Sleep disturbance among breast cancer survivors and controls from midlife to early older adulthood: Pink SWAN
Open accessAbstract
Purpose To compare sleep disturbance from 5 years pre- to 5 years post-diagnosis between breast cancer survivors (BCS) and women without cancer over the same period and to identify BCS subgroups exhibiting different sleep trajectories.Methods Analyses included data from 152 BCS and 2163 controls from 20 years of follow-up in the longitudinal Study of Women's Health Across the Nation (SWAN), a multi-racial/ethnic cohort study. SWAN participants were assessed approximately annually from 1995 to 2015 using a standardized protocol. Pink SWAN focused on women who reported no cancer at SWAN enrollment and developed incident breast cancer after enrollment or did not develop breast cancer. Nonparametric locally weighted scatterplot smoothing plots and linear mixed models were used to compare the prevalence of the most frequently reported sleep problem, frequently waking several times a night (a sleep maintenance problem) during the previous 2 weeks, between BCS and controls in the 5 years pre- to 5 years post-diagnosis. We characterized heterogeneity among BCS on this sleep problem using group-based trajectories and examined pre-diagnosis variables as predictors of group membership.Results No differences were found between BCS and controls in prevalence of frequent nighttime awakenings either before or after diagnosis. Among BCS, three trajectory groups were identified. Thirty-seven percent of BCS had consistently low prevalence of waking several times per night, 30% had high prevalence, and 33% had increasing prevalence which started 2 years pre-diagnosis. Prevalence of pre-diagnosis vasomotor symptoms, anxiety, depressive symptoms, and smoking differed among these groups.Conclusion Among mid-aged women diagnosed with breast cancer, this diagnosis did not trigger/amplify a sleep maintenance problem. The majority of BCS had similar levels of this sleep problem from pre- to post-diagnosis.Implications for cancer survivors Although sleep maintenance problems were not amplified by a cancer diagnosis, a subset of BCS may have sleep issues that should be monitored and treated, as indicated.
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The age of our female patients can be considered a factor that increases the risk of insomnia.
“The age of our female patients can also be considered a factor that increases the risk of insomnia [92].”
From The Effect of Vinyasa Yoga Practice on the Well-Being of Breast-Cancer Patients during COVID-19 Pandemic (2023) · cites this paper as [92]
Cites
The CES-D Scale: A Self-Report Depression Scale for Research in the General Population
Radloff, L. S. (1977) · Applied Psychological Measurement · doi:10.1177/014662167700100306 · Cited by 53,267 · see citing works
A Global Measure of Perceived Stress
Cohen, S., Kamarck, T., & Mermelstein, R. (1983) · Journal of Health and Social Behavior · doi:10.2307/2136404 · Cited by 32,807 · see citing works
Locally Weighted Regression: An Approach to Regression Analysis by Local Fitting
Cleveland, W. S., & Devlin, S. J. (1988) · Journal of the American Statistical Association · doi:10.1080/01621459.1988.10478639 · Cited by 5,740 · see citing works
Cancer treatment and survivorship statistics, 2019
Miller, K. D., Nogueira, L., Mariotto, A. B., Rowland, J. H., Yabroff, K. R., Alfano, C. M., Jemal, A., Kramer, J. L., & Siegel, R. L. (2019) · CA A Cancer Journal for Clinicians · doi:10.3322/caac.21565 · Cited by 4,253 · see citing works
Group-Based Modeling of Development
NAGIN, D. (2005) · doi:10.4159/9780674041318 · Cited by 4,164 · see citing works
(2004) · Choice Reviews Online · doi:10.5860/choice.42-2265 · Cited by 1,385 · see citing works
Sex Differences in Insomnia: A Meta-Analysis
Zhang, B., & Wing, Y.-K. (2006) · Sleep · doi:10.1093/sleep/29.1.85 · Cited by 1,286 · see citing works
Locally Weighted Regression: An Approach to Regression Analysis by Local Fitting
Cleveland, W. S., & Devlin, S. J. (1988) · Journal of the American Statistical Association · doi:10.2307/2289282 · Cited by 854 · see citing works
