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Chong MY, Frenken KG, Eussen SJPM, Koster A, Pot GK, Breukink SO, Janssen-Heijnen M, Keulen ETP, Bijnens W, Buffart LM, Meijer K, Scheer FAJL, Steindorf K, de Vos-Geelen J, Weijenberg MP, van Roekel EH, Bours MJL. Longitudinal associations of diurnal rest-activity rhythms with fatigue, insomnia, and health-related quality of life in survivors of colorectal cancer up to 5 years post-treatment. Int J Behav Nutr Phys Act 2024; 21:51. [PMID: 38698447 PMCID: PMC11067118 DOI: 10.1186/s12966-024-01601-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND There is a growing population of survivors of colorectal cancer (CRC). Fatigue and insomnia are common symptoms after CRC, negatively influencing health-related quality of life (HRQoL). Besides increasing physical activity and decreasing sedentary behavior, the timing and patterns of physical activity and rest over the 24-h day (i.e. diurnal rest-activity rhythms) could also play a role in alleviating these symptoms and improving HRQoL. We investigated longitudinal associations of the diurnal rest-activity rhythm (RAR) with fatigue, insomnia, and HRQoL in survivors of CRC. METHODS In a prospective cohort study among survivors of stage I-III CRC, 5 repeated measurements were performed from 6 weeks up to 5 years post-treatment. Parameters of RAR, including mesor, amplitude, acrophase, circadian quotient, dichotomy index, and 24-h autocorrelation coefficient, were assessed by a custom MATLAB program using data from tri-axial accelerometers worn on the upper thigh for 7 consecutive days. Fatigue, insomnia, and HRQoL were measured by validated questionnaires. Confounder-adjusted linear mixed models were applied to analyze longitudinal associations of RAR with fatigue, insomnia, and HRQoL from 6 weeks until 5 years post-treatment. Additionally, intra-individual and inter-individual associations over time were separated. RESULTS Data were available from 289 survivors of CRC. All RAR parameters except for 24-h autocorrelation increased from 6 weeks to 6 months post-treatment, after which they remained relatively stable. A higher mesor, amplitude, circadian quotient, dichotomy index, and 24-h autocorrelation were statistically significantly associated with less fatigue and better HRQoL over time. A higher amplitude and circadian quotient were associated with lower insomnia. Most of these associations appeared driven by both within-person changes over time and between-person differences in RAR parameters. No significant associations were observed for acrophase. CONCLUSIONS In the first five years after CRC treatment, adhering to a generally more active (mesor) and consistent (24-h autocorrelation) RAR, with a pronounced peak activity (amplitude) and a marked difference between daytime and nighttime activity (dichotomy index) was found to be associated with lower fatigue, lower insomnia, and a better HRQoL. Future intervention studies are needed to investigate if restoring RAR among survivors of CRC could help to alleviate symptoms of fatigue and insomnia while enhancing their HRQoL. TRIAL REGISTRATION EnCoRe study NL6904 ( https://www.onderzoekmetmensen.nl/ ).
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Affiliation(s)
- Marvin Y Chong
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
- Department of Epidemiology, CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Koen G Frenken
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Simone J P M Eussen
- Department of Epidemiology, CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Annemarie Koster
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Gerda K Pot
- Nutrition and Healthcare Alliance, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Stéphanie O Breukink
- Department of Surgery, GROW Research Institute for Oncology and Reproduction, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Maryska Janssen-Heijnen
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Eric T P Keulen
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre Sittard-Geleen, Geleen, The Netherlands
| | - Wouter Bijnens
- Research Engineering (IDEE), Maastricht University, Maastricht, The Netherlands
| | - Laurien M Buffart
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Frank A J L Scheer
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW Research Institute for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Eline H van Roekel
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Martijn J L Bours
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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Innominato PF, Macdonald JH, Saxton W, Longshaw L, Granger R, Naja I, Allocca C, Edwards R, Rasheed S, Folkvord F, de Batlle J, Ail R, Motta E, Bale C, Fuller C, Mullard AP, Subbe CP, Griffiths D, Wreglesworth NI, Pecchia L, Fico G, Antonini A. Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study. JMIR Res Protoc 2024; 13:e52957. [PMID: 38687985 PMCID: PMC11094600 DOI: 10.2196/52957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. OBJECTIVE This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. METHODS This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). RESULTS This study is part of an array of pilots within a European Union funded project, entitled "GATEKEEPER," conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. CONCLUSIONS In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52957.
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Affiliation(s)
- Pasquale F Innominato
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- Warwick Medical School & Cancer Research Centre, University of Warwick, Coventry, United Kingdom
- Chronotherapy, Cancers and Transplantation Research Unit, Faculty of Medicine, Université Paris-Saclay, Villejuif, France
| | - Jamie H Macdonald
- Institute for Applied Human Physiology, School of Psychology and Sports Science, Bangor University, Bangor, United Kingdom
| | - Wendy Saxton
- Research and Development Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Laura Longshaw
- Research and Development Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Rachel Granger
- Institute for Applied Human Physiology, School of Psychology and Sports Science, Bangor University, Bangor, United Kingdom
| | - Iman Naja
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
| | | | - Ruth Edwards
- Dietetics Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Solah Rasheed
- Dietetics Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Frans Folkvord
- PredictBy, Barcelona, Spain
- Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | | | - Rohit Ail
- Health Innovation, Samsung, Staines, United Kingdom
| | - Enrico Motta
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
| | - Catherine Bale
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Claire Fuller
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Anna P Mullard
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Christian P Subbe
- Acute and Critical Care Medicine, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
| | - Dawn Griffiths
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
| | - Nicholas I Wreglesworth
- Oncology Department, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, United Kingdom
- School of Medical Sciences, Bangor University, Bangor, United Kingdom
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry, United Kingdom
- Facoltà Dipartimentale di Ingegneria, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Giuseppe Fico
- Life Supporting Technologies, Escuela Técnica Superior de Ingenieros de Telecomunicaciones, Universidad Politécnica de Madrid, Madrid, Spain
| | - Alessio Antonini
- Knowledge Media Institute, The Open University, Milton Keynes, United Kingdom
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3
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Chen HM, Lee MC, Tian JY, Dai MF, Wu YC, Huang CS, Hsu PK, Duong LT. Relationships Among Physical Activity, Daylight Exposure, and Rest-Activity Circadian Rhythm in Patients With Esophageal and Gastric Cancer: An Exploratory Study. Cancer Nurs 2024; 47:112-120. [PMID: 36728167 DOI: 10.1097/ncc.0000000000001188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although rest-activity circadian rhythm (RACR) disruption is associated with mortality in patients with cancer, few studies have examined the effect of RACR on patients with esophageal and gastric cancer. OBJECTIVE The aim of this study was to identify the predictors of RACR. METHODS This cross-sectional, single-site study included 276 patients with esophageal and gastric cancer recruited from chest-surgery and general-surgery outpatient departments. Actigraphy was used to assess objective physical activity (PA), daylight exposure, and RACR, and 3-day PA was used to indicate the subjective amount of PA. The parameter of objective PA was the up activity mean; the parameter of daylight exposure was >500 lx, and the parameters of RACR were the 24-hour correlation coefficient, in-bed less than out-of-bed dichotomy index, midline estimating statistic of rhythm, and amplitude. The subjective amount of PA was calculated as the sum of mild, moderate, and vigorous PA. RESULTS The up activity mean predicted 24-hour correlation coefficient. The PA amount and up activity mean predicted in-bed less than out-of-bed dichotomy index. The up activity mean and >500-lx daylight exposure predicted midline estimating statistic of rhythm. Finally, the PA amount and up activity mean predicted the amplitude. CONCLUSIONS Increased PA and daylight exposure may improve RACR. IMPLICATIONS FOR PRACTICE Patients with esophageal and gastric cancer should be encouraged to engage in outdoor PA during the daytime as part of their regular lifestyle to maintain a robust circadian rhythm.
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Affiliation(s)
- Hui-Mei Chen
- Author Affiliations: School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences (Drs Chen and Lee); Department of Nursing, Taipei Veterans General Hospital (Mss Tian and Dai); Division of Thoracic Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University (Dr Wu); and Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital (Drs Huang and Hsu), Taipei, Taiwan; Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam; Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam (Ms Duong)
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Wang Y, van Beurden AW, Tersteeg MMH, Michel S, Kastelein A, Neefjes J, Rohling JHT, Meijer JH, Deboer T. Internal circadian misallignment in a mouse model of chemotherapy induced fatigue. Brain Behav Immun 2024; 115:588-599. [PMID: 37984623 DOI: 10.1016/j.bbi.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/14/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Cancer survivors can experience long lasting fatigue resulting in a lower quality of life. How chemotherapy treatment contributes to this fatigue is poorly understood. Previously we have shown in a mouse model of cancer related fatigue that doxorubicin treatment induces fatigue-like symptoms related to disturbed circadian rhythms. However, the specific components of the circadian regulatory circuitry affected by doxorubicin treatment remained unclear. Therefore we investigated the role of the central circadian clock, the suprachiasmatic nucleus (SCN), in chemotherapy-induced fatigue. METHODS We measured circadian controlled behavior and multiunit neuronal activity in the SCN in freely moving mice exhibiting fatigue-like behavior after doxorubicin treatment under both light-dark (LD) and constant dark (DD) conditions. Additionally, we assessed the expression of inflammation related genes in spleen and kidney as potential inducers of CRF. RESULTS Doxorubicin treatment significantly reduced both the running wheel activity and time spent using the running wheel for over five weeks after treatment. In contrast to the pronounced effects on behavior and neuronal activity of doxorubicin on circadian rhythms, peripheral inflammation markers only showed minor differences, five weeks after the last treatment. Surprisingly, the circadian SCN neuronal activity under both LD and DD conditions was not affected. However, the circadian timing of neuronal activity in peri-SCN areas (the brain areas surrounding SCN) and circadian rest-activity behavior was strongly affected by doxorubicin, suggesting that the output of the SCN was altered. The reduced correlation between the SCN neuronal activity and behavioral activity after doxorubicin treatment, suggests that the information flow from the SCN to the periphery was disturbed. CONCLUSION Our preclinical study suggests that chemotherapy-induced fatigue disrupts the circadian rhythms in peripheral brain areas and behavior downstream from the SCN, potentially leading to fatigue like symptoms. Our data suggest that peripheral inflammation responses are less important for the maintenance of fatigue. Chronotherapy that realigns circadian rhythms could represent a non-invasive way to improve patient outcomes following chemotherapy.
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Affiliation(s)
- Yumeng Wang
- Department of Cell and Chemical Biology, Laboratory for Neurophysiology, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands
| | - Anouk W van Beurden
- Department of Cell and Chemical Biology, Laboratory for Neurophysiology, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands
| | - Mayke M H Tersteeg
- Department of Cell and Chemical Biology, Laboratory for Neurophysiology, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands
| | - Stephan Michel
- Department of Cell and Chemical Biology, Laboratory for Neurophysiology, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands
| | - Anneke Kastelein
- Department of Cell and Chemical Biology, Laboratory for Neurophysiology, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands; Department of Cell and Chemical Biology, ONCODE Institute, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands
| | - Jacques Neefjes
- Department of Cell and Chemical Biology, ONCODE Institute, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands
| | - Jos H T Rohling
- Department of Cell and Chemical Biology, Laboratory for Neurophysiology, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands
| | - Johanna H Meijer
- Department of Cell and Chemical Biology, Laboratory for Neurophysiology, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands
| | - Tom Deboer
- Department of Cell and Chemical Biology, Laboratory for Neurophysiology, Leiden University Medical Center, 2333 ZC Leiden, the Netherlands.
