Survey of Sleep Practices Among Clinicians Working With Pediatric Oncology Patients

Objective: Pediatric cancer patients are at increased risk for sleep disturbances; however, there are no clinical practice guidelines for treating sleep disturbances in pediatric oncology, resulting in variable approaches to sleep management across clinicians. The current study surveyed clinicians regarding their approaches to assessing and treating sleep. Methods: A total of 200 pediatric oncology clinicians participated in a REDCap survey about behavioral and medical sleep concerns assessed in their practice and related treatment approaches. Results: Most clinicians (61%) reported assessing sleep when patients or families raised a concern, and 10% reported never assessing sleep. Clinicians rated behavioral difficulties with sleep onset (M = 3.00, SD = 1.08) and insomnia (M = 2.91, SD = 0.99) as the most problematic sleep concerns. Sleep hygiene was the most widely endorsed intervention across almost every sleep concern. Behavioral strategies were used with similar frequency between physicians/APPs compared to other clinicians [ORs = 0.61–1.25]. Pharmacology was used more frequently by physicians/APPs than other clinicians for behavioral sleep concerns [ORs = 0.19–0.36]. Conclusions: Relying on children and families to report concerns can be a missed opportunity to identify sleep disturbances early. The most endorsed treatment, sleep hygiene, is likely ineffective as a standalone treatment for complex sleep disturbances seen in oncology. It is possible that offering patients these simple but likely ineffective treatments alone may perpetuate long-term sleep disturbances and a lack of confidence in the ability to effectively treat sleep. Further research is needed to determine the most effective treatment approaches for behavioral sleep disturbances, informing clinical practice guidelines for pediatric oncology.