Sowers, M. R., Crawford, S. L., Sternfeld, B., Morganstein, D. R., Gold, E. B., Greendale, G. A., Evans, D. A., Neer, R. M., Matthews, K. A., Sherman, S., et al. (2000) · Elsevier eBooks · doi:10.1016/b978-012453790-3/50012-3 · Cited by 539 · see citing works
Self-citationKocevska, D., Lysen, T. S., Dotinga, A., Koopman‐Verhoeff, M. E., Luijk, M. P. C. M., Antypa, N., Biermasz, N. R., Blokstra, A., Brug, J., Burk, W. J., et al. (2020) · Nature Human Behaviour · doi:10.1038/s41562-020-00965-x · Cited by 479 · see citing works
Sleep and Quality of Life in Breast Cancer Patients
Fortner, B. V., Stepanski, E. J., Wang, S. C., Kasprowicz, S., & Durrence, H. H. (2002) · Journal of Pain and Symptom Management · doi:10.1016/s0885-3924(02)00500-6 · Cited by 329 · see citing works
Sleep and Sleep Disorders in the Menopausal Transition
Baker, F. C., Lampio, L., Saaresranta, T., & Polo‐Kantola, P. (2018) · Sleep Medicine Clinics · doi:10.1016/j.jsmc.2018.04.011 · Cited by 321 · see citing works
Bromberger, J. T., Kravitz, H. M., Chang, Y., Randolph, J. F., Avis, N. E., Gold, E. B., & Matthews, K. A. (2013) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0b013e3182730599 · Cited by 296 · see citing works
Self-citationAncoli‐Israel, S., Liu, L., Rissling, M. B., Natarajan, L., Neikrug, A. B., Palmer, B. W., Mills, P. J., Parker, B. A., Sadler, G. R., & Maglione, J. E. (2014) · Supportive Care in Cancer · doi:10.1007/s00520-014-2204-5 · Cited by 218 · see citing works
Prevalence, Natural Course, and Risk Factors of Insomnia Comorbid With Cancer Over a 2-Month Period
Savard, J., Villa, J., Ivers, H., Simard, S., & Morin, C. M. (2009) · Journal of Clinical Oncology · doi:10.1200/jco.2008.21.6333 · Cited by 197 · see citing works
Palesh, O. G., Collie, K., Batiuchok, D., Tilston, J., Koopman, C., Perlis, M. L., Butler, L. D., Carlson, R., & Spiegel, D. (2007) · Biological Psychology · doi:10.1016/j.biopsycho.2006.11.002 · Cited by 183 · see citing works
Impact of breast cancer treatments on sleep disturbances – A systematic review
Costa, A. R., Fontes, F., Pereira, S., Gonçalves, M., Azevedo, A., & Lunet, N. (2014) · The Breast · doi:10.1016/j.breast.2014.09.003 · Cited by 163 · see citing works
Efficacy of cognitive behavioral therapy for insomnia in breast cancer: A meta-analysis
Ma, Y., Hall, D. L., Ngo, L. H., Liu, Q., Bain, P. A., & Yeh, G. Y. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101376 · Cited by 151 · see citing works
Evaluation and management of insomnia in women with breast cancer
Kwak, A., Jacobs, J., Haggett, D., Jimenez, R., & Peppercorn, J. (2020) · Breast Cancer Research and Treatment · doi:10.1007/s10549-020-05635-0 · Cited by 107 · see citing works
Leysen, L., Lahousse, A., Nijs, J., Adriaenssens, N., Mairesse, O., Ivakhnov, S., Bilterys, T., Looveren, E. V., Pas, R., & Beckwée, D. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-04936-5 · Cited by 94 · see citing works
Dhruva, A., Paul, S. M., Cooper, B. A., Lee, K. A., West, C. M., Aouizerat, B. E., Dunn, L. B., Swift, P. S., Wara, W., & Miaskowski, C. A. (2012) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2011.08.010 · Cited by 92 · see citing works
Symptom burden among older breast cancer survivors: The Thinking and Living With Cancer (TLC) study
Mandelblatt, J. S., Zhai, W., Ahn, J., Small, B. J., Ahles, T. A., Carroll, J., Denduluri, N., Dilawari, A. A., Extermann, M., Graham, D. M. A., et al. (2019) · Cancer · doi:10.1002/cncr.32663 · Cited by 84 · see citing works
Lampio, L., Polo‐Kantola, P., Polo, O. J., Kauko, T., Aittokallio, J., & Saaresranta, T. (2014) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000000239 · Cited by 78 · see citing works
Kravitz, H. M., Janssen, İ., Bromberger, J. T., Matthews, K. A., Hall, M. H., Ruppert, K. M., & Joffe, H. (2017) · Current Sleep Medicine Reports · doi:10.1007/s40675-017-0084-1 · Cited by 73 · see citing works
Onselen, C. V., Cooper, B. A., Lee, K. A., Dunn, L. B., Aouizerat, B. E., West, C. M., Dodd, M. J., Paul, S. M., & Miaskowski, C. A. (2012) · Supportive Care in Cancer · doi:10.1007/s00520-012-1381-3 · Cited by 60 · see citing works
Insomnia and Fatigue Symptom Trajectories in Breast Cancer: A Longitudinal Cohort Study
