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Sleep Quality Among Teenagers and Young Adults With Cancer

Fortmann, Judith MSc, BSc; Fisher, Abigail PhD, BSc; Hough, Rachael MD; Gregory, Alice MPhD; Pugh, Gemma PhD, BSc

doi: 10.1097/NCC.0000000000000707
Article: PDF Only

Background Teenagers and young adults (TYAs) with cancer are known to suffer poor sleep quality and sleep disturbances; understanding the level of burden is essential to improving patient outcomes via supportive care interventions.

Objectives To compare sleep quality and the prevalence of sleep disturbances among TYA cancer patients, TYA survivors, and general population TYAs with no history of cancer.

Methods Teenager and young adult patients receiving active cancer treatment (n = 70), TYA cancer survivors (n = 151), and general population TYAs (n = 324) aged between 13 and 24 years completed the Pittsburgh Sleep Quality Index. Analyses of covariance were used to investigate potential group differences. Age at survey diagnosis, gender, ethnicity, and health status were included as covariates.

Results 84.29% of TYA patients, 62.91% of TYA cancer survivors, and 65.12% of general population TYAs reported Pittsburgh Sleep Quality Index scores greater than 5, suggesting clinically significant sleep disorders. Teenager and young adult patients reported significantly poorer global sleep quality compared with TYA survivors (mean difference, 0.99; 95% confidence interval, 0.03-1.96; P = .044) and general population TYAs (mean difference, 1.34; 95% confidence interval, 0.26–2.41; P = .009). Teenager and young adult patients and survivors reported significantly poorer sleep latency (P = .003 for TYA patients, P = .035 for TYA survivors off treatment) and habitual sleep efficiency (P < .001 for TYA patients, P = .014 for TYA survivors) than general population controls.

Conclusions The significant differences observed suggest young people with cancer, particularly those on treatment, may benefit from specialized sleep interventions.

Implications for Practice Efforts to ensure health professionals have the knowledge and skills to provide advice about sleep to young people with cancer are needed.

Author Affiliations: Department of Behavioural Science and Health, University College London (Ms Fortmann and Drs Fisher and Pugh); University College London Hospital’s NHS Foundation Trust (Dr Hough); Department of Psychology, Goldsmiths, University of London (Dr Gregory); and Centre for Sports and Exercise Medicine, William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London (Dr Pugh), London, United Kingdom.

This study was approved by The University College London Ethics Committee 6206/001 and London Hampstead NHS Research Ethics Committee 15/LO/0764. Informed consent was obtained from all individual participants included in the study. By completing and returning the health and lifestyle questionnaire, young people were consenting to their data being used for the purposes outlined within this study.

All phases of the study were supported by an IMPACT Studentship cofunded by CLIC Sargent and University College London awarded to G.P. Cancer Research UK funded the survey printing. G.P. is supported by a Pan-London Research Fellowship funded by RM Partners, UCLH Cancer Collaborative, and South East London Accountable Cancer Network on behalf of the National Cancer Vanguard. This work has not been published previously.

The authors have no conflicts of interest to disclose.

Correspondence: Gemma Pugh, PhD, BSc, Energy Balance and Cancer Research Group, Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, United Kingdom WC1E 6BT (

Accepted for publication January 22, 2019.

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