2.62, P < 0.001) or gained weight after diagnosis (OR = 1.82, P = 0.04) than those with no sleep change. Sustained sleep changes were related to greater subsequent severity, affective, and sensory aspects of fatigue (βs = 2.0, 2.3, 1.8; all P < 0.0001) and lower vitality (β = −10.8, P = 0.005). Survivors treated with chemotherapy and those who gain weight after diagnosis may have increased risk for sustained sleep duration changes, which may increase their fatigue. These results point to the need for routine assessment of sleep as part of survivorship care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bower JE (2008) Behavioral symptoms in patients with breast cancer and survivors. J Clin Oncol 26(5):768–777

    Article  PubMed  Google Scholar 

  2. Fiorentino L, Ancoli-Israel S (2006) Insomnia and its treatment in women with breast cancer. Sleep Med Rev 10(6):419–429

    Article  PubMed  Google Scholar 

  3. Savard J, Simard S, Blanchet J, Ivers H, Morin CM (2001) Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep 24(5):583–590

    PubMed  CAS  Google Scholar 

  4. Fortner BV, Stepanski EJ, Wang SC, Kasprowicz S, Durrence HH (2002) Sleep and quality of life in breast cancer patients. J Pain Symptom Manage 24(5):471–480

    Article  PubMed  Google Scholar 

  5. Carpenter JS, Elam JL, Ridner SH, Carney PH, Cherry GJ, Cucullu HL (2004) Sleep, fatigue, and depressive symptoms in breast cancer survivors and matched healthy women experiencing hot flashes. Oncol Nurs Forum 31(3):591–5598

    Article  PubMed  Google Scholar 

  6. Ancoli-Israel S, Liu L, Marler MR, Parker BA, Jones V, Sadler GR, Dimsdale J, Cohen-Zion M, Fiorentino L (2006) Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer 14(3):201–209

    Article  PubMed  Google Scholar 

  7. Otte JL, Carpenter JS, Russell KM, Bigatti S, Champion VL (2010) Prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors. J Pain Symptom Manage 39(3):535–547

    Google Scholar 

  8. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR (2002) Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 59(2):131–136

    Article  PubMed  Google Scholar 

  9. Heslop P, Smith GD, Metcalfe C, Macleod J, Hart C (2002) Sleep duration and mortality: the effect of short or long sleep duration on cardiovascular and all-cause mortality in working men and women. Sleep Med 3(4):305–314

    Article  PubMed  Google Scholar 

  10. Tamakoshi A, Ohno Y (2004) Self-reported sleep duration as a predictor of all-cause mortality: results from the JACC study, Japan. Sleep 27(1):51–54

    PubMed  Google Scholar 

  11. Patel SR, Ayas NT, Malhotra MR, White DP, Schernhammer ES, Speizer FE, Stampfer MJ, Hu FB (2004) A prospective study of sleep duration and mortality risk in women. Sleep 27(3):440–444

    PubMed  Google Scholar 

  12. Youngstedt SD, Kripke DF (2004) Long sleep and mortality: rationale for sleep restriction. Sleep Med Rev 8(3):159–174

    Article  PubMed  Google Scholar 

  13. Amagai Y, Ishikawa S, Gotoh T, Doi Y, Kayaba K, Nakamura Y, Kajii E (2004) Sleep duration and mortality in Japan: the Jichi Medical School Cohort Study. J Epidemiol 14(4):124–128

    Article  PubMed  Google Scholar 

  14. Payne J, Piper B, Rabinowitz I, Zimmerman B (2006) Biomarkers, fatigue, sleep, and depressive symptoms in women with breast cancer: a pilot study. Oncol Nurs Forum 33(4):775–783

    Article  PubMed  Google Scholar 

  15. Davidson JR, MacLean AW, Brundage MD, Schulze K (2002) Sleep disturbance in cancer patients. Soc Sci Med 54(9):1309–1321

    Article  PubMed  Google Scholar 

  16. Sateia MJ, Lang BJ (2008) Sleep and cancer: recent developments. Curr Oncol Rep 10(4):309–318

    Article  PubMed  Google Scholar 

  17. Savard J, Morin CM (2001) Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19(3):895–908

    PubMed  CAS  Google Scholar 

  18. Janz NK, Mujahid M, Chung LK, Lantz PM, Hawley ST, Morrow M, Schwartz K, Katz SJ (2007) Symptom experience and quality of life of women following breast cancer treatment. J Womens Health (Larchmt) 16(9):1348–1361

    Article  Google Scholar 

  19. Stepanski EJ, Walker MS, Schwartzberg LS, Blakely LJ, Ong JC, Houts AC (2009) The relation of trouble sleeping, depressed mood, pain, and fatigue in patients with cancer. J Clin Sleep Med 5(2):132–136

    PubMed  Google Scholar 

  20. Bardwell WA, Profant J, Casden DR, Dimsdale JE, Ancoli-Israel S, Natarajan L, Rock CL, Pierce JP (2008) The relative importance of specific risk factors for insomnia in women treated for early-stage breast cancer. Psychooncology 17(1):9–18