Bean, H. R., Diggens, J., Ftanou, M., Weihs, K. L., Stanton, A. L., & Wiley, J. F. (2021) · Behavioral Sleep Medicine · doi:10.1080/15402002.2020.1869005 · Cited by 55 · see citing works
Whisenant, M., Wong, B. G., Mitchell, S. A., Beck, S. L., & Mooney, K. H. (2017) · Oncology nursing forum · doi:10.1188/17.onf.739-750 · Cited by 52 · see citing works
Accortt, E. E., Bower, J. E., Stanton, A. L., & Ganz, P. A. (2015) · Archives of Women s Mental Health · doi:10.1007/s00737-015-0504-5 · Cited by 38 · see citing works
Exploring the Relationship Between Fear of Cancer Recurrence and Sleep Quality in Cancer Survivors
Berrett-Abebe, J., Cadet, T., Pirl, W., & Lennes, I. (2015) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2015.1020586 · Cited by 35 · see citing works
Grayson, S., Sereika, S. M., Harpel, C. K., Diego, E. J. B., Steiman, J. G., McAuliffe, P. F., & Wesmiller, S. W. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06373-9 · Cited by 31 · see citing works
Trajectories of sleep quality during the first three years after breast cancer diagnosis
Fontes, F., Severo, M., Gonçalves, M., Pereira, S., & Lunet, N. (2017) · Sleep Medicine · doi:10.1016/j.sleep.2017.03.022 · Cited by 30 · see citing works
Hery, C. M. B., Naughton, M. J., Pennell, M. L., Foraker, R. E., Young, G. S., Hale, L. E., Feliciano, E. M. C., Pan, K., Crane, T. E., Danhauer, S. C., et al. (2018) · npj Breast Cancer · doi:10.1038/s41523-018-0065-7 · Cited by 22 · see citing works
What Factors Affect the Insomnia Symptom Trajectories in Women With Nonmetastatic Breast Cancer?
Wang, Y., Zhu, X., Li, L., Yi, J., & He, J. (2016) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2016.07.001 · Cited by 16 · see citing works
Lopes, C., Severo, M., Fontes, F., Lopes-Conceição, L., Ferreira, A., Pereira, S., Lunet, N., & Araújo, N. (2022) · Healthcare · doi:10.3390/healthcare10040661 · Cited by 14 · see citing works
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Ge, M., Sheng, J., Shen, L., Hu, F., Jia, Y., Ur-Rehman, A., Li, W., Lan, J., Liu, P., & Chen, H. (2025) · Psycho-Oncology · doi:10.1002/pon.70077 · Cited by 24 · see citing works
Sleep disorders in cancer: interactions and intrinsic links
Han, C., Li, N., Wang, X., Zhuang, Z., Cao, Q., & Wang, S. (2025) · Frontiers in Oncology · doi:10.3389/fonc.2025.1535442 · Cited by 14 · see citing works
Zok, A., Matecka, M., Zapala, J., Izycki, D., & Baum, E. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043770 · Cited by 12 · see citing works
“The age of our female patients can also be considered a factor that increases the risk of insomnia [92].”
BackgroundChange in sleep duration following a cancer diagnosis
Donzella, S. M., Newton, C. C., VoPham, T., Peoples, A. R., Bodelón, C., Shams‐White, M., Patel, A. V., Zhong, C., & Phipps, A. I. (2026) · Cancer Causes & Control · doi:10.1007/s10552-025-02101-4
- Authors
- Goyal, N., Levine, B. J., Crawford, S. L., & Avis, N. E.
- Affiliations
- University of California, San Francisco (US)
- Atrium Health Wake Forest Baptist (US)
- University of Massachusetts Chan Medical School (US)
- Corresponding author
- Avis, Nancy E.
- Venue
- Journal of Cancer Survivorship
- Published
- 2022-08-18
- Volume
- 18
- Issue
- 2
- Pages
- 489-498
- ISSN
- 1932-2259 (ISSN-L)
- 1932-2267
- PMC
- PMC9938082
- OpenAlex
- W4292227686
- Cited by
- 4
- References
- 34
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 1
- FWCI
- 0.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Journal of Cancer Survivorship (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (U01NR004061)
- National Institute on Aging (U01AG012553, U19AG063720)
- National Cancer Institute (R01CA199137, R25 CA122061)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Keywords
- breast cancer survivors, sleep disorders, nocturnal awakenings, sleep trajectories, middle-aged women, vasomotor symptoms, anxiety, depressive symptoms, smoking, cancer diagnosis
- MeSH terms
- Cancer Survivors, Aged, Breast Neoplasms, Female, Humans, Longitudinal Studies, Middle Aged, Sleep, Sleep Wake Disorders, Cohort Studies
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