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Hung CM, Zeng BY, Zeng BS, Sun CK, Cheng YS, Su KP, Wu YC, Chen TY, Lin PY, Liang CS, Hsu CW, Chu CS, Chen YW, Yeh PY, Wu MK, Tseng PT, Matsuoka YJ. Cancer related fatigue-light therapy: updated meta-analysis of randomised controlled trials. BMJ Support Palliat Care 2023; 13:e437-e445. [PMID: 34266911 DOI: 10.1136/bmjspcare-2021-003135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/28/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Moderate-to-severe cancer related fatigue occurs in 45% of patients with cancer and interferes with many aspects of quality of life. Although physical exercise has level 1 evidence for improvement of cancer related fatigue, it has a relatively high behavioural demand compared with other non-pharmacological interventions. The aim of this updated meta-analysis was to address the efficacy of light therapy in improving cancer related fatigue in patients with cancer. METHODS We included randomised controlled trials investigating the efficacy of bright white light (BWL) therapy in ameliorating cancer related fatigue in patients with cancer. This meta-analysis was conducted using a random-effects model. The target outcomes were changes in cancer related fatigue associated with BWL or dim red light (DRL). RESULTS There were 9 articles with 231 participants included. The main results revealed that daily morning BWL for 30 min was associated with significantly better improvement in fatigue severity compared with DRL (k=5, Hedges' g=-0.414, 95% CI -0.740 to -0.087, p=0.013). The subgroup without psychiatric comorbidities (k=4, Hedges' g=-0.479, 95% CI -0.801 to -0.156, p=0.004) was associated with significantly better improvement in fatigue severity with BWL than with DRL. In contrary, BWL was not associated with significantly different changes in depression severity or quality of life compared with DRL. Finally, BWL was associated with similar acceptability (ie, dropout rate) and safety profile (ie, any discomfort) as those of DRL. CONCLUSIONS This meta-analysis provides an updated evidence on the rationale for application of BWL in ameliorating cancer related fatigue in patients with different types of cancer. TRIAL REGISTRATION NUMBER INPLASY202140090.
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Affiliation(s)
- Chao-Ming Hung
- Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Bing-Yan Zeng
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Bing-Syuan Zeng
- Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Shian Cheng
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan
| | - Kuan-Pin Su
- Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
- An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Yi-Cheng Wu
- Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Tien-Yu Chen
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Pao-Yen Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Sung Liang
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Che-Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yen-Wen Chen
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
| | - Pin-Yang Yeh
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yutaka J Matsuoka
- Research and Development Division, Health Policy Bureau, Ministry of Health, Labour and Welfare, Tokyo, Japan
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Balachandran DD, Bashoura L, Sheshadri A, Manzullo E, Faiz SA. The Impact of Immunotherapy on Sleep and Circadian Rhythms in Patients with Cancer. Front Oncol 2023; 13:1295267. [PMID: 38090501 PMCID: PMC10711041 DOI: 10.3389/fonc.2023.1295267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/06/2023] [Indexed: 02/01/2024] Open
Abstract
Immunotherapy has revolutionized treatments for both early and advanced cancers, and as their role evolves, their impact on sleep and circadian rhythms continues to unfold. The recognition, evaluation, and treatment of sleep and circadian rhythm disturbance leads to improved symptom management, quality of life and treatment outcomes. An intricate complex relationship exists in the microenvironment with immunity, sleep and the tumor, and these may further vary based on the cancer, addition of standard chemotherapy, and pre-existing patient factors. Sleep and circadian rhythms may offer tools to better utilize immunotherapy in the care of cancer patients, leading to better treatment outcome, reduced symptom burden, and increased quality of life.
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Affiliation(s)
- Diwakar D. Balachandran
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lara Bashoura
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ajay Sheshadri
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ellen Manzullo
- Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Saadia A. Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Gouldthorpe C, Power J, Davies A. Circadian rhythm disorders in patients with advanced cancer: a scoping review. Front Oncol 2023; 13:1240284. [PMID: 37829342 PMCID: PMC10565850 DOI: 10.3389/fonc.2023.1240284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/16/2023] [Indexed: 10/14/2023] Open
Abstract
Circadian rhythms can be demonstrated in several biomarkers and behavioural activities, with rhythmical patterns occurring roughly over a 24-h period. Circadian disorders occur in patients with cancer and may be associated with poor clinical outcomes. This scoping review aimed to identify circadian rhythm research and reporting practices, circadian rhythm patterns, circadian rhythm disorders, and relevant associations of circadian rhythm disorders in patients with advanced cancer. Studies involved adult patients with locally advanced or metastatic cancer and used objective measures of circadian rhythmicity. Two independent authors completed initial screening of title and abstracts, full text reviews, data extraction, and data checking. A total of 98 articles were highlighted in the scoping review, which utilised physical activity measures (actigraphy and polysomnography), biomarkers (cortisol and melatonin), or a combination. Several circadian rhythms are commonly disordered amongst patients with advanced cancer and have significant implications for symptom burden, quality of life, and survival. It remains unclear which patients are most at risk of a circadian rhythm disorder. Significant heterogeneity exists in research and reporting practices. Standardising this approach may address discrepancies in the current literature and allow for research to focus on the most relevant parameters and approaches to improving circadian rhythmicity.
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Affiliation(s)
- Craig Gouldthorpe
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice and Care Services, Dublin, Ireland
| | - Jenny Power
- Academic Department of Palliative Medicine, Our Lady’s Hospice and Care Services, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Andrew Davies
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice and Care Services, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Jagielo AD, Benedict C, Spiegel D. Circadian, hormonal, and sleep rhythms: effects on cancer progression implications for treatment. Front Oncol 2023; 13:1269378. [PMID: 37746277 PMCID: PMC10514358 DOI: 10.3389/fonc.2023.1269378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Circadian, hormonal, and sleep rhythm disruptions are commonly experienced concerns among cancer patients throughout the cancer care continuum. This review aims to summarize the existing literature on circadian, hormonal, and sleep rhythms in the oncological population, focusing on circadian disruption and physiological and psychological abnormalities, disease progression, and chronomodulated treatment approaches. The findings demonstrate that subjectively and objectively measured circadian rhythm disruption is associated with adverse mental health and disease outcomes in patients with cancer. Chronomodulated chemotherapy, light therapy, cognitive behavioral therapy for insomnia, and physical activity have shown evidence of effectiveness in improving sleep, and occasionally, disease outcomes.
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Affiliation(s)
- Annemarie D. Jagielo
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, CA, Stanford, CA, United States
| | - Catherine Benedict
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, CA, Stanford, CA, United States
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, CA, Stanford, CA, United States
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Kang YE, Yoon JH, Park NH, Ahn YC, Lee EJ, Son CG. Prevalence of cancer-related fatigue based on severity: a systematic review and meta-analysis. Sci Rep 2023; 13:12815. [PMID: 37550326 PMCID: PMC10406927 DOI: 10.1038/s41598-023-39046-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023] Open
Abstract
Cancer-related fatigue (CRF) affects therapeutic compliance and clinical outcomes including recurrence and mortality. This study aimed to comprehensively and comparatively assess the severity-based prevalence of CRF. From two public databases (PubMed and Cochrane Library), we extracted data containing information on both prevalence and severity of fatigue in cancer patients through December 2021. We conducted a meta-analysis to produce point estimates using random effects models. Subgroup analyses were used to assess the prevalence and severity by the organ/system tumor development, treatment phase, therapeutic type, sex and assessment method. A total of 151 data (57 studies, 34,310 participants, 11,805 males and 22,505 females) were selected, which indicated 43.0% (95% CI 39.2-47.2) of fatigue prevalence. The total CRF prevalence including 'mild' level of fatigue was 70.7% (95% CI 60.6-83.3 from 37 data). The prevalence of 'severe' fatigue significantly varied by organ/system types of cancer origin (highest in brain tumors 39.7% vs. lowest in gynecologic tumors 3.9%) and treatment phase likely 15.9% (95% CI 8.1-31.3) before treatment, 33.8% (95% CI 27.7-41.2) ongoing treatment, and 24.1% (95% CI 18.6-31.2) after treatment. Chemotherapy (33.1%) induced approximately 1.5-fold higher prevalence for 'severe' CRF than surgery (22.0%) and radiotherapy (24.2%). The self-reported data for 'severe' CRF was 20-fold higher than those assessed by physicians (23.6% vs. 1.6%). Female patients exhibited a 1.4-fold higher prevalence of 'severe' fatigue compared to males. The present data showed quantitative feature of the prevalence and severity of CRF based on the cancer- or treatment-related factors, sex, and perspective of patient versus physician. In the context of the medical impact of CRF, our results provide a comparative reference to oncologists or health care providers making patient-specific decision.
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Affiliation(s)
- Ye-Eun Kang
- Research Center for CFS/ME, Daejeon Oriental Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Ji-Hae Yoon
- Research Center for CFS/ME, Daejeon Oriental Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Na-Hyun Park
- Research Center for CFS/ME, Daejeon Oriental Hospital of Daejeon University, Daejeon, Republic of Korea
| | - Yo-Chan Ahn
- Department of Health Service Management, Daejeon University, Daejeon, Republic of Korea
| | - Eun-Jung Lee
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea
| | - Chang-Gue Son
- Research Center for CFS/ME, Daejeon Oriental Hospital of Daejeon University, Daejeon, Republic of Korea.
- East-West Cancer Center of Daejeon Hospital, Daejeon University, Daejeon, Republic of Korea.
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10
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Jeon S, Conley S, Hollenbeak C, O'Connell M, Wang Z, Tocchi C, Redeker NS. Rest-activity rhythms predict time to hospitalizations and emergency department visits among participants in a randomized control of adults with heart failure and insomnia. Sleep Med 2023; 108:1-7. [PMID: 37301192 PMCID: PMC10336725 DOI: 10.1016/j.sleep.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND We examined the effects of insomnia and diurnal rest-activity rhythms (RARs) on time to hospitalizations and emergency department (ED) visits in a randomized controlled trial of cognitive behavioral therapy for insomnia among people with chronic heart failure (HF) and insomnia. METHODS Among 168 HF patients, we measured insomnia, CPAP use, sleep, symptoms, and 24-h wrist actigraphy and computed the circadian quotient (strength of the RAR) from wrist actigraphy and computed cox-proportional hazard and frailty models. RESULTS Eighty-five (50.1%) and ninety-one (54.2%) participants had at least one hospitalization or ED visit, respectively. NYHA class and comorbidity predicted time to hospitalizations and ED visits, while younger age and male sex predicted earlier hospitalizations. Low ejection fraction predicted time to first cardiac event and composite events. Independent of clinical and demographic predictors, a lower circadian quotient and more severe pain significantly predicted earlier hospitalizations. A more robust circadian quotient, more severe insomnia, and fatigue predicted earlier ED visits independent from clinical and demographic factors. Pain and fatigue predicted composite events. CONCLUSION Insomnia severity and RARs independently predicted hospitalizations and ED visits independent of clinical and demographic variables. Further research is necessary to determine whether improving insomnia and strengthening RARs improves outcomes among people with HF. CLINICAL TRIALS REGISTRATION NCT02660385.
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Affiliation(s)
- Sangchoon Jeon
- Yale School of Nursing, 400 West Campus Dr, Orange, CT, 06477, USA.
| | - Samantha Conley
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | - Meghan O'Connell
- University of Connecticut School of Nursing, 231 Glenbrook Road, Storrs, CT, 06269, USA.
| | - Zequan Wang
- University of Connecticut School of Nursing, 231 Glenbrook Road, Storrs, CT, 06269, USA.
| | - Christine Tocchi
- University of Connecticut School of Nursing, 231 Glenbrook Road, Storrs, CT, 06269, USA.
| | - Nancy S Redeker
- University of Connecticut School of Nursing, 231 Glenbrook Road, Storrs, CT, 06269, USA.