    Article  PubMed  Google Scholar 

  21. Couzi RJ, Helzlsouer KJ, Fetting JH (1995) Prevalence of menopausal symptoms among women with a history of breast cancer and attitudes toward estrogen replacement therapy. J Clin Oncol 13(11):2737–2744

    PubMed  CAS  Google Scholar 

  22. Mao JJ, Armstrong K, Bowman MA, Xie SX, Kadakia R, Farrar JT (2007) Symptom burden among cancer survivors: impact of age and comorbidity. J Am Board Fam Med 20(5):434–443

    Article  PubMed  Google Scholar 

  23. Savard J, Davidson JR, Ivers H, Quesnel C, Rioux D, Dupere V, Lasnier M, Simard S, Morin CM (2004) The association between nocturnal hot flashes and sleep in breast cancer survivors. J Pain Symptom Manage 27(6):513–522

    Article  PubMed  Google Scholar 

  24. Palesh OG, Collie K, Batiuchok D, Tilston J, Koopman C, Perlis ML, Butler LD, Carlson R, Spiegel D (2007) A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biol Psychol 75(1):37–44

    Article  PubMed  Google Scholar 

  25. Sela RA, Watanabe S, Nekolaichuk CL (2005) Sleep disturbances in palliative cancer patients attending a pain and symptom control clinic. Palliat Support Care 3(1):23–31

    Article  PubMed  Google Scholar 

  26. Smets EM, Visser MR, Willems-Groot AF, Garssen B, Oldenburger F, van Tienhoven G, de Haes JC (1998) Fatigue and radiotherapy: (A) experience in patients undergoing treatment. Br J Cancer 78(7):899–906

    Article  PubMed  CAS  Google Scholar 

  27. Savard J, Simard S, Ivers H, Morin CM (2005) Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: sleep and psychological effects. J Clin Oncol 23(25):6083–6096

    Article  PubMed  Google Scholar 

  28. Espie CA, Fleming L, Cassidy J, Samuel L, Taylor LM, White CA, Douglas NJ, Engleman HM, Kelly HL, Paul J (2008) Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. J Clin Oncol 26(28):4651–4658

    Article  PubMed  Google Scholar 

  29. Rich T, Innominato PF, Boerner J, Mormont MC, Iacobelli S, Baron B, Jasmin C, Levi F (2005) Elevated serum cytokines correlated with altered behavior, serum cortisol rhythm, and dampened 24-hour rest-activity patterns in patients with metastatic colorectal cancer. Clin Cancer Res 11(5):1757–1764

    Article  PubMed  CAS  Google Scholar 

  30. Savard J, Simard S, Ivers H, Morin CM (2005) Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part II: immunologic effects. J Clin Oncol 23(25):6097–6106

    Article  PubMed  Google Scholar 

  31. Bowen DJ, Alfano CM, McGregor BA, Kuniyuki A, Bernstein L, Meeske K, Baumgartner KB, Fetherolf J, Reeve BB, Smith AW et al (2007) Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors. Breast Cancer Res Treat 106(1):85–95

    Google Scholar 

  32. Kriska AM, Bennett PH (1992) An epidemiological perspective of the relationship between physical activity and NIDDM: from activity assessment to intervention. Diabetes Metab Rev 8(4):355–372

    Article  PubMed  CAS  Google Scholar 

  33. Pereira MA, FitzerGerald SJ, Gregg EW, Joswiak ML, Ryan WJ, Suminski RR, Utter AC, Zmuda JM (1997) A collection of Physical Activity Questionnaires for health-related research. Med Sci Sports Exerc 29(6 Suppl):S1–S205

    PubMed  CAS  Google Scholar 

  34. Piper BF, Dibble SL, Dodd MJ, Weiss MC, Slaughter RE, Paul SM (1998) The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum 25(4):677–684

    PubMed  CAS  Google Scholar 

  35. Northouse LL (1981) Mastectomy patients and the fear of cancer recurrence. Cancer Nurs 4(3):213–220

    Article  PubMed  CAS  Google Scholar 

  36. Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4):385–396

    Article  PubMed  CAS  Google Scholar 

  37. Hays RD, Sherbourne CD, Mazel RM (1993) The RAND 36-item health survey 1.0. Health Econ 2(3):217–227

    Article  PubMed  CAS  Google Scholar 

  38. Ware JE Jr (1996) The SF-36 health survey. In: Spilker B (ed) Quality of life and pharmacoeconomics in clinical trials, 2nd edn. Lippincott-Raven, Philadelphia, pp 337–345

  39. Patterson RE, Kristal AR, Tinker LF, Carter RA, Bolton MP, Agurs-Collins T (1999) Measurement characteristics of the Women’s Health Initiative food frequency questionnaire. Ann Epidemiol 9(3):178–187

    Article  PubMed  CAS  Google Scholar 

  40. Ganz PA, Day R, Ware JE Jr, Redmond C, Fisher B (1995) Base-line quality-of-life assessment in the National Surgical Adjuvant Breast and Bowel Project Breast Cancer Prevention Trial. J Natl Cancer Inst 87(18):1372–1382

