Pediatric oncology clinicians most commonly assess sleep only when concerns are raised by patients or families, and predominantly recommend sleep hygiene as a standalone treatment, which is likely ineffective for the complex sleep disturbances seen in this population.
Key Findings
Results
Most pediatric oncology clinicians assessed sleep reactively rather than proactively, and a minority never assessed sleep at all.
61% of clinicians reported assessing sleep only when patients or families raised a concern.
10% of clinicians reported never assessing sleep.
The survey included 200 pediatric oncology clinicians administered via REDCap.
Authors note that 'relying on children and families to report concerns can be a missed opportunity to identify sleep disturbances early.'
Results
Behavioral difficulties with sleep onset and insomnia were rated as the most problematic sleep concerns among pediatric oncology clinicians.
Behavioral difficulties with sleep onset received a mean rating of M = 3.00 (SD = 1.08).
Insomnia received a mean rating of M = 2.91 (SD = 0.99).
These were the highest-rated sleep concerns among those assessed in the survey.
Results
Sleep hygiene was the most widely endorsed intervention across almost every sleep concern reported by clinicians.
Sleep hygiene was the top endorsed treatment regardless of the specific sleep concern presented.
Authors note that sleep hygiene 'is likely ineffective as a standalone treatment for complex sleep disturbances seen in oncology.'
Authors warn that offering 'simple but likely ineffective treatments alone may perpetuate long-term sleep disturbances and a lack of confidence in the ability to effectively treat sleep.'
Results
Behavioral sleep intervention strategies were used at similar frequencies by physicians and advanced practice providers (APPs) compared to other clinician types.
Odds ratios for behavioral strategy use between physicians/APPs and other clinicians ranged from OR = 0.61 to 1.25.
The overlapping odds ratio range around 1.0 indicates no substantial difference between clinician groups for behavioral strategies.
Clinician types other than physicians/APPs included in the survey were not specified in the abstract.
Results
Physicians and APPs used pharmacological treatments for behavioral sleep concerns significantly more frequently than other clinician types.
Odds ratios for pharmacology use by physicians/APPs compared to other clinicians ranged from OR = 0.19 to 0.36 (expressed as the inverse, indicating other clinicians were less likely to prescribe).
This pattern was observed specifically for behavioral sleep concerns.
The finding reflects the scope-of-practice distinction between prescribing and non-prescribing clinicians.
Background
There are no clinical practice guidelines for treating sleep disturbances in pediatric oncology, resulting in variable approaches to sleep management across clinicians.
The absence of guidelines was identified as the rationale for conducting the survey.
Pediatric cancer patients are noted to be at increased risk for sleep disturbances.
Authors call for 'further research to determine the most effective treatment approaches for behavioral sleep disturbances, informing clinical practice guidelines for pediatric oncology.'
What This Means
This research suggests that children with cancer frequently experience sleep problems, yet the clinicians who care for them lack standardized guidelines on how to identify and treat those problems. A survey of 200 pediatric oncology clinicians found that most only ask about sleep when a family brings it up, and roughly 1 in 10 never ask at all. The most common advice given was 'sleep hygiene' — basic habits like consistent bedtimes and limiting screens — which was recommended across nearly every type of sleep problem encountered.
However, the researchers point out that sleep hygiene alone is likely not enough to address the complex, serious sleep disturbances that children with cancer often experience. By only responding to concerns raised by families and offering simple interventions, clinicians may be missing early opportunities to catch sleep problems and may inadvertently leave families feeling like nothing can truly help. The study also found that while doctors and advanced practice providers used similar behavioral strategies as other clinicians (such as psychologists or social workers), they were considerably more likely to turn to medication for behavioral sleep concerns, reflecting differences in what each professional type is trained and licensed to do.
This research suggests that pediatric oncology needs formal, evidence-based guidelines for sleep assessment and treatment. Without them, care remains inconsistent and potentially inadequate, which could contribute to lasting sleep difficulties in children already facing the challenges of cancer and its treatment. The authors call for more research to identify what treatments actually work best in this population so that clear clinical guidelines can be developed.
Daniel L, Gola T, Irestorm E, Catarozoli C, Zhou E, van Litsenburg R, et al.. (2026). Survey of Sleep Practices Among Clinicians Working With Pediatric Oncology Patients.. Psycho-oncology. https://doi.org/10.1002/pon.70417