title: Relationship between sleep problems and psychological outcomes in adolescent and young adult cancer survivors and controls.
abstract: OBJECTIVE
  How cancer history and distress relate to sleep outcomes of adolescents and young adults (AYAs) is unclear. The current study compares AYA cancer survivors to controls on indicators of sleep and fatigue; examines the concurrent association between psychological status, sleep, and fatigue; and investigates the lagged relationship between sleep and fatigue problems with psychological functioning.
  
  
  METHODS
  AYA cancer survivors (n = 167) and controls (n = 170), ages 16 to 30, completed measures at a survivorship clinic/primary care visit (time 1) and 2 months later (time 2). Participants completed questions about sleep quality, quantity, sleep medication use, self-reports of sleep problems, and fatigue in addition to measures of depression, anxiety, and posttraumatic stress symptoms (PTSS).
  
  
  RESULTS
  There were no differences in sleep quantity or quality between survivors and controls, but survivors reported significantly more fatigue. Within groups, AYAs with self-reported sleep and fatigue problems reported significantly higher depression, anxiety, and PTS symptoms. Controlling for baseline depression, sleep, and fatigue problems at time 1 significantly predicted depression at time 2 in survivors but not in controls.
  
  
  CONCLUSIONS
  This study offers important insight into the psychological functioning of childhood cancer survivors and prospectively describes sleep and fatigue as risk factors for poor psychological functioning in survivors. These findings support screening for sleep problems in AYA survivors as these difficulties are closely related to mental health functioning.
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA. daniell@email.chop.edu.
authors.forename: Lauren
authors.initials: L
authors.lastname: Daniel
authors.affiliation: Nemours Children's Health System, 1600 Rockland Road, Wilmington, DE, 19803, USA.|Sidney Kimmel Medical School of Thomas Jefferson University, 1025 Walnut St., Philadelphia, PA, 19107, USA.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Kazak
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA.|The Perelman School of Medicine of the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA.
authors.forename: Yimei
authors.initials: Y
authors.lastname: Li
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA.|The Perelman School of Medicine of the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Hobbie
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA.|The Perelman School of Medicine of the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Ginsberg
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA.
authors.forename: Eliana
authors.initials: E
authors.lastname: Butler
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, 3501 Civic Center Blvd, Philadelphia, PA, 19104, USA.|The Perelman School of Medicine of the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005221:Fatigue / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008603:Mental Health; D009369:Neoplasms / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D012890:Sleep; D012893:Sleep Wake Disorders / Q000523:psychology*; D017741:Survivors / Q000523:psychology*; D055815:Young Adult
keywords: AYA; Cancer; Fatigue; Psychosocial; Sleep