Circadian function of patients with advanced non-small cell lung cancer

Abstract

7291 Background: Preclinical data shows that abolishing circadian function accelerates tumor progression and shortens survival, while restoring normal circadian function enhances the survival benefits of chemotherapy. A significant fraction of patients with advanced cancer express the symptoms of disrupted circadian function, such as poor sleep quality and fatigue. There is little data in the literature on circadian function of cancer patients. Consequently, we measured the prevalence of symptoms associated with a disrupted circadian rhythm in advanced non-small cell lung cancer. Methods: Prior to initiation of therapy, actigraphy bracelets were worn on the non-dominant wrist for at least three days. The Pittsburgh Sleep Quality Index (PSQI), assessed sleep quality; European Organization for Research and Treatment for Cancer Care (EORTC) and the Ferrans and Powers Quality of Life Index (QLI) assessed quality of life and fatigue levels. Results: At the time of analysis there were 21 male and 12 female patients enrolled in the study. 20 had metastatic disease while 13 were stage III. 18 had prior treatment while 15 were newly diagnosed. The mean PSQI score was 10.6, a score routinely recorded in insomniacs. QLI domain scores were one to two standard deviations lower and EORTC domain scores were one standard deviation lower than the general population norms with low scores indicating worse QoL. The mean EORTC fatigue item score of 53 was much higher than that in normal population (28.8), higher the score, worse the fatigue. The wrist actigraphs recorded that patients slept 148.5 minutes more during the putative wake span and 113.1 minutes less during the putative sleep span than population controls. Conclusions: Patients with advanced non-small cell lung cancer have significantly disturbed circadian rhythms - experience poor sleep quality, high levels of fatigue, and an overall poor quality of life. The interesting question is whether restoring the patients’ circadian function also improves sleep quality, reduces fatigue levels, and improves QoL. This issue is currently being investigated at our center in a randomized clinical trial evaluating the chronotherapeutic role of melatonin in the treatment of stage III and IV non-small cell lung cancer. No significant financial relationships to disclose.