Lauren C. Daniel

Survivors of childhood cancer frequently experience poor sleep quality, which affects behavioural, emotional, cognitive and physical health. Sleep health is multidimensional, encompassing regularity, satisfaction, alertness, timing, efficiency and duration, yet the influence of social, environmental and interpersonal factors on these dimensions remains poorly understood. This review examines sleep health dimensions among childhood cancer survivors and their associations with social determinants of health. A systematic review was completed in November 2025 using PubMed, Scopus, Web of Science and EBSCO databases. Two reviewers independently screened titles/abstracts and full texts, assessing links between social determinants and sleep outcomes. The risk of bias was evaluated using the ROBINS‐E tool. Of 485 publications screened, 14 met the inclusion criteria. Most studies assessed sleep disturbances ( n = 10), with fewer examining sleep duration ( n = 5), alertness ( n = 3) and sleep efficiency ( n = 2). Social determinants, including race/ethnicity ( n = 5), education ( n = 6) and employment ( n = 4), were associated with specific sleep dimensions; however, comprehensive analyses across the full spectrum of sleep remain limited. Social determinants influence several sleep dimensions among childhood cancer survivors, yet research rarely considers the multidimensional nature of sleep health. We propose a socio‐ecological, multidimensional model to guide the development of targeted interventions and reduce sleep health disparities in this population.

Purpose: The current study examines longitudinal changes in sleep disturbances and the risks they pose for new-onset health conditions in survivors of childhood cancer. Methods: Five-year survivors ( N = 1081; median [range] age 50.0 [45.2–55.0] years) and siblings ( N = 214; age 49.2 [39.9–51.1] years) from the Childhood Cancer Survivor Study completed the Pittsburgh Sleep Quality Index (PSQI) at two time points (median interval = 17 years). Sex-specific changes of PSQI scores were assessed, adjusting for demographics, using generalized estimating equation. Within survivors, logistic regressions estimated associations between persistent clinically significant sleep disturbances with diagnosis and treatment exposures, and new-onset chronic health conditions. Results: Female siblings reported increases in sleep disturbances (T1 35% to T2 47%; PR = 1.30, 95% CI 1.04–1.62). However, increases among female survivors (T1 40% to T2 49%; PR = 1.25, 95% CI 0.99–1.58), male survivors (T1 34% to T2 44%; PR = 0.98, 95% CI 0.68–1.40), and male siblings (T1 24% to T2 32%; PR = 1.28, 95% CI 0.86–1.91) were not significant. Survivors reporting persistent sleep disturbances were more likely to develop new-onset hypertension (PR = 1.498, 95% CI 1.02–2.14), migraines (PR = 1.90, 95% CI 1.40–2.58), and emotional distress (PR = 8.07, 95% CI 4.07–16.00) but not subsequent malignancies (PR = 1.03, 95% CI 0.52–2.01). Conclusions: Persistent sleep disturbances are closely tied to the onset of chronic health conditions and mental health concerns. Implications for Cancer Survivors: Screening for and treating sleep disturbances early in childhood cancer survivorship has the potential to improve long-term health and mental health.

Objective: Pediatric cancer patients are at increased risk for sleep disturbances; however, there are no clinical practice guidelines for treating sleep disturbances in pediatric oncology, resulting in variable approaches to sleep management across clinicians. The current study surveyed clinicians regarding their approaches to assessing and treating sleep. Methods: A total of 200 pediatric oncology clinicians participated in a REDCap survey about behavioral and medical sleep concerns assessed in their practice and related treatment approaches. Results: Most clinicians (61%) reported assessing sleep when patients or families raised a concern, and 10% reported never assessing sleep. Clinicians rated behavioral difficulties with sleep onset ( M = 3.00, SD = 1.08) and insomnia ( M = 2.91, SD = 0.99) as the most problematic sleep concerns. Sleep hygiene was the most widely endorsed intervention across almost every sleep concern. Behavioral strategies were used with similar frequency between physicians/APPs compared to other clinicians [ORs = 0.61–1.25]. Pharmacology was used more frequently by physicians/APPs than other clinicians for behavioral sleep concerns [ORs = 0.19–0.36]. Conclusions: Relying on children and families to report concerns can be a missed opportunity to identify sleep disturbances early. The most endorsed treatment, sleep hygiene, is likely ineffective as a standalone treatment for complex sleep disturbances seen in oncology. It is possible that offering patients these simple but likely ineffective treatments alone may perpetuate long‐term sleep disturbances and a lack of confidence in the ability to effectively treat sleep. Further research is needed to determine the most effective treatment approaches for behavioral sleep disturbances, informing clinical practice guidelines for pediatric oncology.

