Ver Hoeve Elizabeth S, Rumble Meredith E, Gorzelitz Jessica S, Rose Stephen L, Nelson Ashley M, Morris Keayra E, Costanzo Erin S
University of Wisconsin-Madison, Madison, WI, United States of America; Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, United States of America.
University of Wisconsin-Madison, Madison, WI, United States of America; Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, United States of America.
Gynecol Oncol. 2024 Dec;191:265-274. doi: 10.1016/j.ygyno.2024.10.024. Epub 2024 Oct 30.
Endometrial cancer survivors experience persistent health-related quality of life concerns, including pain, fatigue, and disrupted emotional and social functioning. The purpose of this longitudinal study was to evaluate associations between biobehavioral factors, including daytime physical activity, nighttime sleep, and 24-h circadian rest-activity rhythms, with psychological and physical symptoms following endometrial cancer surgery.
This study included 69 adult female patients undergoing surgery for endometrial cancer. At each of three assessment points (1, 4, and 16 weeks post-surgery), participants wore a wrist actigraph for 3 days and completed a sleep log and self-report measures of depression and anxiety (Inventory of Depression and Anxiety Symptoms), pain (Brief Pain Inventory), fatigue (Fatigue Symptom Inventory), and insomnia (Insomnia Severity Index). Physical activity, sleep, and 24-h rest-activity indices were derived from actigraphy. Mixed- and fixed-effects linear regression models were utilized to evaluate relationships between actigraphy indices and patient-reported outcomes.
Clinically elevated fatigue persisted for a majority of participants (64 %), while a sizeable minority continued to report clinically elevated insomnia (41 %) and pain (19 %) at 16-weeks post-surgery. Participants who recorded less daytime activity, more disrupted sleep, and less consistent 24-h rest-activity rhythms by actigraphy reported more depression and anxiety symptoms and greater pain and fatigue. Within individual participants, at time points when activity was lowest, sleep most disrupted, and 24-h rest-activity rhythms least consistent, participants experienced more psychological and physical symptoms.
Findings suggest that disruptions in daytime physical activity, nighttime sleep, and 24-h rest-activity patterns contribute to patient-reported outcomes in the weeks and months after endometrial cancer treatment. Findings support modifiable intervention targets to address co-occurring physical and psychological symptoms and optimize health and recovery after endometrial cancer surgery.
子宫内膜癌幸存者存在与健康相关的生活质量问题，包括疼痛、疲劳以及情绪和社交功能紊乱。这项纵向研究的目的是评估生物行为因素（包括白天身体活动、夜间睡眠和24小时昼夜休息-活动节律）与子宫内膜癌手术后心理和身体症状之间的关联。
本研究纳入了69名接受子宫内膜癌手术的成年女性患者。在三个评估点（术后1周、4周和16周），参与者佩戴腕部活动记录仪3天，并完成睡眠日志以及抑郁和焦虑的自我报告测量（抑郁和焦虑症状量表）、疼痛（简明疼痛量表）、疲劳（疲劳症状量表）和失眠（失眠严重程度指数）。身体活动、睡眠和24小时休息-活动指标由活动记录仪得出。采用混合效应和固定效应线性回归模型来评估活动记录仪指标与患者报告结果之间的关系。
大多数参与者（64%）临床上疲劳持续存在，而相当一部分少数人在术后16周仍报告临床上失眠（41%）和疼痛（19%）。通过活动记录仪记录显示白天活动较少、睡眠干扰较多且24小时休息-活动节律较不一致的参与者报告了更多的抑郁和焦虑症状以及更严重的疼痛和疲劳。在个体参与者中，在活动最低、睡眠干扰最大且24小时休息-活动节律最不一致的时间点，参与者经历了更多的心理和身体症状。
研究结果表明，白天身体活动、夜间睡眠和24小时休息-活动模式的紊乱在子宫内膜癌治疗后的数周和数月内导致了患者报告的结果。研究结果支持可改变的干预目标，以解决同时出现的身体和心理症状，并优化子宫内膜癌手术后的健康和恢复。
