Sleep duration predicts quality of life during colorectal cancer survivorship across age groups: Results from the ColoCare Study

Background Early-onset colorectal cancer (EO-CRC, <50 years) survivors often face unique quality of life (QoL) challenges compared with late-onset (LO-CRC, ≥50 years) patients. Sleep disturbances are common during and after cancer treatment and sleep duration of <7 hours may worsen physical and emotional symptoms, however, longitudinal evidence on QoL is limited. This study examined the influence of sleep duration on QoL trajectories over 24 months after primary tumor resection across EO- and LO-CRC patients. Methods We used mixed-effects models to assess changes in functional and symptom-related QoL domains by age group and sleep duration in 905 CRC patients from three sites of international ColoCare Study: Heidelberg University Hospital, Washington University St. Louis and Cedars-Sinai Medical Center. We assessed sleep duration by the Pittsburgh Sleep Quality Index and QoL scales using the EORTC-QLQ-C30 at enrolment (baseline), and at 6, 12, and 24 months. Time (baseline, 6, 12, 24 months), age group (EO-CRC vs. LO-CRC), and sleep duration (<7 vs. ≥7 hours/night) were included as fixed effects, while QoL scores were used as random effects. Interactions between time, age group, and sleep duration were tested. Results Functional QoL scores improved over time, with higher global and emotional functioning at 12 and 24 months (p < 0.01), while cognitive and role functioning remained stable. Symptom-related QoL fluctuated, with higher dyspnea at 6 months that generally improved by 12 and 24 months. Sleeping fewer than seven hours per night was consistently associated with lower global, social, role, and cognitive functioning as well as greater fatigue, insomnia, nausea, pain, constipation, and appetite loss at baseline (p < 0.01). EO-CRC patients reported higher physical but lower social and role functioning as well as higher fatigue, nausea and financial difficulties at baseline (p < 0.01) with improvements across most domains over time. EO-CRC patients with short sleep duration experienced lower insomnia at 12 months compared to LO-CRC patients sleeping ≥7 hours (p < 0.05). Three-way interactions were limited, suggesting the effects of insufficient sleep on QoL were broadly similar across age groups. Discussion Sleep duration is a predictor of QoL in CRC survivors, independent of age. EO-CRC patients exhibited distinct baseline deficits in social and role functioning, yet short sleep adversely affected all groups. These findings highlight the potential benefit of interventions targeting sleep to improve both functional and symptom-specific QoL throughout CRC survivorship. Integrating sleep screening and management into routine follow-up could further enhance QoL.