{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T22:10:29Z","timestamp":1790633429784,"version":"4.1.0"},"reference-count":82,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:00:00Z","timestamp":1781308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Insomnia is one of the most prevalent and persistent symptoms among patients with breast cancer, yet it remains under-recognized and undertreated in routine clinical practice. Beyond its impact on sleep quality, insomnia is increasingly understood as a multidimensional condition involving neurobiological, psychological, and behavioral mechanisms, closely intertwined with cancer-related stress and psychiatric comorbidities. This narrative review aims to provide a comprehensive and integrative overview of insomnia in breast cancer, focusing on its epidemiology, pathophysiological underpinnings, neuropsychiatric correlates, and clinical implications, while highlighting gaps in current research and management. Methods: A narrative review of the literature was conducted, including studies published in major medical databases (PubMed, Scopus, and Web of Science) up to 2025. Relevant articles addressing insomnia, sleep disturbances, psychiatric symptoms, and neurobiological mechanisms in breast cancer populations were selected and synthesized. Results: Insomnia affects a substantial proportion of breast cancer patients across the disease trajectory, from diagnosis to survivorship. Its etiology is multifactorial, involving dysregulation of the hypothalamic\u2013pituitary\u2013adrenal axis, inflammatory processes, and circadian rhythm, as well as treatment-related factors such as chemotherapy, endocrine therapy, and menopausal symptoms. Insomnia frequently co-occurs with depression, anxiety, fatigue, and pain, forming symptom clusters that significantly impair quality of life and may influence clinical outcomes. Emerging evidence supports a bidirectional relationship between insomnia and psychiatric vulnerability, suggesting a shared neurobiological substrate within the brain\u2013body stress axis. Conclusions: Insomnia in breast cancer should be conceptualized as a neuropsychiatric condition embedded within a broader stress-related symptom network rather than as an isolated sleep disturbance. Improved screening, interdisciplinary management, and the integration of evidence-based interventions such as cognitive behavioral therapy for insomnia are essential. Research should focus on personalized and mechanistically informed approaches to better address this highly prevalent yet insufficiently managed condition.<\/jats:p>","DOI":"10.3390\/jcm15124603","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T08:57:58Z","timestamp":1781513878000},"page":"4603","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Insomnia in Breast Cancer: A Neglected Symptom Cluster"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7058-4927","authenticated-orcid":false,"given":"Giuseppe","family":"Marano","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Head-Neck and Chest, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"},{"name":"Department of Neuroscience, Section of Psychiatry, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7445-3366","authenticated-orcid":false,"given":"Ida","family":"Paris","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6558-2932","authenticated-orcid":false,"given":"Gianandrea","family":"Traversi","sequence":"additional","affiliation":[{"name":"Unit of Medical Genetics, Department of Laboratory Medicine, Ospedale Isola Tiberina-Gemelli Isola, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osvaldo","family":"Mazza","sequence":"additional","affiliation":[{"name":"Spine Surgery Department, Bambino Ges\u00f9 Children\u2019s Hospital IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Migliore","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Ricozzi","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Rotondaro","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4218-6726","authenticated-orcid":false,"given":"Francesco","family":"Pavese","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana","family":"D\u2019Angelo","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9959-4360","authenticated-orcid":false,"given":"Paola","family":"Fuso","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0758-8033","authenticated-orcid":false,"given":"Alessandra","family":"Fabi","sequence":"additional","affiliation":[{"name":"Precision Medicine Unit in Senology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2950-3395","authenticated-orcid":false,"given":"Gianluca","family":"Franceschini","sequence":"additional","affiliation":[{"name":"Breast