Study Shows Sleep Disturbances During the Pandemic Were Similar between Breast Cancer Survivors and Healthy Controls

Traci N. Bethea, PhD

Results from the Thinking and Living with Cancer Study (TLC) showed that the development of sleep disturbances during the early months of the COVID-19 pandemic increased symptoms of depression and anxiety among older women, but the findings did not differ between women who survived breast cancer and women without cancer. It is the first study to assess sleep disturbances and mental health outcomes among cancer survivors during the pandemic.

The study, published in the journal Cancer Medicine, was led by researchers from Georgetown Lombardi Comprehensive Cancer Center and included collaborators from Hackensack Meridian John Theurer Cancer Center (JTCC), a part of Georgetown Lombardi, along with other investigators.

“The pandemic has significantly changed our lives with many studies showing effects on sleep, which itself is related to a wide range of physical and mental health outcomes. Our findings show that breast cancer survivors did not experience worse effects of sleep disturbance on mental health during the early phase of the pandemic compared to others. It was unexpected, but welcome, news,” said lead author Traci N. Bethea, PhD, Assistant Professor in the Office of Minority Health and Health Disparities Research and the Cancer Prevention and Control Program at Georgetown Lombardi.

"We were surprised but at the same time, we weren't surprised because someone who had been diagnosed with breast cancer may have learned coping mechanisms and received support that was already in place when the pandemic began," explained medical oncologist Deena M.A. Graham, MD, who led JTCC's participation in the study.

Breast cancer survivors tend to experience worse sleep than the general population, as well as reporting more depression and anxiety symptoms. TLC is a longitudinal study of breast cancer survivors aged 60 and older and matched controls without cancer who are completing annual assessments over a 5-year period. For this analysis, symptoms of depression and anxiety and reports of restless sleep were compared between 242 breast cancer survivors and 158 controls who were surveyed from May-September 2020.

There was an increase in sleep disturbances and symptoms of depression and anxiety during the pandemic, but survivors and controls did not differ in the magnitude of change. Nearly 1 in 4 participants (22.3%) reported experiencing sleep disturbances during this time, including new restless sleep in 10% of survivors and 13.5% of controls. Symptoms of depression and anxiety significantly increased during the pandemic among women reporting restless sleep, but there were no differences in these findings between survivors and controls.

"Many patients who have been affected by cancer came into the pandemic already having had their lives changed by the diagnosis of an illness," added Dr. Graham.

“Given how a cancer diagnosis and cancer treatment can disrupt a patient’s life and sometimes lead to social isolation, cancer survivors may have been more resilient or more prepared to adapt at the onset of the pandemic due to their cancer journey,” said Dr. Bethea.

The study's results may also inform the future care of patients. The investigators concluded that clinical and public health programs serving older adults should include surveillance of sleep disturbances during the pandemic to detect and treat worsening mental health. "This study provides a platform upon which we can examine new issues facing women who have been diagnosed with breast cancer," noted Dr. Graham. "The fact that our patients were able and willing to participate and provide us with this information will allow us to better meet the needs of all patients going forward."