Tele-Monitoring of Cancer Patients’ Rhythms during Daily Life Identifies Actionable Determinants of Circadian and Sleep Disruption

The dichotomy index (I < O), a quantitative estimate of the circadian regulation of daytime activity and sleep, predicted overall cancer survival and emergency hospitalization, supporting its integration in a mHealth platform. Modifiable causes of I < O deterioration below 97.5%—(I < O)low—were sought in 25 gastrointestinal cancer patients and 33 age- and sex-stratified controls. Rest-activity and temperature were tele-monitored with a wireless chest sensor, while daily activities, meals, and sleep were self-reported for one week. Salivary cortisol rhythm and dim light melatonin onset (DLMO) were determined. Circadian parameters were estimated using Hidden Markov modelling, and spectral analysis. Actionable predictors of (I < O)low were identified through correlation and regression analyses. Median compliance with protocol exceeded 95%. Circadian disruption—(I < O)low—was identified in 13 (52%) patients and four (12%) controls (p = 0.002). Cancer patients with (I < O)low had lower median activity counts, worse fragmented sleep, and an abnormal or no circadian temperature rhythm compared to patients with I < O exceeding 97.5%—(I < O)high—(p < 0.012). Six (I < O)low patients had newly-diagnosed sleep conditions. Altered circadian coordination of rest-activity and chest surface temperature, physical inactivity, and irregular sleep were identified as modifiable determinants of (I < O)low. Circadian rhythm and sleep tele-monitoring results support the design of specific interventions to improve outcomes within a patient-centered systems approach to health care.

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Relevance of a Mobile Internet Platform for Capturing Inter- and Intrasubject Variabilities in Circadian Coordination During Daily Routine: Pilot Study (Preprint)

10.2196/preprints.9779 ◽

2018 ◽

Author(s):

Sandra Komarzynski ◽

Qi Huang ◽

Pasquale F Innominato ◽

Monique Maurice ◽

Alexandre Arbaud ◽

...

Keyword(s):

Body Temperature ◽

Cancer Patients ◽

Healthy Subjects ◽

Mobile Internet ◽

The Body ◽

Circadian Clocks ◽

Daily Routine ◽

Temperature Rhythm ◽

Temperature Rhythms ◽

Rest Activity

BACKGROUND Experimental and epidemiologic studies have shown that circadian clocks’ disruption can play an important role in the development of cancer and metabolic diseases. The cellular clocks outside the brain are effectively coordinated by the body temperature rhythm. We hypothesized that concurrent measurements of body temperature and rest-activity rhythms would assess circadian clocks coordination in individual patients, thus enabling the integration of biological rhythms into precision medicine. OBJECTIVE The objective was to evaluate the circadian clocks’ coordination in healthy subjects and patients through simultaneous measurements of rest-activity and body temperature rhythms. METHODS Noninvasive real-time measurements of rest-activity and chest temperature rhythms were recorded during the subject’s daily life, using a dedicated new mobile electronic health platform (PiCADo). It involved a chest sensor that jointly measured accelerations, 3D orientation, and skin surface temperature every 1-5 min and relayed them out to a mobile gateway via Bluetooth Low Energy. The gateway tele-transmitted all stored data to a server via General Packet Radio Service every 24 hours. The technical capabilities of PiCADo were validated in 55 healthy subjects and 12 cancer patients, whose rhythms were e-monitored during their daily routine for 3-30 days. Spectral analyses enabled to compute rhythm parameters values, with their 90% confidence limits, and their dynamics in each subject. RESULTS All the individuals displayed a dominant circadian rhythm in activity with maxima occurring from 12:09 to 20:25. This was not the case for the dominant temperature period, which clustered around 24 hours for 51 out of 67 subjects (76%), and around 12 hours for 13 others (19%). Statistically significant sex- and age-related differences in circadian coordination were identified in the noncancerous subjects, based upon the range of variations in temperature rhythm amplitudes, maxima (acrophases), and phase relations with rest-activity. The circadian acrophase of chest temperature was located at night for the majority of people, but it occurred at daytime for 26% (14/55) of the noncancerous people and 33% (4/12) of the cancer patients, thus supporting important intersubject differences in circadian coordination. Sex, age, and cancer significantly impacted the circadian coordination of both rhythms, based on their phase relationships. CONCLUSIONS Complementing rest-activity with chest temperature circadian e-monitoring revealed striking intersubject differences regarding human circadian clocks’ coordination and timing during daily routine. To further delineate the clinical importance of such finding, the PiCADo platform is currently applied for both the assessment of health effects resulting from atypical work schedules and the identification of the key determinants of circadian disruption in cancer patients.

