Sleep and survival among women with breast cancer: 30 years of follow-up within the Nurses’ Health Study
Open accessAbstract
Breast cancer is a leading cause of cancer death in women. Sleep has been linked with mortality among cancer-free population; however, its association with survival among women with breast cancer is understudied. Breast cancer patients ( N =3682) reported their average sleep duration post diagnosis. Subsamples also provided their pre-diagnosis sleep duration ( n =1949) and post-diagnosis sleep difficulties ( n =1353). Multivariate Cox models estimated hazard ratios (HR) and confidence intervals (CI) of all-cause, breast cancer, and non-breast cancer mortality. At diagnosis, the mean age was 64.9 years and 91.7% were stage I or II. Women sleeping ⩾ 9 h per night post diagnosis had a strong higher risk of all-cause (multivariate HRs: MV-HR=1.37, CI=1.10–1.71), breast cancer (MV-HR=1.46, CI=1.02–2.07), and non-breast cancer mortality (MV-HR=1.34, CI=1.01–1.79), compared to women sleeping 8 h per night. Increased sleep duration post diagnosis ( vs unchanged) and regular sleep difficulties ( vs rare/none) were associated with a strong elevated risk of all-cause mortality (MV-HR increased duration =1.35, CI=1.04–1.74; MV-HR regular difficulties =1.49, CI=1.02–2.19) and a moderate greater risk of breast cancer and non-breast cancer mortality. Various facets of sleep were associated with higher all-cause mortality risk. If replicated, these findings support evaluation of breast cancer patients’ sleep duration and difficulties to identify those at risk for poorer outcomes.
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Untreated cancer-related insomnia may contribute to poorer treatment response, increased risk of cancer recurrence, and reduced survival.
“Untread cancer-related insomnia may also contribute to poorer treatment response, increased risk of cancer recurrence, and reduced survival. 9-11”
From Digital Cognitive-Behavioral Therapy for Insomnia in Cancer Survivors: Protocol for a Pragmatic Clinical Trial (2024) · cites this paper as [11]
The Results (page not provided) associate regular difficulty falling or staying asleep with higher all-cause mortality among women with breast cancer, supporting the reduced-survival portion. The paper does not establish that insomnia was untreated or assess treatment response or cancer recurrence; its observed association also does not establish that insomnia caused poorer survival. (LLM, conf=0.88)
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- Authors
- Trudel-Fitzgerald, C., Zhou, E. S., Poole, E. M., Zhang, X., Michels, K. B., Eliassen, A. H., Chen, W. Y., Holmes, M. D., Tworoger, S. S., & Schernhammer, E. S.
- Affiliations
- Harvard University (US)
- Brigham and Women's Hospital (US)
- University of California, Los Angeles (US)
- ORCID
- Venue
- British Journal of Cancer
- Published
- 2017-03-30
- Volume
- 116
- Issue
- 9
- Pages
- 1239-1246
- ISSN
- 0007-0920 (ISSN-L)
- 1532-1827
- PMC
- PMC5877366
- OpenAlex
- W2601140727
- Cited by
- 98
- References
- 55
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 7 · 2023: 13 · 2022: 14 · 2021: 16 · 2020: 9 · 2019: 11 · 2018: 11 · 2017: 2
- FWCI
- 11.75
- Type
- journal article
- Language
- en
- Update notices
- erratum (2018-01-09)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- British Journal of Cancer (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- Funders
- Canadian Institutes of Health Research (P01 CA87969, UM1 CA186107)
- National Cancer Institute (K07CA188126, P01CA087969, UM1CA186107)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Keywords
- breast cancer, sleep duration, sleep disorders, cancer survival, mortality, all-cause mortality, breast cancer mortality, non-breast cancer mortality, Nurses' Health Study, women
- MeSH terms
- Adult, Aged, Breast Neoplasms, Female, Follow-Up Studies, Humans, Middle Aged, Neoplasm Recurrence, Local, Risk Factors, Sleep, Time Factors, Proportional Hazards Models, Disease-Free Survival
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