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11
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Gouldthorpe C, Ancoli-Israel S, Cash E, Innominato P, Jakobsen G, Lévi F, Miaskowski C, Parganiha A, Pati AK, Pereira D, Revell V, Zeitzer JM, Davies A. International e-Delphi Consensus Recommendations for the Assessment and Diagnosis of Circadian rest-Activity Rhythm Disorders (CARDs) in Patients with Cancer. Cancers (Basel) 2023; 15:3784. [PMID: 37568600 PMCID: PMC10416864 DOI: 10.3390/cancers15153784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Circadian rest-Activity Rhythm Disorders (CARDs) are common in patients with cancer, particularly in advanced disease. CARDs are associated with increased symptom burden, poorer quality of life, and shorter survival. Research and reporting practices lack standardization, and formal diagnostic criteria do not exist. This electronic Delphi (e-Delphi) study aimed to formulate international recommendations for the assessment and diagnosis of CARDs in patients with cancer. METHODS An international e-Delphi was performed using an online platform (Welphi). Round 1 developed statements regarding circadian rest-activity rhythms, diagnostic criteria, and assessment techniques. Rounds 2 and 3 involved participants rating their level of agreement with the statements and providing comments until consensus (defined internally as 67%) and stability between rounds were achieved. Recommendations were then created and distributed to participants for comments before being finalized. RESULTS Sixteen participants from nine different clinical specialties and seven different countries, with 5-35 years of relevant research experience, were recruited, and thirteen participants completed all three rounds. Of the 164 generated statements, 66% achieved consensus, and responses were stable between the final two rounds. CONCLUSIONS The e-Delphi resulted in international recommendations for assessing and diagnosing CARDs in patients with cancer. These recommendations should ensure standardized research and reporting practices in future studies.
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Affiliation(s)
- Craig Gouldthorpe
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA 92093, USA
| | - Elizabeth Cash
- Department of Otolaryngology-Head & Neck Surgery & Communicative Disorders, UofL Healthcare-Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Pasquale Innominato
- Oncology Department, Alaw, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK
- Cancer Research Centre, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of Medicine, Paris-Saclay University, 94800 Villejuif, France
| | - Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Francis Lévi
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of Medicine, Paris-Saclay University, 94800 Villejuif, France
- Gastro-Intestinal and General Oncology Service, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, 94800 Villejuif, France
- Division of Biomedical Sciences, Cancer Chronotherapy Team, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, CA 94143, USA
| | - Arti Parganiha
- School of Studies in Life Science & Centre for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur 492010, India
| | - Atanu Kumar Pati
- School of Studies in Life Science & Centre for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur 492010, India
- Odisha State Higher Education Council, Government of Odisha, Bhubaneswar 751001, India
- Kalinga Institute of Social Sciences, Bhubaneswar 751024, India
| | - Deidre Pereira
- Department of Clinical and Health Psychology, University of Florida Health, Gainesville, FL 32610, USA
| | - Victoria Revell
- Surrey Sleep Research Centre, University of Surrey, Surrey GU2 7XH, UK
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Andrew Davies
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
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12
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Bouchahda M, Ulusakarya A, Thirot-Bidault A, Attari A, Bossevot R, Tuligenga R, Hammel P, Adam R, Levi F. Multicentre, interventional, single-arm study protocol of telemonitored circadian rhythms and patient-reported outcomes for improving mFOLFIRINOX safety in patients with pancreatic cancer (MultiDom, NCT04263948). BMJ Open 2023; 13:e069973. [PMID: 37286324 DOI: 10.1136/bmjopen-2022-069973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION Circadian clocks regulate cellular proliferation and drug effects. Tolerability and/or efficacy of anticancer therapies have been improved by their administration according to circadian rhythms, while being predicted by circadian robustness. The combination of leucovorin, fluorouracil, irinotecan and oxaliplatin (mFOLFIRINOX) is a standard treatment for pancreatic ductal adenocarcinoma (PDAC), that generates grades 3-4 adverse events in the majority of patients and an estimated 15%-30% emergency admission rate. The MultiDom study evaluates whether mFOLFIRINOX safety can be improved using a novel circadian-based telemonitoring-telecare platform in patients at home. The detection of early warning signals of clinical toxicities could guide their early management, possibly preventing emergency hospital admissions. METHODS AND ANALYSIS This multicentre, interventional, prospective, longitudinal, single-arm study hypothesises that the mFOLFIRINOX-related emergency admission rate will be 5% (95% CI 1.7% to 13.7%), among 67 patients with advanced PDAC. Study participation is 7 weeks for each patient, including a reference week before chemotherapy onset and 6 weeks afterwards. Accelerometry and body temperature are measured q1-min using a continuously worn telecommunicating chest surface sensor, daily body weight is self-measured with a telecommunicating balance and 23 electronic patient-reported outcomes (e-PROs) are self-rated using a tablet. Hidden Markov model, spectral analyses and other algorithms automatically compute physical activity, sleep, temperature, body weight change, e-PRO severity and 12 circadian sleep/activity parameters, including the dichotomy index I<O (% activity 'in-bed' below median activity 'out-of-bed'), once to four times daily. Health professionals access visual displays of near-real time parameter dynamics and receive automatic alerts, with trackable digital follow-up. ETHICS AND DISSEMINATION The study has been approved by the National Agency for Medication and Health Product Safety (ANSM) and Ethics Committee West V (2 July 2019; third amendment, 14 June 2022). The data will be disseminated at conferences and in peer-reviewed journals and will support large-scale randomised evaluation. TRIAL REGISTRATION NUMBERS NCT04263948 and ID RCB-2019-A00566-51.
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Affiliation(s)
- Mohamed Bouchahda
- Oncology Unit, Clinique du Mousseau, Ramsay-Sante, Evry, France
- Research Unit 'Chronotherapy, Cancers and Transplantation', Faculty of Medecine, Paris-Saclay University, Villejuif, France
- Oncology Unit, Clinique de St Jean, Melun, France
- Digestive and Medical Oncology Unit, Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - Ayhan Ulusakarya
- Research Unit 'Chronotherapy, Cancers and Transplantation', Faculty of Medecine, Paris-Saclay University, Villejuif, France
- Digestive and Medical Oncology Unit, Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | | | - Amal Attari
- Research Unit 'Chronotherapy, Cancers and Transplantation', Faculty of Medecine, Paris-Saclay University, Villejuif, France
- Future of Healthcare Program Research & Innovation Direction| France, Altran/Cap Gemini, Meudon, France
| | - Rachel Bossevot
- Digestive and Medical Oncology Unit, Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | | | - Pascal Hammel
- Digestive and Medical Oncology Unit, Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
| | - René Adam
- Research Unit 'Chronotherapy, Cancers and Transplantation', Faculty of Medecine, Paris-Saclay University, Villejuif, France
- Hepato-Biliary Centre, APHP Paul Brousse Hospital, Villejuif, France
| | - Francis Levi
- Research Unit 'Chronotherapy, Cancers and Transplantation', Faculty of Medecine, Paris-Saclay University, Villejuif, France
- Digestive and Medical Oncology Unit, Paul Brousse Hospital, Paris-Saclay University, Villejuif, France
- Warwick University, Warwick, UK
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13
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Kos M, Brouwer CG, van Laarhoven HW, Hopman MT, van Oijen MG, Buffart LM. The association between wearable device metrics and clinical outcomes in oncology: a systematic review with evidence synthesis and meta-analysis. Crit Rev Oncol Hematol 2023; 185:103979. [PMID: 37001837 DOI: 10.1016/j.critrevonc.2023.103979] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The emerging study of wearable devices (WDs) in patients with cancer provides opportunities to harness real-time patient data for predicting clinical outcomes. We conducted a systematic review with best evidence synthesis to examine the association between WD metrics and clinical outcomes in patients with cancer. METHODS MEDLINE and Embase were searched from inception until June 2022. Risk of bias assessment and best evidence synthesis were performed and, If possible, meta-analysis was conducted. RESULTS A total of 34 studies was included. We found moderate-to-strong evidence for associations between circadian rest-activity metrics and OS. Disrupted I<O was associated with increased hazard for death (HR 2.08; 95 %CI: 1.50-2.88). For most associations there was insufficient evidence due to lack of studies (n = 32) or inconsistent results (n = 14). CONCLUSION Meta-analysis was greatly hampered due to heterogeneity and different methodology used between studies. Studies primarily designed to investigate the association between WD metrics and clinical outcomes are warranted.
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14
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Prognostication in Advanced Cancer by Combining Actigraphy-Derived Rest-Activity and Sleep Parameters with Routine Clinical Data: An Exploratory Machine Learning Study. Cancers (Basel) 2023; 15:cancers15020503. [PMID: 36672452 PMCID: PMC9856985 DOI: 10.3390/cancers15020503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/23/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
Survival prediction is integral to oncology and palliative care, yet robust prognostic models remain elusive. We assessed the feasibility of combining actigraphy, sleep diary data, and routine clinical parameters to prognosticate. Fifty adult outpatients with advanced cancer and estimated prognosis of <1 year were recruited. Patients were required to wear an Actiwatch® (wrist actigraph) for 8 days, and complete a sleep diary. Univariate and regularised multivariate regression methods were used to identify predictors from 66 variables and construct predictive models of survival. A total of 49 patients completed the study, and 34 patients died within 1 year. Forty-two patients had disrupted rest-activity rhythms (dichotomy index (I < O ≤ 97.5%) but I < O did not have prognostic value in univariate analyses. The Lasso regularised derived algorithm was optimal and able to differentiate participants with shorter/longer survival (log rank p < 0.0001). Predictors associated with increased survival time were: time of awakening sleep efficiency, subjective sleep quality, clinician’s estimate of survival and global health status score, and haemoglobin. A shorter survival time was associated with self-reported sleep disturbance, neutrophil count, serum urea, creatinine, and C-reactive protein. Applying machine learning to actigraphy and sleep data combined with routine clinical data is a promising approach for the development of prognostic tools.
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15
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Luo X, Xiao P, Li L, Duan Y, Sk CA, Xie J. Research progress in circadian rhythms in the application of psychological rehabilitation of cancer patients. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2022; 47:1740-1747. [PMID: 36748386 PMCID: PMC10930277 DOI: 10.11817/j.issn.1672-7347.2022.220245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Indexed: 02/08/2023]
Abstract
The psychological distress of cancer patients seriously affects their therapeutic effects. Effective psychological rehabilitation of cancer patients significantly improves their survival chance and quality of life. Circadian rhythm results from adaptation to the environment during the organism's evolution. When the endogenous clock system is disrupted or the external environment is changed, the body and the environment are out of synchronization, and the circadian rhythm will be disrupted. Circadian rhythm disorder is a common phenomenon in cancer patients, and the changes of circadian rhythm are closely related to their psychological distress. Many studies believe that the circadian rhythm disorder of cancer patients may directly or indirectly affect their psychology through various mechanisms, and targeted intervention by regulating the circadian rhythm of patients may be an essential means to promote the psychological rehabilitation.
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Affiliation(s)
- Xiaofei Luo
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013.
- Xiangya Nursing School, Central South University, Changsha 410013.
| | - Panpan Xiao
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Lijun Li
- Xiangya Nursing School, Central South University, Changsha 410013
| | - Yinglong Duan
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Cheng Andy Sk
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Jianfei Xie
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha 410013.
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16
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Kwon M, Dickerson SS, Wilding GE, Aquilina AT, Reid M, Dean GE. A nurse-delivered intervention to reduce insomnia in cancer survivors: Study protocol for a randomized-controlled trial. Contemp Clin Trials 2022; 122:106939. [PMID: 36182027 PMCID: PMC10380006 DOI: 10.1016/j.cct.2022.106939] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 01/27/2023]
Abstract
Insomnia has been frequently reported as one of the most burdensome symptoms among cancer survivors. To date, little research exists on strategies to effectively reduce insomnia in cancer survivors, especially in the application of cognitive behavioral therapy for insomnia (CBTI) at the bedside by nurses. The current objective is to determine efficacy and durability of a streamlined, individually delivered version of CBTI, specifically Brief Behavioral Therapy for Insomnia (BBTI) versus a healthy eating attention control, using a large heterogeneous sample of 158 cancer survivors. Study participants will be adults ≥18 years of age; ≥1 month from treatment (except hormones and targeted therapies are acceptable) for stages I through III breast, colorectal, lung or prostate cancers; meet criteria for insomnia defined by Insomnia Severity Index (ISI) >7; screen negative for obstructive sleep apnea <15 events/h; and ability to complete data collection instruments in English. Baseline, and then 1-, 3-, and 12-month objective (i.e., actigraphy) and subjective sleep, mood, and quality of life assessments after the interventions are planned. The primary outcome will be measured with the ISI, a psychometrically-sound instrument used to measure perceived insomnia severity. The results of this trial will demonstrate the application of BBTI in a larger heterogenous sample of cancer survivors for the first time and may lead to implementation strategies that will promote the dissemination and sustainability of this intervention. Clinical trials identifier: http://ClinicalTrials.gov, NCT03810365.
