Background: Physical activity (PA) and sleep quality are associated with improved patient outcomes and quality of life in breast cancer (BC) patients. Perceived stress management skills (PSMS) efficacy has been associated with increased PA and better sleep quality, however, the relationship between the individual subscales of PSMS and these health behaviors is unclear. A quantitative modeling analysis was used to test our hypothesis that each subscale of PSMS is associated with increased PA engagement and better sleep quality

Methods: Participants included BC patients stage III or below (n = 240; M age = 50.34) who had surgery for primary breast cancer in the past 8 weeks. PSMSs were measured by the Measure of Current Status (MOCS) part A subscales (relaxation, awareness of tension, assertiveness, cognitive coping skills). PA was measured using 7-day self-reported moderate-vigorous PA (MVPA). Sleep quality was measured by the Pittsburgh Sleep Quality Index global score (higher scores indicates greater sleep disruption). Structural equation modeling was used to assess the association of PSMS and PA/Sleep Quality while controlling for weeks since surgery, age, and income

Results: The final model met criteria for sufficient fit (CFI=1.00, RMSEA=.000, SRMR =.000). Direct paths were observed from assertiveness to MVPA (β = -.18, p = .018), and cognitive coping to MVPA (β = .17, p = .033). Relaxation and awareness of tension were not associated with MVPA. In addition, direct paths were observed from awareness of tension to sleep quality (β = .24, p <.001), and cognitive coping to sleep quality (β = -.23, p = .003). Weeks since surgery, age, and income were not associated with either MVPA or sleep quality (p > .05).

Conclusions: Several PSMS are uniquely associated with lifestyle factors including PA, and sleep quality. Higher levels of assertiveness were associated with lower MVPA and higher awareness of tension was associated greater sleep disruption. In addition, higher cognitive coping efficacy appeared to be associated with both higher levels of MVPA and less sleep disruption. Cognitive coping strategies may be a key factor to target in interventional studies to enhance MVPA and sleep quality in BC patients after surgery. Future research may investigate how changes in PSMSs influence associated lifestyle behavior changes in addition to long term clinical outcomes (i.e., recurrence and mortality) in BC patients throughout treatment, and into survivorship.