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Supportive Care in Cancer

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01-01-2010 | Original Article

Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy

Authors: Ann M. Berger, Kimberly Wielgus, Melody Hertzog, Patricia Fischer, Lynne Farr

Published in: Supportive Care in Cancer | Issue 1/2010

Abstract

Purpose

The purpose of this study was to examine patterns of circadian activity rhythms and their relationship with fatigue, anxiety/depression, and demographic/medical variables in women receiving breast cancer adjuvant therapy treatments (Tx) at three times within a randomized clinical trial (RCT) designed to improve sleep and modify fatigue.

Methods

A RCT enrolled 219 women with stage I–IIIA breast cancer who were randomized 2 days prior to starting chemotherapy to a behavioral therapy sleep intervention or healthy eating control group. All cases with available data (n = 190) were included in a descriptive, correlational, repeated measures analysis. Activity data were collected continuously by wrist actigraphy for 7 days at three times: the start (Tx 1), continuation (Tx 3), and recovery (30 days after last Tx) of chemotherapy. Circadian activity rhythm parameters were generated using Action4 software (Ambulatory Monitoring, Inc.). Measures collected simultaneously included Piper Fatigue Scale, Hospital Anxiety and Depression Scale, and demographic/medical variables.

Results

Circadian activity rhythm parameters at three times in both groups were disrupted compared to healthy adults, but similar to values of cancer patients. Significant changes in mesor, amplitude, peak activity, and 24 h autocorrelation values were found over time in both groups. The intervention group’s amplitude and circadian quotient values were significantly more robust. More robust activity rhythms were associated with lower fatigue, depressive symptoms, body mass index, and higher performance status in both groups.

Conclusions

Disrupted patterns of circadian activity rhythms were prevalent and associated with distressing fatigue and depressive symptoms during chemotherapy and at recovery. The intervention resulted in more robust rhythms.

Acebo C, LeBourgeois MK (2006) Actigraphy. Respir Care Clin N Am 12(1):23PubMed

Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP (2003) The role of actigraphy in the study of sleep and circadian rhythms. Sleep 26(3):342–392PubMed

Ancoli-Israel S, Klauber MR, Jones DW, Kripke DF, Martin J, Mason W et al (1997) Variations in circadian rhythms of activity, sleep, and light exposure related to dementia in nursing-home patients. Sleep 20(1):18–23PubMed

Ancoli-Israel S, Liu L, Marler MR, Parker BA, Jones V, Sadler GR et al (2006) Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer 14(3):201–209. doi:10.1007/s00520-005-0861-0 CrossRefPubMed

Berger AM (1998) Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy. Oncol Nurs Forum 25(1):51–62PubMed

Berger AM, Farr L (1999) The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue. Oncol Nurs Forum 26(10):1663–1671PubMed

Berger AM, Farr LA, Kuhn BR, Fischer P, Agrawal S (2007) Values of sleep/wake, activity/rest, circadian rhythms, and fatigue prior to adjuvant breast cancer chemotherapy. J Pain Symptom Manage 33(4):398–409. doi:10.1016/j.jpainsymman.2006.09.022 CrossRefPubMed

Berger AM, Higginbotham P (2000) Correlates of fatigue during and following adjuvant breast cancer chemotherapy: a pilot study. Oncol Nurs Forum 27(9):1443–1448PubMed

Berger AM, Kuhn BR, Farr LA, Lynch JC, Agrawal S, Chamberlain JA et al (2008) Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Psycho-oncology. doi:10.1002/pon.1438 online 12/17/08 PMID 19090531

10.

Berger AM, VonEssen S, Kuhn BR, Piper BF, Agrawal S, Lynch JC et al (2003) Adherence, sleep, and fatigue outcomes after adjuvant breast cancer chemotherapy: results of a feasibility intervention study. Oncol Nurs Forum 30(3):513–522. doi:10.1188/03.ONF.513-522 CrossRefPubMed

11.