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Affiliation(s)
- Misol Kwon
- School of Nursing, University at Buffalo, The State University of New York, NY 14214, USA.
| | - Suzanne S Dickerson
- School of Nursing, University at Buffalo, The State University of New York, NY 14214, USA.
| | - Gregory E Wilding
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, The State University of New York, NY 14214, USA.
| | - Alan T Aquilina
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, NY 14214, USA.
| | - Mary Reid
- Cancer Screening, Survivorship and Mentorship, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, NY 14214, USA.
| | - Grace E Dean
- School of Nursing, University at Buffalo, The State University of New York, NY 14214, USA.
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Detecting the Effect Size of Weather Conditions on Patient-Reported Outcome Measures (PROMs). J Pers Med 2022; 12:jpm12111811. [PMID: 36579522 PMCID: PMC9699394 DOI: 10.3390/jpm12111811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/16/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
One of the next frontiers in medical research, particularly in orthopaedic surgery, is personalized treatment outcome prediction. In personalized medicine, treatment choices are adjusted for the patient based on the individual's and their disease's distinct features. A high-value and patient-centered health care system requires evaluating results that integrate the patient's viewpoint. Patient-reported outcome measures (PROMs) are widely used to shed light on patients' perceptions of their health status after an intervention by using validated questionnaires. The aim of this study is to examine whether meteorological or light (night vs. day) conditions affect PROM scores and hence indirectly affect health-related outcomes. We collected scores for PROMs from questionnaires completed by patients (N = 2326) who had undergone hip and knee interventions between June 2017 and May 2020 at the IRCCS Orthopaedic Institute Galeazzi (IOG), Milan, Italy. Nearest neighbour propensity score (PS) matching was applied to ensure the similarity of the groups tested under the different weather-related conditions. The exposure PS was derived through logistic regression. The data were analysed using statistical tests (Student's t-test and Mann-Whitney U test). According to Cohen's effect size, weather conditions may affect the scores for PROMs and, indirectly, health-related outcomes via influencing the relative humidity and weather-related conditions. The findings suggest avoiding PROMs' collection in certain conditions if the odds of outcome-based underperformance are to be minimized. This would ensure a balance between costs for PROMs' collection and data availability.
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18
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Amidi A, Wu LM. Circadian disruption and cancer- and treatment-related symptoms. Front Oncol 2022; 12:1009064. [PMID: 36387255 PMCID: PMC9650229 DOI: 10.3389/fonc.2022.1009064] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/28/2022] [Indexed: 07/27/2023] Open
Abstract
Cancer patients experience a number of co-occurring side- and late-effects due to cancer and its treatment including fatigue, sleep difficulties, depressive symptoms, and cognitive impairment. These symptoms can impair quality of life and may persist long after treatment completion. Furthermore, they may exacerbate each other's intensity and development over time. The co-occurrence and interdependent nature of these symptoms suggests a possible shared underlying mechanism. Thus far, hypothesized mechanisms that have been purported to underlie these symptoms include disruptions to the immune and endocrine systems. Recently circadian rhythm disruption has emerged as a related pathophysiological mechanism underlying cancer- and cancer-treatment related symptoms. Circadian rhythms are endogenous biobehavioral cycles lasting approximately 24 hours in humans and generated by the circadian master clock - the hypothalamic suprachiasmatic nucleus. The suprachiasmatic nucleus orchestrates rhythmicity in a wide range of bodily functions including hormone levels, body temperature, immune response, and rest-activity behaviors. In this review, we describe four common approaches to the measurement of circadian rhythms, highlight key research findings on the presence of circadian disruption in cancer patients, and provide a review of the literature on associations between circadian rhythm disruption and cancer- and treatment-related symptoms. Implications for future research and interventions will be discussed.
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Affiliation(s)
- Ali Amidi
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Sleep and Circadian Psychology Research Group, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lisa M. Wu
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Sleep and Circadian Psychology Research Group, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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An Update on Prevalence, Assessment, and Risk Factors for Sleep Disturbances in Patients with Advanced Cancer—Implications for Health Care Providers and Clinical Research. Cancers (Basel) 2022; 14:cancers14163933. [PMID: 36010925 PMCID: PMC9406296 DOI: 10.3390/cancers14163933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary This review focuses on sleep in patients with advanced cancer. Cancer patients experience multiple symptoms and they receive concomitant medications. These are all factors that may affect sleep. In this paper, we present recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that may contribute to insomnia. Sleep is an essential aspect of health-related quality of life; therefore, it is important for health care providers to focus on sleep to improve patient care. Abstract Patients with advanced cancer experience multiple symptoms, with fluctuating intensity and severity during the disease. They use several medications, including opioids, which may affect sleep. Sleep disturbance is common in cancer patients, decreases the tolerability of other symptoms, and impairs quality of life. Despite its high prevalence and negative impact, poor sleep quality often remains unrecognized and undertreated. Given that sleep is an essential aspect of health-related quality of life, it is important to extend both the knowledge base and awareness among health care providers in this field to improve patient care. In this narrative review, we provide recommendations on sleep assessment in patients with advanced cancer and highlight cancer-related factors that contribute to insomnia. We also present direct implications for health care providers working in palliative care and for future research.
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Basti A, Malhan D, Dumbani M, Dahlmann M, Stein U, Relógio A. Core-Clock Genes Regulate Proliferation and Invasion via a Reciprocal Interplay with MACC1 in Colorectal Cancer Cells. Cancers (Basel) 2022; 14:3458. [PMID: 35884519 PMCID: PMC9319284 DOI: 10.3390/cancers14143458] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/26/2022] [Accepted: 07/12/2022] [Indexed: 12/20/2022] Open
Abstract
The circadian clock coordinates the timing of several cellular processes including transcription, the cell cycle, and metabolism. Disruptions in the clock machinery trigger the abnormal regulation of cancer hallmarks, impair cellular homeostasis, and stimulate tumourigenesis. Here we investigated the role of a disrupted clock by knocking out or knocking down the core-clock (CC) genes ARNTL, PER2 or NR1D1 in cancer progression (e.g., cell proliferation and invasion) using colorectal cancer (CRC) cell lines HCT116, SW480 and SW620, from different progression stages with distinct clock phenotypes, and identified mechanistic links from the clock to altered cancer-promoting cellular properties. We identified MACC1 (metastasis-associated in colon cancer 1), a known driver for metastasis and an EMT (epithelial-to-mesenchymal transition)-related gene, to be significantly differentially expressed in CC manipulated cells and analysed the effect of MACC1 manipulation (knockout or overexpression) in terms of circadian clock phenotype as well as cancer progression. Our data points to a bi-directional MACC1-circadian clock interplay in CRC, via CC genes. In particular, knocking out MACC1 reduced the period of oscillations, while its overexpression increased it. Interestingly, we found the MACC1 protein to be circadian expressed in HCT116 WT cells, which was disrupted after the knockout of CC genes, and identified a MACC1-NR1D1 protein-protein interaction. In addition, MACC1 manipulation and CC knockout altered cell invasion properties of HCT116 cells, pointing to a regulation of clock and cancer progression in CRC, possibly via the interaction of MACC1 with core-clock genes.
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Affiliation(s)
- Alireza Basti
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt—Universität zu Berlin, Institute for Theoretical Biology, 10115 Berlin, Germany; (A.B.); (D.M.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt—Universität zu Berlin, Medical Department of Hematology, Oncology, and Tumor Immunology, Molecular Cancer Research Center, 13353 Berlin, Germany
- Institute for Systems Medicine, Faculty of Human Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
| | - Deeksha Malhan
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt—Universität zu Berlin, Institute for Theoretical Biology, 10115 Berlin, Germany; (A.B.); (D.M.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt—Universität zu Berlin, Medical Department of Hematology, Oncology, and Tumor Immunology, Molecular Cancer Research Center, 13353 Berlin, Germany
- Institute for Systems Medicine, Faculty of Human Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
| | - Malti Dumbani
- Translational Oncology of Solid Tumors, Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine Berlin in the Helmholtz-Association, Robert-Rössle-Straße 10, 13125 Berlin, Germany; (M.D.); (M.D.); (U.S.)
| | - Mathias Dahlmann
- Translational Oncology of Solid Tumors, Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine Berlin in the Helmholtz-Association, Robert-Rössle-Straße 10, 13125 Berlin, Germany; (M.D.); (M.D.); (U.S.)
| | - Ulrike Stein
- Translational Oncology of Solid Tumors, Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine Berlin in the Helmholtz-Association, Robert-Rössle-Straße 10, 13125 Berlin, Germany; (M.D.); (M.D.); (U.S.)
- German Cancer Consortium, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Angela Relógio
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt—Universität zu Berlin, Institute for Theoretical Biology, 10115 Berlin, Germany; (A.B.); (D.M.)
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt—Universität zu Berlin, Medical Department of Hematology, Oncology, and Tumor Immunology, Molecular Cancer Research Center, 13353 Berlin, Germany
- Institute for Systems Medicine, Faculty of Human Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
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21
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Block KI, Gyllenhaal C, Grutsch JF, Block PB, Kazlausky T, Blask D, Carome E, Reynolds J, Huff DFQ, Hrushesky W. Advanced cancer patients in a randomized clinical trial of night-simulating eyeglasses observed to have a normal 24-h circadian rhythm during chemotherapy. SAGE Open Med 2022; 10:20503121221100137. [PMID: 35646366 PMCID: PMC9134428 DOI: 10.1177/20503121221100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 04/22/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives: Cancer patients routinely exhibit dysfunctional circadian organization.
Indeed, a dysfunctional circadian organization is a hallmark of advanced
cancer. A cohort of advanced cancer patients undergoing chemotherapy was
recruited to investigate whether manipulating exposure to blue light could
restore or ameliorate their circadian organization. Methods: Thirty advanced metastatic cancer patients participated in a randomized
crossover trial to evaluate whether blue light-blocking night-simulating
eyeglasses could ameliorate a disrupted circadian organization better than
sham eyeglasses. Circadian organization was evaluated by actigraphy and
patients’ self-reports of sleep, fatigue, and quality of life.
Kruskal–Wallis tests compared patients’ outcomes in circadian organization
with a cohort of non-cancer, disease-free individuals with normal sleep as a
negative control, and with advanced cancer patients with disrupted circadian
organization as a positive control. Quality-of-life outcomes of the patients
were compared with population-based controls (negative controls) and with
cohorts of advanced cancer patients (positive controls). Results: Actigraphy measurements, self-reported sleep, fatigue levels, and
quality-of-life outcomes of trial participants were similar to those of
negative controls with a normal circadian organization, in spite of the
trial patients’ concurrent chemotherapy. Night-simulating glasses did not
improve circadian organization. The 24-h correlation of day-to-day rhythms
of rest and activity was 0.455 for the experimental eyeglasses and 0.476 for
the sham eyeglasses (p = 0.258). Actigraphic and
patient-reported outcomes compared favorably to outcomes of positive
controls. Conclusion: The circadian organization of patients in this study unexpectedly resembled
that of healthy controls and was better than comparison populations with
disrupted circadian organization. The study clinic implements
chronomodulated chemotherapy and a systematic, supportive integrative
treatment protocol. Results suggest a need for further research on
interventions for circadian rhythm. Although the study intervention did not
benefit the participants, this work highlights the value of supporting
circadian time structure in advanced cancer patients.