The current randomized trial tested messaging strategies to increase diverse student participation in the National Marrow Donor Program (NMDP). Undergraduate students ( N = 361, 72.3% female; 58.4% nonwhite, ages 18–35) completed measures about facilitators and barriers to joining the NMDP and enrollment intentions. Participants were randomized to receive an emotional appeal ( n = 181) or a rational appeal ( n = 180) and then asked again about enrollment intentions. Participants answered 21% of marrow donation knowledge questions correctly, and higher knowledge and lower ambivalence were related to a greater likelihood of joining the NMDP. The emotional appeal increased the likelihood of registering more than the rational appeal. Race did not moderate the response to the intervention condition. Future studies seeking to increase participation by diverse young adults should target knowledge and emotional aspects of the need for donors. Trial registration NCT05595382.

Background: Young adult survivors of childhood cancer exhibit rates of frailty similar to adults several decades older without a cancer history. Frailty has been associated with sleep disturbances in non‐cancer populations, but the relationship has not been examined in childhood cancer survivors who are known to exhibit elevated rates of sleep problems.Aims: Examine associations between frailty and poor sleep quality in long‐term survivors of childhood cancer.Methods: This study utilized data from 9044 participants (> 5 years from diagnosis, M_age = 40.8 years [SD = 9.5]) in the Childhood Cancer Survivor Study. Survivors' frailty status, chronic health conditions (CHC), health behaviors, mental health, and pain were collected in 2014–2016, and self‐reported sleep quality in 2017–2019. Multivariable logistic regression models examined frailty status as a predictor of clinically significant poor sleep. All models were adjusted for age at diagnosis, age at survey, sex, race/ethnicity, smoking, risky/heavy alcohol use, and physical inactivity. Separate models included treatment‐related variables, CHC burden (number/severity), and emotional health/pain as co‐variates.Results: Frail survivors had 6‐fold (95% CI 4.48–7.96) increased odds of future poor sleep quality. Little attenuation of this association was observed when accounting for cancer diagnosis (Odds Ratio [OR] 5.80, 95% CI 4.47–7.52), treatment exposures (OR 5.80, 95% CI 4.43–7.71), or chronic health condition burden (OR 5.12, 95% CI 3.98–6.59), but adjustment for emotional health/pain (OR 2.88, 95% CI 2.18–3.82) attenuated the association appreciably.Conclusions: Frail childhood cancer survivors have a higher prevalence of clinically significant poor sleep quality. Addressing poor physiologic reserve may impact sleep in frail childhood cancer survivors.

Background: Adolescent and young adult survivors of childhood cancer (AYA) are at risk for treatment-related late effects (eg, heart and lung problems) which may be mitigated by physical activity (PA). To design effective, tailored PA interventions for this population, predictors and benefits of PA behavior need to be measured in real-time. Purpose: To examine the feasibility and acceptability of ecological momentary assessment (EMA) combined with accelerometry and explore the dynamic associations between PA and real-time physical and psychosocial factors among AYA. Methods: AYA (N = 20, mean age = 18.9 years) recently off cancer treatment participated in a 2-week intensive monitoring protocol in which they completed up to 4 EMA surveys/day assessing current mood, pain, fatigue, arousal, PA intentions and motivation, and social-environmental context, while PA levels were passively monitored using a wrist-worn ActiGraph GT9X accelerometer. Acceptability was measured via self-report. Results: EMA and accelerometry were feasible and acceptable (≥70% compliance and study endorsement) for AYA. Multilevel models showed that AYA engaged in more PA when they were away from home, with others, in a better mood, less fatigued, more energetic, and more motivated than their own average levels. Further, when AYA engaged in more PA than their usual levels in the hour before completing an EMA survey, they subsequently reported less fatigue, less pain, more energy, and a more positive mood. Conclusions: EMA and accelerometry are acceptable and feasible among AYA survivors of childhood cancer. This methodology can be utilized for understanding the real-time barriers, facilitators, and benefits of PA behaviors in this at-risk population to design effective, dynamic PA interventions.

Sleep concerns are common during pediatric cancer treatment and can last into survivorship. The current systematic review sought to identify intervention studies that addressed sleep as a primary or secondary outcome during pediatric cancer treatment up to 5 years after completing treatment. Quality assessment was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The review identified 16 studies with a total of 943 participants that tested a wide range of interventions including psycho‐educational, stress management techniques, medications, and physical activity. Most studies included tested interventions in small samples. None of the included studies had a high risk of bias for all domains, but all included studies had a high risk of bias for at least two risk domains. Several feasible pilot studies were identified that warrant further research to test efficacy. Implications for future research and clinical practice to manage sleep concerns are discussed.

