Abstract
BackgroundCancer Related Fatigue (CRF) and circadian rhythm have a great impact on the quality of life (HRQL) of patients with breast (BC) and colon cancer (CRC). Other patient related outcomes in oncology are measured by new instruments focusing on adaptive characteristics such as sense of coherence or self-regulation, which could be more appropriate as a prognostic tool than classical HRQL. The aim of this study was to assess the association of autonomic regulation (aR) and self-regulation (SR) with survival.Methods146 cancer patients and 120 healthy controls took part in an initial evaluation in 2000/2001. At a median follow up of 5.9 years later, 62 of 95 BC, 17 of 51 CRC patients, and 85 of 117 healthy controls took part in the follow-up study. 41 participants had died. For the follow-up evaluation, participants were requested to complete the standardized aR and SR questionnaires.ResultsOn average, cancer patients had survived for 10.1 years with the disease. Using a Cox proportional hazard regression with stepwise variables such as age, diagnosis group, Charlson co-morbidity index, body mass index (BMI)) aR and SR. SR were identified as independent parameters with potential prognostic relevance on survival While aR did not significantly influence survival, SR showed a positive and independent impact on survival (OR = 0.589; 95%-CI: 0.354 - 0.979). This positive effect persisted significantly in the sensitivity analysis of the subgroup of tumour patients and in the subscale 'Achieve satisfaction and well-being' and by tendency in the UICC stages nested for the different diagnoses groups.ConclusionsSelf-regulation might be an independent prognostic factor for the survival of breast and colon carcinoma patients and merits further prospective studies.
Highlights
Cancer Related Fatigue (CRF) and circadian rhythm have a great impact on the quality of life (HRQL) of patients with breast (BC) and colon cancer (CRC)
In metastasized colon carcinoma patients actimetrically measured disturbed rest/activity rhythm is associated with shorter survival [7] and in breast cancer patients (BC) diminished circadian cortisol rhythm is associated with higher mortality [8]
At study inclusion breast cancer patients participating in the study had a mean disease duration of 4.7 years, 13 (13.7%) of them a disease duration of less than 1 year, only 3 (3.2%) an operation between 2 and 4 weeks before
Summary
Cancer Related Fatigue (CRF) and circadian rhythm have a great impact on the quality of life (HRQL) of patients with breast (BC) and colon cancer (CRC). In metastasized colon carcinoma patients actimetrically measured disturbed rest/activity rhythm is associated with shorter survival [7] and in breast cancer patients (BC) diminished circadian cortisol rhythm is associated with higher mortality [8] Beside physiological measures, another epidemiological available approach is measuring rest/activity regulation with a validated assessment applicable in clinical settings as a part of a questionnaire measuring different functions There is some evidence that questionnaires measuring patients’ adaptive capacity towards disease and healthorientated life-style change, such as the ‘sense of coherence’ (SOC) [10] or ‘self-regulation’ (SR) [11], could have stronger association with prognosis in oncology or other chronic conditions than HRQL scales [12,13,14,15] One of these tools is based on Antonovsky’s core question ‘What may keep one healthy?’ For Antonovsky, SOC is based on three components which are prerequisites for salutogenesis, i.e., comprehensibility, meaningfulness, and manageability [10]. They are often used in sociological studies as a stable personality trait marker, while they have not been developed as clinical measures for physical and oncological conditions [10,16,17,18]
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