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Affiliation(s)
- Keith I Block
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
- Department of Medical Education, University of Illinois College of Medicine at Chicago, Chicago, IL, USA
- Department of Pharmaceutical Sciences, University of Illinois Chicago, Chicago, IL, USA
| | - Charlotte Gyllenhaal
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
- Department of Pharmaceutical Sciences, University of Illinois Chicago, Chicago, IL, USA
| | | | - Penny B Block
- Block Center for Integrative Cancer Treatment, Skokie, IL, USA
| | | | - David Blask
- Tulane Cancer Center and Louisiana Cancer Research Consortium, Tulane Center for Circadian Biology, Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Justin Reynolds
- Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA
- Wellmont Cancer Institute, Bristol, TN, USA
| | | | - William Hrushesky
- Rhythmalytics, LLC, Columbia, SC, USA
- Ambulatory Monitoring, Inc., Ardsley, NY, USA
- Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC, USA
- College of Pharmacy, University of South Carolina, Columbia, SC, USA
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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22
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Zhou L, Zhang Z, Nice E, Huang C, Zhang W, Tang Y. Circadian rhythms and cancers: the intrinsic links and therapeutic potentials. J Hematol Oncol 2022; 15:21. [PMID: 35246220 PMCID: PMC8896306 DOI: 10.1186/s13045-022-01238-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 02/16/2022] [Indexed: 02/07/2023] Open
Abstract
The circadian rhythm is an evolutionarily conserved time-keeping system that comprises a wide variety of processes including sleep-wake cycles, eating-fasting cycles, and activity-rest cycles, coordinating the behavior and physiology of all organs for whole-body homeostasis. Acute disruption of circadian rhythm may lead to transient discomfort, whereas long-term irregular circadian rhythm will result in the dysfunction of the organism, therefore increasing the risks of numerous diseases especially cancers. Indeed, both epidemiological and experimental evidence has demonstrated the intrinsic link between dysregulated circadian rhythm and cancer. Accordingly, a rapidly increasing understanding of the molecular mechanisms of circadian rhythms is opening new options for cancer therapy, possibly by modulating the circadian clock. In this review, we first describe the general regulators of circadian rhythms and their functions on cancer. In addition, we provide insights into the mechanisms underlying how several types of disruption of the circadian rhythm (including sleep-wake, eating-fasting, and activity-rest) can drive cancer progression, which may expand our understanding of cancer development from the clock perspective. Moreover, we also summarize the potential applications of modulating circadian rhythms for cancer treatment, which may provide an optional therapeutic strategy for cancer patients.
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Affiliation(s)
- Li Zhou
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Sciences and Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 610041, China
| | - Zhe Zhang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Sciences and Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 610041, China
| | - Edouard Nice
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC, 3800, Australia
| | - Canhua Huang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, and West China School of Basic Sciences and Forensic Medicine, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu, 610041, China.
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
| | - Wei Zhang
- Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Yong Tang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Acupuncture and Chronobiology Laboratory of Sichuan Province, Chengdu, 610075, China.
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23
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Almaida-Pagan PF, Torrente M, Campos M, Provencio M, Madrid JA, Franco F, Morilla BR, Cantos B, Sousa PA, Madrid MJM, Pimentao J, Rol MÁ. Chronodisruption and Ambulatory Circadian Monitoring in Cancer Patients: Beyond the Body Clock. Curr Oncol Rep 2022; 24:135-149. [PMID: 35061192 PMCID: PMC8857092 DOI: 10.1007/s11912-021-01158-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 02/01/2023]
Abstract
Purpose of Review Circadian rhythms impose daily rhythms a remarkable variety of metabolic and physiological functions, such as cell proliferation, inflammation, and DNA damage response. Accumulating epidemiological and genetic evidence indicates that circadian rhythms’ disruption may be linked to cancer. The integration of circadian biology into cancer research may offer new options for increasing cancer treatment effectiveness and would encompass the prevention, diagnosis, and treatment of this disease. Recent Findings In recent years, there has been a significant development and use of multi-modal sensors to monitor physical activity, sleep, and circadian rhythms, allowing, for the very first time, scaling accurate sleep monitoring to epidemiological research linking sleep patterns to disease, and wellness applications providing new potential applications. Summary This review highlights the role of circadian clock in tumorigenesis, cancer hallmarks and introduces the state-of-the-art in sleep-monitoring technologies, discussing the eventual application of insights in clinical settings and cancer research.
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Affiliation(s)
- Pedro F Almaida-Pagan
- Kronohealth SL, Murcia, Spain
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Torrente
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain.
- Medical Oncology Department, Puerta de Hierro-Majadahonda University Hospital, Calle Manuel de Falla, 1, 28222, Madrid, Spain.
- Faculty of Health Sciences, Francisco de Vitoria University, Madrid, Spain.
| | - Manuel Campos
- Kronohealth SL, Murcia, Spain
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mariano Provencio
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Juan Antonio Madrid
- Kronohealth SL, Murcia, Spain
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fabio Franco
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Beatriz Rodríguez Morilla
- Kronohealth SL, Murcia, Spain
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Blanca Cantos
- Servicio de Oncología Médica, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Pedro A Sousa
- Department of Electrical Engineering, Faculty of Science and Technology, Universidade Nova de Lisboa, Lisbon, Portugal
| | - María José Martínez Madrid
- Kronohealth SL, Murcia, Spain
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Joao Pimentao
- Department of Electrical Engineering, Faculty of Science and Technology, Universidade Nova de Lisboa, Lisbon, Portugal
| | - María Ángeles Rol
- Kronohealth SL, Murcia, Spain
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, IUIE, IMIB-Arrixaca, Murcia, Spain
- Ciber Fragilidad Y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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24
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Gibb M, Winter H, Komarzynski S, Wreglesworth NI, Innominato PF. Holistic Needs Assessment of Cancer Survivors-Supporting the Process Through Digital Monitoring of Circadian Physiology. Integr Cancer Ther 2022; 21:15347354221123525. [PMID: 36154506 PMCID: PMC9520145 DOI: 10.1177/15347354221123525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The year 2022 could represent a significant juncture in the incorporation of mHealth solutions in routine cancer care. With the recent global COVID-19 pandemic leading a surge in both observation- and intervention-based studies predominantly aimed at remote monitoring there has been huge intellectual investment in developing platforms able to provide real time analytics that are readily usable. Another fallout from the pandemic has seen record waiting times and delayed access to cancer therapies leading to exhausting pressures on global healthcare providers. It seems an opportune time to utilize this boom in platforms to offer more efficient “at home” clinical assessments and less “in department” time for patients. Here, we will focus specifically on the role of digital tools around cancer survivorship, a relevant aspect of the cancer journey, particularly benefiting from integrative approaches. Within that context a further concept will be introduced and that is of the likely upsurge in circadian-based interpretation of continuous monitoring and the engendered therapeutic modifications. Chronobiology across the 24-hour span has long been understood to control key bodily aspects and circadian dysregulation plays a significant role in the risk of cancer and also the response to therapy and therefore progressive outcome. The rapid improvement in minimally invasive monitoring devices is, in the opinion of the authors, likely to advance introducing chronobiological amendments to routine clinical practices with positive impact on cancer survivors.
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Affiliation(s)
- Max Gibb
- Cancer Services, Betsi Cadwaladr University Health Board, Bodelwyddan, UK
| | - Hannah Winter
- Respiratory Medicine, Betsi Cadwaladr University Health Board, Bangor, UK
| | | | - Nicholas I Wreglesworth
- Cancer Services, Betsi Cadwaladr University Health Board, Bodelwyddan, UK.,Bangor University, Bangor, UK
| | - Pasquale F Innominato
- Cancer Services, Betsi Cadwaladr University Health Board, Bodelwyddan, UK.,University of Warwick, Coventry, UK.,Paris-Saclay University, Villejuif, France
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25
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Circadian and chemotherapy-related changes in urinary modified nucleosides excretion in patients with metastatic colorectal cancer. Sci Rep 2021; 11:24015. [PMID: 34907230 PMCID: PMC8671418 DOI: 10.1038/s41598-021-03247-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022] Open
Abstract
Urinary levels of modified nucleosides reflect nucleic acids turnover and can serve as non-invasive biomarkers for monitoring tumour circadian dynamics, and treatment responses in patients with metastatic colorectal cancer. In 39 patients, median overnight urinary excretion of LC-HRMS determinations of pseudouridine, was ~ tenfold as large as those of 1-methylguanosine, 1-methyladenosine, or 4-acetylcytidine, and ~ 100-fold as large as those of adenosine and cytidine. An increase in any nucleoside excretion after chemotherapy anticipated plasma carcinoembryonic antigen progression 1–2 months later and was associated with poor survival. Ten fractionated urines were collected over 2-days in 29 patients. The median value of the rhythm-adjusted mean of urinary nucleoside excretion varied from 64.3 for pseudouridine down to 0.61 for cytidine. The rhythm amplitudes relative to the 24-h mean of 6 nucleoside excretions were associated with rest duration, supporting a tight link between nucleosides turnover and the rest-activity rhythm. Moreover, the amplitude of the 1-methylguanosine rhythm was correlated with the rest-activity dichotomy index, a significant predictor of survival outcome in prior studies. In conclusion, urinary excretion dynamics of modified nucleosides appeared useful for the characterization of the circadian control of cellular proliferation and for tracking early responses to treatments in colorectal cancer patients.
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26
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Lin MR, Chen PY, Wang HC, Lin PC, Lee HC, Chiu HY. Prevalence of sleep disturbances and their effects on quality of life in adults with untreated pituitary tumor and meningioma. J Neurooncol 2021; 154:179-186. [PMID: 34304334 DOI: 10.1007/s11060-021-03811-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To explore the prevalence of sleep disturbances and their effects on quality of life in adults with pituitary tumor or meningioma. METHODS This prospective study included 33 and 44 patients with pituitary tumor and meningioma, respectively. All participants completed a series of valid questionnaires for assessing sleep and quality of life; all participants wore 3-day actigraph prior to related treatment. The actigraph-derived sleep parameters included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and dichotomy index (I < O) value. RESULTS The prevalence of insomnia, excessive daytime sleepiness, and poor sleep quality was 46.8%, 6.5%, and 81.8%, respectively. The differences in these sleep parameters between patients with pituitary tumor and those with meningioma were nonsignificant. Only 27 participants completed the actigraphic assessments. The mean I < O value was 95.99%, and nearly 60% participants exhibited circadian rhythm disruption. Sleep quality was the only sleep variable independently correlated with preoperative quality of life, even after adjustments for confounders (B = 0.80, p = 0.02). CONCLUSIONS Insomnia, poor sleep quality, and disrupted circadian rhythm are highly prevalent in adults with untreated pituitary tumor or meningioma. Sleep quality independently correlated with quality of life. We indirectly confirmed that tumor location may not be a possible cause of sleep changes.
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Affiliation(s)
- Mei-Ru Lin
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan
| | - Pin-Yuan Chen
- Department of Neurosurgery and Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung branch, Keelung, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huan-Chih Wang
- Division of Neurosurgery, Department of Surgery Organization, National Taiwan University Hospital, Taipei, Taiwan
- Division of Neurosurgery, Department of Surgery Organization, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Pei-Ching Lin
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan
| | - Hsin-Chien Lee
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wu-Hsing St, Taipei, 110, Taiwan.
- Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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27
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Astronauts well-being and possibly anti-aging improved during long-duration spaceflight. Sci Rep 2021; 11:14907. [PMID: 34290387 PMCID: PMC8295322 DOI: 10.1038/s41598-021-94478-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/12/2021] [Indexed: 02/06/2023] Open
Abstract
This study assesses how circadian rhythms of heart rate (HR), HR variability (HRV) and activity change during long-term missions in space and how they relate to sleep quality. Ambulatory 48-h ECG and 96-h actigraphy were performed four times on ten healthy astronauts (44.7 ± 6.9 years; 9 men): 120.4 ± 43.7 days (Before) launch; 21.1 ± 2.5 days (ISS01) and 143.0 ± 27.1 days (ISS02) after launch; and 86.6 ± 40.6 days (After) return to Earth. Sleep quality was determined by sleep-related changes in activity, RR-intervals, HRV HF- and VLF-components and LF-band. The circadian amplitude of HR (HR-A) was larger in space (ISS01: 12.54, P = 0.0099; ISS02: 12.77, P = 0.0364) than on Earth (Before: 10.90; After: 10.55 bpm). Sleep duration in space (ISS01/ISS02) increased in 3 (Group A, from 370.7 to 388.0/413.0 min) and decreased in 7 (Group B, from 454.0 to 408.9/381.6 min) astronauts. Sleep quality improved in Group B from 7.07 to 8.36 (ISS01) and 9.36 (ISS02, P = 0.0001). Sleep-related parasympathetic activity increased from 55.2% to 74.8% (pNN50, P = 0.0010) (ISS02). HR-A correlated with the 24-h (r = 0.8110, P = 0.0044), 12-h (r = 0.6963, P = 0.0253), and 48-h (r = 0.6921, P = 0.0266) amplitudes of the magnetic declination index. These findings suggest associations of mission duration with increased well-being and anti-aging benefitting from magnetic fluctuations.
