Prevalence and Correlates of Sleep Difficulties in a Large Multicenter Outpatient Oncology Population as Identified...

Sleep disturbances are underidentified and undertreated in oncology. To inform screening and intervention efforts at a large academic cancer center, we identified the prevalence and correlates of patient-reported sleep difficulties. This retrospective study evaluated 20,416 individuals who completed practice-based distress screening from January 2017 to June 2024. Sleep difficulties in the past 2 weeks were reported from 0 (none) to 10 (severe). Uni- and multivariable regression models evaluated the impact of sociodemographic factors (age, sex, race/ethnicity, financial concerns) and medical/psychosocial factors (cancer type/stage, time since diagnosis, distress, anxiety, depression, pain, relationship problems, tobacco and alcohol use) on clinically significant (≥5) and severe (≥7) sleep difficulties. All variables were obtained from patients' first screen, except for cancer type, stage, and diagnosis date, which were from the cancer registry. Among the sample (59% female, 78% non-Hispanic white, 49% stage I to II, mixed cancer sites), 36% reported clinically significant sleep difficulties. In a multivariable model, the strongest correlates (OR ≥ 1.35) of sleep difficulties ≥5 were as follows: age 40 to 64 (OR = 1.35), financial concerns (OR = 1.35), distress (OR = 3.06), pain (OR = 2.80), anxiety (OR = 2.31), and depression (OR = 1.69). Risk varied by cancer type, with upper gastrointestinal, genitourinary, thoracic, and hematologic cancers showing modestly higher odds. Sensitivity analyses (cutoff ≥7, within 90 days of diagnosis) showed broadly similar but not identical correlates. Sleep difficulties are prevalent and correlated with psychosocial concerns and cancer type. Future research should explore sleep trajectories and potential care pathways for patients screening positive.

This large, multicenter study demonstrates that sleep difficulties are highly prevalent among oncology outpatients and are strongly associated with psychosocial distress, pain, and cancer type. Routine screening can identify at-risk patients, supporting the need for integrated, multisymptom management strategies to improve outcomes in cancer care.