Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Clinical Studies

Sleep and cancer recurrence and survival in patients with resected Stage III colon cancer: findings from CALGB/SWOG 80702 (Alliance)

British Journal of Cancer volume 129, pages 283–290 (2023)Cite this article

Subjects

Abstract

Background

We sought to assess the influences of sleep duration, sleep adequacy, and daytime sleepiness on survival outcomes among Stage III colon cancer patients.

Methods

We conducted a prospective observational study of 1175 Stage III colon cancer patients enrolled in the CALGB/SWOG 80702 randomised adjuvant chemotherapy trial who completed a self-reported questionnaire on dietary and lifestyle habits 14–16 months post-randomisation. The primary endpoint was disease-free survival (DFS), and secondary was overall survival (OS). Multivariate analyses were adjusted for baseline sociodemographic, clinical, dietary and lifestyle factors.

Results

Patients sleeping ≥9 h—relative to 7 h—experienced a worse hazard ratio (HR) of 1.62 (95% confidence interval (CI), 1.01–2.58) for DFS. In addition, those sleeping the least (≤5 h) or the most (≥ 9 h) experienced worse HRs for OS of 2.14 (95% CI, 1.14–4.03) and 2.34 (95% CI, 1.26–4.33), respectively. Self-reported sleep adequacy and daytime sleepiness showed no significant correlations with outcomes.

Conclusions

Among resected Stage III colon cancer patients who received uniform treatment and follow-up within a nationwide randomised clinical trial, very long and very short sleep durations were significantly associated with increased mortality. Interventions targeting optimising sleep health among indicated colon cancer patients may be an important method by which more comprehensive care can be delivered.

Trial registration

ClinicalTrials.gov Identifier: NCT01150045.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Derivation of the study cohort.
Fig. 2: Spline curve of disease-free survival and sleep duration.

Similar content being viewed by others

Data availability

Data are from the Alliance for Clinical Trials in Oncology. Investigators may request access to this data per Alliance protocol as outlined below and as detailed at https://www.allianceforclinicaltrialsinoncology.org/main/public/standard.xhtml?path=%2FPublic%2FDatasharing. Per NCI National Clinical Trials Network (NCTN) guidelines, any investigator may submit a request for data from published Alliance or legacy ACOSOG, CALGB, or NCCTG trials. To submit a data request, the investigator should complete an Alliance Data Sharing Request Form and send it by e-mail to gro. NTCNecnailla@stpecnoc. Once received, the request will be forwarded to the Alliance Statistics and Data Center (SDC). The SDC will confirm the availability of the data. Once the SDC confirms availability, the investigator will be asked to provide documentation of Institutional Review Board (IRB) approval or exemption from their institution, as well as to submit an Alliance data release agreement. Once the IRB documentation and the data release agreement are received from the requesting investigator, the SDC will be notified that the requested data may be released. Questions about the process may be directed to gro. NTCNecnailla@stpecnoc.

References

  1. Jiao L, Duan Z, Sangi-Haghpeykar H, Hale L, White DL, El-Serag HB. Sleep duration and incidence of colorectal cancer in postmenopausal women. Br J Cancer. 2013;108:213–21.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Luojus MK, Lehto SM, Tolmunen T, Erkkilä AT, Kauhanen J. Sleep duration and incidence of lung cancer in ageing men. BMC Public Health. 2014;14:295.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Xiao Q, Signorello LB, Brinton LA, Cohen SS, Blot WJ, Matthews CE. Sleep duration and breast cancer risk among black and white women. Sleep Med. 2016;20:25–9.

    Article  PubMed  Google Scholar 

  4. Trudel-Fitzgerald C, Zhou ES, Poole EM, Zhang X, Michels KB, Eliassen AH, et al. Sleep and survival among women with breast cancer: 30 years of follow-up within the Nurses’ Health Study. Br J Cancer. 2017;116:1239–46.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Palesh O, Aldridge-Gerry A, Zeitzer JM, Koopman C, Neri E, Giese-Davis J, et al. Actigraphy-measured sleep disruption as a predictor of survival among women with advanced breast cancer. Sleep. 2014;37:837–42.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sturgeon SR, Luisi N, Balasubramanian R, Reeves KW. Sleep duration and endometrial cancer risk. Cancer Causes Control: Ccc 2012;23:547–53.

    Article  PubMed  Google Scholar 

  7. Girschik J, Heyworth J, Fritschi L. Self-reported sleep duration, sleep quality, and breast cancer risk in a population-based case-control study. Am J Epidemiol. 2013;177:316–27.

    Article  PubMed  Google Scholar 

  8. Vogtmann E, Levitan EB, Hale L, Shikany JM, Shah NA, Endeshaw Y, et al. Association between sleep and breast cancer incidence among postmenopausal women in the Women’s Health Initiative. Sleep. 2013;36:1437–44.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pinheiro SP, Schernhammer ES, Tworoger SS, Michels KB. A prospective study on habitual duration of sleep and incidence of breast cancer in a large cohort of women. Cancer Res. 2006;66:5521–5.

