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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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2
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Kim DW, Mayer C, Lee MP, Choi SW, Tewari M, Forger DB. Efficient assessment of real-world dynamics of circadian rhythms in heart rate and body temperature from wearable data. J R Soc Interface 2023; 20:20230030. [PMID: 37608712 PMCID: PMC10445022 DOI: 10.1098/rsif.2023.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023] Open
Abstract
Laboratory studies have made unprecedented progress in understanding circadian physiology. Quantifying circadian rhythms outside of laboratory settings is necessary to translate these findings into real-world clinical practice. Wearables have been considered promising way to measure these rhythms. However, their limited validation remains an open problem. One major barrier to implementing large-scale validation studies is the lack of reliable and efficient methods for circadian assessment from wearable data. Here, we propose an approximation-based least-squares method to extract underlying circadian rhythms from wearable measurements. Its computational cost is ∼ 300-fold lower than that of previous work, enabling its implementation in smartphones with low computing power. We test it on two large-scale real-world wearable datasets: [Formula: see text] of body temperature data from cancer patients and ∼ 184 000 days of heart rate and activity data collected from the 'Social Rhythms' mobile application. This shows successful extraction of real-world dynamics of circadian rhythms. We also identify a reasonable harmonic model to analyse wearable data. Lastly, we show our method has broad applicability in circadian studies by embedding it into a Kalman filter that infers the state space of the molecular clocks in tissues. Our approach facilitates the translation of scientific advances in circadian fields into actual improvements in health.
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Affiliation(s)
- Dae Wook Kim
- Department of Mathematics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Caleb Mayer
- Department of Mathematics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Minki P. Lee
- Department of Mathematics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sung Won Choi
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Muneesh Tewari
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Daniel B. Forger
- Department of Mathematics, University of Michigan, Ann Arbor, MI 48109, USA
- Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
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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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Harris CS, Pozzar RA, Conley Y, Eicher M, Hammer MJ, Kober KM, Miaskowski C, Colomer-Lahiguera S. Big Data in Oncology Nursing Research: State of the Science. Semin Oncol Nurs 2023; 39:151428. [PMID: 37085404 PMCID: PMC11225574 DOI: 10.1016/j.soncn.2023.151428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To review the state of oncology nursing science as it pertains to big data. The authors aim to define and characterize big data, describe key considerations for accessing and analyzing big data, provide examples of analyses of big data in oncology nursing science, and highlight ethical considerations related to the collection and analysis of big data. DATA SOURCES Peer-reviewed articles published by investigators specializing in oncology, nursing, and related disciplines. CONCLUSION Big data is defined as data that are high in volume, velocity, and variety. To date, oncology nurse scientists have used big data to predict patient outcomes from clinician notes, identify distinct symptom phenotypes, and identify predictors of chemotherapy toxicity, among other applications. Although the emergence of big data and advances in computational methods provide new and exciting opportunities to advance oncology nursing science, several challenges are associated with accessing and using big data. Data security, research participant privacy, and the underrepresentation of minoritized individuals in big data are important concerns. IMPLICATIONS FOR NURSING PRACTICE With their unique focus on the interplay between the whole person, the environment, and health, nurses bring an indispensable perspective to the interpretation and application of big data research findings. Given the increasing ubiquity of passive data collection, all nurses should be taught the definition, characteristics, applications, and limitations of big data. Nurses who are trained in big data and advanced computational methods will be poised to contribute to guidelines and policies that preserve the rights of human research participants.
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Affiliation(s)
- Carolyn S Harris
- Postdoctoral Scholar, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rachel A Pozzar
- Nurse Scientist at Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA and Instructor at Harvard Medical School, Boston, Massachusetts, USA
| | - Yvette Conley
- Professor, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Manuela Eicher
- Associate Professor and Director of the Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, and Lausanne University Hospital, Lausanne, Switzerland
| | - Marilyn J Hammer
- Director, The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA and Lecturer at Harvard Medical School, Boston, Massachusetts, USA
| | - Kord M Kober
- Associate Professor, School of Nursing, University of California, San Francisco, California, USA
| | - Christine Miaskowski
- Professor, Schools of Medicine and Nursing, University of California, San Francisco, California, USA
| | - Sara Colomer-Lahiguera
- Senior Nurse Scientist and Junior Lecturer, Institute of Higher Education and Research in Healthcare (IUFRS), Faculty of Biology and Medicine, University of Lausanne, and Lausanne University Hospital, Lausanne, Switzerland.
