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BMC Cancer
Published in: BMC Cancer 1/2011

Open Access 01-12-2011 | Research article

The association of quality of life with potentially remediable disruptions of circadian sleep/activity rhythms in patients with advanced lung cancer

Authors: James F Grutsch, Carol Ferrans, Patricia A Wood, Jovelyn Du-Quiton, Dinah Faith T Quiton, Justin L Reynolds, Christine M Ansell, Eun Young Oh, Mary Ann Daehler, Robert D Levin, Donald P Braun, Digant Gupta, Christopher G Lis, William JM Hrushesky

Published in: BMC Cancer | Issue 1/2011

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Abstract

Background

Cancer patients routinely develop symptoms consistent with profound circadian disruption, which causes circadian disruption diminished quality of life. This study was initiated to determine the relationship between the severity of potentially remediable cancer-associated circadian disruption and quality of life among patients with advanced lung cancer.

Methods

We concurrently investigated the relationship between the circadian rhythms of 84 advanced lung cancer patients and their quality of life outcomes as measured by the EORTC QLQ C30 and Ferrans and Powers QLI. The robustness and stability of activity/sleep circadian daily rhythms were measured by actigraphy. Fifty three of the patients in the study were starting their definitive therapy following diagnosis and thirty one patients were beginning second-line therapy. Among the patients who failed prior therapy, the median time between completing definitive therapy and baseline actigraphy was 4.3 months, (interquartile range 2.1 to 9.8 months).

Results

We found that circadian disruption is universal and severe among these patients compared to non-cancer-bearing individuals. We found that each of these patient's EORTC QLQ C30 domain scores revealed a compromised capacity to perform the routine activities of daily life. The severity of several, but not all, EORTC QLQ C30 symptom items correlate strongly with the degree of individual circadian disruption. In addition, the scores of all four Ferrans/Powers QLI domains correlate strongly with the degree of circadian disruption. Although Ferrans/Powers QLI domain scores show that cancer and its treatment spared these patients' emotional and psychological health, the QLI Health/Function domain score revealed high levels of patients' dissatisfaction with their health which is much worse when circadian disruption is severe. Circadian disruption selectively affects specific Quality of Life domains, such as the Ferrans/Powers Health/Function domain, and not others, such as EORTC QLQ C30 Physical Domain.

