Associations between longitudinal changes in sleep disturbance and depressive and anxiety symptoms during the COVID-19 virus pandemic among older women with and without breast cancer in the thinking and living with breast cancer study

Traci N Bethea^{1

2}, Wanting Zhai², Xingtao Zhou², Tim A Ahles³, Jaeil Ahn⁴, Harvey J Cohen⁵, Asma A Dilawari^{2

6}, Deena M A Graham⁷, Heather S L Jim⁸, Brenna C McDonald⁹, Zev M Nakamura¹⁰, Sunita K Patel¹¹, Kelly E Rentscher^{12

13}, James Root³, Andrew J Saykin⁹, Brent J Small¹⁴, Kathleen M Van Dyk¹³, Jeanne S Mandelblatt², Judith E Carroll^{12

13}

Affiliations

¹ Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA.
² Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA.
³ Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York City, USA.
⁴ Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, District of Columbia, USA.
⁵ Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA.
⁶ Medstar Washington Hospital Center, Washington, District of Columbia, USA.
⁷ John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA.
⁸ Moffitt Cancer Center, Tampa, Florida, USA.
⁹ Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA.
¹⁰ Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
¹¹ City of Hope National Medical Center, Los Angeles, California, USA.
¹² Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California, USA.
¹³ Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA.
¹⁴ College of Behavioral and Community Sciences, School of Aging Studies, University of South Florida, Tampa, Florida, USA.

PMID: 35315588
PMCID: PMC9110906
DOI: 10.1002/cam4.4682

Associations between longitudinal changes in sleep disturbance and depressive and anxiety symptoms during the COVID-19 virus pandemic among older women with and without breast cancer in the thinking and living with breast cancer study

Traci N Bethea et al. Cancer Med. 2022 Sep.

. 2022 Sep;11(17):3352-3363.

doi: 10.1002/cam4.4682. Epub 2022 Mar 22.

Authors

Affiliations

¹ Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA.
² Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA.
³ Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York City, USA.
⁴ Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, District of Columbia, USA.
⁵ Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA.
⁶ Medstar Washington Hospital Center, Washington, District of Columbia, USA.
⁷ John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA.
⁸ Moffitt Cancer Center, Tampa, Florida, USA.
⁹ Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA.
¹⁰ Department of Psychiatry, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
¹¹ City of Hope National Medical Center, Los Angeles, California, USA.
¹² Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, California, USA.
¹³ Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA.
¹⁴ College of Behavioral and Community Sciences, School of Aging Studies, University of South Florida, Tampa, Florida, USA.

PMID: 35315588
PMCID: PMC9110906
DOI: 10.1002/cam4.4682

Abstract

Purpose: Several studies have reported sleep disturbances during the COVID-19 virus pandemic. Little data exist about the impact of the pandemic on sleep and mental health among older women with breast cancer. We sought to examine whether women with and without breast cancer who experienced new sleep problems during the pandemic had worsening depression and anxiety.

Methods: Breast cancer survivors aged ≥60 years with a history of nonmetastatic breast cancer (n = 242) and frequency-matched noncancer controls (n = 158) active in a longitudinal cohort study completed a COVID-19 virus pandemic survey from May to September 2020 (response rate 83%). Incident sleep disturbance was measured using the restless sleep item from the Center for Epidemiological Studies-Depression Scale (CES-D). CES-D score (minus the sleep item) captured depressive symptoms; the State-Anxiety subscale of the State Trait Anxiety Inventory measured anxiety symptoms. Multivariable linear regression models examined how the development of sleep disturbance affected changes in depressive or anxiety symptoms from the most recent prepandemic survey to the pandemic survey, controlling for covariates.

Results: The prevalence of sleep disturbance during the pandemic was 22.3%, with incident sleep disturbance in 10% and 13.5% of survivors and controls, respectively. Depressive and anxiety symptoms significantly increased during the pandemic among women with incident sleep disturbance (vs. no disturbance) (β = 8.16, p < 0.01 and β = 6.14, p < 0.01, respectively), but there were no survivor-control differences in the effect.

Conclusion: Development of sleep disturbances during the COVID-19 virus pandemic may negatively affect older women's mental health, but breast cancer survivors diagnosed with the nonmetastatic disease had similar experiences as women without cancer.

Trial registration: ClinicalTrials.gov NCT03451383.

Keywords: behavioral science; breast cancer; epidemiology; psychosocial studies.

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Conflict of interest statement

Author Dilawari served on the Oncology Summit Advisory Board for Cardinal Health. Author Jim has consulted for RedHill BioPharma, Janssen Scientific Affairs, and Merck and has received grant funding from Kite Pharma. All other authors declare no conflicts.

Figures

**FIGURE 1**
CONSORT diagram for the Thinking and Living with Cancer Study (Panel A: Survivors; Panel B: Noncancer controls); ^†Survivors ineligible due to missing treatment information; ^‡Participants excluded due to COVID‐19 virus diagnosis; ^§Participants not included in analyses due to missing sleep data

**FIGURE 2**
Change in sleep disturbance and adjusted mean change in depressive symptoms and anxiety symptoms, stratified by case status (Panel A: Depressive symptoms; Panel B: Anxiety symptoms; purple = survivors, blue = controls)

**FIGURE 3**
Change in sleep duration and adjusted mean change in depressive symptoms and anxiety symptoms, stratified by case status (Panel A: Depressive symptoms; Panel B: Anxiety; purple = survivors, blue = controls)

See this image and copyright information in PMC

References

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Associations between longitudinal changes in sleep disturbance and depressive and anxiety symptoms during the COVID-19 virus pandemic among older women with and without breast cancer in the thinking and living with breast cancer study

Affiliations

Associations between longitudinal changes in sleep disturbance and depressive and anxiety symptoms during the COVID-19 virus pandemic among older women with and without breast cancer in the thinking and living with breast cancer study

Authors

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Abstract

Conflict of interest statement

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References

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