Surgery Unit, Department of Woman and Child\u2019s Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy"},{"name":"Department of Medical and Surgical Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3007-8162","authenticated-orcid":false,"given":"Marianna","family":"Mazza","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Head-Neck and Chest, Section of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy"},{"name":"Department of Neuroscience, Section of Psychiatry, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1007\/s11764-023-01336-x","article-title":"Psychosocial experiences of breast cancer survivors: A meta-review","volume":"18","author":"King","year":"2024","journal-title":"J. Cancer Surviv."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Martella, S., Proserpio, P., Guerrieri, M.E., Galbiati, A., Ferini-Strambi, L., Cucinella, L., Iacobone, A.D., Franchi, D., and Nappi, R.E. (2025). Insomnia in Women Surviving Breast and Gynecological Cancers\u2014A Narrative Review to Address the Hormonal Factor. Cancers, 17.","DOI":"10.3390\/cancers17244022"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101376","DOI":"10.1016\/j.smrv.2020.101376","article-title":"Efficacy of cognitive behavioral therapy for insomnia in breast cancer: A meta-analysis","volume":"55","author":"Ma","year":"2021","journal-title":"Sleep Med. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kim, D., Lee, H.S., Jeon, S., Lee, J., Park, W.C., Oh, J., and Yoon, C.I. (2026). Association Between Therapeutic Interventions and Sleep Disorders in Patients with Breast Cancer: A National Population-Based Cohort Study. Cancers, 18.","DOI":"10.3390\/cancers18030397"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s10549-025-07835-y","article-title":"The impact of breast cancer treatment on sleep disturbance: A systematic review","volume":"215","author":"Carson","year":"2025","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.5498\/wjp.v14.i9.1294","article-title":"Impact of gynecological cancers on women\u2019s mental health","volume":"14","author":"Marano","year":"2024","journal-title":"World J. Psychiatry"},{"key":"ref_7","first-page":"702","article-title":"Sleep and inflammation: Partners in sickness and in health","volume":"21","author":"Irwin","year":"2021","journal-title":"Nat. Rev. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hinz, A., Friedrich, M., Schulte, T., Ernst, M., Tibubos, A.N., Petrowski, K., and Dornh\u00f6fer, N. (2025). Sleep Problems and Quality of Life in Breast Cancer Patients. Curr. Oncol., 32.","DOI":"10.3390\/curroncol32090508"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"oyaf297","DOI":"10.1093\/oncolo\/oyaf297","article-title":"Factors associated with sleep disturbance in breast cancer survivors over time","volume":"30","author":"Marell","year":"2025","journal-title":"Oncologist"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1007\/s11920-013-0404-1","article-title":"Depression and insomnia in cancer: Prevalence, risk factors, and effects on cancer outcomes","volume":"15","author":"Irwin","year":"2013","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"pkz041","DOI":"10.1093\/jncics\/pkz041","article-title":"The relationship between insomnia and cognitive impairment in breast cancer survivors","volume":"3","author":"Liou","year":"2019","journal-title":"JNCI Cancer Spectr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1200\/JCO.2009.22.5011","article-title":"Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center\u2013Community Clinical Oncology Program","volume":"28","author":"Palesh","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_13","unstructured":"Martella, S., Fabi, A., Di Napoli, A., Vici, P., Pizzuti, L., Sergi, D., Frezzotti, F., Maugeri-Sacc\u00e0, M., Barba, M., and Giannarelli, D. (2023). Insomnia in women surviving breast and gynecological cancers: A systematic review. Cancers, 15."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Marano, G., D\u2019Abate, C., Traversi, G., Mazza, O., Gaetani, E., Esposito, R., Pavese, F., Paris, I., and Mazza, M. (2026). Neuroinflammation and the female brain: Sex-specific mechanisms underlying mood disorders and stress vulnerability. Life, 16.","DOI":"10.3390\/life16010139"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA\u2014A Scale for the Quality Assessment of Narrative Review Articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. Peer Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"414","DOI":"10.4300\/JGME-D-22-00480.1","article-title":"Narrative Reviews: Flexible, Rigorous, and Practical","volume":"14","author":"Sukhera","year":"2022","journal-title":"J. Grad. Med. Educ."