Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status
Mc. Mormont et al., Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status, CLIN CANC R, 6(8), 2000, pp. 3038-3045
The rest/activity circadian cycle has been used as a reference for chemothe
rapy administration at specific times to improve tolerability and efficacy,
Because cancer processes may be associated with alterations of circadian r
hythms, the rest/activity cycle was monitored noninvasively to assess its r
elationship with tumor response, survival, and quality of life in 200 patie
nts with metastatic colorectal cancer. Patients wore an actigraph, a wristw
atch that records the number of accelerations per minute, for 3 days before
receiving chronomodulated chemotherapy, The circadian rhythms in activity
were estimated by two robust parameters: the autocorrelation coefficient at
24 h (r24), and the dichotomy index (I<O) for comparing amounts of activit
y when in bed and out of bed. Accurate data for inclusion, quality of life,
response, and survival were available for 192 patients. Survival at 2 year
s was 5-fold higher (P = 10(-4)) in patients with marked activity rhythm (I
<O in upper quartile) than in those with rhythm alteration (I<O in lower qu
artile), These results were supported by the multivariate Cox analysis. Mul
tivariate regression analysis showed that circadian rhythms in activity (I<
O; P = 3 x 10(-4)) and in WBCs (P = 0.03) as well as performance status (P
= 0.02) were jointly prognostic of response, Patients with marked rest/acti
vity rhythms also had better quality of life and reported significantly les
s fatigue. The individual rest/activity cycle provides a novel independent
prognostic factor for cancer patients' survival and tumor response as well
as a quantitative indicator for quality of life.