Conclusions

These data suggest the testable possibility that behavioral, hormonal and/or light-based strategies to improve circadian organization may help patients suffering from advanced lung cancer to feel and function better.
Appendix
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Literature
1.
Halberg F: Temporal coordination of physiologic function. Cold Spring Harb Symp Quant Biol. 1960, 25: 289-310.CrossRefPubMed
2.
3.
Lin JD, Liu C, Li S: Integration of energy metabolism and the mammalian clock. Cell Cycle. 2008, 7: 453-7. 10.4161/cc.7.4.5442.CrossRefPubMed
4.
Karatsoreos IN, Silver R: Minireview: The neuroendocrinology of the suprachiasmatic nucleus as a conductor of body time in mammals. Endocrinology. 2007, 148: 5640-7. 10.1210/en.2007-1083.CrossRefPubMedPubMedCentral
5.
Panda S, Hogenesch JB, Kay SA: Circadian rhythms from flies to human. Nature. 2002, 417: 329-35. 10.1038/417329a.CrossRefPubMed
6.
Wever R: The circadian multi-oscillatory system of man. Int J Chronobiol. 1975, 3: 19-55.PubMed
7.
Moore RY, Eichler VB: Central neural mechanisms in diurnal rhythm regulation and neuroendocrine responses to light. Psychoneuroendocrinology. 1976, 1: 265-79. 10.1016/0306-4530(76)90016-0.CrossRefPubMed
8.
Souetre E, Salvati E, Belugou JL, et al: Circadian rhythms in depression and recovery: evidence for blunted amplitude as the main chronobiological abnormality. Psychiatry Res. 1989, 28: 263-78. 10.1016/0165-1781(89)90207-2.CrossRefPubMed
9.
Foster RG, Roenneberg T: Human responses to the geophysical daily, annual and lunar cycles. Curr Biol. 2008, 18: R784-R794. 10.1016/j.cub.2008.07.003.CrossRefPubMed
10.
Levin RD, Daehler MA, Grutsch JF, et al: Circadian function in patients with advanced non-small-cell lung cancer. Br J Cancer. 2005, 93: 1202-8. 10.1038/sj.bjc.6602859.CrossRefPubMedPubMedCentral
11.
Rich T, Innominato PF, Boerner J, et al: Elevated serum cytokines correlated with altered behavior, serum cortisol rhythm, and dampened 24-hour rest-activity patterns in patients with metastatic colorectal cancer. Clin Cancer Res. 2005, 11: 1757-64. 10.1158/1078-0432.CCR-04-2000.CrossRefPubMed
12.
Le Guen Y, Gagnadoux F, Hureaux J, et al: Sleep disturbances and impaired daytime functioning in outpatients with newly diagnosed lung cancer. Lung Cancer. 2007, 58: 139-43. 10.1016/j.lungcan.2007.05.021.CrossRefPubMed
13.
Hrushesky WHE, Lakatua D, Langevin T, Halberg F, Kennedy B: Marker rhythms for cancer chrono-chemotherapy. Chronobiology. Edited by: Haus E, Cabet H. 1985, 493-499.
14.
Mormont MC, Waterhouse J, Bleuzen P, et al: Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status. Clin Cancer Res. 2000, 6: 3038-45.PubMed
15.
Iurisci I, Rich T, Levi F, et al: Relief of symptoms after gefitinib is associated with improvement of rest/activity rhythm in advanced lung cancer. J Clin Oncol. 2007, 25: e17-9. 10.1200/JCO.2007.11.3274.CrossRefPubMed
16.
Ancoli-Israel S, Liu L, Marler MR, et al: Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer. 2006, 14: 201-9. 10.1007/s00520-005-0861-0.CrossRefPubMed
17.
Davidson JR, MacLean AW, Brundage MD, et al: Sleep disturbance in cancer patients. Soc Sci Med. 2002, 54: 1309-1321. 10.1016/S0277-9536(01)00043-0.CrossRefPubMed
18.
Mercadante S, Girelli D, Casuccio A: Sleep disorders in advanced cancer patients: prevalence and factors associated. Support Care Cancer. 2004, 12: 355-9. 10.1007/s00520-004-0623-4.CrossRefPubMed
19.
Cleeland CS, Bennett GJ, Dantzer R, et al: Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms. Cancer. 2003, 97: 2919-25. 10.1002/cncr.11382.CrossRefPubMed
20.
Mormont MC, Waterhouse J: Contribution of the rest-activity circadian rhythm to quality of life in cancer patients. Chronobiol Int. 2002, 19: 313-23. 10.1081/CBI-120002606.CrossRefPubMed
21.
Walsh D, Rybicki L: Symptom clustering in advanced cancer. Support Care Cancer. 2006, 14: 831-6.
22.
Ferrans CE: Differences in what quality-of-life instruments measure. J Natl Cancer Inst Monogr. 2007, 22-6.
23.
Wilson IB, Cleary PD: Clinical predictors of functioning in persons with acquired immunodeficiency syndrome. Med Care. 1996, 34: 610-23. 10.1097/00005650-199606000-00010.CrossRefPubMed
24.
Sadeh A, Alster J, Urbach D, et al: Actigraphically based automatic bedtime sleep-wake scoring: validity and clinical applications. J of Ambulatory Monitoring. 1989, 2: 209-216.
25.
Jean-Louis G, von Gizycki H, Zizi F, et al: Determination of sleep and wakefulness with the actigraph data analysis software (ADAS). Sleep. 1996, 19: 739-743.PubMed
26.
Sadeh A, Sharkey KM, Carskadon MA: Activity-based sleep-wake identification: an empirical test of methodological issues. Sleep. 1994, 17: 201-7.PubMed
27.
Korszun A, Young EA, Engleberg NC, et al: Use of actigraphy for monitoring sleep and activity levels in patients with fibromyalgia and depression. J Psychosom Res. 2002, 52: 439-43. 10.1016/S0022-3999(01)00237-9.CrossRefPubMed
28.
Cole RJ, Kripke DF, Gruen W, et al: Automatic sleep/wake identification from wrist activity. Sleep. 1992, 15: 461-9.PubMed
29.