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Leonardsen ACL, Bååth C, Helgesen AK, Grøndahl VA, Hardeland C. Person-Centeredness in Digital Primary Healthcare Services-A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11091296. [PMID: 37174838 PMCID: PMC10178010 DOI: 10.3390/healthcare11091296] [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: 04/05/2023] [Revised: 04/21/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Background: Transformation toward digital services offers unique opportunities to meet the challenges of responding to changing public healthcare needs and health workforce shortages. There is a knowledge gap regarding digital health and person or patient-centered care. Aim: The aim of the current scoping review was to obtain an overview of existing research on person or patient centeredness in digital primary healthcare services. Design: A scoping review following the five stages by Arksey and O'Malley. Methods: Literature searches were conducted in the databases PubMed, Scopus (Elsevier), APA PsychInfo (Ovid), Embase (Ovid), Cinahl (Ovid) and Cochrane Library in June 2022. The Preferred Reporting Items for Systematic reviews and Meta-Analyzes extension for Scoping Reviews (PRISMA-ScR) Checklist was followed. Results: The electronic database searches identified 782 references. A total of 116 references were assessed in full text against the inclusion and exclusion criteria. Finally, a total of 12 references were included. The included papers represent research from 2015 to 2021 and were conducted in eight different countries, within a variety of populations, settings and digital solutions. Four themes providing knowledge about current research on patient or person centeredness and digital primary health care were identified: 'Accessibility', 'Self-management', 'Digitalization at odds with patient centeredness' and 'Situation awareness'. The review underlines the need for further research on these issues.
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Affiliation(s)
- Ann-Chatrin Linqvist Leonardsen
- Faculty of Health, Welfare and Organization, Ostfold University College, P.O. Box 700, 1757 Halden, Norway
- Department of Anesthesia, Ostfold Hospital Trust, P.O. Box 300, 1714 Grålum, Norway
| | - Carina Bååth
- Faculty of Health, Welfare and Organization, Ostfold University College, P.O. Box 700, 1757 Halden, Norway
- Faculty of Health, Science, and Technology, Department of Health Sciences, Karlstad University, SE-651 88 Karlstad, Sweden
| | - Ann Karin Helgesen
- Faculty of Health, Welfare and Organization, Ostfold University College, P.O. Box 700, 1757 Halden, Norway
| | - Vigdis Abrahamsen Grøndahl
- Faculty of Health, Welfare and Organization, Ostfold University College, P.O. Box 700, 1757 Halden, Norway
| | - Camilla Hardeland
- Faculty of Health, Welfare and Organization, Ostfold University College, P.O. Box 700, 1757 Halden, Norway
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Tripepi M, Pizzocaro E, Giardino A, Frigerio I, Guglielmi A, Butturini G. Telemedicine and Pancreatic Cancer: A Systematic Review. Telemed J E Health 2023; 29:352-360. [PMID: 35861761 DOI: 10.1089/tmj.2022.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Pancreatic cancer requires a multidisciplinary approach in a high-volume center for all the steps of the diagnostic-therapeutic course. However, the most experienced centers are not evenly distributed throughout the country causing a real "health migration" that involves patients and families with relevant economic, time, and energy costs to bear. The COVID-19 pandemic had a deep impact on surgical and oncological care and the travel limits due to COVID-related restrictions, have delayed the care of cancer patient living far from the referral centers. In this scenario, several telemedicine approaches have been proposed to reduce the distance between clinicians and patients and to allow a fast and effective access to care even for patients distant from referral centers. The aim of the study is to analyze the evidence and describe the current utility of telemedicine tool for patients with pancreatic cancer. Methods: We systematically searched the literature in the following databases: Web of Science, PubMed, Scopus, and MEDLINE. The inclusion criteria were article describing a telemedicine intervention (virtual visits, telephone follow-up/counseling, mobile or online apps, telemonitoring) and focusing on adult patients with pancreatic cancer at any stage of the disease. Results: In total, 846 titles/abstracts were identified. Following quality assessment, the review included 40 studies. Telemedicine has been proposed in multiple clinical settings, demonstrating high levels of patient and health professional satisfaction. Conclusion: Successful telemedicine applications in patients with pancreatic cancer are telerehabilitation and nutritional assessment, remote symptom control, teledischarge after pancreatic surgery, tele-education and medical mentoring regarding pancreatic disease as well as telepathology.
