Supportive Care in Cancer

, Volume 24, Issue 2, pp 539–546 | Cite as

Relationship between sleep problems and psychological outcomes in adolescent and young adult cancer survivors and controls

  • Lauren Daniel
  • Anne E. Kazak
  • Yimei Li
  • Wendy Hobbie
  • Jill Ginsberg
  • Eliana Butler
  • Lisa Schwartz
Original Article



How cancer history and distress relate to sleep outcomes of adolescents and young adults (AYAs) is unclear. The current study compares AYA cancer survivors to controls on indicators of sleep and fatigue; examines the concurrent association between psychological status, sleep, and fatigue; and investigates the lagged relationship between sleep and fatigue problems with psychological functioning.


AYA cancer survivors (n = 167) and controls (n = 170), ages 16 to 30, completed measures at a survivorship clinic/primary care visit (time 1) and 2 months later (time 2). Participants completed questions about sleep quality, quantity, sleep medication use, self-reports of sleep problems, and fatigue in addition to measures of depression, anxiety, and posttraumatic stress symptoms (PTSS).


There were no differences in sleep quantity or quality between survivors and controls, but survivors reported significantly more fatigue. Within groups, AYAs with self-reported sleep and fatigue problems reported significantly higher depression, anxiety, and PTS symptoms. Controlling for baseline depression, sleep, and fatigue problems at time 1 significantly predicted depression at time 2 in survivors but not in controls.


This study offers important insight into the psychological functioning of childhood cancer survivors and prospectively describes sleep and fatigue as risk factors for poor psychological functioning in survivors. These findings support screening for sleep problems in AYA survivors as these difficulties are closely related to mental health functioning.


AYA Sleep Fatigue Cancer Psychosocial 



This research was supported by the National Cancer Institute (CA106928). The Principal Investigator, Dr. Kazak, was at CHOP/PENN at the time that the study was conducted. The authors thank the study participants. We also thank Claire Carlson, RN, Sue Ogle, CRNP, and Maureen Reilly, BSN, RN, for assisting with recruitment and access to patients and Andrew Gaffney, Emily Knudsen-Strong, Muhammad Monsour, Ifigenia Mougianis, Sonali Sanyal, Mary Caitlin St. Clair, Mindy Yang, and Lauren Brumley for serving as research assistants.

Compliance with ethical standards

The authors have no conflicts of interest to declare.

The study was approved by the appropriate institutional review board. All procedures performed were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Lauren Daniel
    • 1
  • Anne E. Kazak
    • 2
    • 3
  • Yimei Li
    • 1
    • 4
  • Wendy Hobbie
    • 1
    • 4
  • Jill Ginsberg
    • 1
    • 4
  • Eliana Butler
    • 1
  • Lisa Schwartz
    • 1
    • 4
  1. 1.Division of OncologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Nemours Children’s Health SystemWilmingtonUSA
  3. 3.Sidney Kimmel Medical School of Thomas Jefferson UniversityPhiladelphiaUSA
  4. 4.The Perelman School of Medicine of the University of PennsylvaniaPhiladelphiaUSA

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