Resilience and Mental Health Shape Sleep Quality in Cancer Patients

For adults living with cancer, a bad night’s sleep is rarely just a bad night. Sleep disturbance is one of the most common and most stubborn complaints in oncology, often arriving alongside pain, fatigue, anxiety, and depression in a tangled web of co-occurring symptoms. Now, a new cross-sectional study from the Republic of Korea offers fresh evidence that the quality of a cancer patient’s sleep is shaped not only by clinical factors such as radiotherapy and time since diagnosis, but also by psychological resilience and mental health status — findings that could reshape how supportive oncology care is delivered.

The study, published in Supportive Care in Cancer by Ryan Hae Park of Hallym University and Su Jung Lee of Hallym University’s School of Nursing, set out to identify the factors associated with sleep quality in adults with cancer, with a particular focus on overall symptom burden and psychological resilience. The researchers recruited 159 adults with cancer from a tertiary hospital and online patient communities in Korea, then measured their sleep quality using the Pittsburgh Sleep Quality Index, a widely used self-report instrument that evaluates seven components of sleep, including duration, latency, efficiency, and disturbances.

Symptom burden was assessed with the Patient-Reported Outcomes Measurement Information System 29-Item Profile, known as PROMIS-29, which captures physical, mental, and social health domains through patient self-reports. Resilience — the capacity to adapt and recover in the face of adversity — was measured with the Korean version of the Connor-Davidson Resilience Scale, a validated 25-item instrument. Using multivariable logistic regression and hierarchical multiple linear regression, the team then teased apart which factors were independently associated with poor sleep quality after adjusting for sociodemographic and clinical characteristics.

The results were striking. The mean sleep quality score was 6.99 ± 3.84, and 42.1 percent of participants were classified as poor sleepers — a proportion that underscores just how prevalent sleep problems are in this population. Being one to three years postdiagnosis and having received radiotherapy were independently associated with higher odds of poor sleep, suggesting that the aftermath of treatment and the transitional period after diagnosis may be particularly vulnerable windows for sleep disruption.

But the most compelling findings concerned psychological factors. Higher mental health summary scores — reflecting better self-reported mental well-being on the PROMIS-29 — and higher resilience were associated with lower odds of poor sleep after adjustment for sociodemographic and clinical factors. In other words, even after accounting for the type of cancer, the treatments received, and the time since diagnosis, a patient’s psychological state and capacity for resilience mattered for how well they slept. The final regression model explained 34.1 percent of the variance in sleep quality scores, a substantial proportion for a behavioral health outcome.

These findings align with a growing body of research on symptom clusters — groups of symptoms that co-occur and interact, often sharing underlying biological mechanisms such as proinflammatory cytokine activity. Prior studies have linked sleep disturbance with cancer-related fatigue, depression, and pain, and some have suggested that inflammatory pathways may connect these symptoms at the biological level. The new study adds an important dimension by showing that resilience, a psychosocial construct, is independently associated with sleep quality beyond these clinical characteristics.

The implications for supportive oncology care are significant. Current clinical practice guidelines, including the ESMO clinical practice guideline on insomnia in adult patients with cancer, emphasize the importance of identifying and treating sleep problems in this population. Cognitive-behavioral therapy for insomnia has shown promise in cancer survivors, with systematic reviews and meta-analyses demonstrating improvements in both subjective and actigraphy-measured sleep. But the new findings suggest that assessments of sleep problems should also consider psychosocial factors — such as resilience and mental health status — alongside clinical characteristics like treatment type and time since diagnosis.

The study also highlights the relevance of the transitional period after diagnosis. Being one to three years postdiagnosis was independently associated with higher odds of poor sleep, a finding that echoes prior research on trajectories of sleep disturbance during the first years after treatment. This period often involves a shift from active treatment to survivorship, with lingering uncertainty, fear of recurrence, and the gradual reentry into normal life — all of which can disrupt sleep. Prior work has shown that dysfunctional beliefs about sleep and fear of progression can mediate the relationship between sleep disturbance and psychological distress, suggesting that the psychological aftermath of cancer may be as important as the physical one.

Resilience, meanwhile, has been the subject of increasing interest in psycho-oncology. Longitudinal studies in breast cancer have shown that resilience is associated with better sleep quality over time, and other work has suggested that resilience may mediate the relationship between fear of progression and sleep quality in patients with hematological malignancies. Social support has also been shown to play a role in the relationship between resilience and sleep quality among cancer patients. The new study adds cross-sectional evidence that resilience is independently associated with sleep quality in a mixed sample of adults with cancer, beyond the effects of clinical and sociodemographic factors.

Of course, the study has limitations. Its cross-sectional design means that causality cannot be established — it is possible that poor sleep erodes resilience and mental health, rather than the other way around, or that the relationship is bidirectional. The sample of 159 adults, while adequate for the statistical models used, was recruited from a single tertiary hospital and online communities, which may limit generalizability. The data are not publicly available due to privacy and ethical restrictions. Still, the findings represent a meaningful step forward in understanding the complex interplay between sleep, symptom burden, and psychological factors in adults with cancer — and they make a strong case for treating the mind and body as inseparable partners in the fight for a good night’s sleep during cancer care.

Subject of Research: Sleep Quality in Adults with Cancer: Associations with Symptom Burden and Psychological Resilience

Article Title: Sleep Quality in Adults with Cancer: Associations with Symptom Burden and Psychological Resilience

Article References: Park, R. H., & Lee, S. J. (2026). Sleep Quality in Adults with Cancer: Associations with Symptom Burden and Psychological Resilience. Supportive Care in Cancer, 34(11), Article 1120. https://doi.org/10.1007/s00520-026-11353-y

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11353-y

Keywords: Sleep, Quality, Adults, Cancer, Associations, Symptom, Burden, Psychological, Resilience, scientific research