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PCN30 Treatment Patterns and Outcomes of Breast Cancer Patients in a Patient-Centered Retrospective Research Registry

Value in Health ◽

10.1016/j.jval.2012.08.1223 ◽

2012 ◽

Vol 15 (7) ◽

pp. A414

Author(s):

S. Saokaew ◽

B. Cai ◽

K.L. Kuo ◽

H. Bauer ◽

F. Albright ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Treatment Patterns ◽

Breast Cancer Patients ◽

Patient Centered

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Simulating the action of zeitgebers on a coupled two-oscillator model of the human circadian system

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1984.247.3.r418 ◽

1984 ◽

Vol 247 (3) ◽

pp. R418-R426

Author(s):

P. H. Gander ◽

R. E. Kronauer ◽

C. A. Czeisler ◽

M. C. Moore-Ede

Keyword(s):

Core Temperature ◽

Activity Rhythm ◽

Human Subjects ◽

Model Performance ◽

The Other ◽

Oscillator Model ◽

Temporal Isolation ◽

The Core ◽

Temperature Rhythm ◽

Rest Activity

Our two-oscillator model was originally designed to describe the circadian rhythms of human subjects maintained in temporal isolation. The performance of this model in response to simulated environmental synchronizing cycles (zeitgebers) is examined here. Six distinct types of synchronization are demonstrated between the x oscillator (postulated to regulate the core temperature rhythm), the y oscillator (postulated to regulate the rest-activity rhythm), and z (the zeitgeber). Four types of synchronization are identifiable, if we consider only the periods of the three oscillators. Both x and y may be synchronized by z; either may synchronize with z while the other exhibits a different period; or x, y, and z may each show different periods. Two further classes of synchronization are discernible when phase criteria are taken into account. When either x or y is on the verge of desynchronizing from the other two oscillators, it undergoes periodic phase modulations while retaining the common overall period. The type of synchronization observed depends on the periods of x, y, and z and on the strength of the z drive. The effects of modifying each of these parameters have been systematically investigated by simulation, and model performance is summarized in terms of range of entrainment "maps." These constitute extensive sets of predictions about expected patterns of entrainment of the core temperature and rest-activity rhythms of human subjects exposed to various environmental zeitgebers. Experimental data are available against which model predictions can be tested.

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“How I kept track of it of course was my business”: Cancer patient self-monitoring as self-stylized work

Palliative & Supportive Care ◽

10.1017/s1478951513000308 ◽

2013 ◽

Vol 12 (5) ◽

pp. 355-361 ◽

Cited By ~ 2

Author(s):

Carol J. Hermansen-Kobulnicky ◽

Mary Anne Purtzer

Keyword(s):

