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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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Innominato PF, Komarzynski S, Mohammad-Djafari A, Arbaud A, Ulusakarya A, Bouchahda M, Haydar M, Bossevot-Desmaris R, Plessis V, Mocquery M, Bouchoucha D, Afshar M, Beau J, Karaboué A, Morère JF, Fursse J, Rovira Simon J, Levi F. Clinical Relevance of the First Domomedicine Platform Securing Multidrug Chronotherapy Delivery in Metastatic Cancer Patients at Home: The inCASA European Project. J Med Internet Res 2016; 18:e305. [PMID: 27888171 PMCID: PMC5148811 DOI: 10.2196/jmir.6303] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/07/2016] [Accepted: 09/20/2016] [Indexed: 01/20/2023] Open
Abstract
Background Telehealth solutions can improve the safety of ambulatory chemotherapy, contributing to the maintenance of patients at their home, hence improving their well-being, all the while reducing health care costs. There is, however, need for a practicable multilevel monitoring solution, encompassing relevant outputs involved in the pathophysiology of chemotherapy-induced toxicity. Domomedicine embraces the delivery of complex care and medical procedures at the patient’s home based on modern technologies, and thus it offers an integrated approach for increasing the safety of cancer patients on chemotherapy. Objective The objective was to evaluate patient compliance and clinical relevance of a novel integrated multiparametric telemonitoring domomedicine platform in cancer patients receiving multidrug chemotherapy at home. Methods Self-measured body weight, self-rated symptoms using the 19-item MD Anderson Symptom Inventory (MDASI), and circadian rest-activity rhythm recording with a wrist accelerometer (actigraph) were transmitted daily by patients to a server via the Internet, using a dedicated platform installed at home. Daily body weight changes, individual MDASI scores, and relative percentage of activity in-bed versus out-of-bed (I<O) were computed. Chemotherapy was administered according to the patient medical condition. Compliance was evaluated according to the proportions of (1) patient-days with all data available (full) and (2) patient-days with at least one parameter available (minimal). Acceptability was assessed using the Whole Systems Demonstrator Service User Technology Acceptability Questionnaire. Linear discriminant analysis was used to identify the combination of parameters associated with subsequent unplanned hospitalization. Results A total of 31 patients (males: 55% [17/31]; World Health Organization Performance Status=0: 29% (9/31); age range: 35-91 years) participated for a median of 58 days (38-313). They received a total of 102 chemotherapy courses (64.7% as outpatients). Overall full compliance was 59.7% (522/874), with at least one data available for 830/874 patient-days (95.0%), during the 30-day per-protocol span. Missing data rates were similar for each parameter. Patients were altogether satisfied with the use of the platform. Ten toxicity-related hospitalizations occurred in 6 patients. The combination of weighted circadian function (actigraphy parameter I<O), body weight change, and MDASI scores predicted for ensuing emergency hospitalization within 3 days, with an accuracy of 94%. Conclusions Multidimensional daily telemonitoring of body weight, circadian rest-activity rhythm, and patient-reported symptoms was feasible, satisfactory, and clinically relevant in patients on chemotherapy. This domomedicine platform constitutes a unique tool for the further development of safe home-based chemotherapy administration.
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Affiliation(s)
- Pasquale F Innominato
- Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Coventry, United Kingdom.,Department of Oncology, Queen Elizabeth Hospital, Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom.,French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France
| | - Sandra Komarzynski
- Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Coventry, United Kingdom.,French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France
| | | | - Alexandre Arbaud
- French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France
| | - Ayhan Ulusakarya
- French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.,Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France
| | - Mohamed Bouchahda
- French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.,Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.,Ramsay Générale de Santé, Mousseau Clinics, Evry, France
| | - Mazen Haydar
- Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France
| | - Rachel Bossevot-Desmaris
- Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France
| | - Virginie Plessis
- Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France
| | - Magali Mocquery
- Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France
| | - Davina Bouchoucha
- Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France
| | - Mehran Afshar
- St Georges Hospital, National Health Service Foundation Trust, London, United Kingdom
| | - Jacques Beau
- French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France
| | - Abdoulaye Karaboué
- French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.,AK-SCIENCE, Research and Therapeutic Innovation, Vitry-sur-Seine, France
| | - Jean-François Morère
- Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France.,Faculty of Medicine, Paris South University, Le Kremlin-Bicêtre, France
| | - Joanna Fursse
- Chorleywood Health Centre, Chorleywood, United Kingdom
| | | | - Francis Levi
- Cancer Chronotherapy Unit, Cancer Research Centre, Warwick Medical School, Coventry, United Kingdom.,Department of Oncology, Queen Elizabeth Hospital, Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom.,French National Institute for Health and Medical Research (INSERM), Unit 935, Villejuif, France.,Public Hospitals of Paris (AP-HP), Chronotherapy Unit, Department of Medical Oncology, Paul Brousse Hospital, Villejuif, France
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