Social Determinants of Sleep Health in Survivors of Childhood Cancer: A Systematic Review.
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Survivors of childhood cancer frequently experience poor sleep quality, which affects behavioural, emotional, cognitive and physical health. Sleep health is multidimensional, encompassing regularity, satisfaction, alertness, timing, efficiency and duration, yet the influence of social, environmental and interpersonal factors on these dimensions remains poorly understood. This review examines sleep health dimensions among childhood cancer survivors and their associations with social determinants of health. A systematic review was completed in November 2025 using PubMed, Scopus, Web of Science and EBSCO databases. Two reviewers independently screened titles/abstracts and full texts, assessing links between social determinants and sleep outcomes. The risk of bias was evaluated using the ROBINS-E tool. Of 485 publications screened, 14 met the inclusion criteria. Most studies assessed sleep disturbances (n = 10), with fewer examining sleep duration (n = 5), alertness (n = 3) and sleep efficiency (n = 2). Social determinants, including race/ethnicity (n = 5), education (n = 6) and employment (n = 4), were associated with specific sleep dimensions; however, comprehensive analyses across the full spectrum of sleep remain limited. Social determinants influence several sleep dimensions among childhood cancer survivors, yet research rarely considers the multidimensional nature of sleep health. We propose a socio-ecological, multidimensional model to guide the development of targeted interventions and reduce sleep health disparities in this population.