Background: Sleep problems following childhood cancer treatment may persist into adulthood, exacerbating cancer-related late effects and putting survivors at risk for poor physical and psychosocial functioning. This study examines sleep in long-term survivors and their siblings to identify risk factors and disease correlates. Methods: Childhood cancer survivors (≥5 years from diagnosis; n = 12 340; 51.5% female; mean [SD] age = 39.4 [9.6] years) and siblings (n = 2395; 57.1% female; age = 44.6 [10.5] years) participating in the Childhood Cancer Survivor Study completed the Pittsburgh Sleep Quality Index (PSQI). Multivariable Poisson-error generalized estimating equation compared prevalence of binary sleep outcomes between survivors and siblings and evaluated cancer history and chronic health conditions (CHC) for associations with sleep outcomes, adjusting for age (at diagnosis and current), sex, race/ethnicity, and body mass index. Results: Survivors were more likely to report clinically elevated composite PSQI scores (>5; 45.1% vs 40.0%, adjusted prevalence ratio [PR] = 1.20, 95% CI = 1.13 to 1.27), symptoms of insomnia (38.8% vs 32.0%, PR = 1.26, 95% CI = 1.18 to 1.35), snoring (18.0% vs 17.4%, PR = 1.11, 95% CI = 1.01 to 1.23), and sleep medication use (13.2% vs 11.5%, PR = 1.28, 95% CI = 1.12 to 1.45) compared with siblings. Within cancer survivors, PSQI scores were similar across diagnoses. Anthracycline exposure (PR = 1.13, 95% CI = 1.03 to 1.25), abdominal radiation (PR = 1.16, 95% CI = 1.04 to 1.29), and increasing CHC burden were associated with elevated PSQI scores (PRs = 1.21-1.48). Conclusions: Among survivors, sleep problems were more closely related to CHC than diagnosis or treatment history, although longitudinal research is needed to determine the direction of this association. Frequent sleep-promoting medication use suggests interest in managing sleep problems; behavioral sleep intervention is advised for long-term management.

Background: Patients undergoing hematopoietic stem cell transplant (HSCT) experience barriers to quality sleep. Frequent vital sign checks are necessary early posttransplant given risk of complications but can disrupt sleep. This study tested feasibility and acceptability of extending time between checking vitals (EVs) from every 4 to every 6 h to improve sleep. Procedure: HSCT patients ages 8–21 years ( N = 50, mean age = 14.06, SD = 3.58) and their caregivers were enrolled 1–2 days prior to transplant, and 40 patients completed the 15‐day study (NCT04106089). Patients wore an actigraph to estimate sleep and provided self‐ and caregiver‐report of sleep. Sleep was observed for nights 0 to +4 posttransplant, and patients were then randomized to EVs either Days +5 to +9 or +10 to +14. Patients were assessed daily for medical eligibility to receive EVs; on days patients were eligible, nightshift nurses ( N = 79) reported EV acceptability. Results: Of 200 potential nights for EVs (5 nights x 40 patients), patients were eligible for EVs on 126 nights (63% of eligible nights), and patients received EVs on 116 (92%) of eligible nights. Most patients received EVs ≥3 nights ( n = 26, 65%, median = 3 nights). Most patients (85%), caregivers (80%), and nurses (84%) reported that patients used the additional 2 h during EVs for sleep, with reporters indicating moderate to high acceptability. There was preliminary evidence of efficacy indicated by caregiver‐reported sleep disturbance and actigraphy‐estimated improvements in sleep efficiency during EVs. Conclusion: Extending time between vitals checks is highly acceptable to patients, caregivers, and nurses, and may offer a feasible approach to improve sleep in pediatric HSCT.

Objective: Previous studies of sleep patterns, as well as rates and correlates of perceived problems in early childhood, indicate variation by neighborhood-level socioeconomic indicators. The purpose of this study was to examine variation in (1) sleep patterns, behaviors, and problems by family-based socioeconomic indicators (income-to-needs ratio and caregiver education level) and (2) sociodemographic and sleep correlates of a caregiver-endorsed child sleep problem across and within socioeconomic indicator groups in a diverse sample. Methods: Two hundred eighty-three caregiver-child dyads (ages 1‐5 years) completed the Brief Child Sleep Questionnaire. Family-level socioeconomic indicators included income-to-needs ratio and caregiver educational level. Results: Sleep patterns varied based on income-to-needs ratio, with children living in poverty experiencing the longest sleep onset latencies and night awakening durations and shortest nighttime sleep durations. Rates of an endorsed child sleep problem were similar across income-to-needs groups. Although sleep patterns did not vary by caregiver education level, caregivers with an education beyond high school were more likely to endorse a child sleep problem; later bedtimes, more frequent night awakenings, and greater bedtime difficulties were the strongest correlates of a perceived sleep problem in this subgroup. No specific correlates of a child sleep problem emerged for those with a high school education or less. Conclusion: Sleep patterns may be more robustly linked to family income-to-needs ratio, whereas perceptions of a child sleep problem may be more linked to caregiver education level. Clinicians should consider expanding sleep screening questions to include specific sleep outcomes to effectively assess child sleep and guide intervention.