Cancer Patient ◽

Cancer Patients ◽

Cancer Center ◽

Structured Interviews ◽

Patient Centered ◽

Work Lives ◽

Self Monitoring ◽

Centered Care ◽

Cancer Experience ◽

Present Opportunity

AbstractObjectives:Self-monitoring behaviors of cancer patients benefit patients, caregivers, and providers, and yet the phenomenon of self-monitoring from the cancer-patient perspective has not been studied. We examined cancer patients' self-monitoring preferences and practices, focusing on the meaning of self-monitoring within the cancer experience.Methods:Semi-structured interviews were conducted among adult cancer patients who had been seen at least once at a rural United States cancer center. Questions sought out the meaning of self-monitoring and its practical aspects. Qualitative data were analyzed by adapting the four-stepped method by Giorgi for empirical phenomenological analysis.Results:Twenty participants were interviewed (11 women and 9 men). Transcribed interviews revealed that cancer patient self-monitoring is self-stylized work that ranges from simple to complex, while being both idiosyncratic and routine. Participants reported using tools with systems for use that fit their distinctive lives for the purpose of understanding and using information they deemed to be important in their cancer care. Three conceptual categories were discerned from the data that help to elucidate this self-stylized work as fitting their individual priorities and preferences, reflecting their identities, and being born of their work lives.Significance of results:Findings highlight patients' unique self-monitoring preferences and practices, calling into question the assumption that the sole use of standardized tools are the most effective approach to engaging patients in this practice. Self-monitoring efforts can be validated when providers welcome or adapt to patients' self-stylized tools and systems. Doing so may present opportunity for improved communications and patient-centered care.

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Statin use, HMGCR expression, and breast cancer survival – The Malmö Diet and Cancer Study

Scientific Reports ◽

10.1038/s41598-019-57323-9 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 3

Author(s):

Olöf Bjarnadottir ◽

Maria Feldt ◽

Maria Inasu ◽

Pär-Ola Bendahl ◽

Karin Elebro ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Cancer Survival ◽

Cox Regression ◽

Histological Grade ◽

Breast Cancer Patients ◽

Cancer Study ◽

Drug Register ◽

Diet And Cancer ◽

Statin Use

AbstractStatins, commonly used to treat hypercholesterolemia, have also been proposed as anti-cancer agents. The identification of a predictive marker is essential. The 3-hydroxy-3-methylglutaryl-coenzyme-A reductase (HMGCR), which is inhibited by statins, might serve as such a marker. Thorough antibody validation was performed for four different HMGCR antibodies. Tumor expression of HMGCR (#AMAb90619, CL0260, Atlas Antibodies, Stockholm, Sweden) was evaluated in the Malmö Diet and Cancer Study breast cancer cohort. Statin use and cause of death data were retrieved from the Swedish Prescribed Drug Register and Swedish Death Registry, respectively. Breast cancer-specific mortality (BCM) according to statin use and HMGCR expression were analyzed using Cox regression models. Three-hundred-twelve of 910 breast cancer patients were prescribed statins; 74 patients before and 238 after their breast cancer diagnosis. HMGCR expression was assessable for 656 patients; 119 showed negative, 354 weak, and 184 moderate/strong expressions. HMGCR moderate/strong expression was associated with prognostically adverse tumor characteristics as higher histological grade, high Ki67, and ER negativity. HMGCR expression was not associated with BCM. Neither was statin use associated with BCM in our study. Among breast cancer patients on statins, no or weak HMGCR expression predicted favorable clinical outcome. These suggested associations need further testing in larger cohorts.

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Operationalizing patient‐centered cancer care: A systematic review and synthesis of the qualitative literature on cancer patients' needs, values, and preferences

Psycho-Oncology ◽

10.1002/pon.5500 ◽

2020 ◽

Vol 29 (11) ◽

pp. 1723-1733

Author(s):

Kerri‐Anne R. Mitchell ◽

Kelly J. Brassil ◽

Serena A. Rodriguez ◽

Edward Tsai ◽

Kayo Fujimoto ◽

...

Keyword(s):

Systematic Review ◽

Cancer Patients ◽

Cancer Care ◽

Patient Centered ◽

Qualitative Literature

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Studying Survival of Cancer Patients in Different Populations: Its Potential and Role

Tumori Journal ◽

10.1177/030089169708300104 ◽

1997 ◽

Vol 83 (1) ◽

pp. 3-8 ◽

Cited By ~ 15

Author(s):

Andrea Micheli ◽

Gemma Gatta ◽

Arduino Verdecchia

Keyword(s):