    Article  CAS  PubMed  Google Scholar 

  10. Wong ATY, Heath AK, Tong TYN, Reeves GK, Floud S, Beral V, et al. Sleep duration and breast cancer incidence: results from the Million Women Study and meta-analysis of published prospective studies. Sleep. 2020;44:zsaa166.

    Article  PubMed Central  Google Scholar 

  11. Collins KP, Geller DA, Antoni M, Donnell DM, Tsung A, Marsh JW, et al. Sleep duration is associated with survival in advanced cancer patients. Sleep Med. 2017;32:208–12.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010;33:585–92.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Patel SR, Ayas NT, Malhotra MR, White DP, Schernhammer ES, Speizer FE, et al. A prospective study of sleep duration and mortality risk in women. Sleep. 2004;27:440–4.

    Article  PubMed  Google Scholar 

  14. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA: A Cancer J Clin. 2021;71:7–33.

    Google Scholar 

  15. Lin Y, Peng Y, Liang B, Zhu S, Li L, Jang F, et al. Associations of dinner-to-bed time, post-dinner walk and sleep duration with colorectal cancer: a case-control study. Medicine. 2018;97:e12038.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Papantoniou K, Castaño-Vinyals G, Espinosa A, Turner MC, Martín-Sánchez V, Casabonne D, et al. Sleep duration and napping in relation to colorectal and gastric cancer in the MCC-Spain study. Sci Rep. 2021;11:11822.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Lu Y, Tian N, Yin J, Shi Y, Huang Z. Association between sleep duration and cancer risk: a meta-analysis of prospective cohort studies. PLoS ONE. 2013;8:e74723.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Zhang X, Giovannucci EL, Wu K, Gao X, Hu F, Ogino S, et al. Associations of self-reported sleep duration and snoring with colorectal cancer risk in men and women. Sleep. 2013;36:681–8.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lin CL, Liu TC, Wang YN, Chung CH, Chien WC. The association between sleep disorders and the risk of colorectal cancer in patients: a population-based nested case-control study. In Vivo. 2019;33:573–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Xiao Q, Arem H, Pfeiffer R, Matthews C. Prediagnosis sleep duration, napping, and mortality among colorectal cancer survivors in a large US cohort. Sleep. 2017;40:zsx010.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Innominato PF, Spiegel D, Ulusakarya A, Giacchetti S, Bjarnason GA, Lévi F, et al. Subjective sleep and overall survival in chemotherapy-naïve patients with metastatic colorectal cancer. Sleep Med. 2015;16:391–8.

    Article  PubMed  Google Scholar 

  22. Ratjen I, Schafmayer C, di Giuseppe R, Waniek S, Plachta-Danielzik S, Koch M, et al. Postdiagnostic physical activity, sleep duration, and TV watching and all-cause mortality among long-term colorectal cancer survivors: a prospective cohort study. BMC Cancer. 2017;17:701.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Meyerhardt JA, Shi Q, Fuchs CS, Meyer J, Niedzwiecki D, Zemla T, et al. Effect of celecoxib vs placebo added to standard adjuvant therapy on disease-free survival among patients with stage III Colon cancer: the CALGB/SWOG 80702 (alliance) randomized clinical trial. J Am Med Assoc. 2021;325:1277–86.

    Article  CAS  Google Scholar 

  24. Grothey A, Sobrero AF, Shields AF, Yoshino T, Paul J, Taieb J, et al. Duration of adjuvant chemotherapy for stage III colon cancer. N Engl J Med. 2018;378:1177–88.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. André T, Meyerhardt J, Iveson T, Sobrero A, Yoshino T, Souglakos I, et al. Effect of duration of adjuvant chemotherapy for patients with stage III colon cancer (IDEA collaboration): final results from a prospective, pooled analysis of six randomised, phase 3 trials. Lancet Oncol. 2020;21:1620–9.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.

    Article  PubMed  Google Scholar 

  27. Gangwisch JE, Feskanich D, Malaspina D, Shen S, Forman JP. Sleep duration and risk for hypertension in women: results from the nurses’ health study. Am J Hypertens. 2013;26:903–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Ayas NT, White DP, Manson JE, Stampfer MJ, Speizer FE, Malhotra A, et al. A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med. 2003;163:205–9.

    Article  PubMed  Google Scholar 

  29. Gangwisch JE, Rexrode K, Forman JP, Mukamal K, Malaspina D, Feskanich D. Daytime sleepiness and risk of coronary heart disease and stroke: results from the Nurses’ Health Study II. Sleep Med. 2014;15:782–8.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Drury A, Payne S, Brady AM. Prevalence vs impact: a mixed methods study of survivorship issues in colorectal cancer. Qual Life Res. 2022;31:1117–34.

