Sultan Armiya, Choudhary Vivek, Parganiha Arti
a Chronobiology and Animal Behavior Laboratory, School of Life Sciences , Pt. Ravishankar Shukla University , Raipur , Chhattisgarh , India.
c Regional Cancer Center, Pt. Jawaharlal Nehru Medical College , Dr. B.R. Ambedkar Memorial Hospital , Raipur , Chhattisgarh , India.
Chronobiol Int. 2017;34(5):609-623. doi: 10.1080/07420528.2017.1286501. Epub 2017 Feb 16.
Chemotherapy and its associated side effects can induce the disruption of circadian rest-activity rhythm and may have negative consequences on health-related quality of life (HRQoL) of cancer patients. In the current study, repeated-measures cross-sectional design was implemented to determine the status of circadian rest-activity rhythm and to assess the HRQoL of newly diagnosed female breast cancer patients those were planned to receive six cycles of chemotherapy. Rest activity and HRQoL were assessed in twenty-five patients during chemotherapy cycles 1st (C1), 3rd (C3), and 6th (C6) immediately after they reported to the outdoor ward of the Regional Cancer Center, Pt. J.N.M. Medical College, Dr. B.R. Ambedkar Memorial Hospital, Raipur, India. Wrist actigraphs for consecutive spans of 3-4 days were used to record the rest-activity rhythm, and its parameters were computed with the help of Cosinor Rhythmometry. Quality of life (QoL) parameters were assessed using EORTC QLQ-C30 and QLQ-BR23. Results revealed that average scores of all rhythm parameters, such as MESOR, amplitude, acrophase, rhythm quotient, circadian quotient, peak activity, dichotomy index, and autocorrelation coefficient; and all functional scales of QLQ-C30, such as physical, role, emotional, cognitive, and social, and global quality of life statistically significantly decreased with the increasing number of chemotherapy cycles (C1 to C3 and C6). Scores of symptom scales of QLQ-C30, such as fatigue, pain, dyspnoea, insomnia, appetite loss, and diarrhea increased significantly from C1 to C6. Among the QLQ-BR23 scales, scores of sexual functioning, sexual enjoyment, breast symptoms, and arm symptoms significantly decreased, whereas scores of systemic therapy side effects, and upset by hair loss significantly increased across the chemotherapy cycles. We conclude that rest-activity rhythm disrupted and HRQoL of breast cancer patients worsened along the increasing number of chemotherapy cycles. We suggest that along with the treatment protocol, level of disruption of these parameters should be assessed and managed with the proper interventions that prominently include timing of the chemotherapy administration. The latter is pivotal for maintenance of these parameters, which are likely to enhance the physiological ability of patients for better treatment responses and may improve the overall QoL and survival of the patients.
化疗及其相关副作用可导致昼夜休息 - 活动节律紊乱，并可能对癌症患者的健康相关生活质量（HRQoL）产生负面影响。在本研究中，采用重复测量横断面设计来确定昼夜休息 - 活动节律状态，并评估计划接受六个周期化疗的新诊断女性乳腺癌患者的HRQoL。在印度赖布尔市贾瓦哈拉尔·尼赫鲁医学院附属B.R. 安贝德卡尔纪念医院区域癌症中心户外病房报到后，对25例患者在化疗第1周期（C1）、第3周期（C3）和第6周期（C6）时的休息活动和HRQoL进行了评估。使用连续3 - 4天的手腕活动记录仪记录休息 - 活动节律，并借助余弦节律分析法计算其参数。使用欧洲癌症研究与治疗组织QLQ - C30和QLQ - BR23评估生活质量（QoL）参数。结果显示，随着化疗周期数（从C1到C3和C6）的增加，所有节律参数的平均得分，如中值（MESOR）、振幅、峰相位、节律商、昼夜商、峰值活动、二分指数和自相关系数；以及QLQ - C30的所有功能量表得分，如身体、角色、情感、认知和社会功能量表以及总体生活质量得分在统计学上均显著下降。QLQ - C30症状量表得分，如疲劳、疼痛、呼吸困难、失眠、食欲减退和腹泻，从C1到C6显著增加。在QLQ - BR23量表中，性功能、性享受、乳房症状和手臂症状得分显著下降，而全身治疗副作用得分和脱发困扰得分在化疗周期中显著增加。我们得出结论，随着化疗周期数的增加，乳腺癌患者的休息 - 活动节律紊乱，HRQoL恶化。我们建议，除治疗方案外，应评估这些参数的紊乱程度，并通过适当干预进行管理，其中突出包括化疗给药时间。后者对于维持这些参数至关重要，这可能会增强患者的生理能力以获得更好的治疗反应，并可能改善患者的总体QoL和生存率。