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Affiliation(s)
- Marzia Tripepi
- Department of Surgery, General and Hepatobiliary Surgery, University of Verona, Verona, Italy.,Surgical Department, HPB Unit Pederzoli Hospital, Peschiera del Garda, Verona
| | - Erica Pizzocaro
- Department of Surgical Sciences, University of Verona, Verona, Italy
| | - Alessandro Giardino
- Surgical Department, HPB Unit Pederzoli Hospital, Peschiera del Garda, Verona
| | - Isabella Frigerio
- Surgical Department, HPB Unit Pederzoli Hospital, Peschiera del Garda, Verona
| | - Alfredo Guglielmi
- Department of Surgery, General and Hepatobiliary Surgery, University of Verona, Verona, Italy
| | - Giovanni Butturini
- Surgical Department, HPB Unit Pederzoli Hospital, Peschiera del Garda, Verona
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7
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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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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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Innominato PF, Karaboué A, Focan C, Chollet P, Giacchetti S, Bouchahda M, Ulusakarya A, Torsello A, Adam R, Lévi FA, Garufi C. Efficacy and safety of chronomodulated irinotecan, oxaliplatin, 5-fluorouracil and leucovorin combination as first- or second-line treatment against metastatic colorectal cancer: Results from the International EORTC 05011 Trial. Int J Cancer 2021; 148:2512-2521. [PMID: 33270911 PMCID: PMC8048520 DOI: 10.1002/ijc.33422] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/20/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022]
Abstract
The triplet combination of irinotecan, oxaliplatin and fluorouracil is an active frontline regimen in metastatic colorectal cancer, but scarce data exist on its use as salvage treatment. We aimed at assessing its safety and efficacy profiles with its circadian-based administration (chronoIFLO5) as either first- or second-line treatment, within the time-finding EORTC 05011 trial. Five-day chronoIFLO5 was administered every 3 weeks in patients with PS 0, 1 or 2. It consisted of chronomodulated irinotecan (180 mg/sqm), oxaliplatin (80 mg/sqm) and fluorouracil-leucovorin (2800 and 1200 mg/sqm, respectively). For our study, toxicity and antitumour activity were evaluated separately in first- and second-line settings. Primary endpoints included Grade 3-4 toxicity rates, best objective response rate (ORR), progression-free survival (PFS) and overall survival (OS). One-hundred forty-nine and 44 patients were treated in first-line and second-line settings, respectively, with a total of 1138 cycles with median relative dose intensities of about 90%. Demographics were comparable in the two groups. Thirty-six (24.7%) and 10 (22.2%) patients experienced at least one episode of severe toxicity in first line and second line, respectively. Frontline chronoIFLO5 yielded an ORR of 62.3% [95% CI: 54.2-70.4] and resulted in median PFS and OS of 8.7 months [7.5-9.9] and 19.9 months [15.4-24.5]. Corresponding figures in second line were 37.5% [22.5-52.5], 6.7 months [4.8-8.9] and 16.3 months [11.8-20.8]. International and prospective evaluation revealed the favourable safety and efficacy profiles of chronoIFLO5, both as frontline and as salvage treatment against metastatic colorectal cancer. In particular, encouraging activity in second line was observed, with limited haematological toxicity.
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Affiliation(s)
- Pasquale F. Innominato
- North Wales Cancer Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health BoardBangorUK
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical SciencesWarwick Medical SchoolCoventryUK
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of MedicineParis‐Saclay UniversityVillejuifFrance
| | - Abdoulaye Karaboué
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of MedicineParis‐Saclay UniversityVillejuifFrance
- Medical Oncology UnitGHI Le Raincy‐MontfermeilMontfermeilFrance
| | - Christian Focan
- Department of OncologyCHC‐MontLegia, Groupe Santé CHC‐LiègeLiègeBelgium
| | - Philippe Chollet
- Clinical and Translational Research DivisionJean Perrin Comprehensive Cancer CentreClermont‐FerrandFrance
| | - Sylvie Giacchetti
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of MedicineParis‐Saclay UniversityVillejuifFrance
- Department of OncologySaint Louis Hospital, Public Hospitals of Paris (AP‐HP)ParisFrance
| | - Mohamed Bouchahda
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of MedicineParis‐Saclay UniversityVillejuifFrance
- Medical Oncology UnitClinique du MousseauEvryFrance
- Medical Oncology UnitClinique Saint Jean L'ErmitageMelunFrance
- Chronotherapy Unit, Department of Medical OncologyPaul Brousse Hospital, Public Hospitals of Paris (AP‐HP)VillejuifFrance
| | - Ayhan Ulusakarya
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of MedicineParis‐Saclay UniversityVillejuifFrance
- Chronotherapy Unit, Department of Medical OncologyPaul Brousse Hospital, Public Hospitals of Paris (AP‐HP)VillejuifFrance
| | - Angela Torsello
- Division of Medical OncologySan Giovanni‐ Addolorata HospitalRomeItaly
| | - René Adam
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of MedicineParis‐Saclay UniversityVillejuifFrance
- Hepatobiliary CentrePaul Brousse Hospital, Public Hospitals of Paris (AP‐HP)VillejuifFrance
| | - Francis A. Lévi
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical SciencesWarwick Medical SchoolCoventryUK
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of MedicineParis‐Saclay UniversityVillejuifFrance