Berger AM, Wielgus K, Young-McCaughan S, Fischer P, Farr L, Lee KA (2008) Methodological challenges when using actigraphy in research. J Pain Symptom Manage 36(2):191–199. doi:10.1016/j.jpainsymman.2007.10.008 CrossRefPubMed

12.

Brown AC, Smolensky MH, D'Alonzo GE, Redman DP (1990) Actigraphy: a means of assessing circadian patterns in human activity. Chronobiol Int 7(2):125–133. doi:10.3109/07420529009056964 CrossRefPubMed

13.

Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213. doi:10.1016/0165-1781(89) 90047-4 CrossRefPubMed

14.

Chevalier V, Mormont MC, Cure H, Chollet P (2003) Assessment of circadian rhythms by actimetry in healthy subjects and patients with advanced colorectal cancer. Oncol Rep 10(3):733–737PubMed

15.

Cole RJ, Kripke DF, Gruen W, Mullaney DJ, Gillin JC (1992) Automatic sleep/wake identification from wrist activity. Sleep 15(5):461–469PubMed

16.

de Souza L, Benedito-Silva AA, Pires ML, Poyares D, Tufik S, Calil HM (2003) Further validation of actigraphy for sleep studies. Sleep 26(1):81–85PubMed

17.

Dijk DJ, von Schantz M (2005) Timing and consolidation of human sleep, wakefulness, and performance by a symphony of oscillators. J Biol Rhythms 20(4):279–290. doi:10.1177/0748730405278292 CrossRefPubMed

18.

Donovan KA, Small BJ, Andrykowski MA, Munster P, Jacobsen PB (2007) Utility of a cognitive–behavioral model to predict fatigue following breast cancer treatment. Health Psychol Off J Of The Div Of Health Psychol Am Psychol Assoc 26(4):464–472

19.

Dzaja A, Arber S, Hislop J, Kerkhofs M, Kopp C, Pollmacher T et al (2005) Women's sleep in health and disease. J Psychiatr Res 39(1):55–76. doi:10.1016/j.jpsychires.2004.05.008 CrossRefPubMed

20.

Farr L, Boen L (1996) Comparison of rectal and axillary temperature rhythms with activity. Paper presented at the NASA Space Grant Consortium Symposium, Lincoln, NE

21.

Fernandes R, Stone P, Andrews P, Morgan R, Sharma S (2006) Comparison between fatigue, sleep disturbance, and circadian rhythm in cancer inpatients and healthy volunteers: evaluation of diagnostic criteria for cancer-related fatigue. J Pain Symptom Manage 32(3):245–254. doi:10.1016/j.jpainsymman.2006.03.014 CrossRefPubMed

22.

Lanuza D, Farr L (2003) Circadian rhythm disorders. In: Carrieri-Kohlman VA, Lindsey A, West C (eds) Pathophysiological phenomena in nursing, 3rd edn. Saunders, St Louis, MO, pp 65–90

23.

Lentz MJ (1990) Time-series analysis–cosinor analysis: a special case. West J Nurs Res 12(3):408–412. doi:10.1177/019394599001200313 CrossRefPubMed

24.

Levin RD, Daehler MA, Grutsch JF, Quiton J, Lis CG, Peterson C et al (2005) Circadian function in patients with advanced non-small-cell lung cancer. Br J Cancer 93(11):1202–1208. doi:10.1038/sj.bjc.6602859 CrossRefPubMed

25.

Lichstein KL, Stone KC, Donaldson J, Nau SD, Soeffing JP, Murray D et al (2006) Actigraphy validation with insomnia. Sleep 29(2):232–239PubMed

26.

Littner M, Kushida CA, Anderson WM, Bailey D, Berry RB, Davila DG et al (2003) Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002. Sleep 26(3):337–341PubMed

27.

Mitchell SA, Beck SL, Hood LE, Moore K, Tanner ER (2007) Putting evidence into practice: evidence-based interventions for fatigue during and following cancer and its treatment. Clin J Oncol Nurs 11(1):99–113. doi:10.1188/07.CJON.99-113 CrossRefPubMed

28.

