Cancer-related clinically important sleep disturbance in head and neck cancer survivors: longitudinal findings from the head and neck 5000 prospective clinical cohort.

purposeSleep disturbance is a common issue among patients with head and neck cancer (HNC); it may exacerbate symptom burden and reduce quality of life. However, previous evidence on sleep disturbance trends and predictors is limited; many studies have been small and/or cross-sectional. Therefore, using data from a large, prospective, nationwide cohort, we investigated clinically important sleep disturbance during the first year following diagnosis and the factors associated with it.

methodsHead and Neck 5000 (HN5000) recruited HNC patients newly diagnosed in the UK during 2011-2014, with longitudinal follow-up at 4 months and 12 months post-recruitment. Sociodemographic and clinical data were collected via questionnaires and electronic medical records. Patients completed the EORTC QLQ-C30 questionnaire at baseline (pre-treatment) and follow-up, from which sleep disturbance scores (ranging 0-100) were derived. Following past work, clinically important sleep disturbance was defined as a score of 50 or higher. Multivariable mixed-effects logistic regression was used to investigate time trends and identify associated clinical, sociodemographic and lifestyle factors.

resultsAt baseline, 861 of 2,867 (30.0%) non-recurrent HNC patients reported clinically important sleep disturbance; this proportion remained unchanged at 4 months (29.9%) but decreased at 12 months (23.3%). In the multivariable model, after adjusting for time-point, the odds of having clinically important sleep disturbance over 12 months were significantly increased among females, those living in the most deprived areas, those with comorbidities, those receiving chemoradiotherapy only, and current smokers. In addition, depression at baseline was strongly associated with increased odds of clinically significant sleep disturbance. Older patients (≥ 50) and current alcohol drinkers had lower odds of clinically significant sleep disturbance.

conclusionsIn this longitudinal clinical cohort, we found a high prevalence of clinically important sleep disturbance over time, especially among patients with depression at baseline. These findings highlight the need for targeted interventions and support for HNC survivors, especially for subgroups at higher risk. IMPLICATIONS FOR CANCER SURVIVORS: For HNC patients, sleep disturbance should be screened for and managed from diagnosis through treatment and into survivorship.