Comparison Between Fatigue, Sleep Disturbance, and Circadian Rhythm in Cancer Inpatients and Healthy Volunteers: Evaluation of Diagnostic Criteria for Cancer-Related Fatigue

Abstract

The aim of this study was to evaluate whether diagnostic criteria for cancer-related fatigue syndrome (CRFS) could be rigorously applied to cancer inpatients, and to explore the relationship between subjective fatigue and objective measures of physical activity, sleep, and circadian rhythm. Female cancer patients (n=25) and a comparison group of subjects without cancer (n=25) were studied. Study participants completed a structured interview for CRFS and questionnaires relating to fatigue, psychological symptoms, and quality of life (QoL). Wrist actigraphs worn for 72 hours were used as an objective measure of activity, sleep, and circadian rhythm. Compared to controls, cancer patients were more fatigued, had worse sleep quality, more disrupted circadian rhythms, lower daytime activity levels, and worse QoL. After exclusion of subjects with "probable" mood disorders, the prevalence of CRFS was 56%. Fatigue severity among the cancer patients was significantly correlated with low QoL, depression, constipation, and decreased self-reported physical functioning. It can be concluded that the diagnostic criteria for CRFS can be applied to cancer inpatients but strict application requires a rigorous assessment of psychiatric comorbidity. Despite cancer inpatients having greater impairments of sleep and circadian rhythm, it was found that fatigue severity did not appear to be related to these impairments.

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

“…The consistent relationships found between higher circadian activity rhythm parameters and lower fatigue during treatments support previous studies [5,6,8,21]. These results add to evidence-based guidelines supporting activity interventions for cancer-related fatigue [27,28].…”

“…Twenty-four autocorrelation coefficient Early stage breast cancer patients receiving adjuvant chemotherapy and hospitalized patients with mixed diagnoses were found to have lower 24-h autocorrelations than healthy adults [21,39]. Lower 24-h autocorrelation has been linked to higher fatigue [21] and to depression [39].…”

Circadian rhythms measured by actigraphy during oncological treatments: a systematic review

“…The idea of using locomotor rest-activity to characterize circadian rhythm was derived from animal studies, where SCN abolishment, chronic jet lag exposure, or external de-synchronization led to suppression of this rest-activity rhythm (Filipski & Levi 2009). Actigraphy is a noninvasive method that has proven to be low-cost, ease of use, non-intrusive to the patient, and at same time capable of long-term monitoring; in addition, it also provides sleep data (Ancoli-Israel et al 2003;Littner et al 2003;Ancoli-Israel et al 2006;Fernandes et al 2006). This method, however, is challenged when patients are traveling in a moving vehicle or sleeping with a partner (due to movement masking).…”

Circadian Disruption, Fatigue, and Anorexia Clustering in Advanced Cancer Patients: Implications for Innovative Therapeutic Approaches

“…Table 1 summarizes the data for 1129 cancer patients for whom actigraphy data were correlated with data from fatigue questionnaires. 13,14,[49][50][51][52][53][54][55][56][57][58][59][60][61] In 2 out of 13 studies, no significant correlation between actigraphy parameters and fatigue was described. 56.61 In the remaining 11 studies, performed in patients with different types of cancer, using different actigraphy devices and different fatigue scales, the degree of fatigue was found to be associated with circadian disruption, poor sleep, or lower daytime physical activity.…”