title: Actigraphic assessment of daily sleep-activity pattern abnormalities reflects self-assessed depression and anxiety in outpatients with advanced non-small cell lung cancer.
abstract: OBJECTIVE
  We measured subjectively evaluated depression and anxiety, and objectively measured daily sleep-activity patterns in inpatients and outpatients with advanced non-small cell lung cancer (NSCLC) and determined whether cancer-associated depression and anxiety are accompanied by characteristic circadian rhythm abnormalities.
  
  
  METHODS
  Equal numbers of inpatients (n=42) and outpatients (n=42) with advanced NSCLC were studied. Baseline depression and anxiety, assessed by the Hospital Anxiety and Depression Scale (HADS), and actigraphy were recorded before chemotherapy initiation. The effects of the presence and severity of chronic obstructive pulmonary disease (COPD) on depression, anxiety, and actigraphy were assessed only among the 42 outpatients.
  
  
  RESULTS
  Anxiety occurred in 40% and depression in 25% of these lung cancer patients, equally among inpatients and outpatients. All patients suffer extremely disturbed daily sleep-activity cycles but each patient also maintains some degree of circadian organization. Outpatients maintain more robust daily activity patterns and longer, more consolidated nighttime sleep compared with inpatients. The more disrupted the daily sleep-activity rhythm, the worse the depression and/or anxiety scores for outpatients. These relationships are obscured among inpatients. COPD has no independent measurable effects on the daily organization of sleep-activity, depression, or anxiety.
  
  
  CONCLUSIONS
  Lung cancer patients whose diurnal activity is disturbed by prolonged and frequent sedentary episodes and whose sleep is disturbed by frequent and prolonged waking are most anxious and depressed. These findings and relationships are masked by hospitalization. Since diurnal exercise improves both sleep and mood, it is reasonable to test whether enhancing daytime activity and nighttime sleep can diminish cancer-associated depression.
authors.affiliation: Medical Chronobiological Laboratory, WJB Dorn Veterans Affairs Medical Center, Columbia, SC 29209, USA.
authors.forename: Jovelyn
authors.initials: J
authors.lastname: Du-Quiton
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Wood
authors.forename: James B
authors.initials: JB
authors.lastname: Burch
authors.forename: James F
authors.initials: JF
authors.lastname: Grutsch
authors.forename: Digant
authors.initials: D
authors.lastname: Gupta
authors.forename: Kevin
authors.initials: K
authors.lastname: Tyer
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Lis
authors.forename: Robert D
authors.initials: RD
authors.lastname: Levin
authors.forename: Dinah Faith T
authors.initials: DF
authors.lastname: Quiton
authors.forename: Justin L
authors.initials: JL
authors.lastname: Reynolds
authors.forename: William J M
authors.initials: WJ
authors.lastname: Hrushesky
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D021081:Chronobiology Disorders / Q000175:diagnosis / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017286:Polysomnography; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000453:epidemiology