Document Type
Article
Publication Date
2025
DOI
10.1002/pon.70098
Publication Title
Psycho-Oncology
Volume
34
Issue
2
Pages
e70098 (1-7)
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, M(age) = 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.
Rights
© 2025 The Authors.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (CC BY-NC-ND 4.0), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Data Availability
Article states: "The Childhood Cancer Survivor Study is a US National Cancer Institute funded resource (U24 CA055727) to promote and facilitate research among long-term survivors of cancer diagnosed during childhood and adolescence. CCSS data are publicly available on dbGaP at https://www.ncbi.nlm.nih.gov/gap/ through its accession number phs001327.v2.p1. and on the St Jude Survivorship Portal within the St. Jude Cloud at https://survivorship.stjude.cloud/. In addition, utilization of the CCSS data that leverages the expertise of CCSS Statistical and Survivorship research and resources will be considered on a case-by case basis. For this utilization, a research Application Of Intent followed by an Analysis Concept Proposal must be submitted for evaluation by the CCSS Publications Committee. Users interested in utilizing this resource are encouraged to visit http://ccss.stjude.org. Full analytical data sets associated with CCSS publications since January of 2023 are also available on the St. Jude Survivorship Portal at https://viz.stjude.cloud/community/cancer-survivorship-community~4/publications."
Original Publication Citation
Daniel, L. C., Lubas, M. M., Wang, H., Szklo-Coxe, M., Ness, K. K., Williams, A. M., Mulrooney, D. A., Howell, R., Leisenring, W., Yasui, Y., Robison, L. L., Armstrong, G. T., Chow, E. J., Krull, K. R., & Brinkman, T. M. (2025). Frailty and sleep in adult survivors of childhood cancer: A Childhood Cancer Survivor Study report. Psycho-Oncology, 34(2), 1-7, Article e70098. https://doi.org/10.1002/pon.70098
Repository Citation
Daniel, L. C., Lubas, M. M., Wang, H., Szklo-Coxe, M., Ness, K. K., Williams, A. M., Mulrooney, D. A., Howell, R., Leisenring, W., Yasui, Y., Robison, L. L., Armstrong, G. T., Chow, E. J., Krull, K. R., & Brinkman, T. M. (2025). Frailty and sleep in adult survivors of childhood cancer: A Childhood Cancer Survivor Study report. Psycho-Oncology, 34(2), 1-7, Article e70098. https://doi.org/10.1002/pon.70098
Supporting Information
