Frailty and Sleep in Adult Survivors of Childhood Cancer: A Childhood Cancer Survivor Study Report

Authors

Lauren C Daniel
Margaret M Lubas
Huiqi Wang
Mariana Szklo-Coxe
Kirsten K Ness
AnnaLynn M Williams
Daniel A Mulrooney
Rebecca Howell
Wendy Leisenring
Yutaka Yasui
Leslie L Robison
Gregory T Armstrong
Eric J Chow
Kevin R Krull
Tara M Brinkman

Publication Date

2-1-2025

Journal

Psychooncology

Abstract

Background: Young adult survivors of childhood cancer exhibit rates of frailty similar to adults several decades older without a cancer history. Frailty has been associated with sleep disturbances in non-cancer populations, but the relationship has not been examined in childhood cancer survivors who are known to exhibit elevated rates of sleep problems.

Aims: Examine associations between frailty and poor sleep quality in long-term survivors of childhood cancer.

Methods: This study utilized data from 9044 participants (> 5 years from diagnosis, Mage = 40.8 years [SD = 9.5]) in the Childhood Cancer Survivor Study. Survivors' frailty status, chronic health conditions (CHC), health behaviors, mental health, and pain were collected in 2014-2016, and self-reported sleep quality in 2017-2019. Multivariable logistic regression models examined frailty status as a predictor of clinically significant poor sleep. All models were adjusted for age at diagnosis, age at survey, sex, race/ethnicity, smoking, risky/heavy alcohol use, and physical inactivity. Separate models included treatment-related variables, CHC burden (number/severity), and emotional health/pain as co-variates.

Results: Frail survivors had 6-fold (95% CI 4.48-7.96) increased odds of future poor sleep quality. Little attenuation of this association was observed when accounting for cancer diagnosis (Odds Ratio [OR] 5.80, 95% CI 4.47-7.52), treatment exposures (OR 5.80, 95% CI 4.43-7.71), or chronic health condition burden (OR 5.12, 95% CI 3.98-6.59), but adjustment for emotional health/pain (OR 2.88, 95% CI 2.18-3.82) attenuated the association appreciably.

Conclusions: Frail childhood cancer survivors have a higher prevalence of clinically significant poor sleep quality. Addressing poor physiologic reserve may impact sleep in frail childhood cancer survivors.

Keywords

Humans, Cancer Survivors, Male, Female, Adult, Neoplasms, Sleep Wake Disorders, Frailty, Middle Aged, Sleep Quality, Young Adult, Child

DOI

10.1002/pon.70098

PMID

39924630

PMCID

PMC11807945

PubMedCentral® Posted Date

2-9-2025

PubMedCentral® Full Text Version

Post-print

Published Open-Access

no