  31. Stone CR, Haig TR, Fiest KM, McNeil J, Brenner DR, Friedenreich CM. The association between sleep duration and cancer-specific mortality: a systematic review and meta-analysis. Cancer Causes Control: CCC. 2019;30:501–25.

    Article  PubMed  Google Scholar 

  32. Mormont M-C, Waterhouse J, Bleuzen P, Giacchetti S, Jami A, Bogdan A, et al. Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status. Clin Cancer Res. 2000;6:3038.

    CAS  PubMed  Google Scholar 

  33. Innominato PF, Focan C, Gorlia T, Moreau T, Garufi C, Waterhouse J, et al. Circadian rhythm in rest and activity: a biological correlate of quality of life and a predictor of survival in patients with metastatic colorectal cancer. Cancer Res. 2009;69:4700.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Innominato PF, Giacchetti S, Bjarnason GA, Focan C, Garufi C, Coudert B, et al. Prediction of overall survival through circadian rest-activity monitoring during chemotherapy for metastatic colorectal cancer. Int J Cancer. 2012;131:2684–92.

    Article  CAS  PubMed  Google Scholar 

  35. Lévi F, Dugué PA, Innominato P, Karaboué A, Dispersyn G, Parganiha A, et al. Wrist actimetry circadian rhythm as a robust predictor of colorectal cancer patients survival. Chronobiol Int. 2014;31:891–900.

    Article  PubMed  Google Scholar 

  36. Giovannucci E. Metabolic syndrome, hyperinsulinemia, and colon cancer: a review. Am J Clin Nutr. 2007;86:s836–42.

    Article  PubMed  Google Scholar 

  37. Ayas NT, White DP, Al-Delaimy WK, Manson JE, Stampfer MJ, Speizer FE, et al. A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care. 2003;26:380–4.

    Article  PubMed  Google Scholar 

  38. Nock NL, Li L, Larkin EK, Patel SR, Redline S. Empirical evidence for “syndrome Z”: a hierarchical 5-factor model of the metabolic syndrome incorporating sleep disturbance measures. Sleep. 2009;32:615–22.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Patel SR, Malhotra A, White DP, Gottlieb DJ, Hu FB. Association between reduced sleep and weight gain in women. Am J Epidemiol. 2006;164:947–54.

    Article  PubMed  Google Scholar 

  40. Patel SR, Hu FB. Short sleep duration and weight gain: a systematic review. Obesity. 2008;16:643–53.

  41. Patel SR, Zhu X, Storfer-Isser A, Mehra R, Jenny NS, Tracy R, et al. Sleep duration and biomarkers of inflammation. Sleep. 2009;32:200–4.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Williams CJ, Hu FB, Patel SR, Mantzoros CS. Sleep duration and snoring in relation to biomarkers of cardiovascular disease risk among women with type 2 diabetes. Diabetes Care. 2007;30:1233–40.

    Article  PubMed  Google Scholar 

  43. Collis SJ, Boulton SJ. Emerging links between the biological clock and the DNA damage response. Chromosoma. 2007;116:331–9.

    Article  CAS  PubMed  Google Scholar 

  44. Irwin MR. Why sleep is important for health: a psychoneuroimmunology perspective. Annu Rev Psychol. 2015;66:143–72.

    Article  PubMed  Google Scholar 

  45. Blask DE. Melatonin, sleep disturbance and cancer risk. Sleep Med Rev. 2009;13:257–64.

    Article  PubMed  Google Scholar 

  46. Lauderdale DS, Knutson KL, Yan LL, Liu K, Rathouz PJ. Self-reported and measured sleep duration: how similar are they? Epidemiology. 2008;19:838–45.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Lee S, Meyerhardt JA. Impact of diet and exercise on colorectal cancer. Hematol Oncol Clin North Am. 2022;36:471–89.

    Article  PubMed  Google Scholar 

  48. Cho OH, Hwang KH. Association between sleep quality, anxiety and depression among Korean breast cancer survivors. Nurs Open. 2021;8:1030–7.

    Article  PubMed  Google Scholar 

  49. Fortner BV, Stepanski EJ, Wang SC, Kasprowicz S, Durrence HH. Sleep and quality of life in breast cancer patients. J Pain Symptom Manag. 2022;24:471–80.

    Article  Google Scholar 

  50. Zhou ES, Partridge AH, Syrjala KL, Michaud AL, Recklitis CJ. Evaluation and treatment of insomnia in adult cancer survivorship programs. J Cancer Surviv. 2017;11:74–9.

    Article  PubMed  Google Scholar 

  51. Reynolds-Cowie P, Fleming L. Living with persistent insomnia after cancer: a qualitative analysis of impact and management. Br J Health Psychol. 2021;26:33–49.

