title: Late chronotypes are associated with neoadjuvant chemotherapy-induced nausea and vomiting in women with breast cancer.
abstract: Neoadjuvant chemotherapy, that is, the administration of chemotherapy before surgery, has been commonly used for locally advanced breast cancer to improve the surgical outcomes and increase the opportunity for breast-conserving therapy. Women with breast cancer often receive an anthracycline-based regimen as the neoadjuvant chemotherapy, which is associated with a high risk of emesis. Despite the development of novel antiemetics, chemotherapy-induced nausea and vomiting (CINV) has been commonly reported as a major adverse effect, affecting the quality of life of the patients. However, the factors predicting CINV in women with breast cancer undergoing neoadjuvant chemotherapy remain unclear. In this single-institution, prospective, observational study conducted at an outpatient cancer centre in the Republic of Korea from November 2013 to March 2016, we analysed women with breast cancer who planned to be treated with neoadjuvant chemotherapy before surgery. Candidate factors associated with CINV were assessed before neoadjuvant chemotherapy using the Munich Chronotype Questionnaire, Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale. CINV was assessed after chemotherapy by using the Multinational Association of Supportive Care in Cancer Antiemesis Tool. Of a total of 143 participants, 7 patients were lost to follow-up and 2 patients were excluded due to changes in their treatment plan; thus, 134 patients were finally included in the analyses. Overall, 48.5% of the participants experienced CINV, with delayed CINV prevalence (42.5%) being more common than acute (39.6%). In the univariate analyses, overall CINV was significantly associated with late chronotypes (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.37-8.87; p = 0.009), a history of nausea/vomiting (OR, 2.19; 95% CI, 1.10-4.37; p = 0.026) and anxiety (OR, 2.25; 95% CI, 1.05-4.81; p = 0.036). In the multivariate analyses, late chronotypes (OR, 3.53; 95% CI, 1.27-9.79; p = 0.015) and a history of nausea/vomiting (OR, 2.83; 95% CI, 1.31-6.13; p = 0.008) remained significantly associated with CINV. In conclusion, in women with breast cancer undergoing neoadjuvant chemotherapy before surgery, late chronotypes were found to have an increased risk of CINV; these data suggest that clinicians need to assess and consider the chronotype in the management of CINV.
authors.affiliation: a Department of Psychiatry and Behavioral Sciences , Seoul National University College of Medicine , Seoul , Korea.|b Public Health Medical Service, Seoul National University Hospital , Seoul , Korea.|c Department of Psychiatry , Gyeonggi Provincial Medical Center Uijeongbu Hospital , Uijeongbu , Korea.
authors.forename: Kwang-Min
authors.initials: KM
authors.lastname: Lee
authors.affiliation: d Department of Human Factors Engineering , Ulsan National Institute of Science and Technology , Ulsan , Korea.
authors.forename: Doo-Young
authors.initials: DY
authors.lastname: Jung
authors.affiliation: e Department of Neuropsychiatry , Seoul National University Hospital , Seoul , Korea.
authors.forename: Heesung
authors.initials: H
authors.lastname: Hwang
authors.affiliation: f Department of Psychiatry , Inha University Hospital , Incheon , Korea.
authors.forename: Won-Hyoung
authors.initials: WH
authors.lastname: Kim
authors.affiliation: g Department of Health Management , Armed Forces Medical Command , Seongnam , Korea.
authors.forename: Joo-Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: h Department of Internal Medicine , Seoul National University Hospital , Seoul , Korea.|i Cancer Research Institute, Seoul National University , Seoul , Korea.
authors.forename: Tae-Yong
authors.initials: TY
authors.lastname: Kim
authors.affiliation: h Department of Internal Medicine , Seoul National University Hospital , Seoul , Korea.|i Cancer Research Institute, Seoul National University , Seoul , Korea.|j Department of Internal Medicine , Seoul National University College of Medicine , Seoul , Korea.
authors.forename: Seock-Ah
authors.initials: SA
authors.lastname: Im
authors.affiliation: h Department of Internal Medicine , Seoul National University Hospital , Seoul , Korea.|i Cancer Research Institute, Seoul National University , Seoul , Korea.
authors.forename: Kyung-Hun
authors.initials: KH
authors.lastname: Lee
authors.affiliation: k Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , CA , USA.
authors.forename: David
authors.initials: D
authors.lastname: Spiegel
authors.affiliation: a Department of Psychiatry and Behavioral Sciences , Seoul National University College of Medicine , Seoul , Korea.|e Department of Neuropsychiatry , Seoul National University Hospital , Seoul , Korea.
authors.forename: Bong-Jin
authors.initials: BJ
authors.lastname: Hahm
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000628:therapy*; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced*; D020360:Neoadjuvant Therapy / Q000009:adverse effects*; D011446:Prospective Studies; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000209:etiology; D014839:Vomiting / Q000139:chemically induced*
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; chemotherapy-induced; chronotype; nausea and vomiting; neoadjuvant chemotherapy