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28
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Burchett JB, Knudsen-Clark AM, Altman BJ. MYC Ran Up the Clock: The Complex Interplay between MYC and the Molecular Circadian Clock in Cancer. Int J Mol Sci 2021; 22:7761. [PMID: 34299381 PMCID: PMC8305799 DOI: 10.3390/ijms22147761] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022] Open
Abstract
The MYC oncoprotein and its family members N-MYC and L-MYC are known to drive a wide variety of human cancers. Emerging evidence suggests that MYC has a bi-directional relationship with the molecular clock in cancer. The molecular clock is responsible for circadian (~24 h) rhythms in most eukaryotic cells and organisms, as a mechanism to adapt to light/dark cycles. Disruption of human circadian rhythms, such as through shift work, may serve as a risk factor for cancer, but connections with oncogenic drivers such as MYC were previously not well understood. In this review, we examine recent evidence that MYC in cancer cells can disrupt the molecular clock; and conversely, that molecular clock disruption in cancer can deregulate and elevate MYC. Since MYC and the molecular clock control many of the same processes, we then consider competition between MYC and the molecular clock in several select aspects of tumor biology, including chromatin state, global transcriptional profile, metabolic rewiring, and immune infiltrate in the tumor. Finally, we discuss how the molecular clock can be monitored or diagnosed in human tumors, and how MYC inhibition could potentially restore molecular clock function. Further study of the relationship between the molecular clock and MYC in cancer may reveal previously unsuspected vulnerabilities which could lead to new treatment strategies.
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Affiliation(s)
- Jamison B. Burchett
- Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Amelia M. Knudsen-Clark
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Brian J. Altman
- Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY 14642, USA;
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA
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29
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Milanti A, Chan DNS, Li C, So WKW. Actigraphy-measured rest-activity circadian rhythm disruption in patients with advanced cancer: a scoping review. Support Care Cancer 2021; 29:7145-7169. [PMID: 34142279 DOI: 10.1007/s00520-021-06317-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/25/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Patients with later-stage cancer have been reported to demonstrate more disrupted rest-activity circadian rhythms (RACR) than those with earlier-stage cancer, but consolidated evidence of this is lacking. The aim of this review was to examine and map the existing evidence on actigraphy-measured RACR in terms of their (1) pattern, (2) prevalence, (3) related factors, and (4) outcomes in advanced cancer patients. METHODS A comprehensive scoping review was conducted using Arksey and O'Malley's framework. A literature search was performed using nine databases: MEDLINE, Embase, PsycINFO, CINAHL, British Nursing Index, Cochrane Library, Scopus, Web of Science, and SINTA. RESULTS Twenty-one studies were included in the review. Compared with the healthy population, advanced cancer patients were more likely to display weaker RACR, manifesting as lower activity levels during the day, more frequent and longer daytime naps, and fragmented nighttime sleep. The prevalence of RACR disruption among advanced cancer patients ranged from 31.3 to 54.9%. It was found to be linked to the presence of physical and psychological symptoms (fatigue, appetite loss, pain, dyspnoea, sleep disturbance, depression, and anxiety), chemotherapy, male sex, and also predict the lower quality of life and survival. CONCLUSION Disruption of the RACR is prevalent in advanced cancer patients and is associated with a set of physical and psychological symptoms. It was also found to be a predictor of the quality of life and survival among these patients. These results indicate the importance of interventions to restabilise the disrupted RACR among advance cancer patients to improve their health outcomes.
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Affiliation(s)
- Ariesta Milanti
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
| | - Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Caixia Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
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Kireeva G, Gubareva E, Maydin M, Osetnik V, Kruglov S, Panchenko A, Dorofeeva A, Tyndyk M, Fedoros E, Anisimov V. Efficacy and Safety of Systemic and Locoregional Cisplatin Chronotherapy in Rats with Ovarian Carcinoma. Onco Targets Ther 2021; 14:3373-3381. [PMID: 34079283 PMCID: PMC8163628 DOI: 10.2147/ott.s309285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/28/2021] [Indexed: 12/15/2022] Open
Abstract
Aim Alterations in circadian rhythms caused by tumor growth are thought to be clinically relevant as they affect the prognosis and treatment response. We aimed to evaluate the chronotherapeutic approach in rats with ovarian cancer receiving cisplatin intravenously (IV) or with hyperthermic intraperitoneal chemoperfusion (HIPEC) and to assess daily variations in tumor and intestinal epithelium proliferation. Methods In the pilot study, we used 12 intact rats and 12 rats with transplantable ovarian cancer, which were euthanized at ZT0 (08:00, lights on), ZT6, ZT12 and ZT18. In the main study, we used 45 rats with transplantable ovarian cancer. Animals were randomized into five groups: control, HIPEC with cisplatin at ZT0 (08:00), HIPEC with cisplatin at ZT12 (20:00), IV cisplatin at ZT0 and IV cisplatin at ZT12. We assessed the proliferation rate of tumor and small intestinal epithelium, apoptosis in small intestinal epithelium, and levels of γ-H2AX (DNA damage/repair marker) in kidneys and liver. Survival was calculated in each group. Results Ascitic ovarian cancer disrupted daily variations in intestinal epithelium proliferation and DNA damage/repair in rats. Ovarian carcinoma exhibited no daily variation in mitotic activity. In animals receiving IV cisplatin, massive cell damage in the renal medulla and cystic changes within renal tubules were observed, unlike in rats receiving HIPEC. Tumor mitotic activity was lower in morning-treated groups. The median survival of rats in the control group was 8.5 days (95% CI 6.0–22.0), in HIPEC at ZT0 40.5 days (95% CI 28.0–47.0, p<0.001) and in HIPEC at ZT12 32.0 days (95% CI 28.0–37.0, p<0.001). Conclusion In a rat model, ovarian tumor growth disrupted daily variations in intestinal epithelium proliferation and caused genotoxic stress in tumor-free tissues. HIPEC with cisplatin at ZT0 had a better efficacy/toxicity profile than HIPEC with cisplatin at ZT12 and IV administration at both time points.
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Affiliation(s)
- Galina Kireeva
- Department of Carcinogenesis and Aging, N.N. Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
| | - Ekaterina Gubareva
- Department of Carcinogenesis and Aging, N.N. Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
| | - Mikhail Maydin
- Department of Carcinogenesis and Aging, N.N. Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
| | - Vladislav Osetnik
- Surgical Department, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Stepan Kruglov
- Department of Carcinogenesis and Aging, N.N. Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
| | - Andrey Panchenko
- Department of Carcinogenesis and Aging, N.N. Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
| | - Anastasia Dorofeeva
- Department of Carcinogenesis and Aging, N.N. Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
| | - Margarita Tyndyk
- Department of Carcinogenesis and Aging, N.N. Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
| | - Elena Fedoros
- Department of Carcinogenesis and Aging, N.N. Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
| | - Vladimir Anisimov
- Department of Carcinogenesis and Aging, N.N. Petrov National Medical Research Center of Oncology, Saint-Petersburg, Russia
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Low CA, Li M, Vega J, Durica KC, Ferreira D, Tam V, Hogg M, Zeh Iii H, Doryab A, Dey AK. Digital Biomarkers of Symptom Burden Self-Reported by Perioperative Patients Undergoing Pancreatic Surgery: Prospective Longitudinal Study. JMIR Cancer 2021; 7:e27975. [PMID: 33904822 PMCID: PMC8114161 DOI: 10.2196/27975] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/17/2021] [Accepted: 03/29/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cancer treatments can cause a variety of symptoms that impair quality of life and functioning but are frequently missed by clinicians. Smartphone and wearable sensors may capture behavioral and physiological changes indicative of symptom burden, enabling passive and remote real-time monitoring of fluctuating symptoms. OBJECTIVE The aim of this study was to examine whether smartphone and Fitbit data could be used to estimate daily symptom burden before and after pancreatic surgery. METHODS A total of 44 patients scheduled for pancreatic surgery participated in this prospective longitudinal study and provided sufficient sensor and self-reported symptom data for analyses. Participants collected smartphone sensor and Fitbit data and completed daily symptom ratings starting at least two weeks before surgery, throughout their inpatient recovery, and for up to 60 days after postoperative discharge. Day-level behavioral features reflecting mobility and activity patterns, sleep, screen time, heart rate, and communication were extracted from raw smartphone and Fitbit data and used to classify the next day as high or low symptom burden, adjusted for each individual's typical level of reported symptoms. In addition to the overall symptom burden, we examined pain, fatigue, and diarrhea specifically. RESULTS Models using light gradient boosting machine (LightGBM) were able to correctly predict whether the next day would be a high symptom day with 73.5% accuracy, surpassing baseline models. The most important sensor features for discriminating high symptom days were related to physical activity bouts, sleep, heart rate, and location. LightGBM models predicting next-day diarrhea (79.0% accuracy), fatigue (75.8% accuracy), and pain (79.6% accuracy) performed similarly. CONCLUSIONS Results suggest that digital biomarkers may be useful in predicting patient-reported symptom burden before and after cancer surgery. Although model performance in this small sample may not be adequate for clinical implementation, findings support the feasibility of collecting mobile sensor data from older patients who are acutely ill as well as the potential clinical value of mobile sensing for passive monitoring of patients with cancer and suggest that data from devices that many patients already own and use may be useful in detecting worsening perioperative symptoms and triggering just-in-time symptom management interventions.
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Affiliation(s)
- Carissa A Low
- Mobile Sensing + Health Institute, Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meng Li
- Mobile Sensing + Health Institute, Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Julio Vega
- Mobile Sensing + Health Institute, Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Krina C Durica
- Mobile Sensing + Health Institute, Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Denzil Ferreira
- Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Vernissia Tam
- Department of Surgery, New York-Presbyterian Hospital & Weill Cornell Medical College, New York, NY, United States
| | - Melissa Hogg
- NorthShore University HealthSystem, Evanston, IL, United States
| | - Herbert Zeh Iii
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Afsaneh Doryab
- Systems and Information Engineering, University of Virginia, Charlottesville, VA, United States
| | - Anind K Dey
- Information School, University of Washington, Seattle, WA, United States
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Cash E, Sephton S, Woolley C, Elbehi AM, R I A, Ekine-Afolabi B, Kok VC. The role of the circadian clock in cancer hallmark acquisition and immune-based cancer therapeutics. J Exp Clin Cancer Res 2021; 40:119. [PMID: 33794967 PMCID: PMC8017624 DOI: 10.1186/s13046-021-01919-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/18/2021] [Indexed: 02/07/2023] Open
Abstract
The circadian system temporally regulates physiology to maintain homeostasis. Co-opting and disrupting circadian signals appear to be distinct attributes that are functionally important for the development of a tumor and can enable or give rise to the hallmarks that tumors use to facilitate their initiation, growth and progression. Because circadian signals are also strong regulators of immune cell proliferation, trafficking and exhaustion states, they play a role in how tumors respond to immune-based cancer therapeutics. While immuno-oncology has heralded a paradigm shift in cancer therapeutics, greater accuracy is needed to increase our capability of predicting who will respond favorably to, or who is likely to experience the troubling adverse effects of, immunotherapy. Insights into circadian signals may further refine our understanding of biological determinants of response and help answer the fundamental question of whether certain perturbations in circadian signals interfere with the activity of immune checkpoint inhibitors. Here we review the body of literature highlighting circadian disruption as a cancer promoter and synthesize the burgeoning evidence suggesting circadian signals play a role in how tumors respond to immune-based anti-cancer therapeutics. The goal is to develop a framework to advance our understanding of the relationships between circadian markers, cancer biology, and immunotherapeutics. Bolstered by this new understanding, these relationships may then be pursued in future clinical studies to improve our ability to predict which patients will respond favorably to, and avoid the adverse effects of, traditional and immune-based cancer therapeutics.
