Stress, Isolation, and Sleep Quality among Breast Cancer Survivors throughout the COVID-19 Pandemic: A Longitudinal Study in a Multi-Ethnic Cohort

PURPOSE: This study examined how stress, isolation, and sleep quality were impacted throughout the COVID-19 pandemic among breast cancer survivors (BCS). METHODS: BCS enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort were surveyed in 2020, 2021, and 2022. An 11-item isolation/stress score was repeatedly measured in each survey and its changes were examined through mixed-effects models. Sleep quality was assessed in 2022 by the Insomnia Severity Index (ISI). RESULTS: In total, 1899 BCS responded (response rate: 62.8%), of whom 69% were White and 24% Black (median time since diagnosis: 5.1 years, IQR: 2.3-9.2). The isolation/stress score decreased significantly from 2020 to 2022 for White BCS, but only started declining for Black BCS in 2022. Consequently, although there were no significant racial difference in 2020, Black BCS had significantly higher isolation/stress scores in 2021 and 2022 (P < .01), while it became nonsignificant after adjusting for socioeconomic factors. BCS who were single, on Medicaid, without a high school degree, or with annual household income <$35,000 had significantly higher isolation/stress scores. Regarding sleep quality, 48% of BCS reported clinically-significant insomnia (ISI ≥ 8), and insomnia was strongly associated with higher isolation/stress scores (P-trend < .001). CONCLUSIONS: Our findings suggested that the isolation/stress level improved among BCS as the pandemic subsided, but this positive trend was not observed equally across racial/ethnic groups potentially due to lack of resources. IMPLICATIONS FOR CANCER SURVIVORS: Additional resources, such as access to counseling services and sleep assistance programs, might support the post-pandemic recovery of undersevered BCS.