- Hepatobiliary CentrePaul Brousse Hospital, Public Hospitals of Paris (AP‐HP)VillejuifFrance
| | - Carlo Garufi
- Division of Medical OncologySan Camillo Forlanini HospitalRomeItaly
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10
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Cho Y, Zhang H, Harris MR, Gong Y, Smith EL, Jiang Y. Acceptance and Use of Home-Based Electronic Symptom Self-Reporting Systems in Patients With Cancer: Systematic Review. J Med Internet Res 2021; 23:e24638. [PMID: 33709929 PMCID: PMC7998328 DOI: 10.2196/24638] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electronic symptom self-reporting systems (e-SRS) have been shown to improve symptoms and survival in patients with cancer. However, patient engagement in using e-SRS for voluntary symptom self-reporting is less optimal. Multiple factors can potentially affect patients' acceptance and engagement in using home-based e-SRS. However, such factors have not been fully explored in cancer populations. OBJECTIVE The aim of this study is to understand the acceptance and use of home-based e-SRS by patients with cancer and identify associated facilitators and barriers. METHODS PubMed, CINAHL, Scopus, and PsycINFO (January 2010 to March 2020) were searched using a combination of Medical Subject Headings (MeSH) terms and keywords such as symptom self-reporting, electronic/technology, cancer, and their synonyms. Included studies focused on the use of home-based e-SRS by patients with cancer and their families. Studies on patients' use of e-SRS in clinical settings only were excluded. Of the 3740 papers retrieved, 33 were included in the final review. Factors associated with patient acceptance and use of e-SRS were extracted and synthesized. RESULTS Most e-SRS were web based (22/33, 66%) or mobile app based (9/33, 27%). The e-SRS initial acceptance, represented by patient enrollment rates, ranged from 40% (22/55) to 100% (100/100). High e-SRS acceptance was rated by 69% (59/85) to 77.6% (337/434) of the patients after they used the system. The e-SRS use, measured by patients' response rates to questionnaires (ranging from 1596/3521, 45.33% to 92%) or system log-on rates (ranging from 4/12, 33% to 99/100, 99%), declined over time in general patterns. Few studies (n=7) reported e-SRS use beyond 6 months, with the response rates ranging from 62% (40/64) to 85.1% (541/636) and the log-on rates ranging from 63.6% (103/162) to 77% (49/64). The availability of compatible devices and technical support, interactive system features, information accessibility, privacy, questionnaire quality, patient physical/psychosocial status, and age were associated with patient acceptance and use of home-based e-SRS. CONCLUSIONS Acceptance and use of home-based e-SRS by patients with cancer varied significantly across studies, as assessed by a variety of approaches. The lack of access to technology has remained a barrier to e-SRS adoption. Interactive system features and personalized questionnaires may increase patient engagement. More studies are needed to further understand patients' long-term use of home-based e-SRS behavior patterns to develop personalized interventions to support symptom self-management and self-reporting of patients with cancer for optimal health outcomes.
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Affiliation(s)
- Youmin Cho
- University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Huiting Zhang
- University of Michigan School of Nursing, Ann Arbor, MI, United States
| | | | - Yang Gong
- University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, TX, United States
| | | | - Yun Jiang
- University of Michigan School of Nursing, Ann Arbor, MI, United States
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11
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Hesse J, Malhan D, Yalҫin M, Aboumanify O, Basti A, Relógio A. An Optimal Time for Treatment-Predicting Circadian Time by Machine Learning and Mathematical Modelling. Cancers (Basel) 2020; 12:cancers12113103. [PMID: 33114254 PMCID: PMC7690897 DOI: 10.3390/cancers12113103] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023] Open
Abstract
Tailoring medical interventions to a particular patient and pathology has been termed personalized medicine. The outcome of cancer treatments is improved when the intervention is timed in accordance with the patient's internal time. Yet, one challenge of personalized medicine is how to consider the biological time of the patient. Prerequisite for this so-called chronotherapy is an accurate characterization of the internal circadian time of the patient. As an alternative to time-consuming measurements in a sleep-laboratory, recent studies in chronobiology predict circadian time by applying machine learning approaches and mathematical modelling to easier accessible observables such as gene expression. Embedding these results into the mathematical dynamics between clock and cancer in mammals, we review the precision of predictions and the potential usage with respect to cancer treatment and discuss whether the patient's internal time and circadian observables, may provide an additional indication for individualized treatment timing. Besides the health improvement, timing treatment may imply financial advantages, by ameliorating side effects of treatments, thus reducing costs. Summarizing the advances of recent years, this review brings together the current clinical standard for measuring biological time, the general assessment of circadian rhythmicity, the usage of rhythmic variables to predict biological time and models of circadian rhythmicity.
