Circadian function in patients with advanced non-small-cell lung cancer

Abstract

This study aimed to evaluate whether patients with advanced non-small-cell lung cancer experience disrupted rest -activity daily rhythms, poor sleep quality, weakness, and maintain attributes that are linked to circadian function such as fatigue. This report describes the rest -activity patterns of 33 non-small-cell lung cancer patients who participated in a randomised clinical trial evaluating the benefits of melatonin. Data are reported on circadian function, health-related quality of life (QoL), subjective sleep quality, and anxiety/depression levels prior to randomisation and treatment. Actigraphy data, an objective measure of circadian function, demonstrated that patients' rest -activity circadian function differs significantly from control subjects. Our patients reported poor sleep quality and high levels of fatigue. Ferrans and Powers QoL Index instrument found a high level of dissatisfaction with healthrelated QoL. Data from the European Organization for Research and Treatment for Cancer reported poor capacity to fulfil the activities of daily living. Patients studied in the hospital during or near chemotherapy had significantly more abnormal circadian function than those studied in the ambulatory setting. Our data indicate that measurement of circadian sleep/activity dynamics should be accomplished in the outpatient/home setting for a minimum of 4 -7 circadian cycles to assure that they are most representative of the patients' true condition. We conclude that the daily sleep/activity patterns of patients with advanced lung cancer are disturbed. These are accompanied by marked disruption of QoL and function. These data argue for investigating how much of this poor functioning and QoL are actually caused by this circadian disruption, and, whether behavioural, light-based, and or pharmacologic strategies to correct the circadian/sleep activity patterns can improve function and QoL.

Daily Physical-Rest Activities in Relation to Nutritional State, Metabolism, and Quality of Life in Cancer Patients with Progressive Cachexia

“…Earlier actigraph studies have reported abnormal circadian function in hospitalized cancer patients on chemotherapy when compared with outpatients in their home setting (29,43). Such investigations showed that daily sleep patterns were disturbed and translated into disruption of quality of life in patients with advanced lung cancer (43). Also, cancer-related fatigue in relapse-free patients with previous hematologic malignancies and depressed mood was related to decreased physical activity, rather than to anemia, endocrine, and immunologic alterations (39).…”

“…Many of these oscillating circuits are characterized by circadian periods and their synchronization integrates the many physiologic and behavioral processes required to meet the challenge of daily life (36,42). Earlier actigraph studies have reported abnormal circadian function in hospitalized cancer patients on chemotherapy when compared with outpatients in their home setting (29,43). Such investigations showed that daily sleep patterns were disturbed and translated into disruption of quality of life in patients with advanced lung cancer (43).…”

Mechanisms of Cancer-Related Fatigue

“…These include changes in endocrine rhythms (e.g., cortisol, melatonin, and prolactin secretion), metabolic processes (e.g., temperature and circulating protein levels), the immune system (e.g., levels of circulating leukocytes and neutrophils), and rest-activity patterns [73,[82][83][84][85][86][87][88][89]. Types of rhythm alteration include diminished amplitude, phase shifts, period changes, and erratic peaks and troughs.…”

Circadian Clock Manipulation for Cancer Prevention and Control and the Relief of Cancer Symptoms

“…Table 1 summarizes the actigraphy data during putative daily wake spans and compares 33 cancer patients with a reference population of 35 normal adults. 72 These control data were obtained from a heterogeneous group of 35 adults who were 20 to 50 years old, who wore actigraphs for 3 days on the average, and had no known disease or chronic condition. We found that in all parameters, cancer patients were significantly different from the reference population.…”