Abstract
BackgroundPsychosocial symptoms often cluster together, are refractory to treatment, and impair health‐related quality of life (HR‐QoL) in cancer patients. The contribution of circadian rhythm alterations to systemic symptoms has been overlooked in cancer, despite a causal link shown under jet lag and shift work conditions. We investigated whether the circadian rest‐activity rhythm provides a reliable and objective estimate of the most frequent patient‐reported outcome measures (PROMs).MethodsTwo datasets were used, each involving concomitant 3‐day time series of wrist actigraphy and HR‐QoL questionnaires: EORTC QLQ‐C30 was completed once by 237 patients with metastatic colorectal cancer; MD Anderson Symptom Inventory (MDASI) was completed daily by 31 patients with advanced cancer on continuous actigraphy monitoring, providing 1015 paired data points. Circadian function was assessed using the clinically validated dichotomy index I < O. Nonparametric tests compared PROMs and I < O. Effect sizes were computed. Sensitivity subgroup and temporal dynamics analyses were also performed.Results I < O values were significantly lower with increasing symptom severity and worsening HR‐QoL domains. Fatigue and anorexia were worse in patients with circadian disruption. The differences were both statistically and clinically significant (P < 0.001; d ≥ 0.33). Physical and social functioning, and global quality/enjoyment of life were significantly better in patients with robust circadian rhythm (P < 0.001; d ≥ 0.26). Sensitivity analyses validated these findings.ConclusionObjectively determined circadian disruption was consistently and robustly associated with clinically meaningfully severe fatigue, anorexia, and interference with physical and social functioning. This supports an important role of the circadian system in the determination of cancer patients’ HR‐QoL and symptoms that deserves therapeutic exploitation.
Highlights
One in eight adults carries wearable “well-b eing” activity monitors,[1] with some 50 million such units been sold in the United States in 2016.2 This positive perception of e- Health devices in the general population represents an opportunity for implementing objective measures of physiology and behavior complementing the assessments of symptoms and health-related quality of life (HR-QoL), especially in cancer patients.[3]
The results from two subjective patient-reported outcome measures (PROMs) questionnaires (EORTC QLQ-C30 and MD Anderson Symptom Inventory (MDASI)) were compared to circadian rhythm quantitative estimates computed from wrist actigraphy records in two cohorts of cancer patients
Significant and clinically meaningful associations were found between circadian rest-activity rhythm alterations, and the severity of fatigue and anorexia, as well as the impairment of physical and social dimensions of HR- QoL and that of general well-b eing
Summary
7th Framework Programme of the European Union through the Coordinated Action on Systems Medicine, Grant/Award Number: Grant 305033; Medical Research Council, London, UK, Grant/Award Number: Grant MR/M013170; 7th Framework Programme of the European Union through the inCASA project, Grant/Award Number: Contract CIP 250505; ARTBC International, Villejuif, France
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
