Association of Sleep Disturbance With Survival After Colorectal Cancer Diagnosis: Results From the ColoCare Study

TL;DR

Poor sleep after colorectal cancer diagnosis is linked to worse survival, especially in middle-aged and older patients.

Contribution

This study identifies a novel association between preoperative sleep disturbance and reduced overall survival in colorectal cancer patients.

Findings

Moderate/severe sleep disturbance was linked to 46% higher risk of death compared to no/mild disturbance.

Sleep disturbance's impact on survival was stronger in middle-aged and older, male, and overweight/obese patients.

No significant link was found between sleep disturbance and cancer recurrence.

Abstract

Sleep problems are common among cancer patients. The relationship between sleep disruption and clinical outcomes after colorectal cancer (CRC) diagnosis remains poorly understood. We investigated associations of sleep disruption with survival and recurrence in patients with CRC.

CRC patients with stages I–IV (N = 895) were included in this study. Self‐reported sleep disturbance was assessed presurgery using the sleep item from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire‐Core‐30 and classified into “no/mild” or “moderate/severe” sleep disturbance. Cox‐proportional hazard models were computed (HRs and 95% confidence intervals) to investigate associations of sleep disturbance with overall survival (OS), disease‐free survival (DFS), and risk of recurrence, adjusting for age, sex, body mass index, tumor stage and site, and study site.

Thirty percent of patients reported moderate/severe sleep disturbance. N = 190 (21%) were deceased after a median follow‐up of 31 months, whereas 74 patients (15%) had a recurrence. Patients with moderate/severe vs. no/mild sleep disturbance had worse OS (HR = 1.46; 95% CI = 1.07–1.98; p = 0.02). There were no significant associations for sleep disturbance with DFS and risk of recurrence. Stratified analyses indicated that the worse OS rates due to sleep disturbance were stronger in patients who were middle‐aged and older, male, overweight/obese, diagnosed with rectal cancer and stage I–III.

Poor sleep is common among CRC patients and is associated with worse overall survival. These findings highlight the potential value of preoperative sleep screening as a way to identify patients at higher risk of poor outcomes, warranting further investigation in future studies.

ClinicalTrials.gov identifier: NCT02328677

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