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Affiliation(s)
- Janina Hesse
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.H.); (D.M.); (M.Y.); (O.A.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology and Tumor Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Deeksha Malhan
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.H.); (D.M.); (M.Y.); (O.A.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology and Tumor Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Müge Yalҫin
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.H.); (D.M.); (M.Y.); (O.A.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology and Tumor Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Ouda Aboumanify
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.H.); (D.M.); (M.Y.); (O.A.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology and Tumor Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Alireza Basti
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.H.); (D.M.); (M.Y.); (O.A.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology and Tumor Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Angela Relógio
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany; (J.H.); (D.M.); (M.Y.); (O.A.); (A.B.)
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology and Tumor Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt—Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
- Department of Human Medicine, Institute for Systems Medicine and Bioinformatics, MSH Medical School Hamburg—University of Applied Sciences and Medical University, 20457 Hamburg, Germany
- Correspondence: or
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12
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Melstrom LG, Rodin AS, Rossi LA, Fu P, Fong Y, Sun V. Patient generated health data and electronic health record integration in oncologic surgery: A call for artificial intelligence and machine learning. J Surg Oncol 2020; 123:52-60. [PMID: 32974930 DOI: 10.1002/jso.26232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
In this review, we aim to assess the current state of science in relation to the integration of patient-generated health data (PGHD) and patient-reported outcomes (PROs) into routine clinical care with a focus on surgical oncology populations. We will also describe the critical role of artificial intelligence and machine-learning methodology in the efficient translation of PGHD, PROs, and traditional outcome measures into meaningful patient care models.
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Affiliation(s)
- Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Andrei S Rodin
- Department of Computational and Quantitative Medicine, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
| | - Lorenzo A Rossi
- Applied AI and Data Science Department, City of Hope National Medical Center, Duarte, California, USA
| | - Paul Fu
- Department of Pediatrics, City of Hope National Medical Center, Duarte, California, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Virginia Sun
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA.,Department of Population Sciences, City of Hope National Medical Center, Duarte, California, USA
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13
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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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14
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Kim DW, Zavala E, Kim JK. Wearable technology and systems modeling for personalized chronotherapy. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.coisb.2020.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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15
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Innominato PF, Ballesta A, Huang Q, Focan C, Chollet P, Karaboué A, Giacchetti S, Bouchahda M, Adam R, Garufi C, Lévi FA. Sex-dependent least toxic timing of irinotecan combined with chronomodulated chemotherapy for metastatic colorectal cancer: Randomized multicenter EORTC 05011 trial. Cancer Med 2020; 9:4148-4159. [PMID: 32319740 PMCID: PMC7300418 DOI: 10.1002/cam4.3056] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022] Open
Abstract
The least toxic time (LTT) of irinotecan varied by up to 8 hours according to sex and genetic background in mice. The translational relevance was investigated within a randomized trial dataset, where no LTT stood out significantly in the whole population. 130 male and 63 female eligible patients with metastatic colorectal cancer were randomized to receive chronomodulated Irinotecan with peak delivery rate at 1 of 6 clock hours staggered by 4 hours on day 1, then fixed-time chronomodulated Fluorouracil-Leucovorin-Oxaliplatin for 4 days, q3 weeks. The sex-specific circadian characteristics of grade (G) 3-4 toxicities were mapped with cosinor and time*sex interactions confirmed with Fisher's exact test. Baseline characteristics of male or female patients were similar in the six treatment groups. Main grade 3-4 toxicities over six courses were diarrhea (males vs females, 39.2%; vs 46.0%), neutropenia (15.6% vs 15.0%), fatigue (11.5% vs 15.9%), and anorexia (10.0% vs 7.8%). They were reduced following irinotecan peak delivery in the morning for males, but in the afternoon for females, with statistically significant rhythms (P < .05 from cosinor) and sex*timing interactions (Fisher's exact test, diarrhea, P = .023; neutropenia, P = .015; fatigue, P = .062; anorexia, P = .032). Irinotecan timing was most critical for females, with grades 3-4 ranging from 55.2% of the patients (morning) to 29.4% (afternoon) for diarrhea, and from 25.9% (morning) to 0% (afternoon) for neutropenia. The study results support irinotecan administration in the morning for males and in the afternoon for females, in order to minimize adverse events without impairing efficacy.
