title: The association of quality of life with potentially remediable disruptions of circadian sleep/activity rhythms in patients with advanced lung cancer.
abstract: BACKGROUND
  Cancer patients routinely develop symptoms consistent with profound circadian disruption, which causes circadian disruption diminished quality of life. This study was initiated to determine the relationship between the severity of potentially remediable cancer-associated circadian disruption and quality of life among patients with advanced lung cancer.
  
  
  METHODS
  We concurrently investigated the relationship between the circadian rhythms of 84 advanced lung cancer patients and their quality of life outcomes as measured by the EORTC QLQ C30 and Ferrans and Powers QLI. The robustness and stability of activity/sleep circadian daily rhythms were measured by actigraphy. Fifty three of the patients in the study were starting their definitive therapy following diagnosis and thirty one patients were beginning second-line therapy. Among the patients who failed prior therapy, the median time between completing definitive therapy and baseline actigraphy was 4.3 months, (interquartile range 2.1 to 9.8 months).
  
  
  RESULTS
  We found that circadian disruption is universal and severe among these patients compared to non-cancer-bearing individuals. We found that each of these patient's EORTC QLQ C30 domain scores revealed a compromised capacity to perform the routine activities of daily life. The severity of several, but not all, EORTC QLQ C30 symptom items correlate strongly with the degree of individual circadian disruption. In addition, the scores of all four Ferrans/Powers QLI domains correlate strongly with the degree of circadian disruption. Although Ferrans/Powers QLI domain scores show that cancer and its treatment spared these patients' emotional and psychological health, the QLI Health/Function domain score revealed high levels of patients' dissatisfaction with their health which is much worse when circadian disruption is severe. Circadian disruption selectively affects specific Quality of Life domains, such as the Ferrans/Powers Health/Function domain, and not others, such as EORTC QLQ C30 Physical Domain.
  
  
  CONCLUSIONS
  These data suggest the testable possibility that behavioral, hormonal and/or light-based strategies to improve circadian organization may help patients suffering from advanced lung cancer to feel and function better.
authors: Cancer Treatment Centers of America® at Midwestern Regional Medical Center, Zion, IL 60099, USA.
authors: James F
authors: JF
authors: Grutsch
authors: Carol
authors: C
authors: Ferrans
authors: Patricia A
authors: PA
authors: Wood
authors: Jovelyn
authors: J
authors: Du-Quiton
authors: Dinah Faith T
authors: DF
authors: Quiton
authors: Justin L
authors: JL
authors: Reynolds
authors: Christine M
authors: CM
authors: Ansell
authors: Eun Young
authors: EY
authors: Oh
authors: Mary Ann
authors: MA
authors: Daehler
authors: Robert D
authors: RD
authors: Levin
authors: Donald P
authors: DP
authors: Braun
authors: Digant
authors: D
authors: Gupta
authors: Christopher G
authors: CG
authors: Lis
authors: William J M
authors: WJ
authors: Hrushesky
references: Soc Sci Med. 2002 May;54(9):1309-21
references: 12058848
references: J Pain Symptom Manage. 2007 Apr;33(4):398-409
references: 17397701
references: J Clin Oncol. 1998 Mar;16(3):1188-96
references: 9508207
references: J Support Oncol. 2007 Apr;5(4):167-74; discussion 176-7
references: 17500504
references: Sleep. 2007 Dec;30(12):1659-66
references: 18246975
references: J Natl Cancer Inst. 1993 Mar 3;85(5):365-76
references: 8433390
references: Psychoneuroendocrinology. 1976;1(3):265-79
references: 792940
references: J Pineal Res. 2009 Apr;46(3):245-7
references: 19215573
references: Psychiatry Res. 1989 Jun;28(3):263-78
references: 2762432
references: Am J Physiol. 1998 Dec;275(6):H2334-7
references: 9843836
references: J Natl Cancer Inst Monogr. 2007;(37):22-6
references: 17951227
references: Oncologist. 2002;7(2):120-5
references: 11961195
references: Cancer. 2003 Jun 1;97(11):2919-25
references: 12767108
references: Support Care Cancer. 2006 Aug;14(8):831-6
references: 16482450
references: Sleep. 1997 Jan;20(1):24-7
references: 9130330
references: Neuropsychopharmacology. 1991 Sep;5(2):115-26
references: 1930614
references: Cell Cycle. 2008 Feb 15;7(4):453-7
references: 18235232
references: Sleep. 2003 May 1;26(3):342-92
references: 12749557
references: Sleep. 1996 Nov;19(9):739-43
references: 9122562
references: Endocrinology. 2007 Dec;148(12):5640-7
references: 17901227
references: Br J Cancer. 2005 Nov 28;93(11):1202-8
references: 16265345
references: Med Care. 1996 Jun;34(6):610-23
references: 8656726
references: Science. 1965 Jun 11;148(3676):1427-32
references: 14294139
references: Br Med J. 1977 Dec 10;2(6101):1521-2
references: 589313
references: Nature. 2002 May 16;417(6886):329-35
references: 12015613
references: J Soc Integr Oncol. 2008 Winter;6(1):13-8
references: 18302906
references: J Clin Oncol. 2007 Jun 1;25(16):e17-9
references: 17538154
references: J Psychosom Res. 2002 Jun;52(6):439-43
references: 12069867
references: Chronobiol Int. 2002 Jan;19(1):313-23
references: 11962684
references: Sleep. 1994 Apr;17(3):201-7
references: 7939118
references: Support Care Cancer. 2006 Mar;14(3):201-9
references: 16010529
references: J Pain Symptom Manage. 2004 Feb;27(2):140-8
references: 15157038
references: Int J Chronobiol. 1975;3(1):19-55
references: 1193771
references: EMBO Rep. 2008 Nov;9(11):1070-3
references: 18978807
references: PLoS One. 2008 Apr 30;3(4):e2050
references: 18446212
references: Clin Cancer Res. 2005 Mar 1;11(5):1757-64
references: 15755997
references: Sleep. 1992 Oct;15(5):461-9
references: 1455130
references: Mol Carcinog. 2008 Dec;47(12):925-33
references: 18444243
references: Science. 1985 Apr 5;228(4695):73-5
references: 3883493
references: Clin Cancer Res. 2000 Aug;6(8):3038-45
references: 10955782
references: Br Med J. 1977 Dec 10;2(6101):1503-6
references: 589305
references: Pathol Biol (Paris). 2003 Jun;51(4):216-9
references: 12852994
references: Cold Spring Harb Symp Quant Biol. 1960;25:289-310
references: 13710673
references: Curr Biol. 2008 Sep 9;18(17):R784-R794
references: 18786384
references: J Natl Cancer Inst. 2000 Jun 21;92(12):994-1000
references: 10861311
references: Crit Care Clin. 2008 Jul;24(3):461-76, v-vi
references: 18538195
references: Lung Cancer. 2007 Oct;58(1):139-43
references: 17614157
references: Sleep. 2007 Jun;30(6):737-42
references: 17580595
references: Support Care Cancer. 2004 May;12(5):355-9
references: 15064937
references: Physiol Genomics. 2007 Nov 14;31(3):441-57
references: 17698924