Colorectal Cancer Anatomical Site and Sleep Quality

The Phipps Group, Division of Public Health Sciences

After a cancer diagnosis, cancer patients tend to have poorer sleep quality compared to the general population. Two-thirds of patients undergoing chemotherapy alone report poor sleep quality. A routine of inadequate sleep can promote high blood pressure, inflammation, chronic diseases, diabetes, stroke, cancer, and negative impacts on metabolism and endocrine function. When a person’s sleep is disturbed, it negatively affects work productivity and staying alert during social activities. In turn, it increases fatigue and mood disturbances.  Cancer related factors can affect sleep quality – fatigue, anxiety, pain, nausea, and lower quality of life. Colorectal cancer (CRC) patients have reported sleep issues and identifying at-risk patients may lead to treatments to improve sleep quality among CRC patients and patients with other types of cancer. Anatomic site within CRC patients may influence sleep issues; also, patients with rectal cancer have different symptoms and treatments compared to patients with colon cancer. Site-specific survivorship care recommendations may be necessary for colon and rectal cancer patients.  The Phipps Group, from the Division of Public Health Sciences, examined whether anatomic site (rectal vs. colon) was associated with sleep quality in a large prospective study. According to the first author, Mimi Ton, “previous studies have not assessed sleep quality and how it may differ among colon versus rectal cancer patients.” The study is published in Cancers.

The CRC patient data was collected from the Cancer Surveillance System (CSS), which is a population-based registry that collects data on cancer cases in a 13-county western-Washington state region. A total of 1453 participants consented to the study and provided sleep information. Sleep quality was self-reported via baseline questionnaires conducted by telephone, online-portals, or paper surveys after the cancer diagnosis. Components of the Pittsburgh Sleep Quality Index were used to assess the following for the prior month: hours of sleep, reasons related to trouble sleeping, trouble staying awake, sleep quality, snoring, stopping breathing during sleep, and change in sleep behavior. Also, participants were asked if they took any medication at bedtime to help with sleep.

Logistic regression was utilized to compare the odds of sleep quality components according to CRC site (rectal vs. colon cancer).  Among a total of 1453 participants, 70% reported sleep issues (75% among rectal cancer and 68% among colon rectal patients).  Major sleep issues included: unable to sleep within 30 min (18%), waking up to use the bathroom (30%), and waking up in the middle of sleep (26%).  Rectal patients were 53% and 58% more likely than colon cancer patients to have trouble sleeping due to waking up to use the bathroom (OR: 1.53, 95% CI: 1.20-1.96) and due to pain (OR:1.58, 95% CI: 1.15-2.17), respectively.  Rectal patients were less likely to have trouble sleeping due to breathing, coughing, or snoring compared to colon cancer patients (OR: 0.51, 95% CI: 0.27-0.99).  Rectal patients experienced a greater change in sleep behavior after diagnosis compared to colon cancer patients (OR: 1.38, 95% CI: 1.05-1.80).  Thus, there were statistically significant associations between CRC site and different factors of sleep quality. Also, patients diagnosed at a later stage were more likely to take sleep medication (distant vs. localized, OR: 2.13, 95% CI: 1.38-3.27) and have changes in sleep behavior (distant vs. localized, OR: 2.50, 95% CI: 1.73-3.62).  

Graphical Representation of Association of sleep quality among rectal cancer patients compared to colon cancer patients
Association of sleep quality among rectal cancer patients compared to colon cancer patients Image from Mimi Ton

This is the first study to examine differences in sleep quality by CRC anatomic site.  Ton stated, “Our study suggests that there is a significant difference in sleep quality between the two and suggests sleep-focused survivorship care according to colorectal cancer site, particularly for rectal cancer patients, to improve sleep quality post-diagnosis.”  Rectal patients may endure poorer sleep quality because of their symptoms and treatments. The Phipps Group recommends that clinical providers pay close attention to sleep quality among rectal cancer patients. The relationship between sleep quality with outcomes within this population is complex. Colon and rectal cancer were differentially associated with sleep quality. Ton concluded, “this study suggests that additional studies should explore the driving factors of the association between colorectal cancer anatomic site (colon versus rectal) to better address clinical evaluation and management of sleep problems about these cancer survivors

This research was supported by the National Cancer Institute.

Fred Hutch/UW Cancer Consortium members Amanda I. Phipps and Polly A. Newcomb contributed to this work.

Ton M, Watson NF, Sillah A, Malen RC, Labadie JD, Reedy AM, Cohen SA, Burnett-Hartman AN, Newcomb PA, Phipps AI. Colorectal Cancer Anatomical Site and Sleep Quality. Cancers. 2021 Jan;13(11):2578.