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Affiliation(s)
- Pasquale F Innominato
- North Wales Cancer Centre, Betsi Cadwaladr University Health Board, Bangor, United Kingdom.,Division of Biomedical Sciences, Cancer Chronotherapy Team, Cancer Research Centre, Warwick Medical School, Coventry, United Kingdom.,UMRS 935, "Cancer Chronotherapy and Postoperative Liver Functions", French National Institute for Health and Medical Research (INSERM) and Paris-Sud University, Villejuif, France
| | - Annabelle Ballesta
- Division of Biomedical Sciences, Cancer Chronotherapy Team, Cancer Research Centre, Warwick Medical School, Coventry, United Kingdom.,UMRS 935, "Cancer Chronotherapy and Postoperative Liver Functions", French National Institute for Health and Medical Research (INSERM) and Paris-Sud University, Villejuif, France
| | - Qi Huang
- Division of Biomedical Sciences, Cancer Chronotherapy Team, Cancer Research Centre, Warwick Medical School, Coventry, United Kingdom.,Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Christian Focan
- Department of Oncology, Clinique Saint-Joseph, CHC-Liège Hospital Group, Liège, Belgium
| | - Philippe Chollet
- Clinical and Translational Research Division, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
| | | | - Sylvie Giacchetti
- UMRS 935, "Cancer Chronotherapy and Postoperative Liver Functions", French National Institute for Health and Medical Research (INSERM) and Paris-Sud University, Villejuif, France.,Department of Oncology, Saint Louis Hospital, Public Hospitals of Paris (AP-HP), Paris, France
| | - Mohamed Bouchahda
- UMRS 935, "Cancer Chronotherapy and Postoperative Liver Functions", French National Institute for Health and Medical Research (INSERM) and Paris-Sud University, Villejuif, France.,Mousseau Clinics, Evry, France.,Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
| | - René Adam
- UMRS 935, "Cancer Chronotherapy and Postoperative Liver Functions", French National Institute for Health and Medical Research (INSERM) and Paris-Sud University, Villejuif, France.,Hepatobiliary Centre, Paul Brousse Hospital, AP-HP, Villejuif, France
| | - Carlo Garufi
- Division of Medical Oncology, San Camillo Forlanini Hospital, Roma, Italy
| | - Francis A Lévi
- Division of Biomedical Sciences, Cancer Chronotherapy Team, Cancer Research Centre, Warwick Medical School, Coventry, United Kingdom.,UMRS 935, "Cancer Chronotherapy and Postoperative Liver Functions", French National Institute for Health and Medical Research (INSERM) and Paris-Sud University, Villejuif, France.,Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
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16
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Komarzynski S, Huang Q, Lévi FA, Palesh OG, Ulusakarya A, Bouchahda M, Haydar M, Wreglesworth NI, Morère JF, Adam R, Innominato PF. The day after: correlates of patient-reported outcomes with actigraphy-assessed sleep in cancer patients at home (inCASA project). Sleep 2019; 42:zsz146. [PMID: 31323086 PMCID: PMC7587155 DOI: 10.1093/sleep/zsz146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/26/2019] [Indexed: 12/23/2022] Open
Abstract
Subjective sleep assessment in cancer patients poorly correlates with actigraphy parameters that usually encompass multiple nights. We aimed to determine the objective actigraphy measures that best correlated with subjective sleep ratings on a night-by-night basis in cancer patients. Thirty-one cancer patients daily self-rated sleep disturbances using the single dedicated item of the MD Anderson Symptom Inventory (0-10 scale) with 18 other items, and continuously wore a wrist actigraph for 30 days. Objective sleep parameters were computed from the actigraphy nighttime series, and correlated with subjective sleep disturbances reported on the following day, using repeated measures correlations. Multilevel Poisson regression analysis was performed to identify the objective and subjective parameters that affected subjective sleep rating. Poor subjective sleep score was correlated with poor sleep efficiency (rrm = -0.13, p = 0.002) and large number of wake episodes (rrm = 0.12, p = 0.005) on the rated night. Multilevel analysis demonstrated that the expected sleep disturbance score was affected by the joint contribution of the wake episodes (exp(β) = 1.01, 95% confidence interval = 1.00 to 1.02, p = 0.016), fatigue (exp(β) = 1.35, 95% confidence interval = 1.15 to 1.55, p < 0.001) and drowsiness (exp(β) = 1.70, 95% confidence interval = 1.19 to 2.62, p = 0.018), self-rated the following evening, and sleep disturbance experienced one night before (exp(β) = 1.77, 95% confidence interval = 1.41 to 2.22, p < 0.001). The night-by-night approach within a multidimensional home tele-monitoring framework mainly identified the objective number of wake episodes computed from actigraphy records as the main determinant of the severity of sleep complaint in cancer patients on chemotherapy. This quantitative information remotely obtained in real time from cancer patients provides a novel framework for streamlining and evaluating interventions toward sleep improvement in cancer patients.