    Article  PubMed  Google Scholar 

Download references

Funding

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers U10CA180821 and U10CA180882 (to the Alliance for Clinical Trials in Oncology.) https://acknowledgments.alliancefound.org. UG1CA233163, UG1CA233180, UG1CA233253, UG1CA233290, UG1CA233320, UG1CA233337, UG1CA233339, UG1CA189954, and U10CA180863 to the Canadian Cancer Trials Group; UG1CA233234; and U10CA180820 to the ECOG–ACRIN Cancer Research Group; U10CA180868 to NRG Oncology; and U10CA180888 to the SWOG Cancer Research Network from the National Cancer Institute of the National Institutes of Health. Dr. Meyerhardt is supported by the Douglas Gray Woodruff Chair Fund, the Guo Shu Shi Fund, Anonymous Family Fund for Innovations in Colorectal Cancer, and the George Stone Family Foundation. The National Cancer Institute was involved in the design of the study and review of the manuscript. Pfizer participated in initial protocol development and review and approval of the final manuscript. Pfizer provided celecoxib and placebo tablets. Pfizer was not involved in the collection, management, analysis, or interpretation of the data. Neither Pfizer nor the National Cancer Institute had the right to veto publication or control the decision to which journal the article was submitted. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Yale School of Medicine, New Haven, CT, USA

    Seohyuk Lee

  2. Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA

    Chao Ma & Jeffrey A. Meyerhardt

  3. Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA

    Qian Shi & Jeffrey Meyers

  4. Illinois CancerCare PC, Peoria, IL, USA

    Pankaj Kumar

  5. Hôtel-Dieu de Québec, Québec, QC, Canada

    Felix Couture

  6. Columbus NCI Community Oncology Research Program, Columbus, OH, USA

    Philip Kuebler

  7. Cleveland Clinic, Cleveland, OH, USA

    Smitha Krishnamurthi

  8. Cone Health Medical Group, Asheboro, NC, USA

    DeQuincy Lewis

  9. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA

    Benjamin Tan

  10. Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, NY, USA

    Eileen M. O’Reilly

  11. Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA

    Anthony F. Shields

Authors
  1. Seohyuk Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chao Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qian Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey Meyers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pankaj Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Felix Couture
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Philip Kuebler
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Smitha Krishnamurthi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. DeQuincy Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Benjamin Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Eileen M. O’Reilly
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Anthony F. Shields
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jeffrey A. Meyerhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualisation: JAM and SL; data curation: JAM and CM; formal analysis: JAM and CM; funding acquisition: JAM; investigation: JAM and SL; methodology: JAM; validation: QS and JM; visualisation: SL and CM; writing and original draft: JAM and SL; writing, review and editing: SL, CM, QS, JM, PK, FC, PK, SK, DL, BT, EMO, AFS and JAM.

Corresponding author

Correspondence to Jeffrey A. Meyerhardt.

Ethics declarations

Competing interests

Dr. Shi reported receiving institutional grant support from Celgene–Bristol Myers Squibb and Roche/Genentech; serving as a consultant to Yiviva Inc and Boehringer Ingelheim Pharmaceuticals; and owning stock in Johnson & Johnson, Merck, and Amgen. Dr. Kuebler reported receiving grants from the Columbus National Community Oncology Research Program and the National Institutes of Cancer. Dr. O’Reilly reported receiving institutional grants from Genentech/Roche, Celgene/Bristol Myers Squibb, BioNTech, AstraZeneca, and Arcus; receiving personal fees from CytomX Therapeutics, Rafael Therapeutics, Sobi Consulting, and Synthorx Inc; nonfinancial support from Silenseed Consulting, consulting fees from Boehringer Ingelheim, BioNTech, Ipsen, and Merck; and his spouse receives consulting fees from Bayer, Genentech/Roche, Celgene/Bristol Myers Squibb, Eisai, and Polaris; and personal fees from Molecular Templates Consulting. Dr. Shields reported receiving grants from National Cancer Institute. Dr. Meyerhardt reported receiving grants from National Cancer Institute and personal fees for serving on the advisory boards of COTA Healthcare and Merck, and institutional support from Boston Biomedical for a clinical trial outside the submitted work. The remaining authors declare no competing interests.

Ethics approval and consent to participate

All patients signed study-specific informed consent, which was approved by the NCI Cancer Treatment Evaluation Program and each participating site’s institutional review board. The study was performed in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, S., Ma, C., Shi, Q. et al. Sleep and cancer recurrence and survival in patients with resected Stage III colon cancer: findings from CALGB/SWOG 80702 (Alliance). Br J Cancer 129, 283–290 (2023). https://doi.org/10.1038/s41416-023-02290-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41416-023-02290-2

This article is cited by

Search

Advanced search

Quick links