Aaronson NK, Ahmedzai S, Bergman B, et al: The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993, 85: 365-76. 10.1093/jnci/85.5.365.CrossRefPubMed
30.
Bottomley A: The cancer patient and quality of life. Oncologist. 2002, 7: 120-5. 10.1634/theoncologist.7-2-120.CrossRefPubMed
31.
Ferrans CE: Definitions and conceptual models of quality of life. 2005, Cambridge, UK, Cambride University Press
32.
Scott NW, Fayers PM, Aaronson NK, et al: EORTC Reference Manual 2008. 2008, Brussels, Belgium, EORTC Quality of Life Group
33.
Hjermstad MJ, Fayers PM, Bjordal K, et al: Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: the QLQ = C30 (+ 3). J Clin Oncol. 1998, 16: 1188-96.PubMed
34.
Gupta D, Grutsch JF, Lis CG: Comparison of two quality of life instruments for cancer patients: the Ferrans and Powers Quality of Life Index and the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire C30. J Soc Integr Oncol. 2008, 6: 13-8.PubMed
35.
Ancoli-Israel S, Cole R, Alessi C, et al: The role of actigraphy in the study of sleep and circadian rhythms. Sleep. 2003, 26: 342-92.PubMed
36.
Murphy F, Bentley S, Ellis BW, et al: Sleep deprivation in patients undergoing operation: a factor in the stress of surgery. Br Med J. 1977, 2: 1521-2.CrossRefPubMedPubMedCentral
37.
Bentley S, Murphy F, Dudley H: Perceived noise in surgical wards and an intensive care area: an objective analysis. Br Med J. 1977, 2: 1503-6. 10.1136/bmj.2.6101.1503.CrossRefPubMedPubMedCentral
38.
Salas RE, Gamaldo CE: Adverse effects of sleep deprivation in the ICU. Crit Care Clin. 2008, 24: 461-76. 10.1016/j.ccc.2008.02.006. v-viCrossRefPubMed
39.
Hunter P: To sleep, perchance to live. Sleeping is vital for health, cognitive function, memory and long life. EMBO Rep. 2008, 9: 1070-3. 10.1038/embor.2008.197.CrossRefPubMedPubMedCentral
40.
Lin YM, Chang JH, Yeh KT, et al: Disturbance of circadian gene expression in hepatocellular carcinoma. Mol Carcinogensis. 2008, 47: 925-33. 10.1002/mc.20446.CrossRef
41.
Filipski E, King VM, Li X, et al: Disruption of circadian coordination accelerates malignant growth in mice. Pathol Biol (Paris). 2003, 51: 216-9.CrossRef
42.
Erren TC, Reiter RJ: Defining chronodisruption. J Pineal Res. 2009, 46: 245-7. 10.1111/j.1600-079X.2009.00665.x.CrossRefPubMed
43.
Penev PD, Kolker DE, Zee PC, et al: Chronic circadian desynchronization decreases the survival of animals with cardiomyopathic heart disease. Am J Physiol. 1998, 275: H2334-7.PubMed
44.
Ferrie JE, Shipley MJ, Cappuccio FP, et al: A prospective study of change in sleep duration: associations with mortality in the Whitehall II cohort. Sleep. 2007, 30: 1659-66.PubMedPubMedCentral
45.
Sephton SE, Sapolsky RM, Kraemer HC, et al: Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst. 2000, 92: 994-1000. 10.1093/jnci/92.12.994.CrossRefPubMed
46.
Hrushesky WJ: Circadian timing of cancer chemotherapy. Science. 1985, 228: 73-5. 10.1126/science.3883493.CrossRefPubMed
47.
Rich TA: Symptom clusters in cancer patients and their relation to EGFR ligand modulation of the circadian axis. J Support Oncol. 2007, 5: 167-74. discussion 176-7PubMed
48.
Mackiewicz M, Shockley KR, Romer MA, et al: Macromolecule biosynthesis: a key function of sleep. Physiol Genomics. 2007, 31: 441-57.
49.
Mystakidou K, Parpa E, Tsilika E, et al: The relationship of subjective sleep quality, pain, and quality of life in advanced cancer patients. Sleep. 2007, 30: 737-42.PubMedPubMedCentral
50.
Beck SL, Schwartz AL, Towsley G, et al: Psychometric evaluation of the Pittsburgh Sleep Quality Index in cancer patients. J Pain Symptom Manage. 2004, 27: 140-8. 10.1016/j.jpainsymman.2003.12.002.CrossRefPubMed
51.
Nakamura T, Takumi T, Takano A, et al: Of mice and men--universality and breakdown of behavioral organization. PLoS One. 2008, 3: e2050-10.1371/journal.pone.0002050.CrossRefPubMedPubMedCentral
52.
Bogdan A, Lellouch J, Misset J-L, et al: Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status. Clin Cancer Res. 2000, 6: 3038-45.PubMed
53.
Berger AM, Farr LA, Kuhn BR, et al: Values of sleep/wake, activity/rest, circadian rhythms, and fatigue prior to adjuvant breast cancer chemotherapy. J Pain Symptom Manage. 2007, 33: 398-409. 10.1016/j.jpainsymman.2006.09.022.CrossRefPubMedPubMedCentral
54.
Satlin A, Teicher MH, Lieberman HR, et al: Circadian locomotor activity rhythms in Alzheimer's disease. Neuropsychopharmacology. 1991, 5: 115-26.PubMed
55.
Ancoli-Isreal S, Clopton P, Klauber MR, et al: Use of wrist activity for monitoring sleep/wake in demented nursing-home patients. Sleep. 1997, 20: 24-27.
Metadata
Title
The association of quality of life with potentially remediable disruptions of circadian sleep/activity rhythms in patients with advanced lung cancer
Authors
James F Grutsch
Carol Ferrans
Patricia A Wood
Jovelyn Du-Quiton
Dinah Faith T Quiton
Justin L Reynolds
Christine M Ansell
Eun Young Oh
Mary Ann Daehler
Robert D Levin
Donald P Braun
Digant Gupta
Christopher G Lis
William JM Hrushesky
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2011
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/1471-2407-11-193

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