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Affiliation(s)
- Sandra Komarzynski
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, UK
- Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France
| | - Qi Huang
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, UK
- Cancer Chronotherapy Team, Department of Statistics, University of Warwick, Coventry, UK
| | - Francis A Lévi
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, UK
- Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France
- Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
| | - Oxana G Palesh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
- Stanford Cancer Institute, Stanford School of Medicine, Stanford, CA
| | - Ayhan Ulusakarya
- Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France
- Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
| | - Mohamed Bouchahda
- Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France
- Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
- Mousseau Clinics, Ramsay Générale de Santé, Evry, France
- Clinique St Jean, Melun, France
| | - Mazen Haydar
- Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
| | - Nicholas I Wreglesworth
- North Wales Cancer Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Jean-François Morère
- Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
- Faculty of Medicine, Paris South University, Le Kremlin-Bicêtre, France
| | - René Adam
- Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France
- Hepatobiliary Centre, Paul Brousse Hospital, Public Hospitals of Paris (AP-HP), Villejuif, France
| | - Pasquale F Innominato
- Cancer Chronotherapy Team, Cancer Research Centre, Division of Biomedical Sciences, Warwick Medical School, Coventry, UK
- Unit 935, French National Institute for Health and Medical Research (INSERM), Villejuif, France
- North Wales Cancer Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, UK
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17
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Technology-Based Interventions in the Pediatric Oncology Population. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Liao Y, Thompson C, Peterson S, Mandrola J, Beg MS. The Future of Wearable Technologies and Remote Monitoring in Health Care. Am Soc Clin Oncol Educ Book 2019; 39:115-121. [PMID: 31099626 DOI: 10.1200/edbk_238919] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mobile technology has become a ubiquitous part of everyday life and is changing the way we offer clinical care and perform clinical research. We have unprecedented access to data for one's self-care as well as for sharing with health care providers. Meeting the challenge posed by the influx of wearable device data requires a multidisciplinary team of researchers, clinicians, software developers, information technologists, and statisticians. Although the possibility of what can be achieved with the ever-evolving wearable technologies seems to be unlimited, regulatory agencies have provided a framework to establish standards for clinical applications, which will also affect research applications. Clinical programs and electronic medical records vendors should prepare to establish a framework to implement these technologies into clinicians' workflow and to allow feedback to measure the impact on clinical outcome. In this article, we discuss how a new brand of multidisciplinary care is evolving around mobile health devices and present a vision of up-and-coming technology in this space.
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Affiliation(s)
- Yue Liao
- 1 Division of Cancer Prevention and Population Sciences, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX
| | - Carrie Thompson
- 2 Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Susan Peterson
- 1 Division of Cancer Prevention and Population Sciences, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX
| | | | - Muhammad Shaalan Beg
- 4 Division of Hematology and Medical Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Bae JH, Ku B, Bae SE, Kim JU. Circadian variations in electric current responses at ryodoraku points across the waking stage: A prospective observational study. Medicine (Baltimore) 2019; 98:e14688. [PMID: 30817602 PMCID: PMC6831389 DOI: 10.1097/md.0000000000014688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Human body undergoes the 24-hour daily rhythm in response primarily to light and darkness. The circadian rhythms of biomarkers reflect bodily conditions including the prognosis of some pathologies. As a sensitive index of sympathetic nervous response (SNR), electrodermal activity (EDA) is a recent research topic in healthcare industry as a noninvasive and easy-access biosignal. The EDA response at Ryodoraku points (RPs) is of potential clinical usage in relation to SNR and meridian theory, but still remains in its primitive development stage.In this study, the 24-hour variations of EDA for 14 hospitalized participants were monitored over 3 days using a Ryodoraku device, and a circadian model of EDA was constructed using a cosinor analysis based on the linear mixed effect model.As a result, EDA at every RP showed a circadian cycle with its value the lowest in the morning and increased gradually until the late afternoon, and monotonically decreased again until the next morning. Circadian variations were observed in EDAs of all 12 RPs. However, Ryodoraku-specific features were not detected. Midline estimating statistic of rhythm (MESOR) values in men and young group were higher than in women and old group, and cosinor analysis showed significant circadian rhythms, especially for men and young groups. Especially, circadian variation in EDA in the young group went above 35% of the MESOR value.It implies that the circadian rhythm should be considered for the Ryodoraku analysis to examine bodily conditions or the prognosis of some pathologies.
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General Architecture for Development of Virtual Coaches for Healthy Habits Monitoring and Encouragement. SENSORS 2018; 19:s19010108. [PMID: 30598011 PMCID: PMC6339204 DOI: 10.3390/s19010108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/06/2018] [Accepted: 12/22/2018] [Indexed: 12/26/2022]
Abstract
Good health is the result of a healthy lifestyle, where caring about physical activity and nutrition are key concerns. However, in today’s society, nutritional disorders are becoming increasingly frequent, affecting children, adults, and elderly people, mainly due to limited nutrition knowledge and the lack of a healthy lifestyle. A commonly adopted therapy to these imbalances is to monitor physical activity and daily habits, such as recording exercise or creating custom meal plans to count the amount of macronutrients and micronutrients acquired in each meal. Nowadays, many health tracking applications (HTA) have been developed that, for instance, record energy intake as well as users’ physiological parameters, or measure the physical activity during the day. However, most existing HTA do not have a uniform architectural design on top of which to build other applications and services. In this manuscript, we present system architecture intended to serve as a reference architecture for building HTA solutions. In order to validate the proposed architecture, we performed a preliminary evaluation with 15 well recognized experts in systems and software architecture from different entities around world and who have estimated that our proposal can generate architecture for HTA that is adequate, reliable, secure, modifiable, portable, functional, and with high conceptual integrity. In order to show the applicability of the architecture in different HTA, we developed two telemonitoring systems based on it, targeted to different tasks: nutritional coaching (Food4Living) and physical exercise coaching (TrainME). The purpose was to illustrate the kind of end-user monitoring applications that could be developed.