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/anae.16016","article-title":"How to Write a Narrative Review","volume":"78","author":"Agarwal","year":"2023","journal-title":"Anaesthesia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.jpainsymman.2009.07.004","article-title":"Prevalence, severity, and correlates of sleep-wake disturbances in long-term breast cancer survivors","volume":"39","author":"Otte","year":"2010","journal-title":"J. Pain Symptom Manag."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Li, Z., Wang, Q., Xu, J., Song, Q., Ling, X., Gao, Y., and Lei, J. (2023). Comparative efficacy and acceptability of interventions for insomnia in breast cancer patients: A protocol for systematic review and network meta-analysis. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0282614"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.genhosppsych.2023.12.004","article-title":"Global prevalence of poor sleep quality in cancer patients: A systematic review and meta-analysis","volume":"87","author":"Chen","year":"2024","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1038\/bjc.2017.85","article-title":"Sleep and survival among women with breast cancer: 30 years of follow-up within the Nurses\u2019 Health Study","volume":"116","author":"Zhou","year":"2017","journal-title":"Br. J. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.bbi.2013.01.003","article-title":"Psychoneuroimmunology and cancer: A decade of discovery, paradigm shifts, and methodological innovations","volume":"30","author":"Lutgendorf","year":"2013","journal-title":"Brain Behav. Immun."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e71586","DOI":"10.1002\/cam4.71586","article-title":"Sleep, depressive symptoms, and quality of life among women with newly diagnosed breast cancer: Baseline results from the AMBER cohort study","volume":"15","author":"Yang","year":"2026","journal-title":"Cancer Med."},{"key":"ref_24","first-page":"257","article-title":"Clinical insights into the management of sleep disturbances within cancer care: A qualitative analysis","volume":"34","author":"Adams","year":"2026","journal-title":"Support. Care Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"18343","DOI":"10.1038\/s41598-024-69086-z","article-title":"Investigation of screening questions to identify insomnia in cancer patients","volume":"14","author":"Pfeifer","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_26","first-page":"845","article-title":"Sleep disturbance and cancer-related fatigue symptom cluster in breast cancer patients undergoing chemotherapy","volume":"28","author":"Fox","year":"2020","journal-title":"Support. Care Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Hajj, A., Chamoun, R., Salameh, P., Khoury, R., Hachem, R., Sacre, H., Chahine, G., Kattan, J., and Rabbaa Khabbaz, L. (2022). Fatigue in breast cancer patients on chemotherapy: A cross-sectional study exploring clinical, biological, and genetic factors. BMC Cancer, 22.","DOI":"10.1186\/s12885-021-09072-0"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1093\/jnci\/92.12.994","article-title":"Diurnal cortisol rhythm as a predictor of breast cancer survival","volume":"92","author":"Sephton","year":"2013","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"S58","DOI":"10.1016\/j.bbi.2012.05.002","article-title":"Sleep disturbance, inflammation and depression risk in cancer survivors","volume":"30","author":"Irwin","year":"2012","journal-title":"Brain Behav. Immun."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.bbi.2021.03.004","article-title":"Vulnerability to inflammation-related depressive symptoms: Moderation by stress in women with breast cancer","volume":"94","author":"Manigault","year":"2021","journal-title":"Brain Behav. Immun."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Huang, Z., Cheng, L., He, J., Cheng, X., Wang, Y., Lin, X., Miao, X., Wang, R., and Xia, S. (2025). The Potential Mediating Role of Inflammation on the Association Between Dietary Inflammatory Index and Sleep Disturbance Among Breast Cancer Patients: A Cross-Sectional Study. Nutrients, 17.","DOI":"10.3390\/nu17243889"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S48","DOI":"10.1016\/j.bbi.2012.06.011","article-title":"Inflammation and cancer-related fatigue: Mechanisms, contributing factors, and treatment implications","volume":"30","author":"Bower","year":"2013","journal-title":"Brain Behav. Immun."