A Selective Cortico-Limbic Network Organizes Behavior During Reward Seeking Under Threat.

Cancer is the second leading cause of years of life lost in adolescents and young adults (AYA) aged 15–24 in Australia []. Advances in screening and treatments have improved 5‐year survival from 79% to 90% over the last 3 decades []. With improved survival comes a growing population of AYA in need of ongoing care []. Recent statistics suggest 60%–90% of AYA who survive cancer experience adverse late effects [], with studies documenting psychosocial and physical sequelae at least up to 10 years after active treatment []. AYA are particularly vulnerable to sleep disturbance due to complex physiological, hormonal and psychosocial changes characteristic of the developmental period []. Cancer and its treatments place AYA at a higher risk for sleep problems. Anticancer treatments (e.g., chemotherapy), side‐effects (e.g., pain), psychological distress (e.g., anxiety), frequent hospitalizations and medications (e.g., glucocorticoids) all markedly disrupt sleep [, ]. Accordingly, several studies have indicated AYA with cancer have significantly poorer sleep relative to the general population and healthy siblings [, ]. Moreover, sleep problems comorbid with cancer are most prevalent in younger individuals []. Prevalence rates for sleep problems in AYA with cancer range from 16.7% to 85% [, , , ], with variability reflecting differences in population (e.g., assessment around the time of diagnosis or during the treatment phase), assessment methodology and symptom classification []. Insomnia symptoms, are most common during cancer treatment (55%–85%) [, , ], however may persist for several years post treatment []. Insomnia is the sleep disorder with highest prevalence in AYA survivors []. Approximately, one third of AYA survivors report symptoms of insomnia [, ], and in 9.6%–30.8% of AYA, these symptoms exceed accepted thresholds for normal or mild levels of insomnia symptoms and are clinically significant [, ]. Left untreated, insomnia can impair health‐related quality of life [, ]. Insomnia in AYA with cancer have been linked with emotional distress (e.g., depression, anxiety, post‐traumatic stress), physical morbidity (e.g., migraines, pain), and impaired overall functioning []. This is of particular significance as AYA with cancer seek to resume normal life amidst significant developmental and social transitions []. Sleep interventions administered within routine care may minimize symptom severity and impact.