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Affiliation(s)
- Elizabeth Cash
- Department of Otolaryngology and Communicative Disorders, University of Louisville School of Medicine, James Graham Brown Cancer Center, 529 S Jackson Street, Louisville, KY, 40202, USA.
| | - Sandra Sephton
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Cassandra Woolley
- Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Attia M Elbehi
- Department of Oncology, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Anu R I
- Department of Clinical Biochemistry, MVR Cancer Center and Research Institute, Kerala, India
| | - Bene Ekine-Afolabi
- ZEAB Therapeutic Ltd, London, UK
- Department of Health, Sport & Bioscience, University of East London, Stratford, UK
| | - Victor C Kok
- Department of Medical Oncology, Kuang Tien General Hospital Cancer Center, Taichung, Taiwan
- Department of Bioinformatics and Medical Engineering, Asia University Taiwan, Taichung, Taiwan
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Hrushesky WJM, Lis CG, Levin RD, Grutsch JF, Birdsall T, Wood PA, Huff DFQ, Reynolds JL, Pearl DK, Shen X, Gupta D, Blask DE. Daily evening melatonin prolongs survival among patients with advanced non-small-cell lung cancer. BIOL RHYTHM RES 2021. [DOI: 10.1080/09291016.2021.1899485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- William J. M. Hrushesky
- Cancer Treatment Centers of America® at Midwestern Regional Medical Center, Elisha Ave. Zion, USA
| | - Christopher G. Lis
- Cancer Treatment Centers of America® at Midwestern Regional Medical Center, Elisha Ave. Zion, USA
| | - Robert D. Levin
- Cancer Treatment Centers of America® at Midwestern Regional Medical Center, Elisha Ave. Zion, USA
| | - James F. Grutsch
- Rhythmalytics LLC West Orange NJ 07052 and Ambulatory Monitoring Inc, Ardsley NY, USA
| | - Timothy Birdsall
- Cancer Treatment Centers of America® at Midwestern Regional Medical Center, Elisha Ave. Zion, USA
| | - Patricia A. Wood
- Oncology, Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, USA
| | - Dinah Faith Q. Huff
- Rhythmalytics LLC West Orange NJ 07052 and Ambulatory Monitoring Inc, Ardsley NY, USA
| | | | | | | | - Digant Gupta
- Cancer Treatment Centers of America® at Midwestern Regional Medical Center, Elisha Ave. Zion, USA
| | - David E. Blask
- Dept. Of SCB, Tulane University School of Medicine, New Orleans, USA
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Detection of melatonin-onset in real settings via wearable sensors and artificial intelligence. A pilot study. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2020.102386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zefferino R, Di Gioia S, Conese M. Molecular links between endocrine, nervous and immune system during chronic stress. Brain Behav 2021; 11:e01960. [PMID: 33295155 PMCID: PMC7882157 DOI: 10.1002/brb3.1960] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/17/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The stress response is different in various individuals, however, the mechanisms that could explain these distinct effects are not well known and the molecular correlates have been considered one at the time. Particular harmful conditions occur if the subject, instead to cope the stressful events, succumb to them, in this case, a cascade reaction happens that through different signaling causes a specific reaction named "sickness behaviour." The aim of this article is to review the complex relations among important molecules belonging to Central nervous system (CNS), immune system (IS), and endocrine system (ES) during the chronic stress response. METHODS After having verified the state of art concerning the function of cortisol, norepinephrine (NE), interleukin (IL)-1β and melatonin, we describe as they work together. RESULTS We propose a speculative hypothesis concerning the complex interplay of these signaling molecules during chronic stress, highlighting the role of IL-1β as main biomarker of this effects, indeed, during chronic stress its increment transforms this inflammatory signal into a nervous signal (NE), in turn, this uses the ES (melatonin and cortisol) to counterbalance again IL-1β. During cortisol resistance, a vicious loop occurs that increments all mediators, unbalancing IS, ES, and CNS networks. This IL-1β increase would occur above all when the individual succumbs to stressful events, showing the Sickness Behaviour Symptoms. IL-1β might, through melatonin and vice versa, determine sleep disorders too. CONCLUSION The molecular links here outlined could explain how stress plays a role in etiopathogenesis of several diseases through this complex interplay.
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Affiliation(s)
- Roberto Zefferino
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Sante Di Gioia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Massimo Conese
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Quality of life for older patients with cancer: a review of the evidence supporting melatonin use. Aging Clin Exp Res 2020; 32:2459-2468. [PMID: 32236899 PMCID: PMC7680320 DOI: 10.1007/s40520-020-01532-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/07/2020] [Indexed: 12/13/2022]
Abstract
Purpose The proportion of older populations living with cancer is on the increase. Maintaining or improving their quality of life (QoL) has become an important goal in the treatment of cancer and has become an endpoint in clinical trials. Melatonin regulates a wide variety of physiological functions and is involved in the initiation of sleep and the improvement of QoL. With age, the secretion of melatonin decreases and could lead to a deterioration in QoL. Methods Literature searches were conducted using the PubMed database. The search terms and derivatives of “metastatic cancer”, “older patients”, “quality of life” and “melatonin” were used. Titles and abstracts were screened to identify whether studies were relevant for full-text screening. Results There is major concern about the symptoms older cancer patients encounter during treatment because they can impact their QoL. Melatonin supplementation presents several benefits for older patients: improvement in survival, decrease in symptoms induced by cancer and cancer treatment, and also improvements in quality of life. Conclusion It therefore seems appropriate to study the impact of melatonin supplementation during cytotoxic therapy on QoL among elderly patients with metastatic cancer. The use of melatonin as a therapeutic strategy seems particularly suitable for elderly patients, a population known to secrete significantly less melatonin. However, to date, no studies have been conducted in this population.
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The short-term impact of methylprednisolone on patient-reported sleep in patients with advanced cancer in a randomized, placebo-controlled, double-blind trial. Support Care Cancer 2020; 29:2047-2055. [PMID: 32856209 PMCID: PMC7892512 DOI: 10.1007/s00520-020-05693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/19/2020] [Indexed: 11/13/2022]
Abstract
Purpose Although corticosteroids are frequently used in patients with advanced cancer, few studies have examined the impact of these drugs on patient-reported sleep. We aimed to examine the short-term impact of methylprednisolone on patient-reported sleep in patients with advanced cancer. Methods Patient-reported sleep was a predefined secondary outcome in a prospective, randomized, placebo-controlled, double-blind trial that evaluated the analgesic efficacy of corticosteroids in advanced cancer patients (18+), using opioids, and having pain ≥ 4 past 24 h (NRS 0–10). Patients were randomized to the methylprednisolone group with methylprednisolone 16 mg × 2/day or placebo for 7 days. The EORTC QLQ-C30 (0–100) and the Pittsburgh Sleep Quality Index questionnaire (PSQI) (0–21) were used to assess the impact of corticosteroids on sleep at baseline and at day 7. Results Fifty patients were randomized of which 25 were analyzed in the intervention group and 22 in the control group. Mean age was 64 years, mean Karnofsky performance status was 67 (SD 13.3), 51% were female, and the mean oral daily morphine equivalent dose was 223 mg (SD 222.77). Mean QLQ-C30 sleep score at baseline was 29.0 (SD 36.7) in the methylprednisolone group and 24.2 (SD 27.6) in the placebo group. At day 7, there was no difference between the groups on QLQ-C30 sleep score (methylprednisolone 20.3 (SD 32.9); placebo 28.8 (SD 33.0), p = 0.173). PSQI showed similar results. Conclusions Methylprednisolone 16 mg twice daily for 7 days had no impact on patient-reported sleep in this cohort of patients with advanced cancer. Trial registration Clinical trial information NCT00676936 (13.05.2008)
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Lévi F, Komarzynski S, Huang Q, Young T, Ang Y, Fuller C, Bolborea M, Brettschneider J, Fursse J, Finkenstädt B, White DP, Innominato P. Tele-Monitoring of Cancer Patients' Rhythms during Daily Life Identifies Actionable Determinants of Circadian and Sleep Disruption. Cancers (Basel) 2020; 12:cancers12071938. [PMID: 32708950 PMCID: PMC7409071 DOI: 10.3390/cancers12071938] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
The dichotomy index (I < O), a quantitative estimate of the circadian regulation of daytime activity and sleep, predicted overall cancer survival and emergency hospitalization, supporting its integration in a mHealth platform. Modifiable causes of I < O deterioration below 97.5%—(I < O)low—were sought in 25 gastrointestinal cancer patients and 33 age- and sex-stratified controls. Rest-activity and temperature were tele-monitored with a wireless chest sensor, while daily activities, meals, and sleep were self-reported for one week. Salivary cortisol rhythm and dim light melatonin onset (DLMO) were determined. Circadian parameters were estimated using Hidden Markov modelling, and spectral analysis. Actionable predictors of (I < O)low were identified through correlation and regression analyses. Median compliance with protocol exceeded 95%. Circadian disruption—(I < O)low—was identified in 13 (52%) patients and four (12%) controls (p = 0.002). Cancer patients with (I < O)low had lower median activity counts, worse fragmented sleep, and an abnormal or no circadian temperature rhythm compared to patients with I < O exceeding 97.5%—(I < O)high—(p < 0.012). Six (I < O)low patients had newly-diagnosed sleep conditions. Altered circadian coordination of rest-activity and chest surface temperature, physical inactivity, and irregular sleep were identified as modifiable determinants of (I < O)low. Circadian rhythm and sleep tele-monitoring results support the design of specific interventions to improve outcomes within a patient-centered systems approach to health care.
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Affiliation(s)
- Francis Lévi
- Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK; (S.K.); (Q.H.); (M.B.); (J.F.); (P.I.)
- European Laboratory U935, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Saclay University, 94801 Villejuif, France;
- Hepato-Biliary Centre, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 94800 Villejuif, France
- Correspondence: ; Tel.: +44-2476-575-132
| | - Sandra Komarzynski
- Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK; (S.K.); (Q.H.); (M.B.); (J.F.); (P.I.)
- European Laboratory U935, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Saclay University, 94801 Villejuif, France;
| | - Qi Huang
- Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK; (S.K.); (Q.H.); (M.B.); (J.F.); (P.I.)
- Department of Statistics, University of Warwick, Coventry CV4 7AL, UK;
| | - Teresa Young
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, Middlesex HA6 2RN, UK;
| | - Yeng Ang
- Salford Royal NHS Foundation Trust, Salford M6 8HD, UK;
- Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Claire Fuller
- North Wales Cancer Treatment Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK;
| | - Matei Bolborea
- Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK; (S.K.); (Q.H.); (M.B.); (J.F.); (P.I.)
| | | | - Joanna Fursse
- Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK; (S.K.); (Q.H.); (M.B.); (J.F.); (P.I.)
| | - Bärbel Finkenstädt
- European Laboratory U935, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Saclay University, 94801 Villejuif, France;
- Department of Statistics, University of Warwick, Coventry CV4 7AL, UK;
| | - David Pollard White
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02130, USA;
- Philips Respironics, Murrysville, PA 15668, USA
| | - Pasquale Innominato
- Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK; (S.K.); (Q.H.); (M.B.); (J.F.); (P.I.)
- European Laboratory U935, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Saclay University, 94801 Villejuif, France;
- North Wales Cancer Treatment Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK;
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Jeon S, Conley S, Redeker NS. Rest-activity rhythms, daytime symptoms, and functional performance among people with heart failure. Chronobiol Int 2020; 37:1223-1234. [PMID: 32588662 DOI: 10.1080/07420528.2020.1779280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Sleep disturbance and decreased daytime activity are well-described among people with chronic heart failure (HF) who suffer from disabling daytime symptoms and poor function. Alterations in the circadian rhythmicity of rest-activity may also be associated with these outcomes. However, little is known about the associations between rest-activity rhythms (RARS), symptoms, and functional performance or the extent to which they are explained by sleep characteristics among people with HF. The purpose of this study is to evaluate parametric and non-parametric circadian characteristics of RARs and the associations between these variables, daytime symptoms, and functional performance among patients with stable heart failure (HF). We recruited adults with stable HF from HF disease management programs. Participants wore wrist actigraphs for 3 d, completed one night of unattended polysomnography and the Six Minute Walk Test, and reported daytime symptoms and physical function. We performed cosinor, non-parametric, and spectral analyses to evaluate the rest-activity rhythms and computed bivariate correlations between the rest-activity rhythm, demographics, daytime symptoms, and functional performance. We conducted multiple regression analysis to examine how RARs contribute to daytime symptoms and functional performance after controlling for insomnia and covariates. The sample included 135 participants [Mean age = 60.6 (16.1) y, n = 88 (65.2%) male]. Older age, greater comorbidity, and poorer New York Heart Association (NYHA) Class, and more EEG arousals were associated with greater intra-daily variability of the RAR. More robust rhythmicity represented by the circadian quotient was associated with better NYHA class and less sleep fragmentation. A higher circadian quotient was significantly associated with lower fatigue, depression, and sleepiness, and better functional performance after controlling for insomnia and clinical and demographic characteristics. Circadian parameters of rest-activity are associated with symptoms and functional performance among people with HF independent of insomnia or sleep disordered breathing. Interventions targeted at improving the stability and strength of rest-activity rhythms may improve symptom and functional outcomes for these patients.