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1159\/000550315","article-title":"Inflammatory Proteins Mediate the Causal Association between Sleep Traits and Breast Cancer: A Mendelian Randomization Study","volume":"19","author":"Zhou","year":"2026","journal-title":"Lifestyle Genom."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.lfs.2017.02.008","article-title":"Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: Health impacts and mechanisms of circadian disruption","volume":"173","author":"Touitou","year":"2021","journal-title":"Life Sci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"102235","DOI":"10.1016\/j.smrv.2026.102235","article-title":"Unravelling the association between sleep traits and reproductive cancers: A systematic review and meta-analysis","volume":"85","author":"Pagkalidou","year":"2026","journal-title":"Sleep Med. Rev."},{"key":"ref_36","first-page":"43","article-title":"Prevalence and risk factors for insomnia among breast cancer patients on aromatase inhibitors","volume":"21","author":"Desai","year":"2013","journal-title":"Support. Care Cancer"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/j.sleh.2023.04.004","article-title":"Global prevalence of sleep disturbances among breast cancer survivors: A systematic review with meta-analysis","volume":"9","author":"Cheng","year":"2023","journal-title":"Sleep Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"102471","DOI":"10.1016\/j.canep.2023.102471","article-title":"Sleep disturbances among cancer survivors","volume":"87","author":"Yarosh","year":"2023","journal-title":"Cancer Epidemiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"163","DOI":"10.2190\/PM.40.2.c","article-title":"It\u2019s not over when it\u2019s over: Long-term symptoms in cancer survivors\u2014A systematic review","volume":"40","author":"Harrington","year":"2010","journal-title":"Int. J. Psychiatry Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e13928","DOI":"10.1111\/jsr.13928","article-title":"Hyperarousal in insomnia disorder: Current evidence and potential mechanisms","volume":"32","author":"Dressle","year":"2023","journal-title":"J. Sleep Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e70150","DOI":"10.1111\/jsr.70150","article-title":"Sleep Medicine\u2014What\u2019s in a Name?","volume":"34","author":"Pevernagie","year":"2025","journal-title":"J. Sleep Res."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Pan, H., Zhang, J., Wan, F., Ma, M., and Zheng, W. (2026). Symptom networks in breast cancer patients during chemotherapy and their impact on daily living status. Front. Oncol., 16.","DOI":"10.3389\/fonc.2026.1709837"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"djw253","DOI":"10.1093\/jnci\/djw253","article-title":"Advancing symptom science through symptom cluster research: Expert panel proceedings and recommendations","volume":"109","author":"Miaskowski","year":"2017","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Bradley-Garcia, M., Tanguay, A.F.N., and Sekeres, M.J. (2026). Persistent adverse effects of cancer treatments on mental health, fatigue, and sleep disturbances in breast cancer survivors. BMC Womens Health, 26.","DOI":"10.1186\/s12905-026-04325-1"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1093\/annonc\/mds575","article-title":"Prevalence of depression in adults with cancer: A systematic review","volume":"24","author":"Walker","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jad.2011.01.011","article-title":"Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal studies","volume":"135","author":"Baglioni","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref_47","first-page":"4401","article-title":"Prevalence and risk factors of sleep disturbances in breast cancer survivors: Systematic review and meta-analyses","volume":"27","author":"Leysen","year":"2019","journal-title":"Support. Care Cancer"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/jjco\/hyab169","article-title":"Comorbid insomnia among breast cancer survivors and its prediction using machine learning: A nationwide study in Japan","volume":"52","author":"Ueno","year":"2022","journal-title":"Jpn. J. Clin. Oncol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"zsaf322","DOI":"10.1093\/sleep\/zsaf322","article-title":"Insomnia and elevated risk of major depressive disorder in older adult, long-term breast cancer survivors vs a matched cohort","volume":"49","author":"Irwin","year":"2026","journal-title":"Sleep"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1017\/S2045796025100401","article-title":"Gender differences in the incidence of psychiatric disorders among breast cancer patients: A nationwide cohort study","volume":"35","author":"Kim","year":"2026","journal-title":"Epidemiol. Psychiatr. Sci."