Cancer Patients ◽

Health Expenditure ◽

Cancer Survival ◽

Relative Survival ◽

Cancer Registries ◽

Population Based ◽

Malignant Neoplasms ◽

Regional Health ◽

Italian Regions ◽

Different Populations

Rationale Survival figures from a population-based study incorporate the overall practice in diagnosis, cure and clinical follow-up for a specific disease within a given health care system. Being the outcome of a number of individual, social and economical aspects, population-based survival may be thought as index for measuring the level of a country's development. Data The EUROCARE project, a European Cancer Registries (CR) concerted action, provided reliable information on survival for more than 800,000 cancer patients from 11 European countries. A great deal of epidemiologic information has derived from EUROCARE. Women had a longer survival than men for all studied tumour sites, except for the colon. European survival variability was fairly high for several cancers, but it was lower for cancers with a relatively good prognosis and those sensitive to treatment. The ranking of populations of cancer survival tended to be fairly stable for many cancers: CR of Switzerland and Finland ranked high and Polish CR low. Denmark, Italian and France CR did not substantially differ from the European survival average. For most cancers, prognosis improved during the studied period (years of diagnosis: 1978–1985). Survival figures for colon (r = 0.74, males; r = 0.73, women) and female breast cancer (r = 0.57) well correlated with the national health expenditure of different participating countries. The ITACARE study, a new Italian Cancer Registries collaborative project involving more than 100,000 cancer patients, was set up to study survival differences within the country. Survival of cancer patients was not homogeneous in 7 studied Italian regions (the estimated 5-year relative survival for all malignant neoplasms combined ranked from 37.8% in CR of Sicily to 42.1% in those of Emilia-Romagna). The lowest levels of regional health expenditures were accompanied by the lowest levels of prognosis for overall cancers. However, a relatively low correlation among patient cancer survival and the regional health expenditure (r = 0.21) was found, suggesting that other factors such as different efficiency in managing cancer may play a role in explaining the intracountry differences. Conclusions Population-based survival figures may be used to study epidemiologic aspects, comparing different health systems, and may be interpreted as indexes for discussing inequalities in health in different populations.

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Survival of cervical cancer patients and its prognostic factors at Cipto Mangunkusumo Hospital, Jakarta

Medical Journal of Indonesia ◽

10.13181/mji.v23i3.739 ◽

2014 ◽

Vol 23 (3) ◽

pp. 163-8 ◽

Cited By ~ 1

Author(s):

Laila Nuranna ◽

Rahma Prastasari ◽

Bambang Sutrisna

Keyword(s):

Cervical Cancer ◽

Prognostic Factors ◽

Survival Rate ◽

Cancer Patients ◽

Median Survival ◽

Survival Probability ◽

Cancer Survival ◽

Stage Iii ◽

Cox Regression Analysis ◽

Lower Survival

Background: Cervical cancer is the second most common cancer among Indonesian women. Information concerning survival probability is very important for the patient and institution. Our last data about cervical cancer survival was studied for more than 10 years ago. This study aimed to know the latest cervical cancer survival and its prognostic factors.Methods: This is a retrospective cohort study which enrolled cervical cancer patients treated at Cipto Mangunkusumo Hospital in 2005-2006. Subjects were followed-up for minimum of 5 years. Kaplan-Meier and Cox regression analysis was used to determine the survival probability and to assess prognostic factors.Results: A total of 447 patients who met the study criteria were selected. Stage III was the largest proportion on the study (41.6%). Most of the histopathology type was squamous cell carcinoma (71.6%). This study revealed that median survival was 63 months with the overall 5-years survival probability to be 52%. Tumor size did not influence overall survival rate. Stage III and IV had lower survival probability (HR 3.27 and 6.44). Poor differentiation and uncompleted therapy also had lower survival probability (HR 2.26 and 2.22). Histopathology of others (neuroendocrine) had lower survival probability (HR 2.85). However, it was not statistically significant on multivariate analysis.Conclusion: Median survival time for cervical cancer patients at Cipto Mangunkusumo Hospital was 63 months. There were improvement in the survival rate comparing from the study in 1997. In this study, the independent prognostic factors for survival were tumor staging, tumor differentiation, and completion of therapy.

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