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Yang PL, Ward TM, Burr RL, Kapur VK, McCurry SM, Vitiello MV, Hough CL, Parsons EC. Sleep and Circadian Rhythms in Survivors of Acute Respiratory Failure. Front Neurol 2020; 11:94. [PMID: 32117040 PMCID: PMC7033606 DOI: 10.3389/fneur.2020.00094] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Little is known about sleep and circadian rhythms in survivors of acute respiratory failure (ARF) after hospital discharge. Objectives: To examine sleep and rest-activity circadian rhythms in ARF survivors 3 months after hospital discharge, and to compare them with a community-dwelling population. Methods: Sleep diary, actigraphy data, and insomnia symptoms were collected in a pilot study of 14 ARF survivors. Rest-activity circadian rhythms were assessed with wrist actigraphy and sleep diary for 9 days, and were analyzed by cosinor and non-parametric circadian rhythm analysis. Results: All participants had remarkable actigraphic sleep fragmentation, 71.5% had subclinical or clinical insomnia symptoms. Compared to community-dwelling adults, this cohort had less stable rest-activity circadian rhythms (p < 0.001), and weaker circadian strength (p < 0.001). Conclusion: Insomnia and circadian disruption were common in ARF survivors. Sleep improvement and circadian rhythm regularity may be a promising approach to improve quality of life and daytime function after ARF.
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Affiliation(s)
- Pei-Lin Yang
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Teresa M. Ward
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Robert L. Burr
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Vishesh K. Kapur
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, United States
| | - Susan M. McCurry
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Michael V. Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Catherine L. Hough
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, United States
| | - Elizabeth C. Parsons
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, United States
- VA Puget Sound Health Care System, Seattle, WA, United States
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Sulli G, Lam MTY, Panda S. Interplay between Circadian Clock and Cancer: New Frontiers for Cancer Treatment. Trends Cancer 2019; 5:475-494. [PMID: 31421905 DOI: 10.1016/j.trecan.2019.07.002] [Citation(s) in RCA: 255] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 07/07/2019] [Accepted: 07/08/2019] [Indexed: 12/23/2022]
Abstract
Circadian clocks constitute the evolutionary molecular machinery that dictates the temporal regulation of physiology to maintain homeostasis. Disruption of the circadian rhythm plays a key role in tumorigenesis and facilitates the establishment of cancer hallmarks. Conversely, oncogenic processes directly weaken circadian rhythms. Pharmacological modulation of core clock genes is a new approach in cancer therapy. The integration of circadian biology into cancer research offers new options for making cancer treatment more effective, encompassing the prevention, diagnosis, and treatment of this devastating disease. This review highlights the role of the circadian clock in tumorigenesis and cancer hallmarks, and discusses how pharmacological modulation of circadian clock genes can lead to new therapeutic options.
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Affiliation(s)
- Gabriele Sulli
- The Salk Institute for Biological Studies, La Jolla, CA, USA; Department of Medicine, Division of Regenerative Medicine, Moores Cancer Center, University of California, San Diego, La Jolla, CA 92093, USA; Scintillon Institute, San Diego, CA 92121, USA.
| | - Michael Tun Yin Lam
- The Salk Institute for Biological Studies, La Jolla, CA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, 9300 Campus Point Drive, La Jolla, CA 92037, USA
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Gaspar LS, Álvaro AR, Carmo‐Silva S, Mendes AF, Relógio A, Cavadas C. The importance of determining circadian parameters in pharmacological studies. Br J Pharmacol 2019; 176:2827-2847. [PMID: 31099023 PMCID: PMC6637036 DOI: 10.1111/bph.14712] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 12/25/2022] Open
Abstract
In mammals, most molecular and cellular processes show circadian changes, leading to daily variations in physiology and ultimately in behaviour. Such daily variations induce a temporal coordination of processes that is essential to ensure homeostasis and health. Thus, it is of no surprise that pharmacokinetics (PK) and pharmacodynamics (PD) of many drugs are also subject to circadian variations, profoundly affecting their efficacy and tolerability. Understanding how circadian rhythms influence drug PK, PD, and toxicity might significantly improve treatment efficacy and decrease related side effects. Therefore, it is essential to take circadian variations into account and to determine circadian parameters in pharmacological studies, especially when drugs have a short half-life or target rhythmic processes. This review provides an overview of the current knowledge on circadian rhythms and their relevance to the field of pharmacology. Methodologies to evaluate circadian rhythms in vitro, in rodent models and in humans, from experimental to computational approaches, are described and discussed. Lastly, we aim at alerting the scientific, medical, and regulatory communities to the relevance of the physiological time, as a key parameter to be considered when designing pharmacological studies. This will eventually lead to more successful preclinical and clinical trials and pave the way to a more personalized treatment to the benefit of the patients.
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Affiliation(s)
- Laetitia S. Gaspar
- CNC—Center for Neuroscience and Cell BiologyUniversity of CoimbraCoimbraPortugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB)University of CoimbraCoimbraPortugal
- Institute for Interdisciplinary Research (IIIUC)University of CoimbraCoimbraPortugal
| | - Ana Rita Álvaro
- CNC—Center for Neuroscience and Cell BiologyUniversity of CoimbraCoimbraPortugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB)University of CoimbraCoimbraPortugal
| | - Sara Carmo‐Silva
- CNC—Center for Neuroscience and Cell BiologyUniversity of CoimbraCoimbraPortugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB)University of CoimbraCoimbraPortugal
| | - Alexandrina Ferreira Mendes
- CNC—Center for Neuroscience and Cell BiologyUniversity of CoimbraCoimbraPortugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB)University of CoimbraCoimbraPortugal
- Faculty of PharmacyUniversity of CoimbraCoimbraPortugal
| | - Angela Relógio
- Institute for Theoretical BiologyCharité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
- Medical Department of Hematology, Oncology, and Tumor Immunology, Molecular Cancer Research CenterCharité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt—Universität zu Berlin, and Berlin Institute of HealthBerlinGermany
| | - Cláudia Cavadas
- CNC—Center for Neuroscience and Cell BiologyUniversity of CoimbraCoimbraPortugal
- Center for Innovation in Biomedicine and Biotechnology (CIBB)University of CoimbraCoimbraPortugal
- Faculty of PharmacyUniversity of CoimbraCoimbraPortugal
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Pavic M, Klaas V, Theile G, Kraft J, Tröster G, Guckenberger M. Feasibility and Usability Aspects of Continuous Remote Monitoring of Health Status in Palliative Cancer Patients Using Wearables. Oncology 2019; 98:386-395. [PMID: 31336377 DOI: 10.1159/000501433] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/07/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mobile health is a promising strategy aiming to anticipate and prevent the deterioration of health status in palliative cancer patients. A prerequisite for successful implementation of this technology into clinical routine is a high level of usability and acceptance of devices. OBJECTIVES We aimed to evaluate feasibility as well as patients' acceptance of remote monitoring using wearables in palliative cancer patients. METHODS In this prospective single-center observational feasibility study, 30 cancer patients treated with palliative intent in an inpatient setting with an estimated life expectancy of >8 weeks and <12 months were provided with a smartphone including a pre-installed "Activity Monitoring" app and a sensor-equipped bracelet and monitored over a period of 12 weeks starting at discharge from hospital. We report detailed feasibility and usability aspects and comment on patients' acceptance of the wearables. RESULTS Between February 2017 and May 2018 a total of 30 patients were included in the study. From these, 25 participants (83%) completed the whole study period. On average, the bracelet was worn on 53% and smartphone used on 85% of the study days. The completion rate of daily digital questionnaires for subjective ratings (pain and distress scale) was 73%, and 28 patients were able to handle the wearables and to operate the app without major problems. Use of the bracelet was low during the night hours, with a wearing time of 1.7% of all night hours (8 p.m. to 8 a.m.). CONCLUSIONS Remote monitoring of health care status in palliative cancer patients with a limited life expectancy is feasible and patients are able to handle the smartphone and the sensor-equipped bracelet. Feedback towards use of this monitoring system was mostly positive.
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Affiliation(s)
- Matea Pavic
- Department of Radiation Oncology/Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland,
| | - Vanessa Klaas
- Swiss Federal Institute of Technology, Wearable Computing Laboratory, Zurich, Switzerland
| | - Gudrun Theile
- Department of Radiation Oncology/Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Johannes Kraft
- Department of Radiation Oncology/Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Gerhard Tröster
- Swiss Federal Institute of Technology, Wearable Computing Laboratory, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology/Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
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Innominato PF, Komarzynski S, Palesh OG, Dallmann R, Bjarnason GA, Giacchetti S, Ulusakarya A, Bouchahda M, Haydar M, Ballesta A, Karaboué A, Wreglesworth NI, Spiegel D, Lévi FA. Circadian rest-activity rhythm as an objective biomarker of patient-reported outcomes in patients with advanced cancer. Cancer Med 2018; 7:4396-4405. [PMID: 30088335 PMCID: PMC6143939 DOI: 10.1002/cam4.1711] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/25/2018] [Accepted: 06/29/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Psychosocial 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). METHODS Two 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. CONCLUSION Objectively 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.
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Affiliation(s)
- Pasquale F. Innominato
- North Wales Cancer CentreYsbyty GwyneddBetsi Cadwaladr University Health BoardBangorUK
- Cancer Chronotherapy TeamCancer Research CentreWarwick Medical SchoolCoventryUK
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
| | - Sandra Komarzynski
- Cancer Chronotherapy TeamCancer Research CentreWarwick Medical SchoolCoventryUK
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
| | - Oxana G. Palesh
- Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordCalifornia
- Stanford Cancer InstituteStanford School of MedicineStanfordCalifornia
| | - Robert Dallmann
- Cancer Chronotherapy TeamCancer Research CentreWarwick Medical SchoolCoventryUK
| | | | - Sylvie Giacchetti
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
- Department of OncologySaint Louis HospitalPublic Hospitals of Paris (AP‐HP)ParisFrance
| | - Ayhan Ulusakarya
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
- Chronotherapy UnitDepartment of Medical OncologyPaul Brousse HospitalPublic Hospitals of Paris (AP‐HP)VillejuifFrance
| | - Mohamed Bouchahda
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
- Chronotherapy UnitDepartment of Medical OncologyPaul Brousse HospitalPublic Hospitals of Paris (AP‐HP)VillejuifFrance
- Mousseau ClinicsEvryFrance
| | - Mazen Haydar
- Chronotherapy UnitDepartment of Medical OncologyPaul Brousse HospitalPublic Hospitals of Paris (AP‐HP)VillejuifFrance
| | - Annabelle Ballesta
- Cancer Chronotherapy TeamCancer Research CentreWarwick Medical SchoolCoventryUK
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
- Warwick Mathematics InstituteUniversity of WarwickCoventryUK
| | | | | | - David Spiegel
- Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordCalifornia
- Stanford Cancer InstituteStanford School of MedicineStanfordCalifornia
| | - Francis A. Lévi
- Cancer Chronotherapy TeamCancer Research CentreWarwick Medical SchoolCoventryUK
- Unit 935French National Institute for Health and Medical Research (INSERM)VillejuifFrance
- Chronotherapy UnitDepartment of Medical OncologyPaul Brousse HospitalPublic Hospitals of Paris (AP‐HP)VillejuifFrance
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