Quality of life (QoL) correlates with the rest/activity circadian rhythm (RAR) in patients (pts) with metastatic colorectal cancer (MCC) on first line chemotherapy with 5-fluorouracil, leucovorin and oxaliplatin: An international multicenter study (EORTC 05963)

Abstract

8029 Background: The assessment of quality of life with questionnaires is limited by their subjective nature. Actigraphy monitoring is non invasive and provides quantitative parameters of the RAR that correlate with QoL items and can complement QoL questionnaires (Clin Cancer Res, 2000: 6; 3038). In this multicenter trial, we prospectively investigated the correlation between QoL and RAR parameters in previously untreated MCC pts. Methods: Before the first chemotherapy course, 94 MCC pts completed the EORTC QLQ-C30 and had RAR assessment for 3 days using a small wrist-watch (actigraph), which records the number of arm movements per minute. Three validated RAR parameters were calculated: mean activity (mAct), autocorrelation coefficient at 24h (r24), indicating the robustness of the activity pattern over a period of 24-h, and dichotomy index (I<O), quantifying the differences in activity distribution between the rest span and the active phase. QoL items were correlated with RAR parameters by the Spearman rank 2-sided test. Results: Global QoL correlated positively with mAct (r = 0.36, p = 0.0005), r24 (r = 0.35, p = 0.0006) and I<O (r = 0.40, p < 0.0001). I<O was negatively correlated with fatigue (r = -0.39, p < 0.0001), appetite loss (r = -0.38, p < 0.0001) and pain (r = -0.37, p = 0.0002). A positive correlation was found between r24 and social functioning (r = 0.35, p = 0.0006) as well as I<O and physical functioning (r = 0.36, p = 0.0004). Conversely, RAR parameters were poorly or not correlated with insomnia, cognitive and emotional functioning. Conclusions: This prospective multicenter study has established the correlation between the RAR and global QoL, several symptom scores and functioning scales in chemotherapy-naïve MCC pts. The circadian timing system, that generates the RAR, can be disrupted in cancer. Monitoring this system gives an objective and quantitative estimate of QoL and symptom clusters in cancer pts. The strength of the relation between RAR output and QoL is being further assessed during interventions targeted at the circadian system. No significant financial relationships to disclose.