    Article  PubMed  CAS  Google Scholar 

  41. Alfano CM, McGregor BA, Kuniyuki A, Reeve BB, Bowen DJ, Baumgartner KB, Bernstein L, Ballard-Barbash R, Malone KE, Ganz PA et al (2006) Psychometric properties of a tool for measuring hormone-related symptoms in breast cancer survivors. Psychooncology 15(11):985–1000

    Google Scholar 

  42. Lichstein KL, Durrence HH, Riedel BW, Taylor DJ, Bush AJ (2004) Epidemiology of sleep: age, gender, and ethnicity. Lawrence Erlbaum Associates, Inc., Mahwah, NJ

  43. Thompson WD (1994) Statistical analysis of case-control studies. Epidemiol Rev 16(1):33–50

    PubMed  CAS  Google Scholar 

  44. Mickey RM, Greenland S (1989) The impact of confounder selection criteria on effect estimation. Am J Epidemiol 129(1):125–137

    PubMed  CAS  Google Scholar 

  45. Alfano CM, Rowland JH (2006) Recovery issues in cancer survivorship: a new challenge for supportive care. Cancer J 12(5):432–443

    Article  PubMed  Google Scholar 

  46. Berger AM, Wielgus K, Hertzog M, Fischer P, Farr L (2009) Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy. Support Care Cancer 18:105–114

    Google Scholar 

  47. Kripke DF, Ancoli-Israel S, Klauber MR, Wingard DL, Mason WJ, Mullaney DJ (1997) Prevalence of sleep-disordered breathing in ages 40–64 years: a population-based survey. Sleep 20(1):65–76

    PubMed  CAS  Google Scholar 

  48. Patel SR, Blackwell T, Redline S, Ancoli-Israel S, Cauley JA, Hillier TA, Lewis CE, Orwoll ES, Stefanick ML, Taylor BC et al (2008) The association between sleep duration and obesity in older adults. Int J Obes (Lond) 32(12):1825–1834

    Article  Google Scholar 

  49. Bastard JP, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, Capeau J, Feve B (2006) Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw 17(1):4–12

    PubMed  CAS  Google Scholar 

  50. Marshall NS, Glozier N, Grunstein RR (2008) Is sleep duration related to obesity? A critical review of the epidemiological evidence. Sleep Med Rev 12(4):289–298

    Article  PubMed  Google Scholar 

  51. Donovan KA, Jacobsen PB (2007) Fatigue, depression, and insomnia: evidence for a symptom cluster in cancer. Semin Oncol Nurs 23(2):127–135

    Article  PubMed  Google Scholar 

  52. Goedendorp MM, Gielissen MF, Verhagen CA, Peters ME, Bleijenberg G (2008) Severe fatigue and related factors in cancer patients before the initiation of treatment. Br J Cancer 99(9):1408–1414

    Article  PubMed  CAS  Google Scholar 

  53. Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR (2000) Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 18(4):743–753

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Supported by contracts from the National Cancer Institute: N01-CN-75036-20, N01-CN-05228, N01-PC-67010.

Conflicts of interest

No authors declare conflicts of interest for this manuscript.

Author information

Authors and Affiliations

  1. Office of Cancer Survivorship, National Cancer Institute, DCCPS/NCI/NIH/DHHS, 6116 Executive Blvd, Suite 404, Bethesda, MD, 20892-8336, USA

    Catherine M. Alfano

  2. Department of Psychology, University of Alabama, Tuscaloosa, AL, USA

    Kenneth L. Lichstein & Gregory S. Vander Wal

  3. Outcomes Research Branch, ARP/DCCPS/NCI/NIH/DHHS, Bethesda, MD, USA

    Ashley Wilder Smith

  4. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Bryce B. Reeve

  5. Fred Hutchinson Cancer Research Center & University of Washington, Seattle, WA, USA

    Anne McTiernan

  6. Department of Cancer Etiology, City of Hope National Medical Center, Duarte, CA, USA

    Leslie Bernstein

  7. Department of Epidemiology & Clinical Information Sciences, University of Louisville, Louisville, KY, USA

    Kathy B. Baumgartner

  8. Applied Research Program, DCCPS/NCI/NIH/DHHS, Bethesda, MD, USA

    Rachel Ballard-Barbash

Authors
  1. Catherine M. Alfano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenneth L. Lichstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregory S. Vander Wal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ashley Wilder Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bryce B. Reeve
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anne McTiernan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Leslie Bernstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kathy B. Baumgartner
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rachel Ballard-Barbash
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Catherine M. Alfano.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Alfano, C.M., Lichstein, K.L., Vander Wal, G.S. et al. Sleep duration change across breast cancer survivorship: associations with symptoms and health-related quality of life. Breast Cancer Res Treat 130, 243–254 (2011). https://doi.org/10.1007/s10549-011-1530-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-011-1530-2

Keywords

Search

Navigation