Are you a health professional?

This section does not replicate the other information on this topic but provides additional details or context most relevant to professionals.

Clinical practice guidelines

The 2020 NCCN survivorship care guidelines recommend ensuring an adequate amount of sleep. Registration is required for access.

Counseling patients

If you don’t already inquire regularly about your patients’ sleep durations and schedules, you may want to consider making this a part of your routine topics to discuss. As we’ve detailed within this topic, sleep time and quality are both indicators of and contributors to many other health issues and overall well-being.

Modes of action: cortisol, sleep and cancer

Cancer incidence, progression and mortality are linked to stress and disruption of the circadian rest and activity cycle. Cortisol, our primary stress hormone, helps regulate the sleep-wake cycle. Activation of the processes that produce cortisol (the hypothalamic-pituitary-adrenal (HPA) axis) can lead to arousal and sleeplessness.1Nicolaides NC, Vgontzas AN et al, editors. HPA axis and sleep. Endotext [Internet]. South Dartmouth (MA):, Inc.; 2000–.

Although the mechanisms are not fully understood, high cortisol levels and disrupted sleep-wake cycles are connected to these outcomes:2Berger AM, Farr L. The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue. Oncology Nursing Forum 1999; 26(10):1663-71; Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009. pp. 412-414.

  • Slower healing and recovery from surgery
  • Greater fatigue
  • More pain
  • Anxiety
  • Depression
  • Diminished appetite

Cortisol in excess may push several cancer processes forward, especially metastasis. A rise in blood cortisol in response to stress or poor sleep quality can speed up tumor growth. Cortisol suppresses immunity which may have a negative influence on recurrence risk.3Randall M. The physiology of stress: cortisol and the hypothalamic-pituitary-adrenal axis. Dartmouth Undergraduate Journal of Science. 2010 Fall. February 3, 2011. Viewed February 20, 2022.

The combination of cortisol and adrenaline increases blood glucose levels. Chronic high blood glucose episodes can be a direct or indirect mediator of the increase in tumor cell growth.4Ryu TY, Park J, Scherer PE. Hyperglycemia as a risk factor for cancer progression. Diabetes & Metabolism Journal. 2014 Oct;38(5):330-6. Cortisol also increases insulin resistance and seems to stimulate the ability of some cancer cells to grow and metastasize.5 Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009. p. 411; Moreno-Smith M, Lutgendorf SK, Sood AK. Impact of stress on cancer metastasis. Future Oncology. 2010 Dec; 6(12):1863-1881; Andrews RC, Walker BR. Glucocorticoids and insulin resistance: old hormones, new targets. Clinical Science (London, England). 1999 May;96(5):513-23.

Studies have investigated cancer outcomes related to cortisol and sleep disruption:

  • Breast cancer patients who don’t have normal cortisol rhythms have less-active natural killer cells and have reduced survival compared to others.6Sephton SE, Sapolsky RM, Kraemer HC, Spiegel D. Diurnal cortisol rhythm as a predictor of breast cancer survival. Journal of the National Cancer Institute. 2000;92(12):994-1000; Andersen BL, Farrar WB et al. Stress and immune responses after surgical treatment for regional breast cancer. Journal of the National Cancer Institute. 1998 Jan 7;90(1):30-6.
  • In adults with cardiovascular and cerebrovascular diseases, sleeping less than 6 hours a night is associated with almost triple the risk of cancer mortality compared with sleeping 6 or more hours a night.7Fernandez-Mendoza J, He F, Vgontzas AN, Liao D, Bixler EO. Interplay of objective sleep duration and cardiovascular and cerebrovascular diseases on cause-specific mortality. Journal of the American Heart Association. 2019 Oct 15;8(20):e013043.

Fortunately, improving sleep can block this cascade of effects. Sleep, and especially deep sleep, inhibits the HPA axis that produces cortisol.8Nicolaides NC, Vgontzas AN et al, editors. HPA axis and sleep. Endotext [Internet]. South Dartmouth (MA):, Inc.; 2000–. Further, melatonin, the “sleep hormone”, promotes sleep. It is a powerful antioxidant and exerts “protective effects against oxidative stress,  abnormal immune activation and/or inflammation, obesity, cardiovascular disorders, cancer development, and neurodegeneration.”9Ferlazzo N, Andolina G et al. Is melatonin the cornucopia of the 21st century? Antioxidants (Basel). 2020 Nov 5;9(11):1088. Melatonin is also instrumental in eliminating cancer cells and reducing the side effects of chemotherapy.10Winters N, Higgins Kelley J. The Metabolic Approach to Cancer: Integrating Deep Nutrition, the Ketogenic Diet, and Nontoxic Bio-Individualized Therapies. Vermont: Chelsea Green Publishing. 2017. p. 252. Promoting optimal melatonin and cortisol cycles can bring many benefits.

Health professional comment

We invite health professionals to contribute expertise or send us questions.

"*" indicates required fields

Please share your thoughts about content on the CancerChoices website. If you have a correction for us to consider, or additional information to add, please include references and links if possible.

Keep reading


Laura Pole, MSN, RN, OCNS

Senior Clinical Consultant
View profile

Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, MSN, RN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher
View profile

Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher and writer for CancerChoices and also served as the first program manager. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher


Whitney You, MD, MPH

Maternal-Fetal Medicine Physician
View profile

Dr. You is a physician specializing in maternal-fetal medicine (MFM) with a specific interest in cancer in the context of pregnancy. She completed a postdoctoral fellowship in health services research with a focus in health literacy and received a Master of Public Health.

Whitney You, MD, MPH Maternal-Fetal Medicine Physician

Last update: January 18, 2024

Last full literature review: November 2021

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.