Association of Physical Activity, Sleep Duration, and Trouble Sleeping With Survival Among US Cancer Survivors: A Population-Based Cohort Study

BACKGROUND: Few studies have explored the combined impact of physical activity (PA), sleep duration, and trouble sleeping on mortality outcomes in patients with cancer. OBJECTIVE: We aimed to investigate the independent and combined prognostic effects of PA and sleep on mortality outcomes among cancer survivors in the United States. METHODS: Using the National Health and Nutrition Examination Survey (2007-2018), data of 2651 cancer survivors were analyzed. Mortality was ascertained using the National Death Index. Kaplan-Meier curves and Cox proportional hazards models were used to evaluate associations. RESULTS: Independent analyses demonstrated reduced mortality risk among survivors with sufficient PA (PA ≥ 600 metabolic equivalent minutes/week) and adequate sleep time (7-9 hours/d), whereas those reporting trouble sleeping showed elevated risk. Joint analyses demonstrated that survivors with sufficient PA and either adequate sleep time or without trouble sleeping had significantly lower all-cause mortality (hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.39-0.64; HR: 0.48, 95% CI: 0.37-0.62, respectively) and cancer-specific mortality (HR: 0.56, 95% CI: 0.36-0.86; HR: 0.46, 95% CI: 0.30-0.70, respectively). Importantly, abnormal sleep time (<7 or >9 hours/d) and trouble sleeping were not associated with risk of all-cause or noncancer mortality among individuals who achieved sufficient PA. CONCLUSIONS: The combination of sufficient PA, adequate sleep time, and absence of trouble sleeping reduces mortality risk among cancer survivors. The harms of abnormal sleep time and trouble sleeping were offset by sufficient PA. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE: Survivorship care should integrate the concurrent assessment and management of PA and sleep.