Mock V, Atkinson A, Barsevick AM, Berger AM, Cimprich B, Eisenberger MA et al (2007) Cancer-related fatigue. Clinical practice guidelines in oncology. J Natl Compr Cancer Netw 5(10):1054–1078

29.

Monk TH (2005) Aging human circadian rhythms: conventional wisdom may not always be right. J Biol Rhythms 20(4):366–374. doi:10.1177/0748730405277378 CrossRefPubMed

30.

Mor V, Laliberte L, Morris JN, Wiemann M (1984) The Karnofsky Performance Status Scale. An examination of its reliability and validity in a research setting. Cancer 53(9):2002–2007. doi:10.1002/1097-0142(19840501)53:9<2002::AID-CNCR2820530933>3.0.CO;2-W CrossRefPubMed

31.

Morgenthaler T, Alessi C, Friedman L, Owens J, Kapur V, Boehlecke B et al (2007) Practice parameters for the use of actigraphy in the assessment of sleep and sleep disorders: an update for 2007. Sleep 30(4):519–529PubMed

32.

Mormont MC, Langouet AM, Claustrat B, Bogdan A, Marion S, Waterhouse J et al (2002) Marker rhythms of circadian system function: a study of patients with metastatic colorectal cancer and good performance status. Chronobiol Int 19(1):141–155. doi:10.1081/CBI-120002593 CrossRefPubMed

33.

Mormont MC, Waterhouse J (2002) Contribution of the rest-activity circadian rhythm to quality of life in cancer patients. Chronobiol Int 19(1):313–323. doi:10.1081/CBI-120002606 CrossRefPubMed

34.

Mormont MC, Waterhouse J, Bleuzen P, Giacchetti S, Jami A, Bogdan A et al (2000) 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 6(8):3038–3045PubMed

35.

Mullaney DJ, Kripke DF, Messin S (1980) Wrist-actigraphic estimation of sleep time. Sleep 3(1):83–92PubMed

36.

Mustian KM, Morrow GR, Carroll JK, Figueroa-Moseley CD, Jean-Pierre P, Williams GC (2007) Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. Oncologist 12(Suppl 1):52–67. doi:10.1634/theoncologist.12-S1-52 CrossRefPubMed

37.

Piper BF, Dibble SL, Dodd MJ, Weiss MC, Slaughter RE, Paul SM (1998) The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum 25(4):677–684PubMed

38.

Rich T, Innominato PF, Boerner J, Mormont MC, Iacobelli S, Baron B et al (2005) 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 11(5):1757–1764. doi:10.1158/1078-0432.CCR-04-2000 CrossRefPubMed

39.

Roscoe JA, Morrow GR, Hickok JT, Bushunow P, Matteson S, Rakita D et al (2002) Temporal interrelationships among fatigue, circadian rhythm and depression in breast cancer patients undergoing chemotherapy treatment. Support Care Cancer 10(4):329–336. doi:10.1007/s00520-001-0317-0 CrossRefPubMed

40.

Sephton S, Spiegel D (2003) Circadian disruption in cancer: a neuroendocrine-immune pathway from stress to disease? Brain Behav Immun 17(5):321–328. doi:10.1016/S0889-1591(03) 00078-3 CrossRefPubMed

41.

Snaith RP (2003) The hospital anxiety and depression scale. Health Qual Life Outcomes 1:29. doi:10.1186/1477-7525-1-29 CrossRefPubMed

42.

Teychenne M, Ball K, Salmon J (2008) Physical activity and likelihood of depression in adults: a review. Prev Med 46(5):397–411. doi:10.1016/j.ypmed.2008.01.009 CrossRefPubMed

43.

Van Gelder RN (2004) Recent insights into mammalian circadian rhythms. Sleep 27(1):166–171PubMed

44.

Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370. doi:10.1111/j.1600-0447.1983.tb09716.x CrossRefPubMed

Title: Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy
Authors: Ann M. Berger
Kimberly Wielgus
Melody Hertzog
Patricia Fischer
Lynne Farr
Publication date: 01-01-2010
Publisher: Springer-Verlag
Published in: Supportive Care in Cancer / Issue 1/2010
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-009-0636-0

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