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Komarzynski S, Huang Q, Innominato PF, Maurice M, Arbaud A, Beau J, Bouchahda M, Ulusakarya A, Beaumatin N, Breda G, Finkenstädt B, Lévi F. Relevance of a Mobile Internet Platform for Capturing Inter- and Intrasubject Variabilities in Circadian Coordination During Daily Routine: Pilot Study. J Med Internet Res 2018; 20:e204. [PMID: 29704408 PMCID: PMC6018238 DOI: 10.2196/jmir.9779] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 12/14/2022] Open
Abstract
Background Experimental and epidemiologic studies have shown that circadian clocks’ disruption can play an important role in the development of cancer and metabolic diseases. The cellular clocks outside the brain are effectively coordinated by the body temperature rhythm. We hypothesized that concurrent measurements of body temperature and rest-activity rhythms would assess circadian clocks coordination in individual patients, thus enabling the integration of biological rhythms into precision medicine. Objective The objective was to evaluate the circadian clocks’ coordination in healthy subjects and patients through simultaneous measurements of rest-activity and body temperature rhythms. Methods Noninvasive real-time measurements of rest-activity and chest temperature rhythms were recorded during the subject’s daily life, using a dedicated new mobile electronic health platform (PiCADo). It involved a chest sensor that jointly measured accelerations, 3D orientation, and skin surface temperature every 1-5 min and relayed them out to a mobile gateway via Bluetooth Low Energy. The gateway tele-transmitted all stored data to a server via General Packet Radio Service every 24 hours. The technical capabilities of PiCADo were validated in 55 healthy subjects and 12 cancer patients, whose rhythms were e-monitored during their daily routine for 3-30 days. Spectral analyses enabled to compute rhythm parameters values, with their 90% confidence limits, and their dynamics in each subject. Results All the individuals displayed a dominant circadian rhythm in activity with maxima occurring from 12:09 to 20:25. This was not the case for the dominant temperature period, which clustered around 24 hours for 51 out of 67 subjects (76%), and around 12 hours for 13 others (19%). Statistically significant sex- and age-related differences in circadian coordination were identified in the noncancerous subjects, based upon the range of variations in temperature rhythm amplitudes, maxima (acrophases), and phase relations with rest-activity. The circadian acrophase of chest temperature was located at night for the majority of people, but it occurred at daytime for 26% (14/55) of the noncancerous people and 33% (4/12) of the cancer patients, thus supporting important intersubject differences in circadian coordination. Sex, age, and cancer significantly impacted the circadian coordination of both rhythms, based on their phase relationships. Conclusions Complementing rest-activity with chest temperature circadian e-monitoring revealed striking intersubject differences regarding human circadian clocks’ coordination and timing during daily routine. To further delineate the clinical importance of such finding, the PiCADo platform is currently applied for both the assessment of health effects resulting from atypical work schedules and the identification of the key determinants of circadian disruption in cancer patients.
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Affiliation(s)
- Sandra Komarzynski
- Cancer Chronotherapy Team, School of Medicine, University of Warwick, Coventry, United Kingdom.,European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Qi Huang
- Cancer Chronotherapy Team, School of Medicine, University of Warwick, Coventry, United Kingdom.,Cancer Chronotherapy Team, Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Pasquale F Innominato
- Cancer Chronotherapy Team, School of Medicine, University of Warwick, Coventry, United Kingdom.,European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France.,Department of Oncology, North Wales Cancer Treatment Centre, Bodelwyddan, United Kingdom
| | - Monique Maurice
- Cancer Chronotherapy Team, School of Medicine, University of Warwick, Coventry, United Kingdom.,European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Alexandre Arbaud
- European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Jacques Beau
- European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France
| | - Mohamed Bouchahda
- European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France.,Department of Oncology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Ayhan Ulusakarya
- European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France.,Department of Oncology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | | | | | - Bärbel Finkenstädt
- European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France.,Cancer Chronotherapy Team, Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Francis Lévi
- Cancer Chronotherapy Team, School of Medicine, University of Warwick, Coventry, United Kingdom.,European Associated Laboratory of the Unité Mixte de Recherche Scientifique 935, Institut National de la Santé et de la Recherche Médicale, Villejuif, France.,Department of Oncology, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, Villejuif, France
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