Sleep Quality, Fatigue, and Quality of Life Among Teenage and Young Adult Cancer Survivors

Purpose: Teenage and young adult (TYA) cancer survivors experience a range of health-related problems during and beyond the active treatment period. This study examined associations between fatigue, sleep quality, and health-related quality of life (HRQOL) among TYA survivors. Methods: Self-reported data on sleep quality (Pittsburgh Sleep Quality Index), fatigue (Functional Assessment of Chronic Illness Therapy Fatigue), and HRQOL (EuroQoL-5) were gathered from United Kingdom TYA survivors between 13 and 24 years of age. TYA survivors were stratified into those on (n=67) and off (n=135) treatment. Linear regression analyses were used with HRQOL as the dependent variable to investigate potential associations. Fatigue and sleep were entered separately and together in the same model. Age at survey and diagnosis, gender, and ethnicity were included as covariates. Results: 85.07% of TYAs on and 62.69% of TYAs off treatment had sleep quality scores suggestive of clinically significant sleep disorders. 56.72% of TYAs on and 26.67% of TYAs off treatment reported clinically significant levels of fatigue. Strong independent associations between sleep (B=0.05, 95% confidence intervals [CI]=0.03-0.07, p<0.001), fatigue (B=0.02, 95% CI=0.01-0.03, p<0.001), and HRQOL were observed among TYA survivors on treatment. TYAs off treatment showed moderate to strong associations between sleep (B=0.04, 95% CI=0.02-0.05, p<0.001) and fatigue (B=0.02, 95% CI=0.01-0.02, p<0.001), and HRQOL, when examined separately. Sleep was not independently associated with HRQOL among TYAs off treatment (B=0.01, 95% CI=-0.01 to 0.02, p=0.296). Conclusion: The significant associations reported suggest that sleep quality and fatigue are potential modifiable factors associated with HRQOL. Further research is warranted to understand the direction of associations.