},{"key":"ref_51","first-page":"3265","article-title":"From normal response to clinical problem: Definition and clinical features of fear of cancer recurrence","volume":"24","author":"Lebel","year":"2016","journal-title":"Support. Care Cancer"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"5788053","DOI":"10.1155\/tbj\/5788053","article-title":"Fear of Cancer Recurrence Contributes Largely to Patient Anxiety and Depression and Quality of Life in a Prospective Cohort of Chinese Breast Cancer Patients for Postoperative Radiotherapy","volume":"2025","author":"Li","year":"2025","journal-title":"Breast J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/NUR.0000000000000938","article-title":"Factors That Influence the Quality of Life of Breast Cancer Survivors","volume":"40","author":"Overcash","year":"2026","journal-title":"Clin. Nurse Spec."},{"key":"ref_54","first-page":"2461","article-title":"Multinational Association of Supportive Care in Cancer Fatigue Study Group-Biomarker Working Group. The biology of cancer-related fatigue: A review of the literature","volume":"23","author":"Saligan","year":"2015","journal-title":"Support. Care Cancer"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1016\/j.jpain.2013.08.007","article-title":"The association of sleep and pain: An update and a path forward","volume":"14","author":"Finan","year":"2022","journal-title":"J. Pain"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"3675","DOI":"10.1200\/JCO.2012.43.0116","article-title":"Cancer- and cancer treatment-associated cognitive change: An update on the state of the science","volume":"30","author":"Ahles","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_57","first-page":"373","article-title":"\u201cA machine that won\u2019t shut down, a clogged pipe\u201d: A qualitative study on the lived experience and integrative coping strategies of Chinese cancer patients with insomnia and cognitive impairment","volume":"34","author":"Chen","year":"2026","journal-title":"Support. Care Cancer"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1017\/S0033291719003404","article-title":"The network approach to psychopathology: A review of the literature 2008\u20132018 and an agenda for future research","volume":"50","author":"Robinaugh","year":"2020","journal-title":"Psychol. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"287","DOI":"10.5665\/sleep.1642","article-title":"The Consensus Sleep Diary: Standardizing Prospective Sleep Self-Monitoring","volume":"35","author":"Carney","year":"2012","journal-title":"Sleep"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S1389-9457(00)00065-4","article-title":"Validation of the Insomnia Severity Index as an Outcome Measure for Insomnia Research","volume":"2","author":"Bastien","year":"2001","journal-title":"Sleep Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"101615","DOI":"10.1016\/j.smrv.2022.101615","article-title":"Systematic review and meta-analysis of cognitive-behavioural therapy for insomnia on subjective and actigraphy-measured sleep and comorbid symptoms in cancer survivors","volume":"63","author":"Squires","year":"2022","journal-title":"Sleep Med. Rev."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Cooper, J.T., Svoboda, E., Prochazka, A.V., and Ha, D.M. (2025). Effects of cognitive-behavioral therapy for insomnia compared with controls among cancer survivors: A systematic review and meta-analysis of randomized trials. BMC Cancer, 25.","DOI":"10.1186\/s12885-025-14192-y"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e70418","DOI":"10.1002\/pon.70418","article-title":"A Randomized Controlled Trial: Evaluating the Sleep, Cancer and Rest (SleepCaRe) Trial to Improve Health-Related Quality of Life in Women Undergoing Chemotherapy for Breast Cancer","volume":"35","author":"Wallace","year":"2026","journal-title":"Psychooncology"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"e70409","DOI":"10.1002\/pon.70409","article-title":"Real World Outcomes of a Condensed Classroom-Based Cognitive Behavioral Therapy for Cancer-Related Cognitive Impairment","volume":"35","author":"Kucherer","year":"2026","journal-title":"Psychooncology"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1001\/jamapsychiatry.2016.3249","article-title":"Effect of a web-based cognitive behavioral therapy for insomnia intervention with 1-year follow-up: A randomized clinical trial","volume":"74","author":"Ritterband","year":"2022","journal-title":"JAMA Psychiatry"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"25","DOI":"10.6004\/jadpro.2026.17.1.3","article-title":"Melatonin for the Management of Cancer-Related Fatigue in Breast Cancer: An Integrative Review","volume":"17","author":"Pontinen","year":"2026","journal-title":"J. Adv. Pract. Oncol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.2147\/NSS.S380465","article-title":"Melatonin\u2019s benefits and risks as a therapy for sleep disturbances: Current insights","volume":"14","author":"Cardinali","year":"2022","journal-title":"Nat. Sci. Sleep"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/s11325-025-03331-1","article-title":"Melatonin supplementation: New insights into health and disease","volume":"29","author":"Palotta","year":"2025","journal-title":"Sleep Breath."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2827","DOI":"10.1200\/JCO.2015.65.7874","article-title":"Examination of broad symptom improvement resulting from mindfulness-based stress reduction in breast cancer survivors: A randomized controlled trial","volume":"34","author":"Lengacher","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Wang, X., Gao, L., Pang, Y., and Huang, T. (2025). Effect of mindfulness-based stress on cancer-related fatigue in breast cancer patients: A systematic review and meta-analysis. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1585383"},{"key":"ref_73","first-page":"623","article-title":"Effectiveness of an online mindfulness-based stress-reduction intervention to reduce anxiety in breast cancer survivors: A randomized-controlled trial","volume":"33","author":"Platas","year":"2025","journal-title":"Support. Care Cancer"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1007\/s10549-026-07923-7","article-title":"Effect of a supervised intermittent exercise program on insomnia in breast cancer patients undergoing chemotherapy","volume":"216","author":"Drozd","year":"2026","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_75","first-page":"1113","article-title":"Sleeping well with cancer: A systematic review of cognitive behavioral therapy for insomnia in cancer patients","volume":"10","author":"Garland","year":"2014","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Gao, L., Sun, Y., Luo, T., Chen, H., Huang, S., Zhu, L., and Ye, M. (2025). Acupuncture for systemic therapy-associated insomnia in patients with breast cancer: A systematic review and meta-analysis of randomized controlled trials. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1494929"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Marano, G., Paris, I., Traversi, G., Mazza, O., Pavese, F., D\u2019Angelo, T., Franceschini, G., and Mazza, M. (2026). Modern Personalized Strategies for Breast Cancer Treatment: Bridging Precision Oncology and Psycho-Oncology. J. Clin. Med., 15.","DOI":"10.3390\/jcm15041574"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"70","DOI":"10.4103\/hm.HM-D-25-00100","article-title":"Integrative approaches in oncology: The mental health benefits of Tai Chi and Qigong","volume":"10","author":"Marano","year":"2026","journal-title":"Heart Mind"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Fei, Y., Liu, F., Ding, X., Tang, J., Ye, X., Zhou, T., and Xu, H. (2026). Functional exercise, fear of recurrence, and sleep quality: A longitudinal path analysis of quality of life in postoperative breast cancer patients. Front. Oncol., 16.","DOI":"10.3389\/fonc.2026.1607256"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"21235","DOI":"10.1038\/s41598-025-05315-3","article-title":"The need for comprehensive sleep disturbances assessment and management in breast cancer care","volume":"15","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"98271","DOI":"10.12998\/wjcc.v13.i16.98271","article-title":"Territories of mourning: Addressing submerged problems of grief through multidisciplinary care","volume":"13","author":"Marano","year":"2025","journal-title":"World J. Clin. Cases"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"112617","DOI":"10.1016\/j.jpsychores.2026.112617","article-title":"The correlation between gut microbiota and sleep quality changes in breast cancer patients receiving postoperative chemotherapy: A longitudinal study","volume":"205","author":"Wu","year":"2026","journal-title":"J. Psychosom. Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4603\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T09:41:28Z","timestamp":1781516488000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4603"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,13]]},"references-count":82,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124603"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124603","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,13]]}}}